Full Information Maximum Likelihood Estimation Research Articles

Depression mediates the relationship between exposure to stigma and medication adherence among people living with HIV in low-resource setting: a structural equation modeling approach.

This study hypothesizes that depression mediates the association between exposure to stigma and medication non-adherence in people living with HIV (PLHIV). We recruited 372 PLHIV from the Stigma, health-related Quality of life, antiretroviral Adherence, and Depression among people living with HIV (SQuAD-HIV) project, a multicenter cross-sectional study conducted between October 2021 and February 2022 among PLHIV attending six ART clinics in two geopolitical regions of northern Nigeria. A structural equation modeling (SEM) framework, utilizing the full information maximum likelihood estimator, was used to elucidate the pathways linking stigma, depression, and ART medication adherence, adjusting for sociodemographic characteristics. The total number of eligible participants analyzed (353) included 32.7% male PLHIV with a mean age (SD) of 39.42 (10.14). Being female was positively associated with adherence (β, 95% CI 0.335, 0.163-0.523, p-value < 0.001) but negatively associated with stigma (β, 95% CI - 0.334, - 0.561 to - 0.142, p-value = 0.001), while urban residence was negatively associated with stigma (β, 95% CI - 0.564, - 0.804 to - 0.340, p-value < 0.001). Our analysis also indicated that a higher level of experienced stigma was associated with decreased medication adherence. This association was partially mediated by depression (indirect effect = (0.256) (- 0.541) =  - 0.139; p-value < 0.01). The proportion of the association between stigma and medication adherence explained through mediation by depression was 35.6%. These findings underscore the need for targeted interventions aimed at lowering exposure to stigma among PLHIV to improve medication adherence.

Impact of missing data and ICC on full information maximum-likelihood estimation in multilevel SEMs

A Monte Carlo simulation study was conducted to investigate the performance of full information maximum-likelihood (FIML) estimator in multilevel structural equation modeling (SEM) with missing data and different intra-class correlations (ICCs) coefficients. The study simulated the influence of two independent variables (missing data patterns, and ICC coefficients) in multilevel SEM on five outcome measures (model rejection rates, parameter estimate bias, standard error bias, coverage, and power). Results indicated that FIML parameter estimates were generally robust for data missing on outcomes and/or higher-level predictor variables under the data completely at random (MCAR) and for data missing at random (MAR). However, FIML estimation yielded substantially lower parameter and standard error bias when data was not missing on higher-level variables, and in high rather than in low ICC conditions (0.50 vs 0.20). Future research should extend to further examination of the impacts of data distribution, complexity of the between-level model, and missingness on the between-level variables on FIML estimation performance.

Social support and mental well-being among people with and without chronic illness during the Covid-19 pandemic: evidence from the longitudinal UCL covid survey

PurposeAn immediate research priority recovering from the COVID-19 pandemic is well-being among some of our most vulnerable—people with chronic illness. We studied how mental health changed among people with and without chronic illness throughout the pandemic and the mediating role of social support.MethodsWe used the 3-waves of COVID-19 survey within the Millennium Cohort Study (MCS, age 19, N = 5522) and MCS Parent (MCSP, age > > 19, N = 7479) samples, with additional pre-pandemic measures of some outcomes and exposure. Using Structural Equation Panel Models with Full Information Maximum Likelihood estimation to address missing data, we studied differences between respondents with a chronic illness and without, regarding depressive symptoms and mental well-being, with social provision, social support, and loneliness as potential mediators.ResultsMental well-being (SWEMWBS) and psychological distress (Kessler-6) worsened significantly during the pandemic relative to baseline for people with and without chronic illness, while the latter group had substantially better well-being at all waves and the baseline regarding both outcomes. When the lockdown was lifted during wave-2, mental well-being temporarily rebounded, and distress waned among people without chronic illness but continued to worsen among people with chronic illness. Social support partially mediated the link between chronic illness and mental well-being.ConclusionsThe large mental well-being gap between people with and without chronic illness persisted during the pandemic. However, social support and provision can partially narrow this gap, hence should be employed in future pandemic management.

