Vulnerability Factors Research Articles

Is there a relationship between psychiatrist’s clinical assessment of medication non-adherence and treatment outcomes? Implications for practice

BackgroundThere is considerable research on the ramifications of medication non-adherence for adults with psychotic illnesses. Much of which has tightly controlled designs and strict inclusion/exclusion procedures (i.e., it is less “ecologically valid,” or consistent with real-world challenges in care). The authors sought to determine predictive relationships between psychiatrists’ clinical assessments of non-adherence and treatment outcomes, via a design that would be more applicable to practice.MethodMultiple regression analyses were conducted on non-adherence, symptom severity upon admission, number of recent hospitalizations, and length of hospital stay. The sample consisted of 182 inpatients with psychotic spectrum disorders and significant risk and vulnerability factors. Non-adherence was measured via the psychiatrists’ diagnosis of V15.81. Symptom severity was measured via the 24-item Brief Psychiatric Rating Scale (BPRS-E).ResultsThere were null findings on non-adherence and BPRS-E pretest score (χ2= 2, p = 0.16), recent hospitalizations (χ2= 1.2, p = 0.27), and length of stay (β = 0.003, p = 0.97). Higher symptom severity predicted a modestly longer length of stay (χ2= .20, p = 0.007), though Bonferroni correction nullified this finding. White/Caucasian participants were far more likely to be non-adherent than black/African-American participants (t = -8.66; p > .00001).ConclusionsNull findings suggest the psychiatrist’s initial, quick-form assessment of non-adherence may not necessarily presume a poor prognosis. Perhaps, because individuals with severe and chronic psychotic disorders may have greater coping, adaptive, and survival skills than is often assumed. In severely under-resourced hospitals, such second thoughts and more reliable information about adherence and contributing factors may improve treatment outcomes.

The Influence of Early Maladaptive Schemas on Recovery and Psychological Capital in Borderline Personality Disorder Clients: Findings From Rural Dwelling Sample.

Early maladaptive schemas (EMSs) are among the key vulnerability factors explaining the development and persistence of symptoms in borderline personality disorder (BPD). Furthermore, it was suggested that EMSs might impact recovery-related outcomes, including psychological and recovery capital, among individuals with BPD. To investigate the relationship among EMSs, psychological and recovery capital in individuals with BPD disorder. A descriptive correlational research design was conducted in Minya Outpatients' Psychiatric Hospital Clinic, using the Young Schema Questionnaire-Short Form (YSQ-S2), Psychological Capital Questionnaire (PCQ) and Recovery Assessment Scale (RAS) to collect data from 200 individuals with BPD. The findings suggest that EMSs significantly correlated with the total psychological and recovery capital scores (0.119, 0.024 and -0.025, 0.05). Moreover, linear regression analyses exhibit that EMSs, regarding social isolation failure and vulnerability to harm, are significant negative predictors of recovery capital (t = -2.760, p = 0.006 and t = -3.919, p < 0.001, respectively). The complex interplay between EMSs and recovery-related outcomes provides valuable insights for planning and implementing structured psychotherapeutic interventions based on specific schema patterns. Our existing findings can also serve as a valuable reference for mental health nursing in clinical practice by enhancing their understanding of the underlying causes of maladaptive behaviours commonly seen in BPD, allowing them to tailor patient-centred care interventions and thereby reduce the risk of relapse.

Vulnerable to disappearance. Experiences of missing and found teenage girls and young men in Nuevo León, Mexico

In Mexico, the phenomenon of disappearance resurfaced with the Drug War (2006) and in the state of Nuevo Leon it was mainly young men who disappeared the most between 2007 and 2012. However, since 2018, the disappearances of teenage girls increased. To analyze this situation, a study was undertaken in collaboration with the National Search Commission, whose methodology relies on analyzing the experiences of missing and found persons. With the support of the Local Search Commission in Nuevo León, a survey was sent to found persons between the ages of 0 and 29, interviews were conducted with missing and found persons, and files of the public child protection services were reviewed. This new methodology established the immediate and structural causes of disappearances and that the main factors of vulnerability are structural violence, mental health and addictions, gender violence and police abuse.

