Multilevel Multiple Regression Research Articles

The effectiveness of the in-person and online Gottman Seven Principles Couple Enhancement Program: A propensity score matching design.

This study investigates the effectiveness of the 12-h Gottman Seven Principles couple enhancement program delivered in person and online. In Norway, we recruited 490 participants and 242 people for a control group. All were in close relationships. The revised dyadic adjustment scale (RDAS) was used to assess the quality of their relationships before and after program participation, and at 6-month follow-up. Repeated measures ANOVA, t tests, reliable change, and multilevel multiple regression using propensity score matching to control for confounders were used to investigate the effectiveness of the course. The results demonstrate that the Gottman Seven Principles course improves couple relationships and is equally effective whether delivered in person or online. Furthermore, it does not matter whether there are therapists with a clinical background delivering the course, suggesting that the material itself is sufficient.

Trends and determinants of the mobility of older adults in the USA and Germany, 2001–2017

Using the 2001 and 2017 National Household Travel Surveys (NHTS) for the USA and the 2002 and 2017 Mobility in Germany Surveys (MiD) for Germany, this paper examines differences between the two countries in the travel behavior of older adults and to what extent it has changed between 2001/2002 and 2017. We use five mobility indicators to portray the travel behavior of older adults: whether or not a trip is made at all on the survey day (i.e., mobile or not); number of trips per day for mobile individuals; km of travel per day for mobile individuals; modal distribution of trips; and trip purpose. In analyzing the travel behavior of older adults, we grouped them into 5-year age categories: from 60–64, 65–69, 70–74, 75–79, and then 80+ years. In addition to a descriptive, graphical analysis, we employ multi-level multiple regression analysis to examine factors that may affect the mobility of older adults.Mobility levels generally declined with increasing age in both countries in both years, but the declines were gradual, except for a steep drop for the 80+ age group. Mobility levels in 2001 were generally higher for all age groups in the USA than in Germany, especially for older adults. By 2017, however, the gap between the two countries diminished because mobility increased more for all age groups in Germany than in the USA from 2001/2002 to 2017. Indeed, Germans of all age groups in 2017 were more likely than Americans to make at least one trip during their travel day.The largest increases in mobility in both countries were for the oldest age categories (75–79 and 80+). From 2002 to 2017, the share of car trips among older adults in Germany rose considerably, while it fell slightly in the USA from 2001 to 2017. Nevertheless, car dependence among the oldest adults in 2017 was still twice as high in the USA as in Germany. One reason for Germany’s lower modal share of driving is that the transport system in Germany offers far more attractive alternatives to car use than in the USA, while policies at every government level make car ownership, parking and use more expensive and more difficult than in the USA.

Stress of school performance among secondary students: The role of classroom goal structures and teacher support

With concern growing about the increasing levels of school stress among secondary school students, examining its associations with students' perceptions of important elements in classroom climate can offer valuable scientific information. However, there is minimal research about the role of perceived classroom goal structures and teacher support in school stress. In addition, most research on classroom goal structure has not made a distinction between performance-approach structures and performance-avoidance structures, which may have different effects on school stress. The aim of the present study was to examine the role of classroom goal structures and teacher support in students' stress linked to school performance. We also examined the potential moderating effect of teacher support in the association between classroom goal structures and stress. Our sample consisted of 4768 secondary school students aged 11–17 years (Mage = 13.74; 47.9% boys) from 54 schools in Andalusia, Spain. Consistent with the study's aims, hierarchical multilevel multiple regression was used to examine the relationships between mastery goal structure, performance-approach goal structure, performance-avoidance goal structure, and teacher support on our stress of school performance outcome. After controlling for gender, age, and previous academic achievement, performance-avoidance goal structure was significantly associated with higher levels of stress of school performance (p < .01). Furthermore, perceived classroom goals and teacher support tended to work together, with the role of performance-approach goal structure being dependent on the levels of mastery goal structure and teacher support (p < .05). Practical implications from these findings and future research directions are discussed.