The interplay of depression symptoms and physical activity: Bidirectional insights from 25-years of the Americans' changing lives panel

BackgroundDepression symptomology (DSx) and insufficient Physical Activity (PA) are among the leading causes of illness, and major contributors to global public health burden. Reviews and meta-analyses indicate that DSx and PA cause each other, yet most studies conducted use data and analyses which cannot specify their bidirectional associations across the life course. MethodThe present study estimates dynamic panel models with fixed effects through structural equation models with full-information maximum likelihood estimation (ML-SEM) based on 5 waves (1986–2011) of the Americans' Changing Lives (ACL) panel. This is a nationally representative probability sample of 3499 non-institutionalized U.S. adults ages 25 and older in 1986. Respondents participated in an average of 3.29 waves, with 67.84% participating in at least 3 waves, and 27.26% participating in all 5 waves. Models adjust for age, partner status, social integration, activity limitations, and serious financial problems. Data are available from the ICPSR (4690). ResultsEstimates from ML-SEM reveal negative and significant bidirectional cross-sectional associations between DSx and PA. Models also indicate a negative and significant cross-lagged association from DSx to PA, but not from cross-lagged PA to DSx. On both sides, earlier levels are significantly associated with future levels of PA and DSx. ConclusionsThis study is the first to use a causal inference technique which adjusts for all time-invariant confounders while modelling the bidirectional linkages between depression symptoms and physical activity over 25-years of adulthood. It supports literature showing a consistent cross-sectional relationship, and advances understanding on how DSx earlier in the adult life course may influence PA as people age.

Two-Stage Limited-Information Estimation for Structural Equation Models of Round-Robin Variables

We propose and demonstrate a new two-stage maximum likelihood estimator for parameters of a social relations structural equation model (SR-SEM) using estimated summary statistics (Σ^) as data, as well as uncertainty about Σ^ to obtain robust inferential statistics. The SR-SEM is a generalization of a traditional SEM for round-robin data, which have a dyadic network structure (i.e., each group member responds to or interacts with each other member). Our two-stage estimator is developed using similar logic as previous two-stage estimators for SEM, developed for application to multilevel data and multiple imputations of missing data. We demonstrate out estimator on a publicly available data set from a 2018 publication about social mimicry. We employ Markov chain Monte Carlo estimation of Σ^ in Stage 1, implemented using the R package rstan. In Stage 2, the posterior mean estimates of Σ^ are used as input data to estimate SEM parameters with the R package lavaan. The posterior covariance matrix of estimated Σ^ is also calculated so that lavaan can use it to calculate robust standard errors and test statistics. Results are compared to full-information maximum likelihood (FIML) estimation of SR-SEM parameters using the R package srm. We discuss how differences between estimators highlight the need for future research to establish best practices under realistic conditions (e.g., how to specify empirical Bayes priors in Stage 1), as well as extensions that would make 2-stage estimation particularly advantageous over single-stage FIML.

MID-LIFE FINANCIAL STRESS AND COGNITIVE AND PHYSICAL PROBLEMS IN OLDER AGE: THE ROLE OF POTENTIALLY MODIFYING FACTORS

Abstract Financial stress is an important source of chronic stress and has been associated with cognitive and physical impairments. This study investigates whether midlife financial stress is associated with the combination of cognitive and physical impairment, the role of potentially modifiable factors, and sex differences. Methods: The Cardiovascular Risk Factors, Aging, and Dementia population-based cohort study from Finland was used (n=1497) (baseline collected 1972-1987, mean age 50 years). There were two late-life re-examinations (mean total follow-up 25 years). Midlife financial stress was measured using two questions on financial situation. Cognitive impairment was based on six cognitive domains. Physical impairment was self-reported. Potential modifying factors investigated were smoking, alcohol, physical activity, cohabiting/not, non-manual work, and sleep disturbances. Sex differences were investigated. We used path analyses with full information maximum likelihood estimation. Results: Among women and men, midlife financial stress associated with cognitive impairment, physical impairment and their combination. Smoking and sleep disturbances mediated associations between financial stress, physical impairment, and combined impairments. Among men: manual/non-manual work mediated the association to cognitive impairments; cohabitation mediated to cognitive impairment; financial stress was associated with cognitive impairment only among smokers and stress had a stronger association to physical and combined impairments among non-drinkers. Among women, sleep seems to have role in the association between financial stress and cognitive impairment. Conclusions: Midlife financial stress associates with late-life impairments, and lifestyle/sociodemographic factors may modify these associations. Sex differences were observed. Interventions promoting healthier lifestyle and psychosocial factors may buffer against the deleterious role of financial stress.