Structural Vulnerability Factors and Gestational Weight Gain: A Scoping Review on the Extent, Range, and Nature of the Literature

Structural Vulnerability Factors and Gestational Weight Gain: A Scoping Review on the Extent, Range, and Nature of the Literature

Gross anatomical features of the insular cortex in affective disorders

IntroductionThe number of insular gyri is elevated in patients with schizophrenia. Thus, it has potential as a marker of early neurodevelopmental abnormalities. However, currently it remains unclear whether patients with other neuropsychiatric disorders, such as affective disorders, also have this gross brain anatomical feature.Materials and methodsThe macroscopic features of the insular cortex in 26 patients with bipolar disorder (BD), 56 with major depressive disorder (MDD), and control subjects for each clinical group (24 for BD and 33 for MDD) were assessed using magnetic resonance imaging.ResultsThe number of short insular gyri was higher in BD patients than in matched controls bilaterally with well-developed accessory and middle short gyri. Furthermore, the left middle short gyrus was more developed in MDD patients than in matched controls, and was weakly associated with the severity of depressive symptoms.DiscussionThe present results indicate that changes in the gross morphology of the insular cortex in BD and MDD is a potential vulnerability factor associated with their neurodevelopmental pathologies, and may also contribute to the severity of symptoms in MDD.

Investigation of Certain Cognitive and Metacognitive Factors Affecting Anxiety and Depression Symptoms Through Parallel Serial Mediation Models

Objective: This study aims to investigate the parallel serial mediating effects of cognitive flexibility, attentional control, and worry in the relationship between rumination—which has been repeatedly proven to persist in the etiology of depression—and the symptoms of depression. This model will also be tested with anxiety symptoms. Method: The study involved 832 university students, all emerging adults. The Personal Information Form, Ruminative Thought Style Questionnaire, Penn State Worry Questionnaire, Cognitive Flexibility Inventory, Attentional Control Scale, and Depression, Anxiety, and Stress Scale Short Form were used. Results: In two separate parallel serial mediation analyses, where gender was included as a control variable and depression and anxiety symptoms were included as dependent variables, the findings of the significant models were consistent. Accordingly, in both models in which both depression and anxiety are predicted, while the parallel serial mediation effect of cognitive flexibility and worry was significant (respectively; B=.003, SE=.001, %95 BCa CI [.001, .005]; B=.004, SE=.001, %95 BCa CI [.003, .007]), the parallel serial mediation effect of cognitive flexibility and attentional control was not significant (respectively; B=.000, SE=.000, %95 BCa CI [-.001, .001]; B=.00, SE=.00, %95 BCa CI [-.001, .001]). Conclusion: The findings of models that include certain cognitive and metacognitive factors seem to support the idea proposed by the transdiagnostic approach that there are common vulnerability factors in the explanation of disorders.

Cognitive control impairment in suicide behaviors: what do we know? A systematic review and meta-analysis of Stroop in suicide behaviors.

