Psychobehavioral Characteristics Research Articles

The psychological mechanisms of the better-than-average effect in the moral and competence domains under self-enhancement and self-protection motives among young Japanese adults.

The better-than-average effect (BTAE) refers to the phenomenon where individuals perceive themselves as better than the average person. This effect has been independently examined in terms of social perception dimension and motivation. Additionally, no psychobehavioral traits have been found to be associated with the BTAE in the moral domain. However, the interactive effects of social perception dimension and motivation on the BTAE remain unclear, and its association with a broad range of psychobehavioral traits has not been extensively validated. In this study, we assess self-and average other-evaluations across four domains, based on two social perception dimensions and two motivations, to investigate their interactive effects on the BTAE (n = 678). We measured seven sets of psychobehavioral characteristics to examine their association with the BTAE, as well as self-and other-evaluations. Results indicated that the BTAE occurred only under negative moral conditions, while the worse-than-others effect was observed under two competence conditions. Furthermore, the BTAE was associated with only a few psychobehavioral characteristics in the moral domains, compared to many in the competence domains. Notably, both self-and other-evaluations were correlated with many trust-relevant characteristics in the moral domains. These findings suggest that sociocultural dynamics may influence the BTAE differently across various domains.

Psycho-Behavioral Characteristics Perceived as Facilitators by Brazilian Adults with Type 1 Diabetes Mellitus in a Public Health Service.

Type 1 diabetes imposes a complex and challenging routine on patients and caregivers. Therefore, considering individual experiences and personal facilitators to promote assertive interventions is crucial. However, no studies have addressed these perspectives in the Brazilian adult population. We aimed to identify psycho-behavioral characteristics perceived as facilitators for coping with the condition. We used a biographical method to conduct semi-structured, face-to-face, in-depth interviews for each participant. Transcripts were analyzed using inductive thematic analysis. Participants (n = 22) were aged 18-57 years (mean: 30.2; standard deviation (SD): 8.7), and the duration since diagnosis was approximately 20.6 years (SD: 4.6). A total of 12 (54.4%) were women, 13 (59.1%) used insulin pumps, 14 (63.6%) had at least a college degree, and 13 (59.1%) had HbA1C (glycated hemoglobin) levels above 58 mmol/mol (7.5%). Five major themes emerged: (1) peer learning, (2) ownership, (3) welcoming experiences, (4) equity, and (5) reframing the path (P.O.W.E.R.). All themes appeared in the lived experiences shared by participants with HbA1C levels below 58 mmol/mol (7.5%). Improved glycemic control can be achieved, and the challenges encountered in diabetes care within similar socioeconomic contexts can be addressed by an interdisciplinary care team that takes P.O.W.E.R. into consideration when providing person-centered care strategies.

“The show must go on!” dance talent development in the context of coping during the COVID-19 pandemic

ABSTRACT Psychobehavioral skills are acknowledged as useful for coping within talent development pathways, but the idiosyncratic nature of challenge experienced across individuals makes it hard to evaluate their use and efficacy. This study aimed to explore the impact of a generic stressor, the COVID-19 lockdowns, on dancers within a talent development pathway. We were interested in how dancers were perceived to have coped with this challenge and what skills, if any, they used. Fifteen practitioners (11 females, 4 males; M age = 42.3 years; M experience = 18.4 years) were interviewed across eight Scottish performance/educational government-funded organisations. Data analysis used reflexive thematic analysis. Findings revealed important perceived impacts on physical and psychological health and wellbeing, with the majority of participants reporting surprise that some coped differently than expected. Coping well was perceived to result from taking advantage of developmental opportunities, facilitative environmental factors, and possessing key psychobehavioral characteristics. Performers who were perceived to struggle did not cope well with teaching, interpersonal, physical, and psychological factors which were exacerbated by social/environmental contexts, leading to pathway disengagement/derailment. Data suggest a need for greater and proactive integration of psychobehavioral skills within this pathway to better support those advancing to professional status and those who do not.

Functional Somatic Disorders, Their Subtypes, and Their Association With Self-Rated Health in the German General Population.