Factors Affecting Resilience in University Students in a Single Region

This study aimed to investigate the effects of optimism and self-esteem on resilience in university students. A total of 127 university students were surveyed on optimism, self-esteem, and resilience. The collected data were analyzed using a t-test, one-way ANOVA, correlation analysis, and multilevel multiple regression analysis. The results of this study are as follows: First, university students displayed a statistically significant positive correlation between optimism, self-esteem, and resilience. Second, the factors that most significantly affected resilience in college student were self-esteem (β = .59, p &lt; .001) and optimism (β = .25, p = .001). and these factors explained 62.5% of resilience. Through this study, we looked for approaches to enhance optimism and self-esteem and ultimately improve resilience in university students. It is hoped that this study will be used I meaningfully in follow-up research.

Цифровая трансформация и ее влияние на социально-экономическое развитие российских регионов

The modern world economy is transforming into the digital economy. Digital transformation can be a driver of socio-economic and technological development of various states and regions. As shown by the experience of developed countries, digital transformation contributes to the creation of new business opportunities, emergence of new markets and niches, and consequently affects regional socio-economic development. However, this process is uneven across countries, leading to significant differences between regions. Additionally, the connection between digital transformation and regional sustainable development should be considered. The paper presents the authors’ perspective on digital transformation and analyses the impact of digital transformation on the socio-economic development of Russian regions in terms of sustainable development priorities. The research aims to develop and verify a multilevel multiple regression model, which illustrates regional digital transformation through integral indicators and describes its impact on regional sustainable development. In particular, the study examined the integral indicator of digital transformation and integral indicator of sustainable development, revealing a correlation between them for Russian regions. The regions were clustered according these indicators. Panel data econometric models for different clusters showed that such factors as digital labour and digital capital greatly influence socio-economic indicators of Russian regions. The direct correlation between the share of manufacturing in gross regional product and regional digital transformation was established. The calculation of integral indicators for all Russian regions identified significant spatial heterogeneity of Russian regions in terms of their sustainable development and digital transformation. At the same time, an increase in the share of manufacturing share in gross regional product causes a decrease in regional sustainable development.

Wear behaviour of direct composite restorations in tooth wear patients: a 5-year clinical study

ObjectiveThis study aimed to investigate the wear behaviour of direct composite restorations after 5 years and associated patient factors. Methods38 patients (6 females, 32 males; 35.2 ± 7.6y) from the Radboud Tooth Wear Project with generalized moderate to severe tooth wear were treated with direct composite restorations on all teeth. Ethical approval was sought and granted before the study was undertaken. Intraoral 3D scans were recorded at 1 month (baseline) and 5 years (recall) after treatment. The amount of height loss was measured at six index teeth (first molars and upper central incisors). Patient factors (age, vertical dimension of occlusion increase, bite force, aetiology score, jaw position and bearing/ non-bearing cusps) were included in the analysis. Multilevel multiple regression with bootstrapping was used to analyse the influence of these factors on wear behaviour of restorations. Observer reliability was tested by paired t-tests and Band-Altman plots (p<0.05) ResultsAfter 5 years, the mean height loss was 0.23± 0.19 mm for incisors and 0.43± 0.24 mm for molars (p≤0.001). Patient factors did not show any significant influence on height loss of the composite restorations, while bearing cusps showed significant more wear compared to non-bearing cusps (p≤0.001). The observer reliability tests confirmed the repeatability (correlation of 0.809, DME 0.103). ConclusionsWear of composite restorations is a significant and relevant factor over time in patients treated with severe tooth wear. Within the limitations of this clinical study, patient factors were found not to have a significant effect on wear behaviour of direct composite restorations.

Merging the peer selection and peer influence effects: Can neutralization beliefs and cognitive impulsivity serve as links in the chain?

