Measures Of Emotional Distress Research Articles

Perceived Gender Presentation Among Transgender and Gender Diverse Youth: Approaches to Analysis and Associations with Bullying Victimization and Emotional Distress.

As measures of birth-assigned sex, gender identity, and perceived gender presentation are increasingly included in large-scale research studies, data analysis approaches incorporating such measures are needed. Large samples capable of demonstrating variation within the transgender and gender diverse (TGD) community can inform intervention efforts to improve health equity. A population-based sample of TGD youth was used to examine associations between perceived gender presentation, bullying victimization, and emotional distress using two data analysis approaches. This secondary data analysis of the Minnesota Student Survey included 2168 9th and 11th graders who identified as "transgender, genderqueer, genderfluid, or unsure about their gender identity." Youth reported their biological sex, how others perceived their gender presentation, experiences of four forms of bullying victimization, and four measures of emotional distress. Logistic regression and multifactor analysis of variance (ANOVA) were used to compare and contrast two analysis approaches. Logistic regressions indicated that TGD youth perceived as more gender incongruent had higher odds of bullying victimization and emotional distress relative to those perceived as very congruent with their biological sex. Multifactor ANOVAs demonstrated more variable patterns and allowed for comparisons of each perceived presentation group with all other groups, reflecting nuances that exist within TGD youth. Researchers should adopt data analysis strategies that allow for comparisons of all perceived gender presentation categories rather than assigning a reference group. Those working with TGD youth should be particularly attuned to youth perceived as gender incongruent as they may be more likely to experience bullying victimization and emotional distress.

Emotional distress when studying sensitive topics in psychology, and its relationship with hardiness and mental health

ABSTRACTThis observational, cross-sectional study examined students’ retrospective recall of emotional distress when studying sensitive topics in psychology, and whether hardiness had a mediated pathway to emotional distress through a mental health condition (MHC). Psychology undergraduates (155 women, 34 men) from South Australian universities completed self-report questionnaires assessing hardiness, retrospective measures of emotional distress when studying a range of topics, their concurrent MHC and lifetime cumulative trauma. As hypothesised, students reported more emotional distress to sensitive topics relative to nonsensitive ones, p < .001 (r = −.69). Hardiness was significantly negatively correlated with MHC, p < .001 (r = −.38). Causal mediation analysis revealed, as predicted, that MHC mediated the effect of hardiness on emotional distress (p < .001). These results are consistent with existing literature on students’ reactions to sensitive topics in medical, law and social work education, as well as previous findings of negative associations between hardiness and mental health outcomes. Implications for higher education policy and practice are discussed, including the use of hardiness assessments as an early screening tool for mental health decline. Future research should identify the specific MHCs involved in the mediated pathway from hardiness to course-related emotional distress, and employ longitudinal designs to confirm the temporal ordering of variables.

Psychometric Properties of the Problem Areas in Diabetes: Teen and Parent of Teen Versions.

This study adds to the literature on the psychometric properties of the Problem Areas in Diabetes-Teen (PAID-T) and Parent (P-PAID-T) Versions. It also aims to shorten the measures of diabetes-specific distress, determine construct validity, and establish cutoff scores. Data are from two independent studies (N = 1,265). Adolescent-caregiver dyads completed measures of emotional distress, diabetes strengths, hemoglobin A1c, blood glucose checks, and average blood glucose. Exploratory and confirmatory factor analyses assessed factor structures for each measure. Correlational analyses provided support for concurrent validity. Receiver-operating characteristic curves identified cutoff scores based on clinically meaningful groups identified with latent profile analysis. Analyses supported a 14-item PAID-T and a 15-item P-PAID-T, with preliminary cutoff scores ≥44 and ≥54, respectively. Measures were associated with emotional and health outcomes as hypothesized. The PAID-T and P-PAID-T are valid, reliable, and useful measures of diabetes-specific distress for teenagers with type 1 diabetes and parents of teenagers.

Measuring Emotional Intelligence Enhances the Psychological Evaluation of Chronic Pain.