The heterogeneous conceptualizations and classifications of persistent and troublesome physical symptoms impede their adequate clinical management. Functional somatic disorder (FSD) is a recently suggested interface concept that is etiologically neutral and allows for dysfunctional psychobehavioral characteristics as well as somatic comorbidity. However, its prevalence and impact are not yet known. We analyzed 2379 participants (mean age = 48.3 years, 52.5% female) from a representative German community survey using operationalized FSD criteria. These criteria defined FSD types based on somatic symptom count, type, and severity assessed by the Bodily Distress Syndrome Checklist. In addition, the associations of those types with health concerns, comorbidity, psychological distress, and self-rated health were determined. There were four clearly demarcated groups with no relevant bothering symptoms, with one or with few bothering symptoms from one organ system, and with multiple bothering symptoms from at least two organ systems. Psychological distress, health concerns, and comorbidity steadily increased, and self-rated health decreased according to the number and severity of symptoms. Somatic symptom burden, health concerns, and comorbidity independently predicted self-rated health, with no interaction effect between the latter two. Our data support an FSD concept with two severity grades according to persistent and troublesome symptoms in one versus more organ systems. The delimitation of subtypes with psychobehavioral characteristics and/or with somatic comorbidity seems useful, while still allowing the demarcation of a group of participants with high symptom burden but without those additional characteristics.

Gender gap-related issues among mothers revealed by a comparative study of adolescent hikikomori between Japan and France

IntroductionAround 2010, the number of hikikomori cases increased rapidly. Hikikomori is a global problem that characterizes the current era, and has become an increasingly deep-rooted social issue that affects the younger generation, especially during the coronavirus disease-2019 (COVID-19) pandemic. In our previous comparative study of adolescent hikikomori between Japan and France (Hamasaki et al. BMC Psychiatry 2022; 22, 477), we investigated its psychopathology, including potential cultural influencing factors. The study showed no difference in terms of psycho-behavioral characteristics of hikikomori between Japan and France. However, the sociocultural factors that make hikikomori more severe differed between the two countries, i.e., in Japan: lack of communication between parents, in France: lack of communication between the family and the community.ObjectivesSince these differences in sociocultural factors are closely related to the social context in which the mothers were placed, the factors in terms of maternal gender issues were examined, along with reviewing previous studies.MethodsStatistical data from the “Global Gender Gap Report 2022” of the World Economic Forum, the “Towards real gender equality 2021” of the Ministry of Gender Equality, Diversity, and Equal Opportunities of France, the “Women and Men in Japan 2020” of the Gender Equality Bureau, Cabinet Office, Government of Japan, and other sources were evaluated. Further, previous literature on the family environmental factors of hikikomori were reviewed.ResultsAn absent father, a subsequent mother-child closeness and over-interference, and the inhibition of children’s independence, have been repeatedly mentioned in studies as factors leading to hikikomori. The time spent on housework and childcare by Japanese men is at the lowest level globally (Japan’s gender gap index ranks 116th out of 146 countries, the lowest among the seven major G7 nations). In Japan, where generally little cooperation exists between parents, particularly in those families where communication between parents is self-rated as relatively poor, the above factors may surpass the threshold for triggering hikikomori. In France (ranked 15th in gender gap index), the isolation of mothers and children from society is an important factor associated with hikikomori. Adequate social participation of the mother may be a protective factor against hikikomori.ConclusionsGender gap-related issues among mothers may be involved in the root of the hikikomori problem. Hikikomori has emerged from various socio-familial factors. Further studies are warranted to determine the causal relationships of these factors with the onset and severity of hikikomori.Disclosure of InterestNone Declared

The mediating role of appraisal on health-related quality of life in adolescent and young adult cancer survivors.

Adolescent and young adult (AYA) cancer survivors (first diagnosed with cancer at age 15-39) are distinct within the cancer community due to their unique challenges and diverse psycho-behavioral characteristics. This study aimed to analyze psycho-behavioral pathways and further explore the mediating role of cognitive appraisals on AYA cancer survivors' quality of life (QoL). Three hundred and eighty-nine AYA cancer survivors were eligible for analyses and recruited to self-administer questionnaires on QoL (the Chinese version of EORTC Quality of Life Questionnaire-C30 v3.0), resilience, coping, and appraisal on site. This study performed structural equation modeling (SEM) to examine pathways on QoL based on the Rapkin & Schwartz QoL Appraisal Model. The average age of participants (47.6% female) was 32.7 ± 4.1years. The SEM results closely fit the measured data (RMSEA = 0.053, GFI = 0.955, CFI = 0.964, SRMR = 0.052). The final model showed direct negative effects of later clinical-stage, more comorbidities, and more Acceptance-Resignation coping on QoL; indirect positive effects of better resilience on QoL through less Acceptance-Resignation coping (β = 0.286, P = 0.002). Appraisal mediated the effects of treatment and resilience on QoL (β = -0.024, P = 0.038). Further, Calm, Peaceful, and Active appraisal patterns were associated with improved Cognitive Functioning (β = 0.119, P = 0.009). Appraisal, coping, and resilience could significantly mediate the effects of cancer and its treatment on the QoL of AYA cancer survivors. Future interventions targeting cognitive appraisals and psycho-behaviors will be helpful. Figuring out what matters to such a unique population and how they appraise a cancer diagnosis through treatment trajectories could help nurses adjust support.