The commonly cited connection between peer influence and peer selection effects was explored in an effort to understand whether cognitive distortion, as represented by neutralization beliefs and cognitive impulsivity, plays a role in linking the peer influence and peer selection effects to each other. Participants were 3568 children (51.3% female) enrolled in the longitudinal portion of the Gang Resistance Education and Training study. Data from five waves of Gang Resistance Education and Training were organized into a series of paths and subjected to multilevel multiple regression longitudinal analysis, where data were clustered by classroom. Two principal analyses were performed. In the first analysis, peer delinquency and participant delinquency were cross-lagged to form four prospective peer selection paths (delinquency → peer delinquency) and four prospective peer influence paths (peer delinquency → delinquency). These paths were then subjected to multilevel (complex sampling design) multiple regression analysis, controlling for age, sex, race, group status, and the most proximal prior measure of the outcome variable. Seven of the eight paths proved significant. In the second analysis, neutralization beliefs and cognitive impulsivity were included in the middle wave of the five-wave model, controlling once again for age, sex, race, group status, and the proximal autoregressive path of the outcome variable. The results of this second analysis revealed that both neutralization beliefs and cognitive impulsivity mediated the connection running from peer selection to peer influence, although neither mediated the peer influence-to-peer selection chain. The direct effects for delinquency and peer delinquency across the five waves were also significant. These findings suggest that the peer selection and influence effects are interdependent, reciprocal, and linked, in part, by cognitive distortion.

Participation in After-School Extracurricular Activities and Cognitive Ability Among Early Adolescents in China: Moderating Effects of Gender and Family Economic Status.

Although theories and research suggest that participation in extracurricular activities plays an important role in adolescents’ cognitive development, few studies have addressed this issue among early adolescents in China. Based on the responses of 9,830 Chinese junior high school students (Mage = 14.54 years, SD = 0.70 years), we investigated the relationships between different types of extracurricular activities and cognitive ability among junior high school students and the moderating effects of gender and family economic status. Using multi-level multiple regression analyses, results indicated that while time spent completing homework and physical exercise was positively associated with students’ cognitive ability, time spent on extracurricular tutoring, interest classes, watching TV, and surfing online and playing games was negatively related to students’ cognitive ability. The observed relationships were also moderated by gender and family economic status. Specifically, time spent on completing homework had a stronger positive relationship with boys’ cognitive ability, whereas time spent attending extracurricular tutoring on weekdays had a stronger negative relationship with girls’ cognitive ability, and time spent on physical exercise was more strongly related to girls’ cognitive ability in a positive manner. Besides, time spent attending interest classes on weekdays had a stronger negative relationship with cognitive ability among students from wealthy families, and time spent watching TV and physical exercise had stronger negative and positive effects on the cognitive ability among students from economically disadvantaged families, respectively. The theoretical and practical implications of the findings regarding the role of extra-curricular activities on adolescent development are discussed.

O46 Differences in ARCP outcome by surgical specialty: a longitudinal cohort study

Abstract Introduction Surgical training in the UK is comprised of ten specialties: cardiothoracic, general, neurosurgery, oral and maxillofacial (OMFS), otolaryngology, paediatric, plastic, trauma and orthopaedics, urology and vascular surgery. Progression through training is assessed by the Annual Review of Competency Progression (ARCP). The aim is to examine ARCP outcomes within UK surgical specialty training and identify differences between specialties. Method A longitudinal cohort study using data from United Kingdom Medical Education Database (UKMED) was performed across surgical specialities. ARCP outcome was the primary outcome measure. Multi-level univariate and multiple ordinal regression analyses were performed. Result 8,220 trainees with an ARCP outcome between 2010 and 2017 were included, comprising 31,788 ARCP outcomes. There was substantial variation in the proportion of non-standard outcomes across specialties with general surgery trainees having the highest proportion of non-standard outcomes (22.5%) and urology trainees the fewest 12.4%. After adjustment, general surgery trainees were 1.3 times more likely to receive a non-standard outcome compared to T&amp;O trainees (OR 1.33 95% CI 1.21–1.45). Urology trainees were 36% less likely to receive a non-standard outcome compared to T&amp;O trainees (OR 0.64 95% CI 0.54–0.75). Female trainees and older age were associated with non-standard outcomes (OR 1.11 95% CI 1.02–1.22; OR 1.04 95% CI 1.03–1.05). Conclusion There is wide variation in the outcomes of surgical ARCP’s across specialties. General surgery has higher rates of non-standard ARCP outcomes compared to other surgical specialities. Across all specialities, female sex and older age were associated with non-standard outcomes. Further studies are required to explore these associations. Take-home Message There is significant variation in ARCP outcomes between specialities. Women and older trainees receive significantly more non-standard outcomes.