The assessment of emotional factors, in addition to other psychosocial factors, has been recommended as a means of identifying individuals with chronic pain who may not respond to certain pain treatments. Systematic reviews of the evidence regarding the prediction of responsiveness to a treatment called the spinal cord stimulator (SCS) have yielded inconclusive results. Emotional intelligence is a term which refers to the ability to identify and manage emotions in oneself and others and has been shown to be inversely associated with emotional distress and acute pain. This study aims to investigate the relationship between emotional intelligence, chronic pain, and the more established psychosocial factors usually used for SCS evaluations by clinical psychologists in medical settings. A sample of 112 patients with chronic pain on an acute hospital waiting list for SCS procedures in a pain medicine service were recruited. Psychological measures were completed including: a novel measure of emotional intelligence; usual measures of emotional distress and catastrophizing; and a numerical rating scale designed to assess pain intensity, pain-related distress, and interference. As predicted, findings revealed significant associations between most of the measures analyzed and current pain intensity. When entered into a simultaneous regression analysis, emotional intelligence scores remained the only significant predictor of current pain intensity. There are potential clinical, ethical, and organizational implications of emotional intelligence processes partially predicting pain in patients on a waiting list for a medical procedure. These results may offer new insight, understanding, and evaluation targets for clinical psychologists in the field of pain management.

Dimensionality of the Chinese hospital anxiety depression scale in psychiatric outpatients: Mokken scale and factor analyses

Objective: The hospital anxiety and depression scale (HADS) is a widely used scale of anxiety and depression. However, recent studies have challenged the bi-dimensional scoring of the HADS. The present study was to examine the dimensionality of the Chinese HADS.Methods: We recruited a convenience sample of 214 adult psychiatric outpatients at a medical centre in Taiwan, and they completed the Chinese HADS. We used Mokken scale analysis (MSA), exploratory factor analysis (EFA), exploratory bifactor analysis (EBA) and confirmatory factor analysis (CFA) to examine the dimensionality of the Chinese HADS.Results: The Chinese HADS was a moderate Mokken scale (Hs = 0.44), and had a two-factor structure. EBA showed that one general factor, emotional distress, explained 68% of the common variance of the Chinese HADS. CFA confirmed that the bifactor model had the best fit statistics. The items 5 and 7 of the Chinese HADS contributed to structural ambiguity in the Chinese HADS subscales.Conclusions: The sum scores of the Chinese HADS were a reliable and valid unidimensional measure of emotional distress. The Chinese HADS subscales were incapable of differentiating between anxiety and depression. Clinicians and researchers should choose other scales that are specifically designed for measuring anxiety and depression.

Hypothalamic-pituitary-adrenal-axis dysregulation and double product increases potentiate ischemic heart disease risk in a Black male cohort: the SABPA study.

Emotional distress has been associated with a poorer prognosis in myocardial infarction patients. Elevated adrenocorticotrophic hormone (ACTH), lower cortisol, dehydroepiandrosterone sulfate (DHEAS) and cortisol:DHEAS, as measures of emotional distress, might correlate with silent myocardial ischemia (SMI) and workload. Thus, we assessed the relationship between emotional distress, SMI and double product (systolic blood pressure (SBP) × heart rate). Cross-sectional South African biethnic single-set cohorts (N=378), aged 44.7±9.52 years, were investigated. Depressive symptoms (Patient Health Questionnaire-9), anthropometric, fasting blood, 24-h double product and 24-h 2-lead electrocardiogram (ST-segment depression) values were obtained. Blacks, mostly men, had increased depressive symptoms, hyperglycemia, SMI, double product, SBP hypertension and ACTH but lower cortisol, DHEAS and cortisol:DHEAS than their White counterparts. Black men had the highest combined SBP hypertension and below-median cortisol prevalence, 38%, compared with 5.9-13.8% in the other groups. Their SMI was associated with ACTH and cortisol:DHEAS (adj. R2 0.29; β 0.27-0.31 (0.12-0.64); P⩽0.05), double product (adj. R2 0.29; β 0.38 (0.18-0.57); P=0.050) and SBP hypertension (area under the curve: 0.68 (95% CI: 0.56, 0.80); P=0.042; sensitivity/specificity 49/85%). Double product was positively associated with central obesity in all sex groups and with cortisol in the Black men (P<0.05). A dysregulated hypothalamic-pituitary-adrenal-axis (HPAA) showed signs of a hyporesponsive adrenal cortex, suggesting chronic emotional stress in the Black male cohort. In this cohort, HPAA dysregulation and compensatory increases in double product occur as a potential defense mechanism to alleviate perfusion deficits, thereby potentiating ischemic heart disease risk.