Loneliness and cognitive function in older adults: Longitudinal analysis in 15 countries.

This study aims to evaluate the directionality of the association between loneliness and cognitive performance in older adults, accounting for confounding factors. Data were from 55,662 adults aged ≥ 50 years who participated in Waves 5-8 of the Survey of Health, Ageing and Retirement in Europe (SHARE). Loneliness was assessed with the Three-Item Loneliness Scale (TILS) and with a one-item direct question. Cognitive performance was assessed with four measures: verbal fluency, numeracy, immediate recall, and delayed recall. Age, sex, geographical area, educational attainment, partnership status, depressive symptoms, and previous chronic diseases at baseline were used as covariates. We analyzed the associations with three-wave random intercept cross-lagged panel models (RI-CLPM) and conducted age-stratified analysis among those younger versus older than 65 years. Full information maximum likelihood estimators were used to handle missing values in Waves 6-8 in the main analyses. We also conducted additional sensitivity analyses stratified by retirement status (retired vs. not) at baseline. At the within-person level, loneliness and cognitive performance were not associated with each other among those aged 50-64 years in the main time-lagged analysis. Among those aged ≥ 65 years, loneliness was associated with lower cognitive performance in the next wave in all four cognitive domains. In addition, lower verbal fluency predicted greater loneliness in the next waves among this age group. Similar patterns were found independently of retirement status at baseline. These results suggest that loneliness is a psychosocial risk factor for cognitive decline among older adults (≥ 65 years). (PsycInfo Database Record (c) 2023 APA, all rights reserved).

1 Executive Functioning and Anxiety/Depressive Symptoms as Mediators Between ADHD and Quality of Life: A 10-year Longitudinal Study

Objective:Attention-Deficit/Hyperactivity Disorder (ADHD) is associated with impaired executive functioning and anxiety/depressive symptoms, which may contribute to reduced quality of life. We tested the hypotheses that (1) a childhood diagnosis of ADHD is related to reduced quality of life in emerging adulthood and that (2) this relationship is mediated by impaired executive functioning and anxiety/depressive symptoms.Participants and Methods:We assessed 85 children and adolescents with ADHD and 50 typically developing peers at baseline (Mean age = 11.6 years, 58% males), two-year follow-up, and 10-year follow-up with neuropsychological tests of executive functioning, the Behavioral Rating Inventory of Executive Function (BRIEF), the Short Moods and Feelings Questionnaire (SMFQ), and the Revised Children’s Manifest Anxiety Scale, second edition (RCMAS-2), as well as the Perceived Quality of Life scale (PQoL) at the 10-year follow-up. Four neuropsychological tests of executive functioning, the Letter-Number Sequencing test (working memory), the Color-Word Interference test condition 3 (response inhibition), the Color-Word Interference test condition 4 (shifting), and the trail making test condition 4 (cognitive flexibility) were combined into a neuropsychological executive functioning composite score based on high factor loadings (&gt; .73). the parent-reported BRIEF indexes, the behavioral regulation index, and the metacognition index were used as measures of everyday executive functioning. We conducted independent samples t-tests to compare the groups and simple and parallel mediation analyses with full information maximum likelihood estimation to examine whether the different executive functioning measures and anxiety/depressive symptoms at two-year follow-up mediated the relationship between baseline ADHD and self-reported quality of life at 10-year follow-up.Results:Baseline ADHD was associated with more difficulties with executive functioning on a composite measure of neuropsychological tests (p &lt; .001, Hedges g = .79) and parent-reported everyday metacognitive (p &lt; .001, Hedges g = 2.37) and behavioral regulation executive functioning (p &lt; .001, Hedges g = 1.55), as well as self-reported anxiety (p &lt; .001, Hedges g = 1.05) and depressive symptoms (p &lt; .001, Hedges g = 1.00) at two-year follow-up. Baseline ADHD was associated with lower self-reported quality of life (p = .001, Hedges g = -.67) at 10-year follow-up. The mediation analysis showed that everyday metacognitive executive functioning (p = .011, ß = -.497) and an anxiety/depressive symptoms composite (p &lt; .001, ß = -.404) parallelly mediated the relationship between ADHD and quality of life.Conclusions:Impaired everyday executive functioning and anxiety/depressive symptoms may represent two distinct pathways to reduced quality of life in emerging adults with a childhood diagnosis of ADHD. These findings stress the importance of targeting both cognitive and emotional aspects in interventions for children and adolescents with ADHD to improve later quality of life.