Personal Characteristics Associated with Progression in Trauma and Orthopaedic Specialty Training: A Longitudinal Cohort Study

To identify demographic factors, including protected characteristics, and training specific factors which predict a nonstandard Annual Review of Competency Progression (ARCP) outcome during Trauma and Orthopedic Specialty training in the United Kingdom (UK). A longitudinal cohort study using data from UKMED was performed. ARCP outcome was the primary outcome measure. Multilevel univariate and multiple ordinal regression analyses were performed using STATA v 15. Two thousand five hundred and ten Trauma and Orthopedic surgery trainees (ST3-ST8) with an ARCP outcome between 2010 and 2017 were included, comprising 11,011 ARCP outcomes. Eighty five percent (2130/2510) of trainees were male. Eighty two percent of outcomes were satisfactory. Female trainees had a 26% increased risk of nonstandard outcome (OR 1.26 95% CI 1.10-1.44) after adjusting for other factors. Older age at ARCP was associated with an increased risk of nonstandard ARCP outcome (OR 1.04 95% CI 1.03-1.06). International medical graduates had a 34% decreased risk of nonstandard outcome compared to UK graduates (OR 0.66 95% CI 0.54-0.81). Less than full time training was not associated with risk of a nonstandard ARCP outcome (OR 0.92 95% CI 0.76-1.12). Female sex and older age at ARCP were significantly associated with nonstandard ARCP outcomes in Trauma and Orthopedic surgery, while international medical graduation was protective.

The contribution of employer characteristics to continued employment of employees with residual work capacity: evidence from register data in The Netherlands.

Objectives:This study aimed to examine the contribution of employer characteristics to continued employment of employees with residual work capacity. Moreover, we examined whether the contribution of employer characteristics differs across types of employers and employees’ types of diseases.Methods:Register data on disability assessments and employment status of N=84 394 long-term sick-listed employees with residual work capacity were obtained from the Dutch Employee Insurance Agency between 2010 and 2017. The dependent variable was continued employment four months after the assessment. We linked employees to their (former) employer to measure sector, firm size, and workforce composition. The average employment outcome of all employees assessed in the same firm and year served as a proxy measure for the extent of implemented disability-related policies and practices. Using multilevel multiple regression analysis, we compared the relative contribution of employer characteristics with employees’ characteristics.Results:Employer characteristics accounted for 10% of the variability in employment outcomes. In comparison, employees’ socio-demographic and disease characteristics accounted for 13% of the variability. The prevalence of continued employment was lowest in smaller firms and construction and low-wage service-orientated sectors. Furthermore, there were sizeable differences in employment outcomes between similar employers in terms of size, sector and workforce-composition, particularly between larger firms and among employees with mental or musculoskeletal disorders compared to other diseases.Conclusions:This study shows substantial differences between employers in facilitating continued employment of employees with residual work capacity. Encouraging firms to invest more in disability-related policies and practices may result in better employment opportunities for these employees.