Ecological Momentary Assessment of Adolescent Problems, Coping Efficacy, and Mood States Using a Mobile Phone App: An Exploratory Study.

BackgroundMobile technologies have the potential to be used as innovative tools for conducting research on the mental health and well-being of young people. In particular, they have utility for carrying out ecological momentary assessment (EMA) research by capturing data from participants in real time as they go about their daily lives.ObjectiveThe aim of this study was to explore the utility of a mobile phone app as a means of collecting EMA data pertaining to mood, problems, and coping efficacy in a school-based sample of Irish young people.MethodsThe study included a total of 208 participants who were aged 15-18 years, 64% female (113/208), recruited from second-level schools in Ireland, and who downloaded the CopeSmart mobile phone app as part of a randomized controlled trial. On the app, participants initially responded to 5 single-item measures of key protective factors in youth mental health (formal help-seeking, informal help-seeking, sleep, exercise, and sense of belonging). They were then encouraged to use the app daily to input data relating to mood states (happiness, sadness, anger, stress, and worry), daily problems, and coping self-efficacy. The app automatically collected data pertaining to user engagement over the course of the 28-day intervention period. Students also completed pen and paper questionnaires containing standardized measures of emotional distress (Depression, Anxiety, and Stress Scale; DASS-21), well-being (World Health Organization Well-Being Index; WHO-5), and coping (Coping Strategies Inventory; CSI).ResultsOn average the participants completed 18% (5/28) of daily ratings, and engagement levels did not differ across gender, age, school, socioeconomic status, ethnicity, or nationality. On a scale of 1 to 10, happiness was consistently the highest rated mood state (overall mean 6.56), and anger was consistently the lowest (overall mean 2.11). Pearson correlations revealed that average daily ratings of emotional states were associated with standardized measures of emotional distress (rhappiness=–.45, rsadness=.51, ranger=.32, rstress=.41, rworry=.48) and well-being (rhappiness=.39, rsadness =–.43, ranger=–.27, rstress=–.35, rworry=–.33). Inferential statistics indicated that single-item indicators of key protective factors were related to emotional distress, well-being, and average daily mood states, as measured by EMA ratings. Hierarchical regressions revealed that greater daily problems were associated with more negative daily mood ratings (all at the P<.001 level); however, when coping efficacy was taken into account, the relationship between problems and happiness, sadness, and anger became negligible.ConclusionsWhile engagement with the app was low, overall the EMA data collected in this exploratory study appeared valid and provided useful insights into the relationships between daily problems, coping efficacy, and mood states. Future research should explore ways to increase engagement with EMA mobile phone apps in adolescent populations to maximize the amount of data captured by these tools.Trial RegistrationClinicaltrials.gov NCT02265978; http://clinicaltrials.gov/ct2/show/NCT02265978 (Archived by WebCite at http://www.webcitation.org/6mMeYqseA).