A correlated traits correlated (methods - 1) multitrait-multimethod model for augmented round-robin data.

We didactically derive a correlated traits correlated (methods - 1) [CTC(M - 1)] multitrait-multimethod (MTMM) model for dyadic round-robin data augmented by self-reports. The model is an extension of the CTC(M - 1) model for cross-classified data and can handle dependencies between raters and targets by including reciprocity covariance parameters that are inherent in augmented round-robin designs. It can be specified as a traditional structural equation model. We present the variance decomposition as well as consistency and reliability coefficients. Moreover, we explain how to evaluate fit of a CTC(M - 1) model for augmented round-robin data. In a simulation study, we explore the properties of the full information maximum likelihood estimation of the model. Model (mis)fit can be quite accurately detected with the test of not close fit and dynamic root mean square errors of approximation. Even with few small round-robin groups, relative parameter estimation bias and coverage rates are satisfactory, but several larger round-robin groups are needed to minimize relative parameter estimation inaccuracy. Further, neglecting the reciprocity covariance-structure of the augmented round-robin data does not severely bias the remaining parameter estimates. All analyses (including data, R scripts, and results) and the simulation study are provided in the Supporting Information. Implications and limitations are discussed.

Social causation, social selection, and economic selection in the health outcomes of Chinese older adults and their gender disparities

BackgroundThe economic selection hypothesis, which argues that the initial economic situation determines both subsequent health and economic conditions, has been drawn into the debate on causation-selection issues. This study aims to construct a path model with self-rated health and depression score of older adults as health outcomes to measure and compare the social causation forces of wealth accumulation, social selection forces of adulthood health, and economic selection forces of childhood economics, and to examine their gender disparities. MethodsData was obtained from a sample of 19613 older adults aged 45 years or above from the 2014 life history survey and the 2015 routine follow-up survey of the China Health and Retirement Longitudinal Study. Structural equation modeling analysis was conducted employing the full information maximum likelihood estimation method. ResultsThe presence of social causation, social selection, and economic selection were all statistically supported. In self-rated health, social selection forces held the dominant position, while social causation forces were comparable to economic selection forces. In depression score, social selection still exhibited stronger forces than economic selection, but social causation had forces close to social selection and greater than economic selection. The forces of the three hypotheses in self-rated health did not significantly change with gender, but social causation exerted mightier forces than economic selection within the male group, unlike the female group. The forces of economic selection in depression score were greater in females than males and no significant differences were observed among the forces of the three hypotheses in the female group. ConclusionsSocial causation, social selection, and economic selection operate simultaneously on the self-rated health and depression score of older adults. However, the force magnitudes of the three hypotheses and/or their rankings differ by health outcomes and gender.

New computations for RMSEA and CFI following FIML and TS estimation with missing data.