The effectiveness of a web-based Dutch parenting program to prevent overweight in children age 9-13

Abstract Background We developed a web-based parenting program for parents entitled “Making a healthy deal with your child”. This e-learning program can be incorporated into existing prevention programs, thereby improving these interventions by reinforcing the role of parenting and providing parents with practical tools for use in everyday situations in order to stimulate a healthy lifestyle. Methods The effectiveness was studied in a two-armed cluster randomized controlled trial. We recruited 548 parent-child dyads of children 9-13 years in the Netherlands who participated in an existing school-based overweight prevention program. Primary outcomes included the child’s dietary and sedentary behavior, and level of physical activity. Secondary outcomes included general parenting style, specific parenting practices (set of rules, modeling, monitoring), and parental self-efficacy. Multilevel multiple regression analyses in Mplus were conducted. Results 87% of the parent-child dyads participated in the study and 47% of the parents in the intervention group completed 2 or more episodes of the e-learning. The score that parents gave to the e-learning is a 7.Main effect analyses showed in the intention-to-treat analyses that the the parents in the intervention group have more strict rules regarding eating snacks (0.046) and children of parents in the intervention group drink more milk (p = 0.018) and less sugar sweetened beverages (p = 0.024). The completers only analyses showed that the children of parents in the intervention group eat more vegetables and fruit, drink more water and less sugar sweetened beverages, and had less screentime than the children in the control group. Conclusions The e-learning program showed small indications to be effective. A second effectiveness study is currently being investigated. If the e-learning proves to be effective it can be easily incorporated into existing overweight prevention programs for children, as well as activities regarding Youth Health Care. Key messages The e-learning can easily incorporated into existing overweight prevention programs for children. www.gezondeafsprakenmetjekind.nl

University academics’ state emotions and appraisal antecedents: an intraindividual analysis

ABSTRACTThis study investigates university academics’ emotions in the moment they occurred, and value and control appraisal dimensions on an intraindividual level. Applying the Experience-Sampling method, N = 50 German university academics reported their current emotions and appraisals for two weeks. A total of N = 1691 state assessments were collected. Positive emotions were reported as more intensely compared to negative emotions. Multilevel multiple regression analysis indicated that significant amounts of the variances in the emotions can be explained by value and control appraisals. In addition, the analyses yielded significant correlations between emotions and appraisals: appraisals of value and of self-determination were related to positive emotions, whereas time-pressure and control appraisals were related to negative emotions.

Patient centred consultation, satisfaction and young patients: A cross-country analysis

ObjectivesThe aim of this study was to investigate the link between perceived dimensions of patient centred care and the satisfaction of adolescents and young adults within the UK, USA, Australian, Italian, and Chinese healthcare systems. MethodsOne thousand and thirty-four participants (212 from China,206 from Australia,208 from UK, 202 from USA, and 206 from Italy) answered a self-report questionnaire assessing the perceived dimensions of patient centred care. Factor analysis (PFA) was conducted on the data to identify relevant dimensions. One-way ANOVAs were run to identify differences between country samples related to perceived dimensions of patient centredness, and a multi-level multiple regression model was computed to assess the link between satisfaction and dimensions of patient centred care. ResultsCountries’ mean scores on ‘Satisfaction with Care’ (PF1) and on ‘Psychosocial Context’ (PF2) were statistically significant by inspecting the ANOVAs (p < .05). Satisfaction with care was predicted by PF2 and clinical utilization. ConclusionAn online survey collected meaningful data on perceptions of healthcare received by respondents from five countries. This initial international study highlights important associations worthy of closer investigation. Practice implicationsHealthcare providers should assess comprehensively the psychosocial context of young patients during consultations.

Using TIMSS items to evaluate the effectiveness of different instructional practices

Can instructional quality be measured using TIMSS items on how often certain instructional practices are used in the mathematics classroom? We focused on three instructional practices that have been the topics of longstanding debates in the educational literature: memorizing formulas, listening to the teacher, and relating mathematics to daily life. In a multi-level multiple regression analysis, we examined how class-level responses to these items predicted mathematics achievement. In Sweden, across four waves of TIMSS, relating to daily life was a negative predictor of achievement, whereas memorizing formulas and listening to the teacher were positive predictors. This was also the typical pattern of results across all countries participating in two waves of the international TIMSS. Our findings are in line with certain positions on the abovementioned debates. Although conclusions are limited by the correlational nature of the data, we argue that TIMSS is a promising tool for evaluating the effectiveness of different instructional practices. We also suggest several improvements.