Measuring family functioning in families with parental cancer: Reliability and validity of the German adaptation of the Family Assessment Device (FAD)

ObjectiveThe concept of family functioning is gaining importance in psycho-oncology research and health care services. The Family Assessment Device (FAD) is a well-established measure of family functioning. Psychometric properties inherent in the German 51-item adaptation of the FAD are examined in different samples of families with parental cancer. MethodsAcceptance, reliability, and validity of FAD scales are analysed in samples from different study settings (N=1701 cancer patients, N=261 partners, N=158 dependent adolescent children 11 to 18years old). ResultsMissing items in the FAD scales (acceptance) are rare for adults (<1.1%) and adolescent children (<4.4%). In samples of adults and older adolescents (15 to 18years), all FAD scales except for the Roles scale are significantly reliable (0.75≤Cronbach's α≤0.88). The scales correlate highly (0.46≤Pearson's r≤0.59) with the criterion satisfaction with family life (convergent validity), and have smaller correlations (0.16≤r≤0.49) with measures of emotional distress and subjective well-being (divergent validity). In most FAD scales, adults seeking family counselling report worse family functioning (0.24≤Cohen's d≤0.59) than adults in other samples with parental cancer (discriminative validity). ConclusionOverall, the German 51-item adaptation of the FAD reveals good acceptance, reliability, and validity for cancer patients and their relatives. Particularly the scale General Functioning shows excellent psychometric properties. The FAD is suitable in the assessment of families with parental cancer for adults and adolescents older than 11years.

Confirmatory factor analysis of Clinical Outcomes in Routine Evaluation (CORE-OM) used as a measure of emotional distress in people with tinnitus.

BackgroundPeople with troublesome tinnitus often experience emotional distress. Therefore a psychometrically sound instrument which can evaluate levels of distress and change over time is necessary to understand this experience. Clinical Outcomes in Routine Evaluation (CORE-OM) is a measure of emotional distress which has been widely used in mental health research. Although originally designed as a 4-factor questionnaire, factor analyses have not supported this structure and a number of alternative factor structures have been proposed in different samples. The aims of this study were to test the factor structure of the CORE-OM using a large representative tinnitus sample and to use it to investigate levels of emotional distress amongst people with a range of tinnitus experience.MethodsThe CORE-OM was completed by 342 people experiencing tinnitus who self-rated their tinnitus on a 5-point scale from ‘not a problem’ to ‘a very big problem’. Confirmatory factor analysis was used to test all ten factor models which have been previously derived across a range of population samples. Model fit was assessed using fit criterion and theoretical considerations. Mean scores on the full questionnaire and its subscales were compared between tinnitus problem categories using one-way ANOVA.ResultsThe best fitting model included 33 of the 34 original items and was divided into three factors: negatively worded items, positively worded items and risk. The full questionnaire and each factor were found to have good internal consistency and factor loadings were high. There was a statistically significant difference in total CORE-OM scores across the five tinnitus problem categories. However there was no significant difference between those who rated their tinnitus ‘not a problem’, and ‘a small problem’ or ‘a moderate problem.’ConclusionThis study found a 3-factor structure for the CORE-OM to be a good fit for a tinnitus population. It also found evidence of a relationship between emotional distress as measured by CORE-OM and perception of tinnitus as a problem. Its use in tinnitus clinics is to be recommended, particularly when emotional distress is a target of therapy.Electronic supplementary materialThe online version of this article (doi:10.1186/s12955-016-0524-5) contains supplementary material, which is available to authorized users.

Abstract 3473: Psychosocial functioning in research participants at enrollment in a Li-Fraumeni syndrome study