Suicidal behavior results from a complex interplay between stressful events and vulnerability factors, including cognitive deficits. Poorer performance on the Stroop task, a measure of cognitive control, has been associated with suicidal behavior in numerous studies. The objective was to conduct an updated systematic review of the literature on the Stroop task as a neuropsychological test of vulnerability to suicidal acts in patients with mood and other psychiatric disorders, while also looking at how the type (classic versus emotional) or the version (paper or computerized) of the Stroop task, as well as the characteristics of the patient (clinical population, age, sex) moderated the Stroop effect. A search on Medline, Embase, PsycInfo databases, and article references was performed. 53 studies (6781 participants) met the selection criteria. Interference time and errors of the Stroop Test were assessed in at least 3 studies to be analyzed. Moderators, such as the type (classic versus emotional) of the Stroop task and the characteristics of the patient (clinical population, age, sex) were also assessed. Interference time on Stroop performance was lower in suicide attempters than in patient controls (g = 0.20; 95%CI [0.10-0.30]) and healthy controls (g = 0.79; 95 % CI [0.29-1.29]), with patient controls scoring lower than healthy controls (g = -0.63; 95%CI [-1.01-0.25]). This was moderated by age and having a mood disorder. In terms of interference errors, suicide attempters performed worse than healthy controls (g = 0.57; 95%CI [0.01-1.15]) but did not perform differently from patient controls (g = 0.20; 95 % CI [-0.06-0.45]). Patient controls also did not score differently than healthy controls (g = -0.18; 95 % CI [-0.54-0.18]). There was a significant moderation effect for the type (i.e., original Stroop task) and version (i.e., paper format) of the Stroop task, and for some characteristics of the patient (i.e., older patients and having a mood disorder). Cognitive control impairment was associated with a history of suicidal behavior in patients, especially in older populations and those with mood disorders, however this result was moderated by outcome measure (interference time vs. errors), the type (i.e., original Stroop task) and the version (i.e., paper format) of the Stroop task. Cognitive control processes may be an important factor of suicidal vulnerability. Choosing the right neurocognitive test in the right population to detect suicide vulnerability is important direction for future research.

Vulnerability factors shed light on stress generation in depression

Vulnerability factors shed light on stress generation in depression

The long-run effect of historical redlining practices on social vulnerability in U.S. cities

Historical redlining practices in the United States date back to the 1930s and have continued to impact cities socially, environmentally, and economically since then. This study explores current social vulnerability inequity among former HOLC (Home Owners' Loan Corporation) neighborhoods with four color-coded grades in 196 U.S. digitized cities. Social vulnerability measurements for each historical HOLC neighborhood were calculated using 2018 census tract-level social vulnerability data through areal apportionment. Kruskal-Wallis tests were employed to compare four grades of former HOLC neighborhoods regarding overall social vulnerability index (SVI), four thematic SVIs (Social economic status, Household composition and disability, Minority status and language, and Housing type and transportation), and SVIs for fifteen social vulnerability factors. After applying multiple comparison corrections, the results indicate significant differences among four HOLC grades concerning overall social vulnerability, four themes, and most of social vulnerability factors. In general, grade A (green) neighborhoods exhibit the lowest vulnerability, while grade D (red) neighborhoods have the highest vulnerability. A similar pattern of social vulnerability inequity persists even after adjusting for inter-city differences in baseline social factors using the city-normalized SVI (CSVI). This finding suggests that urban planners and policymakers should work to reduce social vulnerability inequity across neighborhoods of different grades.

The occurrence of single-site pharyngeal Neisseria gonorrhoeae among female sex workers in the Netherlands.

Female sex workers (FSW) have a higher burden of sexually transmitted infections (STI), including Neisseria gonorrhoeae (NG), than the non-sex worker population, mainly due to social vulnerability and work-related factors. This large study evaluated the anatomical site distribution of NG, and specifically the occurrence of single-site pharyngeal NG, among FSW visiting Dutch STI clinics in the Netherlands. Coded STI clinic consultations from FSW attending any Dutch STI clinic between 2016 and 2021, in which tests were performed on all three anatomical sites, according to the Dutch testing policy for FSW, were included in analyses (n = 22,304). To compare the anatomical site distribution of NG among FSW with women in general, 15,494 consultations from women who were tested on three anatomical sites in clinics that performed standard testing at three anatomical sites were used. Descriptive statistics were used to compare the anatomical site distribution of NG and occurrence of single-site pharyngeal NG among FSW and universally tested women. NG was diagnosed among 3.5% (782/22,034) among FSW and 1.7% (271/15,494) among universally tested women (p < 0.001). Pharyngeal NG was diagnosed among 2.3% among FSW, versus 0.8% among universally tested women (p < 0.001). Single-site pharyngeal NG was diagnosed in 19.9% (156/782) of all NG infections, compared to 14.8% (40/271) of NG infections among universally tested women. The substantial proportion pharyngeal NG and single-site pharyngeal NG among FSW, confirms the relevance of pharyngeal testing among this key population for optimal patient management, also in the context of the potential role of pharyngeal NG in antimicrobial resistance.