The full-information maximum likelihood (FIML) is a popular estimation method for missing data in structural equation modeling (SEM). However, previous research has shown that SEM approximate fit indices (AFIs) such as the root mean square error of approximation (RMSEA) and the comparative fit index (CFI) can be distorted relative to their complete data counterparts when they are computed following the FIML estimation. The main goal of the current paper is to propose and examine an alternative approach for computing AFIs following the FIML estimation, which we refer to as the FIML-corrected or FIML-C approach. The secondary goal of the article is to examine another existing estimation method, the two-stage (TS) approach, for computing AFIs in the presence of missing data. Both FIML-C and TS approaches remove the bias due to missing data, so that the resulting incomplete data AFIs estimate the same population values as their complete data counterparts. For both approaches, we also propose a series of small sample corrections to improve the estimates of AFIs. In two simulation studies, we found that the FIML-C and TS approaches, when implemented with small sample corrections, estimated the population-complete-data AFIs with little bias across a variety of conditions, although the FIML-C approach can fail in a small number of conditions with a high percentage of missing data and a high degree of model misspecification. In contrast, the FIML AFIs as currently computed often performed poorly. We recommend FIML-C and TS approaches for computing AFIs in SEM. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Analytic Approaches to Handle Missing Data in Simple Matrix Sampling Planned Missing Designs

Simple matrix sampling planned missing (SMS PD) design, introduce missing data patterns that lead to covariances between variables that are not jointly observed, and create difficulties for analyses other than mean and variance estimations. Based on prior research, we adopted a new multigroup confirmatory factor analysis (CFA) approach to handle missing data in such designs, in comparison to a regular CFA with full information maximum likelihood estimator. In Study 1, we tested the two approaches in 36 scenarios (4 sample sizes 3 inter-item correlations 3 numbers of x-set items) given a total of 20 items. We found that, the multigroup CFA approach performed with acceptable convergence rates, power to recover population values, acceptable standard errors and model fit in certain scenarios by larger sample size, higher bivariate correlation, and more items in the x-set. We found a few scenarios where regular CFA with FIML performed well. These findings suggested that the approaches can be implemented to handle the special missing data introduced by the SMS PM designs, and, thereby, enhance the utility of SMS PM data. In Study 2, we applied the multigroup CFA approach in real-world data to demonstrate the feasibility and analytic value of this approach.

The effect of mobile phone utilization for enhanced adherence counselling intervention among persons with HIV

ABSTRACT The conduct of physical enhanced adherence counselling (EAC) for antiretroviral therapy (ART) non-adherers is often flawed by objectionable time lag from commencement to timely completion of the process. Therefore, we conducted a retrospective cohort study of 342 adults (≥18 years) with HIV on ART to determine the outcome of utilizing mobile phone based EAC intervention. Structural equation modelling framework, with full information maximum likelihood estimator was used to elucidate the pathways linking the relationship between individual characteristics, perceived barriers to ART adherence, and the applied interventions. A total of 321(93.9%) participants completed the required 3 EAC sessions over 60-days. The proportion of viral load (VL) re-suppression (<1000 copies/mL) after EAC intervention was 66.6%. The mean durations of EAC onset from time of high VL confirmation and completion of EAC were 6.26 ± 3.22 and 59.99 ± 5.14 days, respectively. In the simultaneous model (Comparative Fit Index = 0.89, Tucker–Lewis Index = 0.851, Root Mean Square (RMS) Error of Approximation = 0.049, Standardized RMS Residual = 0.059), the variables: forgot, knowledge/beliefs, side effect of drugs, lost/ran out of drugs, scheduling, and stigma were significant barrier factors contributing to poor ART adherence. The use of mobile phones for EAC intervention was effective for early initiation and timely completion of the sessions.