Abstract Background: Li Fraumeni Syndrome (LFS) is an autosomal dominant cancer predisposition syndrome in which about 90% of individuals develop cancer by age 60. Approximately 70% of individuals with LFS have germline TP53 mutation. We hypothesized that this high level of cancer risk may be associated with increased emotional distress, cancer risk perceptions and cancer worry in individuals from LFS families. Methods: Data from 276 adult (≥18 years old) TP53 mutation carriers (TP53+), mutation negative (TP53-) and untested (UT) participants enrolled in an IRB-approved study at the Clinical Genetics Branch, NCI were obtained between January 2011 and June 2014.. Using questionnaires at baseline, we assessed emotional distress (global distress, somatization, anxiety and depression) as measured by the BSI-18, cancer risk perceptions (comparative: scores 1-5; 1 = much less than other people your age to 5 = much more than other people your age and absolute: 10-point scale; 1 = no chance; 5 = may or may not; 10 = almost certainly) and cancer worry scales (frequency of cancer thoughts, interference with mood and daily activity, scores 1-4; = not at all or rarely to 4 = several times a day). Results: TP53+ estimated their comparative lifetime risk of cancer as higher than TP53- and UT; [4.9 (SD = 0.5) vs. 3.8 (SD = 1) and 3.2 (SD = 1.3) p&amp;lt;0.01], respectively]. TP53+ also estimated their absolute cancer risk as significantly higher than TP53- and UT on a [8.6(SD = 1.5) vs. 6.3 (SD = 1.6) and 5.7 (SD = 2.1), p&amp;lt;0.01].Cancer worry was higher in TP53+ than TP53-or UT. TP53+ also indicated they thought about their cancer risk more frequently thanTP53- and UT [2.3 (SD = 0.9) vs. 1.3 (0.6) and 1.3 (SD = 0.6), p&amp;lt;0.01]. There was a small but statistically significant difference between TP53+, TP53- and UT in their appraisal of whether cancer worry affected their mood over the past month [1.6 (SD = 0.6) vs. 1.2 (SD = 0.6) and 1.1 (SD = 0.2), p = &amp;lt;0.01] and whether thoughts of cancer affected their ability to perform daily activities [1.2 (SD = 0) vs. 1.1 (SD = 0.4) and 1 (SD = 0.2), p = &amp;lt;0.01]. No statistically significant differences were observed on measures of emotional distress between TP53+, TP53- or UT somatization [46.7 (SD = 8.1) vs. 45.9 (SD = 9.3) and 45.9 (SD = 7.6); depression [50.1 (SD 9.7) vs. 49.6 (SD - 9.3) and 45.9 (SD = 7.6); anxiety [48.2 (SD = 9.1) vs. 45.4 (SD = 9.7) and 45.8 (SD = 7.9) or global distress [47.9(SD = 9.9); vs. 45.1(12.1) and 44.9 (SD = 9.5)]. Conclusions: Participants in the LFSS do not demonstrate high levels of emotional distress. TP53+ appropriately identify their comparative and absolute cancer risk as high, but have levels of cancer worry that appears to be only slightly affecting their mood or ability to perform daily activities. Future research will focus on longitudinal changes in risk perception, cancer worry and emotional well-being while enrolled in a cancer screening study. Citation Format: Jennifer T. Loud, Renee C. Bremer, Rosamma Decastro, June A. Peters, Phuong L. Mai, Sharon A. Savage. Psychosocial functioning in research participants at enrollment in a Li-Fraumeni syndrome study. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3473.

Associations between nonauditory hallucinations, dissociation, and childhood adversity in first-episode psychosis

ABSTRACTAlthough repeated associations have been found between adversity exposure (particularly exposure to childhood sexual abuse), dissociation, and auditory hallucinations in the context of psychosis, there is little comparable research examining hallucinations in other modalities. This study aimed to determine whether cumulative adversity exposure influences the likelihood of experiencing visual, tactile, olfactory, and gustatory hallucinations among psychosis patients and whether measures of dissociation are significantly associated with nonauditory hallucinations when exposure to childhood adversity and psychological distress are adjusted for. Self-report measures and a retrospective case-control design were applied to assess nonauditory hallucinations, dissociation, psychological distress, and childhood adversity exposure in a sample of first-episode psychosis patients reporting nonauditory hallucinations (n = 36) and controls from the same clinical population without nonauditory hallucinations (n = 31). Case participants reported higher levels of dissociation, psychological distress, and exposure to childhood rape than the control group. Dissociation remained significantly associated with nonauditory hallucinations when we adjusted for childhood sexual abuse, other types of childhood adversity, and a combined measure of emotional distress. Indication of a dose–response relationship was detected, in that total number of adversities was significantly associated with reporting more than one modality of nonauditory hallucination. Observed associations between auditory hallucinations and dissociation in psychosis may extend to other hallucination modalities. It is suggested that more research attention be paid to the etiology and impact of nonauditory hallucinations in psychosis samples.