Persistent negative self-referent thinking in the context of depression: examining the role of temperament and emotion regulation.

Cognitive models of depression posit that persistent negative self-referent thinking (PNSRT) is an important vulnerability factor for depressive symptoms. The mechanisms involved are still understudied, especially in adolescence. PNSRT has been assessed by a behavioural decision-making task, namely the emotional reversal learning task (ERLT). Within the ERLT, PNSRT is operationalised as the learning rate for negative self-reference. The first aim of the current study is to examine the association between PNSRT and depressive symptoms at baseline and follow-up. Second, the current study investigated associations of PNSRT with temperamental and emotion regulation variables. We found no significant effect between PNSRT and baseline depressive symptoms, although the small effect size pointed in the expected direction. No significant prospective effect was found. Additionally, adolescents with greater capacity for response inhibition and better attentional control exhibited less PNSRT. No other significant associations were found with other temperamental dimensions or emotion regulation variables. In conclusion, while the small effect size of the cross-sectional association between PNSRT and depressive symptoms points in the expected direction, no significant evidence was found that PNSRT acts as either a concomitant or precursor to depressive symptomatology. However, the current study did find a relation between low effortful control and PNSRT.

Sleep-Related Sudden Unexpected Infant Death Among Infants Prenatally Substance Exposed.

Maternal substance use during pregnancy heightens risk of sudden unexpected infant death (SUID), including through unsafe sleep practices. Families impacted by substance use frequently experience disproportionate social drivers of poor health and family vulnerability likely contributory to fatality risk. Characteristics of sleep-related SUID among infants born prenatally substance exposed versus nonexposed were compared to identify targeted prevention opportunities. Using the Sudden Death in the Young Registry, we examined SUID with sleep-related death between 2015 and 2020 across infants prenatally exposed versus nonexposed. Distribution of sleep environment characteristics, social drivers of poor health, and family vulnerability factors were examined using descriptive statistics and χ2. Of 2010 infants who experienced sleep-related deaths, 283 (14%) were prenatally exposed. More than half of deaths involved an adult bed (52%, n = 1045) or surface sharing with an adult (53%, n = 1074). Supervisors of prenatally exposed infants were disproportionately impaired at infant death versus nonexposed (34%, n = 97 vs 16%, n = 279). Statistically significant associations between prenatal exposure history and vulnerability factors (insurance, child welfare involvement, intimate partner violence, health care barriers) were identified (P < .05). Sleep-related SUID across infants prenatally exposed versus nonexposed differ in sleep environment characteristics and contributory social vulnerability. Disproportionate sleep environment hazards (surface sharing, supervisor impairment) are identified among prenatally exposed infants that should compel targeted prevention efforts, including safe sleep messaging, discouraging surface sharing, and engaging support persons during impairment periods. Addressing social needs and family vulnerability are also paramount to increase access to health care, safe sleep education, and material resource provision.

Structural vulnerability factors and gestational weight gain in high-income countries

Structural vulnerability factors and gestational weight gain in high-income countries

Drug addiction resulting from the abusive use of opioids: a literature review

The severity of drug addiction resulting from the abusive use of opioids, primarily starting from chronic pain treatments, represents a serious threat to public health and social well-being. This study, through a literature review, analyzed the transition from therapeutic use to opioid abuse and consequent addiction, focusing on oxycodone. This review article aimed to understand the pharmacodynamics of opioids and their relationship with neuroinflammation, discussing biopsychosocial vulnerability factors, and better comprehending how healthcare professionals may assist in addressing the consequences of opioid abuse and its social and economic impact, as well as possible preventive and intervention measures. The methodology involved a qualitative analysis of scientific articles published between 2000 and 2024, based on rigorous inclusion and exclusion criteria. The results highlighted the central role of neuroinflammation and toll-like receptor 4 (TLR4) receptor activation in tolerance development and the association of social factors with dependency, in addition to the socioeconomic and public health impacts stemming from opioid abuse. In conclusion, multidisciplinary interventions, stricter public policies, and monitoring systems are essential to mitigate the consequences of inappropriate opioid use, while awareness strategies and less abuse-prone therapeutic alternatives are fundamental for safer management.