Optimizing Shared Decision Making about Hydroxyurea in Young Children with Sickle Cell Anemia

Introduction: The National Heart, Lung, and Blood Institute (NHLBI) recommends hydroxyurea (HU) be offered to all children with sickle cell anemia (SCA) age >9 months via shared decision-making (SDM). However, HU remains underutilized, largely due to parental concerns about safety and potential long-term effects. SDM was recommended because it can decrease parental uncertainty as families clarify their values/preferences and understand scientific evidence about HU. Funded by the Patient-Centered Outcomes Research Institute (PCORI), the Engage HU study (NCT03442114) compared two methods for optimizing SDM for HU in young children with SCA: the American Society of Hematology's (ASH) HU clinician pocket guide (usual care condition) and a HU SDM toolkit (toolkit condition) created by the research team. This study aimed to compare the impact of these on caregiver decisional uncertainty and caregiver perception of clinician use of SDM. Methods: Engage HU was a prospective, multi-site intervention trial with a unidirectional crossover design in which each clinic began enrolling in the usual care condition and then one-by-one crossed over to the toolkit condition. Inclusion criteria included children ages 0-5 years followed at 12 SCA centers in the US who were candidates for HU and whose caregivers had not decided about HU therapy within 3 months prior to enrollment. After receiving a flyer/letter, eligible caregivers were approached in clinic or by phone. Caregivers completed an e-consent form. Study visits were conducted in-person or via telehealth. Primary endpoints were caregiver decisional uncertainty (Decisional Conflict Scale-DCS) and caregiver perception of clinician use of SDM (Dyadic OPTION scale-OPTION). Lower scores on the DCS indicate less decisional uncertainty and higher scores on the OPTION indicate that the clinician demonstrated more SDM behaviors (e.g., asked about caregiver preferences/values). All survey data were collected using paper surveys or electronically via REDCap™. Data were analyzed using linear regression models in Stata version 17 for each main outcome of interest (DCS and OPTION Total Scores). Our primary predictor was group (toolkit versus usual care). The model was estimated using full information maximum likelihood estimation on the full analysis sample (N=132) to account for missing data. We also accounted for site-level variation, when the sites crossed from usual care to toolkit (i.e., the cluster), when data were collected (0=pre-COVID, 1=during COVID), and the impact of COVID-19 on caregivers (assessed using the COVID-19 Exposure and Family Impact Survey [CEFIS]). Results: A total of 176 caregivers of eligible children consented. Twelve SCA clinical sites participated; however, four sites were terminated early due to staff turnover or low accrual. Mean caregiver age was 30.19 (SD=6.97); most identified as female (93.1%), Black/African American (89.3%), or Mixed race (6.1%), and mothers (90.8%). Most children had HbSS (94.7%). Preliminary analyses were conducted on 132 caregivers with complete data (n=85 Usual Care; n=47 Toolkit). Regression analyses showed that participants in the toolkit condition had significantly lower DCS Total scores (i.e., lower decisional conflict) than those in usual care condition (b=-7.33, 95% CI=-13.3 to 1.31, p=.017). In addition, significant differences were found on the DCS subscales (see Table 1). Similarly, participants in the toolkit condition had significantly higher OPTION Total scores (i.e., parents reported that the clinician exhibited more SDM behaviors) than those in usual care (b=2.38, 95% CI=0.44 to 4.34, p=.016). Conclusions: Use of the HU toolkit compared to the usual care approach significantly improved SDM between providers and caregivers of children with SCA; however, given site team turnover, lower than expected accrual, and study interruption due to the COVID-19 pandemic, additional research is needed to confirm these preliminary findings. Future studies should also seek to identify context-specific factors (e.g., clinic processes) that are key to successful implementation of SDM with both younger and older children with SCA. This project was supported by an award fromPCORI contract number CDR-1609-36055 (PI: Crosby).Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Body image and depression in endometriosis: Examining self-esteem and rumination as mediators