The measurement of maladaptive cognitions underlying problematic video-game playing among adults

Research has shown that some individuals can develop excessive patterns of video-gaming, leading to significant psychological and interpersonal problems. Recent reviews of problematic gaming suggest that treatment is best approached from a cognitive-behavioural perspective. However, relatively little research has examined the underlying cognitive factors that might be usefully targeted in an intervention. To address this gap, we present the findings of a study involving N = 485 adult regular video-game players (84% male, Mage = 26 years) who completed a questionnaire about gaming activity, problematic gaming, and problematic cognitions. Gaming cognitions fell on four dimensions: (1) perfectionism, (2) cognitive salience, (3) regret, and (4) behavioural salience. All cognition subscales correlated moderately to highly with two different measures of problematic gaming (r = .49–.76), as well as a measure of emotional distress (DASS-21; r = .25–.35). Large effect sizes (d = .87–1.96) were found when comparing problematic and non-problematic gamers on all four cognition types. This study is among the first to provide empirical evidence for cognitive differences between problematic and non-problematic video-game players, and to identify specific cognitions which could be practically addressed in clinical settings. The implications for the further development and refinement of clinical approaches to problematic gaming, including formulation, assessment, and intervention, are discussed.

Linkage between the PROMIS® pediatric and adult emotional distress measures.

Research studies that measure health-related quality of life (HRQOL) in both children and adults and longitudinal studies that follow children into adulthood need measures that can be compared across these age groups. This study links the PROMIS pediatric and adult emotional distress measures using data from participants with diverse health conditions and disabilities. Analyses were conducted and compared in two separate samples to confirm the stability of results. One sample (n = 874) included individuals aged 14-20 years with special health care needs and who require health services. The other sample (n = 641) included individuals aged 14-25 years who have a physical or cognitive disability. Participants completed both PROMIS pediatric and adult measures. Item response theory-based scores were linked using the linear approximation to calibrated projection. The estimated latent-variable correlation between pediatric and adult PROMIS measures ranged from 0.87 to 0.94. Regression coefficients β 0 (intercept) and β 1 (slope), and mean squared error are provided to transform scores from the pediatric to the adult measures, and vice versa. This study used a relatively new linking method, calibrated projection, to link PROMIS pediatric and adult measure scores, thus expanding the use of PROMIS measures to research that includes both populations.

The frequency of involuntary autobiographical memories and future thoughts in relation to daydreaming, emotional distress, and age.

We introduce a new scale, the Involuntary Autobiographical Memory Inventory (IAMI), for measuring the frequency of involuntary autobiographical memories and involuntary future thoughts. Using the scale in relation to other psychometric and demographic measures provided three important, novel findings. First, the frequency of involuntary and voluntary memories and future thoughts are similarly related to general measures of emotional distress. This challenges the idea that the involuntary mode is uniquely associated with emotional distress. Second, the frequency of involuntary autobiographical remembering does not decline with age, whereas measures of daydreaming, suppression of unwanted thoughts and dissociative experiences all do. Thus, involuntary autobiographical remembering relates differently to aging than daydreaming and other forms of spontaneous and uncontrollable thoughts. Third, unlike involuntary autobiographical remembering, the frequency of future thoughts does decrease with age. This finding underscores the need for examining past and future mental time travel in relation to aging and life span development.