Gender and Cohort Influences on Depressive Trajectories

The purpose of this longitudinal study is to identify depressive trajectories between women and men ages 40 or older, along with the influence of cohort over the course of a decade. A national probability sample of 2,080 men and 3,125 women from middle to older age are drawn from the 1st wave through 10th wave of Korea welfare panel study (KOWPS). Results of multilevel multiple regression analyses show that at the intraindividual level, depressive symptoms are curvilinear over the decade. At the interindividual level, both gender and cohort interact with the level of depression. The depression slope for females is milder than for males, suggesting that the depressive symptoms for the elderly female are more severe over a ten year duration. Relative to the older cohort, the slope of the younger cohort is steeper, indicating the depressive symptoms of the older cohort stay higher over a decade. This study implies that either being an elderly female or older cohort deserves better attention to alleviate the level of depression.

Do Pain Coping and Pain Beliefs Associate With Outcome Measures Before Knee Arthroplasty in Patients Who Catastrophize About Pain? A Cross-sectional Analysis From a Randomized Clinical Trial.

Pain-coping strategies and appraisals are responses to the pain experience. They can influence patient-reported and physical performance outcome measures in a variety of disorders, but the associations between a comprehensive profile of pain-coping responses and preoperative pain/function and physical performance measures in patients scheduled for knee arthroplasty have not been examined. Patients with moderate to high pain catastrophizing (a pain appraisal approach associated with an exaggerated focus on the threat value of pain) may represent an excellent study population in which to address this knowledge gap. We asked the following questions among patients with high levels of pain catastrophizing who were scheduled for TKA: (1) Do maladaptive pain responses correlate with worse self-reported pain intensity and function and physical performance? (2) Do adaptive pain-coping responses show the opposite pattern? As an exploratory hypothesis, we also asked: (3) Do maladaptive responses show more consistent associations with measures of pain, function, and performance as compared with adaptive responses? A total of 384 persons identified with moderate to high levels of pain catastrophizing and who consented to have knee arthroplasty were recruited. The sample was 67% (257 of 384) women and the mean age was 63 years. Subjects were consented between 1 and 8 weeks before scheduled surgery. All subjects completed the WOMAC pain and function scales in addition to a comprehensive profile of pain coping and appraisal measures and psychologic health measures. Subjects also completed the Short Physical Performance Battery and the 6-minute walk test. For the current study, all measures were obtained at a single point in time at the preoperative visit with no followup. Multilevel multivariate multiple regression was used to test the hypotheses and potential confounders were adjusted for in the models. Maladaptive pain responses were associated with worse preoperative pain and function measures. For example, the maladaptive pain-coping strategy of guarding and the pain catastrophizing appraisal measures were associated with WOMAC pain scores such that higher guarding scores (β = 0.12, p = 0.007) and higher pain catastrophizing (β = 0.31, p < 0.001) were associated with worse WOMAC pain; no adaptive responses were associated with better WOMAC pain or physical performance scores. Maladaptive responses were also more consistently associated with worse self-reported and performance-based measure scores (six of 16 associations were significant in the hypothesized direction), whereas adaptive responses did not associate with better scores (zero of 16 scores were significant in the hypothesized direction). The maladaptive responses of guarding, resting, and pain catastrophizing were associated with worse scores on preoperative pain and performance measures. These are pain-related responses surgeons should consider when assessing patients before knee arthroplasty. TKA candidates found to have these pain responses may be targets for treatments that may improve postoperative outcome given that these responses are modifiable. Future intervention-based research should target this trio of maladaptive pain responses to determine if intervention leads to improvements in postsurgical health outcomes. Level I, prognostic study.

Does Organizational and Coworker Support Moderate Diabetes Risk and Job Stress Among Employees?