Endometriosis is a chronic systemic disease affecting 1 in 10 people assigned female at birth, that can result in appearance-based and functional bodily changes which can negatively impact body image. Empirical evidence supports the body dissatisfaction-driven hypothesis that negative body image leads to greater depressive symptoms; but potential underlying mechanisms are under-researched. This prospective study investigated the mediating role of two theoretically-derived intervening factors, self-esteem and rumination, in individuals living with endometriosis who typically report high rates of body image concerns and depressive symptoms. Initially, 996 participants completed the first online survey (T0) assessing demographic, medical and psychological factors. Of these, 451 completed surveys at 1-month (T1) and 2-months (T2) follow-up assessing self-esteem, rumination and depression. Bootstrapped analyses with full-information maximum likelihood estimation indicated that poor body image (T0) predicted greater depressive symptoms over time (T2). Self-esteem (T1), but not rumination (T1), mediated the body image-depression relationship. These results provide support for the body dissatisfaction-driven hypothesis and further identify that self-esteem is a key meditating factor. This highlights the importance of addressing self-esteem in body image focused interventions.

FACTOR STRUCTURE OF PRE-LOSS GRIEF-12 IN CAREGIVERS OF PEOPLE LIVING WITH DEMENTIA

Abstract While several studies on post-loss grief have been conducted, little research has examined assessment and treatment for pre-loss grief in family caregivers of persons living with dementia (PLWD). A total of 699 caregivers of PLWD were recruited through relevant dementia associations. The recruitment e-mail provided information about the study and instructions on how to participate by a link to the online survey. Confirmatory factor analysis (CFA) was performed to test the fit of the data from the caregivers and to assess the factor structure of the Prolonged Grief-12 (PG-12) to evaluate pre-loss grief accurately by identifying relevant items and eliminating items that are not appropriate for caregivers of PLWD to assess pre-loss grief accurately. CFA was conducted via the Full Information Maximum Likelihood estimation method to test the unidimensional model of the PG-12 in the study population. The initial model was modified to develop a better-fitting model and to detect misfitting parameters in the PG-12 by deleting irrelevant items for caregivers of PLWD. The adjusted dementia-specific 10-item version (PG-10-D) had significantly improved fit indices with RMSEA = .064, CFI = .972, and GFI = .963. An overall assessment of fit indicated that the model adequately approximated the data. Factor loadings ranged from 0.53 to 0.85. This study suggests that the dementia-specific, unidimensional PG-10-D, modifying the original PG-12, may be useful and parsimonious in assessing and quantifying pre-loss grief in caregivers. Further research is required to establish psychometric properties, including factorial validity and reliability, factorial invariance analysis and further factor analysis.

A discussion on the outcomes of adopted agricultural technological products and specific sustainable development goals: Evidence from Pakistan

Establishing a link between specific sustainable development goals (SDGs) and the outcomes of adopted agricultural technological products is lacking in developing countries. Therefore, this study aims to address food security SDG 02 by adopting crop protection products of multinational brands versus sub-standard crop protection products SDG 12 by smallholder farming households. We employ endogenous switching probit models using a survey of smallholder farming households in the cotton-wheat zone in Pakistan. Full information maximum likelihood estimates illustrate that comparative advantage guide the adoption of crop protection products of multinational brands (CMBs). Our findings suggest that adopting CMBs rather than sub-standard crop protection products may translate as a responsible farming practice if assuming the use of crop protection products is inevitable. In sum, CMBs enhance food security and can play a vital role in the current debate on responsible consumption and production, particularly for sustainable development. Our findings also indicate that promoting agricultural extension information via radio broadcasts has a significant and positive relationship with adoption. Hence, it stands out as the most promising policy option.

Self-compassion and body image in pregnancy and postpartum: A randomized pilot trial of a brief self-compassion meditation intervention

The current study evaluated the efficacy of a three-week self-compassion (SC) meditation intervention in improving body image and SC during pregnancy and postpartum. Participants (n = 71; age = 31.92 ± 3.98 years; white = 61, 85.9%; intervention = 35, 49.3%; pregnant = 33, 46.5%; postpartum = 38, 53.5%) were recruited from a health coaching program and 35 were randomly assigned into a three-week SC meditation intervention while 36 were randomly assigned to a waitlist control condition. Linear regressions using full-information maximum likelihood estimation examined the effect of intervention group on body image and SC outcomes controlling for baseline level of outcome, pregnancy or postpartum status, previous meditation experience, and physical activity. Results indicated women in the intervention group reported significantly reduced body shame and body dissatisfaction and improved body appreciation and self-compassion compared to women in the control group. Implementation of a brief SC meditation intervention during pregnancy and postpartum has potential to improve mental health outcomes related to body image. Future work should replicate this study with a larger, more diverse sample of women.