RANO NEGATIVNO ISKUSTVO KAO REGULATOR REAKTIVNOSTI NA STRES

Najveći broj modela koji se bave efektima negativnih iskustava u detinjstvu, pretpostavlja da rana averzivna iskustva imaju ulogu moderatora koji menja način na koji će osoba reagovati na aktuelne životne stresore. Osnovni cilj ovog istraživanja je provera osnovnih postavki modela senzitizacije na stres i modela inokulacije stresa. Istraživanje je longitudinalnog tipa, sa tri ponovljena merenja, u intervalima od oko 6 meseci. Ispitano je 293 ispitanika (80% ženskog pola), prosečne starosti 20.56 godina. U 1. fazi ispitanici su izveštavali o negativnim iskustvima u porodičnom kontekstu u periodu detinjstva, u 2. fazi su popunjavali listu negativnih životnih događaja u prethodnih šest meseci, a u 3. fazi su dali podatke o aktuelnim simptomima distresa. Rezultati potvrđuju početnu pretpostavku o moderatorskoj ulozi ranih negativnih iskustava u relaciji između aktuelnih stresora i nivoa distresa, i u skladu su sa modelom saturacije stresa koji pripada grupi modela o senzitizaciji na stres. Postoji pozitivna povezanost između broja aktuelnih stresora i nivoa distresa, ali samo kod ispitanika koji su imali nizak i umeren nivo izloženosti ranim averzivnim iskustvima. Ispitanici sa visokim nivoom negativnih ranih iskustava izveštavaju o povišenom nivou distresa nezavisno od broja aktuelnih stresora. Kada se uporede ispitanici sa malim i umerenim nivoom ranog negativnog iskustva u situacijama sa malim brojem aktuelnih stresora, kao adekvatniji model se pokazuje model inokulacije stresa, jer ispitanici sa umerenim nivoom negativnih iskustava, kada se nađu u situaciji malog broja stresora, ispoljavaju najniži distres.

Reduction of autonomic regulation in children and adolescents with conversion disorders.

Conversion symptoms--functional neurological disturbances of body function--occur in association with extreme arousal, often in the context of emotional distress. The mechanisms that determine how and why such symptoms occur remain unknown. In this study, we used cardiac measures to assess arousal and cardiac autonomic regulation in children and adolescents who presented with acute conversion symptoms. Heart rate was recorded in 57 children and adolescents (41 girls; 8.5-18 years old) with acute conversion symptoms and 57 age- and sex-matched healthy controls, during a resting condition and then during tasks involving cognitive and emotional activation. Arousal and autonomic regulation were assessed by measures of heart rate and heart rate variability. Psychological measures included attachment and emotional distress. Children and adolescents with conversion symptoms displayed higher autonomic arousal than did the controls, both at baseline and during task conditions (higher heart rate: baseline mean [standard deviation] = 82 [9.49] versus 74 [10.79] beats/min, p < .001; lower root mean squared successive differences-heart rate variability: 45.35 [27.97] versus 58.62 [25.69] ms(2), p = .012; and lower high-frequency heart rate variability: 6.50 [1.19] versus 7.01 [0.95] ln[ms(2)] p = .017), and decreased autonomic regulation (attenuation of heart rate increases across tasks). The baseline pattern of increased autonomic arousal was especially pronounced in children with coercive-preoccupied patterns of attachment. Autonomic measures were not correlated with measures of emotional distress. High autonomic arousal may be a precondition for generating conversion symptoms. Functional dysregulations of the cardiac, respiratory, and circulatory systems may mediate fainting episodes and nonepileptic seizures, and aberrant patterns of functional connectivity between motor areas and central arousal systems may be responsible for generating motor conversion symptoms.

More than a (negative) feeling: Validity of the perceived stress scale in Serbian clinical and non-clinical samples

The goal of the present study was to test the validity of a Serbian version of the Perceived Stress Scale. The PSS was administered to 157 psychiatric outpatients, 165 adults from the non-clinical population, and 283 university students. The results of the confirmatory factor analysis supported a bifactor model of the PSS with one general factor and two specific factors reflecting perceived distress and perceived self-efficacy. Internal consistencies of the scale and its two subscales were adequate across clinical and non-clinical samples. Results supported the ability of the scale to discriminate between clinical and non-clinical samples. The PSS evidenced good convergent validity, showing moderate to high positive correlations with measures of unpleasant emotional states and moderate negative correlations with positive affect and life satisfaction. All but one correlation remained significant after controlling for the measures of emotional distress. The results of the present research support validity of the PSS and its use in both clinical and non-clinical samples.