Examine the moderating role of perceived organizational and coworker support on the relationship between job stress and type 2 diabetes risk among employees. A cross-sectional survey was administered to employees at the workplace. One national retail organization. Baseline data were obtained from 1595 employees in 21 retail stores. Self-reported organizational and coworker support to encourage and fulfill job responsibilities and job stress. Diabetes risk was calculated using age, gender, race/ethnicity, blood pressure, physical activity, weight status, and self-reported diagnosed type 2 diabetes. Multilevel multiple regression was conducted to test the interaction effect of support on the association between job stress and diabetes risk. Mean age was 37.95 years (±12.03) and body mass index was 26.72 (±4.95). Three percent of participants reported diagnosed diabetes. Organizational support was positively associated with coworker support. Both were negatively associated with job stress. Organizational support, but not coworker support, moderated the relationship of job stress with diabetes risk. Participants with greater perceived organizational support had lower diabetes risk scores compared to those with lower perceived organizational support. Organizational support may be a key factor for workplaces to reduce stress and diabetes risk. Further testing of organizations' supportive role on employee health may be helpful in developing future workplace programs.

Posttraumatic stress disorder symptomatology in the course of allogeneic HSCT: a prospective study.

Despite the life-threatening character of allogeneic hematopoietic stem cell transplantation (allogeneic HSCT), very few longitudinal research exists on posttraumatic stress disorder (PTSD) symptomatology in this patient group. We investigated prevalence, temporal course and predictors of PTSD symptomatology in this population. Patients were assessed before conditioning (T0), 100days (T1), and 12months after HSCT (T2). PTSD symptomatology was measured with the PTSD Checklist-Civilian Version. We conducted multilevel modeling and multiple regression analyses. Two hundred thirty-nine patients participated at baseline, 150 at T1, and 102 at T2. Up to 15% met the criteria for PTSD at least once during the course of assessment. Fifty-two percent showed diagnostic relevant levels of intrusion, 30% of avoidance, and 33% of arousal at least once. Apart from arousal, which increased between T0 and T1 (γ=0.56, p=0.03), no other severity score significantly differed between time points. Being impaired by pain (γ=2.89, p<0.01), pain level (γ=0.63, p=0.02), and being female (γ=3.81, p<0.01) emerged as significant predictors of PTSD symptomatology when taking into account all time points. Acute plus chronic graft-versus-host-disease and longer hospital stay predicted PTSD symptomatology at T2 (γ=3.39, p=0.04; γ=0.1, p=0.03). A considerable number of patients undergoing allogeneic HSCT met the criteria for PTSD. PTSD symptomatology is prominent at all assessment points. Burden of pain, being female, and medical complications are risk factors for elevated levels of PTSD symptomatology. Psychological support should be offered not only after treatment but also in the long-term and even before HSCT. Professionals should be aware of the psychological consequences accompanied by pain and complications.

Correlates of psychological outcomes among family members of people with diabetes in the second Diabetes Attitudes, Wishes and Needs (DAWN2(™) ) study.

To conduct a second Diabetes Attitudes, Wishes and Needs (DAWN2(™) ) study, examining the experiences of family members caring for adults with diabetes in order to identify correlates of family member psychological outcomes (generic psychological well-being, perceived quality of life, and diabetes-related burden, impact and distress). A total of 2057 family members living with a person with diabetes and involved in their care participated in an online, telephone or in-person survey. Samples of 120 respondents were recruited in each of 17 countries. Significant (P < 0.05) correlates of psychological outcomes were identified by multi-level multiple regression. Outcomes were worse for family members not working because of diabetes or those who had other competing obligations. Outcomes were worse if the person with diabetes was not a partner or parent, used injected diabetes medication, or had more frequent hypoglycaemia. Outcomes were worse for family members who believed that diabetes was more severe, were more involved in diabetes care, had more conflict over diabetes care or were frustrated about not knowing how to help the person with diabetes. Outcomes were better for those who had greater support from others and felt they found good ways to help the person with diabetes. There were significant differences in outcomes among countries before and after adjustment for individual characteristics, and correlates of outcomes varied by country. Several modifiable risk and protective factors for family member psychological outcomes were identified in this study. Diabetes education and social support were associated with improved outcomes, especially if they were helpful in supporting people with diabetes.