Sensitivity analyses for data missing at random versus missing not at random using latent growth modelling: a practical guide for randomised controlled trials

BackgroundMissing data are ubiquitous in randomised controlled trials. Although sensitivity analyses for different missing data mechanisms (missing at random vs. missing not at random) are widely recommended, they are rarely conducted in practice. The aim of the present study was to demonstrate sensitivity analyses for different assumptions regarding the missing data mechanism for randomised controlled trials using latent growth modelling (LGM).MethodsData from a randomised controlled brief alcohol intervention trial was used. The sample included 1646 adults (56% female; mean age = 31.0 years) from the general population who had received up to three individualized alcohol feedback letters or assessment-only. Follow-up interviews were conducted after 12 and 36 months via telephone. The main outcome for the analysis was change in alcohol use over time. A three-step LGM approach was used. First, evidence about the process that generated the missing data was accumulated by analysing the extent of missing values in both study conditions, missing data patterns, and baseline variables that predicted participation in the two follow-up assessments using logistic regression. Second, growth models were calculated to analyse intervention effects over time. These models assumed that data were missing at random and applied full-information maximum likelihood estimation. Third, the findings were safeguarded by incorporating model components to account for the possibility that data were missing not at random. For that purpose, Diggle-Kenward selection, Wu-Carroll shared parameter and pattern mixture models were implemented.ResultsAlthough the true data generating process remained unknown, the evidence was unequivocal: both the intervention and control group reduced their alcohol use over time, but no significant group differences emerged. There was no clear evidence for intervention efficacy, neither in the growth models that assumed the missing data to be at random nor those that assumed the missing data to be not at random.ConclusionThe illustrated approach allows the assessment of how sensitive conclusions about the efficacy of an intervention are to different assumptions regarding the missing data mechanism. For researchers familiar with LGM, it is a valuable statistical supplement to safeguard their findings against the possibility of nonignorable missingness.Trial registrationThe PRINT trial was prospectively registered at the German Clinical Trials Register (DRKS00014274, date of registration: 12th March 2018).

Self-efficacy in controlling upsetting thoughts, but not positive gains, mediates the effects of benefit-finding group intervention for Alzheimer family caregivers.

This study aimed to examine the therapeutic mechanism of the benefit-finding therapeutic (BFT) intervention that used cognitive reappraisal and alternative thinking to construct positive aspects of caregiving (PAC), in a cluster-randomized controlled trial for Alzheimer caregivers. Forty two caregivers received BFT, whereas 87 received psychoeducation as control. Depressive symptoms and global burden were outcomes measured at baseline, postintervention, and 4- and 10-month follow-up. Mediators considered included PAC (measured by benefit word count to a qualitative measure) and three self-efficacies-controlling upsetting thoughts (SE-CUT), responding to disruptive behaviors, and obtaining respite. Using mixed-effects regression, we demonstrated that benefit-finding increased caregivers' PAC and SE-CUT, but that only SE-CUT uniquely predicted depressive symptoms and global burden longitudinally. Path analyses with bootstrapped confidence intervals, using full information maximum likelihood estimation to retain the whole sample with partial missing data, showed that SE-CUT change from baseline to postintervention mediated intervention effects on depressive symptoms, but not global burden, at both follow-ups. No mediation effects were found for PAC and the other self-efficacies. The BFT effect on depressive symptoms was partly accounted for by improvement in SE-CUT. The therapeutic mechanism for the effect on burden remained unknown. The study sheds light on the importance of actively promoting positive caregiver functioning. (PsycInfo Database Record (c) 2022 APA, all rights reserved).