Does exercise habit strength moderate the relationship between emotional distress and short-term memory in Malaysian primary school children?

Purpose: We examined the moderating effects of exercise habit strength on the relationship between emotional distress and short-term memory in primary school children. Methods: The sample consisted of 165 primary school students (10–12 years old). Participants completed measures of emotional distress, exercise habit strength, and the Digit Span Test. Mid-year exam results were used as an indicator of academic performance. Structural equation modelling (SEM) was used to analyse the data. Results: The results of SEM revealed an acceptable fit for the hypothesised model. Exercise habit was positively associated with short-term memory, and better short-term memory was associated with better academic performance. However, although an inverse relationship was found between emotional distress and short-term memory, a positive association was found between exercise habit strength and emotional distress. Conclusion: The findings indicate that exercise habit is positively associated with cognitive ability and mediates the negative effect of distress.

Long-term mortality risk in patients with an implantable cardioverter–defibrillator: Influence of heart rate and QRS duration

BackgroundA paucity of studies has investigated the role of autonomic cardiac regulation as well as cardiac conduction in relation to prognosis in implantable cardioverter–defibrillator (ICD) patients. Therefore, we examined the association of heart rate and QRS duration with long-term mortality risk in first-time ICD patients, adjusting also for measures of emotional distress. MethodsResting heart rate and QRS duration were assessed prior to ICD implantation in 448 patients. Primary study endpoint was all-cause mortality (up to 6.0year follow-up, median follow-up of 5.6years (IQR: 1.9)). The impact of heart rate and QRS duration on time to all-cause mortality was separately assessed with Cox proportional hazard regression analysis, adjusting for clinical factors and symptoms of depression and anxiety. ResultsMean (SD) heart rate was 68.0±13.3bpm and mean QRS duration was 130.9±36.9ms. Heart rate of ≥80bpm was associated with increased risk of mortality (HR=1.86; 95% CI=1.15–3.00; p=.011) in unadjusted analysis. In adjusted analyses, this relationship remained significant both with depression (HR=1.86, 95% CI=1.12–3.09; p=.017) and anxiety (HR=1.82, 95% CI=1.10–3.03; p=.021) and clinical measures as covariates. QRS duration of ≥120ms was associated with impaired prognosis in unadjusted analysis (HR=2.00, 95% CI=1.27–3.14; p=.003), but was reduced to non-significance in adjusted analysis when medical comorbidities were included (HR=1.15, 95% CI=0.70–1.89; p=.60). ConclusionsThis study shows that increased heart rate is associated with impaired prognosis. Since heart rate is a relatively easy measurable parameter of autonomic functioning, heart rate should be included as a measure for risk stratification in daily clinical practice.

The Relationship Between Cognitive Behavioral Therapy Maintenance Processes, Emotional Distress, and Positive Psychotic Symptoms: Evidence That CBT Is "Not a Quasi-Neuroleptic".

Cognitive behavioral therapy for psychosis (CBTp) has enjoyed a steep rise in popularity over the past 15 years; however, recent systematic reviews and meta-analyses have concluded that CBTp has only modest effects on psychotic syndrome outcomes and that empirical evidence of its superiority over other psychosocial treatments is poor. And although it has been argued by some prominent authors that CBTp is not designed to alleviate the "psychotic syndrome," there is little empirical evidence linking CBTp change mechanisms with syndrome versus single-symptom outcome measures. This study investigated the relationship between CBTp change processes, beliefs about voices, and thought control strategies, with a range of outcome measures including global positive psychotic symptoms in a sample of 40 voice hearers with established diagnosis of psychotic disorder. Consistent with the assertions of Birchwood and Trower (2006), global positive symptoms were found to be generally poorly related to CBTp change processes. Conversely, these CBTp change processes were found to be generally strongly related to measures of emotional distress and some measures of single psychotic symptoms. The implications for past and future CBTp treatment outcome studies are discussed.