Water resource vulnerability assessment in Hubei Province: a case study

In view of the different views of academia on the weight allocation of vulnerability assessment indicators, this study creatively proposed a data-based objective evaluation framework of water resource vulnerability, and applied it to the evaluation of water resource vulnerability in Hubei Province. According to the conceptual model of DPSIR proposed by the United Nations, five vulnerability factors are proposed: driving force, pressure, state, influence and response. In this study, 15 indicators were selected and the projection tracing model was used to identify vulnerability. Aiming at the complex problem of optimization calculation of projection index function in the projection tracing model, the accelerated genetic algorithm is used to speed up the optimization speed, solves the optimization problem in the process of projection tracing, and determines the objective weight of all indicators. Example calculation shows that the model can deal with complex multi-index optimization problems, and is an effective way to solve the comprehensive evaluation of complex vulnerability, and the weighting method is important for the evaluation of water resources vulnerability. The results of this paper show that the combination of projection tracing method and machine learning algorithm can improve the efficiency, objectivity and accuracy of high-dimensional data analysis, and can provide scientific basis for policy makers.

Internalizing symptoms and affective vulnerability among heterosexual and sexual minority young adults.

Sexual minority young adults report higher rates of anxiety and depression, and affective vulnerability factors (i.e. anxiety sensitivity, distress tolerance, emotion dysregulation) may help explain these mental health disparities. The current cross-sectional study examined differences between sexual minority and heterosexual college students (n = 465; Mage = 19.84, SD = 3.51; 76.3% female) in anxiety, depression and affective vulnerability and whether affective vulnerability served as an explanatory mechanism in these associations. Participants completed self-report measures for course credit. Sexual minority young adults reported greater anxiety, depression, anxiety sensitivity, emotion regulation difficulties and lower distress tolerance. There were also significant indirect effects for all three affective vulnerability variables for anxiety symptoms and for emotion regulation difficulties for depression symptoms. Affective vulnerability, particularly emotion regulation difficulties, appears to serve as a mechanism through which sexual minority status is associated with anxiety and depression. Improving emotion regulation skills may help to reduce mental health disparities in this population.

Housing conditions and COVID-19 in Barcelona: do they change by gender?

BackgroundEvidence has linked poor housing conditions to negative health outcomes. However, in urban contexts characterized by social vulnerability and population-level inequalities, the gender perspective is often overlooked, despite evidence showing that housing conditions impact men and women differently in terms of health. This study aimed to describe the association between housing conditions and the prevalence of COVID-19 among men and women in Barcelona, Spain.MethodsAn observational cross-sectional study was conducted using the 2021 Barcelona Health Survey. The study population consisted of non-institutionalized residents over 14 years of age in Barcelona. The survey was administered to a sample of 3,545 participants during the COVID-19 pandemic, between February 2021 and February 2022. Crude and adjusted prevalence ratios of COVID-19 (aPR), along with 95% confidence intervals (95% CI), were estimated using multivariate Poisson regression models with robust variance. The analysis was stratified by gender.ResultsA significant gradient was observed across age groups for both men and women, with higher COVID-19 prevalence in younger categories. The prevalence was notably higher among individuals born in low-income countries, particularly for women (aPR 1.62). We also identified a significant association between housing conditions, vulnerability factors, and COVID-19 prevalence in both men and women. Living with four or more cohabitants was associated with higher prevalence (aPR 1.96 for women and 1.89 for men), as was the presence of dampness in the home (aPR 1.34 for women and 1.27 for men). Additionally, energy poverty was significantly associated with higher COVID-19 prevalence in women (aPR 1.36), but not in men.ConclusionThis study highlights the association between housing conditions and COVID-19 in Barcelona, with a pronounced impact on young people, women from low-income countries, and women experiencing energy poverty.

Dual-encoder architecture for metal artifact reduction for kV-cone-beam CT images in head and neck cancer radiotherapy

During a radiotherapy (RT) course, geometrical variations of target volumes, organs at risk, weight changes (loss/gain), tumor regression and/or progression can significantly affect the treatment outcome. Adaptive RT has become the effective methods along with technical advancements in imaging modalities including cone-beam computed tomography (CBCT). Planning CT (pCT) can be modified via deformable image registration (DIR), which is applied to the pair of pCT and CBCT. However, the artifact existed in both pCT and CBCT is a vulnerable factor in DIR. The dose calculation on CBCT is also suggested. Missing information due to the artifacts hinders the accurate dose calculation on CBCT. In this study, we aim to develop a deep learning-based metal artifact reduction (MAR) model to reduce the metal artifacts in CBCT for head and neck cancer RT. To train the proposed MAR model, we synthesized the kV-CBCT images including metallic implants, with and without metal artifacts (simulated image data pairs) through sinogram image handling process. We propose the deep learning architecture which focuses on both artifact removal and reconstruction of anatomic structure using a dual-encoder architecture. We designed four single-encoder models and three dual-encoder models based on UNet (for an artifact removal) and FusionNet (for a tissue restoration). Each single-encoder model contains either UNet or FusionNet, while the dual-encoder models have both UNet and FusionNet architectures. In the dual-encoder models, we implemented different feature fusion methods, including simple addition, spatial attention, and spatial/channel wise attention. Among the models, a dual-encoder model with spatial/channel wise attention showed the highest scores in terms of peak signal-to-noise ratio, mean squared error, structural similarity index, and Pearson correlation coefficient. CBCT images from 34 head and neck cancer patients were used to test the developed models. The dual-encoder model with spatial/channel wise attention showed the best results in terms of artifact index. By using the proposed model to CBCT, one can achieve more accurate synthetic pCT for head and neck patients as well as better tissue recognition and structure delineation for CBCT image itself.

Heterogeneous effects of climate change on displacement-inducing disasters

With an estimated 357.7 million internal displacements caused since 2008, weather-related disasters are a major driver of human mobility worldwide. As climate change is projected to increase the frequency and intensity of extreme weather events in many parts of the world, it is important to better understand how trends in weather patterns related to global warming have affected the intensity of disasters that have caused displacements. Here we combined observational and counterfactual climate data with global internal displacement records to estimate how climate change has affected precipitation and wind speeds at the time and location of floods and storms that led to internal displacements. We estimate that, on average, climate change increased precipitation and decreased wind speeds during such events by +3.7% and − 1.4%, respectively. However, the variability across events is considerable (±28.6 and ± 6.6%, respectively), highlighting the large signal of natural variability of the weather system as compared to the global warming signal. Our results caution against overstating the role of climate change in displacement-inducing disasters in the past, especially compared to socio-economic and development factors of vulnerability and adaptive capacity that determine whether weather-related hazards turn into disasters.’

Land degradation vulnerability modelling for landscape restoration planning in Eastern DR Congo using the analytical hierarchy process (AHP) and geospatial techniques

Land degradation is a major issue for attainment of sustainable development in Eastern DR Congo. This study aims to assess and model the spatial pattern of land degradation vulnerability (LDV) in this region through the application of the Analytical Hierarchy Process (AHP) and geospatial techniques by using the Kalehe territory as a case study. LDV has been defined as the resultant of three components: the exposure to erosion risk, the sensitivity associated with biophysical factors, and the adaptability associated with socioeconomic factors of vulnerability. These factors were weighted using the EasyAHP plugin and multisource open spatial data to obtain the LDV model. This model was validated using the frequency ratio of physical land degradation features. The LDV map was obtained through the application of the weighted overlay technique in QGIS. The results indicated that about 32% of the territory is prone to high to very high vulnerability, representing the hotspot of LDV. The developed model has an overall accuracy of 77.8% in predicting the area with high to very high LDV. Thus, it can be used during land conservation planning to identify the priority areas for implementation of landscape restoration initiatives at the territorial level in Eastern DR Congo.