A Comparative Study of Adolescent Social Withdrawal (Hikikomori) in Japan and France

IntroductionPreviously, we conducted a statistical case-control study of adolescent Hikikomori patients in Japan using the Parental Assessment of Psychological, Behavioral and Environment Scales. That study did not reveal any pathologies specific to Hikikomori patients. On the other hand, environmental factors such as “lack of communication between parents” and “overuse of the Internet” were shown to be significant predictors of Hikikomori severity.ObjectivesIn this study, using the same methodology as our previous study in Japan, we conducted a case-control study in France. The following questions were examined : (1) whether the pathology of Hikikomori patients in Japan and France is the same, and (2) whether the environmental factors associated with the severity of Hikikomori are the same in Japan and France.MethodsUsing CBCL and our original scales, we descriptive-statistically compared clinical and subclinical psycho-behavioral characteristics of adolescent Hikikomori patients and a control group. In addition, environmental factors that make Hikikomori more severe were clarified by multiple regression analysis.ResultsThe results showed that there was no difference in the pathology of Hikikomori between Japan and France. On the other hand, the statistical predictors of Hikikomori severity were “lack of communication between parents and children” and “Lack of communication with the community,” which differed from those in Japan.ConclusionsAlthough it is safe to assume that Japanese and French Hikikomori’s pathology is generally the same, different strategies may be needed to prevent the onset of Hikikomori and to stop it from becoming severe.DisclosureNo significant relationships.

Characteristics of outpatients with functional somatic syndromes at a university hospital's general medicine clinic.

BackgroundThe term medically unexplained symptoms (MUS) is unhelpful for both patients and physicians, and more acceptable illness categories are needed as substitutes for MUS. While some potential substitutes are characterized by excessive psychological burden related to somatic symptoms, “functional somatic syndromes” (FSS) is a category that focuses on physical dysfunction and emphasizes similarities among individual syndromes. Examples of FSS include irritable bowel syndrome, functional dyspepsia, and fibromyalgia syndrome. This study aimed to distinguish FSS from MUS and compare the somatic and psychobehavioral characteristics of FSS with those of other diseases.MethodsThis study included 1975 first‐visit outpatients at a Japanese university hospital's general medicine clinic. According to their first‐listed diagnosis, they were classified as having FSS, acute infection, organic disease (OD), psychiatric disorder, and unknown condition (UC). The somatic symptom burden and health‐related quality of life (HRQoL) were assessed using the Somatic Symptom Scale‐8 and EuroQol‐5 Dimension, respectively; the involvement of psychobehavioral factors affecting somatic symptoms was also evaluated.ResultsOverall, 33% of patients were included in the FSS category, and 93% of the supposed MUS (FSS and UC) were diagnosed with FSS. Compared with OD, FSS showed more severe somatic symptom burden, similar reduced HRQoL, and higher involvement of psychobehavioral factors.ConclusionIt can be useful to improve FSS diagnostic skills for the reduction of MUS misdiagnosis. Psychobehavioral factors might be less associated with MUS (in the narrow sense of the term) than FSS.

Nutrition Meets Social Marketing: Targeting Health Promotion Campaigns to Young Adults Using the Living and Eating for Health Segments.

Young adults are a key target age group for lifestyle behaviour change as adoption of healthier behaviours has the potential to impact long term health. This paper arises from a multi-disciplinary research project, Communicating Health, which aims to bridge the gap between nutritionists, media, and social marketing professionals to produce the tools that may be used to improve engagement with young adults and reduce the prevalence of obesity. The aim of this paper is to provide nuanced details of the psycho-behavioral characteristics of each of these Living and Eating for Health Segments (LEHS). The design and validation of the LEHS employed a four-stage mixed methods design underpinned by the Integrated Model of Behaviour Change and incorporating sequential formative, qualitative, and quantitative phases. This paper defines the psycho-behavioural characteristics of six distinct market segments: Lifestyle Mavens, Aspirational Healthy Eaters, Balanced-all Rounders, the Health Conscious, those Contemplating Another Day, and the Blissfully Unconcerned. These psycho-behavioural characteristics are important to understand to help build our capability in designing campaigns that are specifically and purposefully targeting these different market segments of young adults. Social marketing practices can enhance the utility of nutrition and health messages to young adults in order to engage them in adopting positive lifestyle change. Tailoring health promotions to the perceived needs of sub-groups or segments of young adults should lead to increased engagement and uptake of messages and cost-efficient use of health promotion budgets.

Risk factors for severity of social withdrawal in adolescence: Understanding hikikomori as a spectrum

IntroductionSocial withdrawal, or hikikomori, is one of Japan’s most serious psychosocial issues. The concept gained international attention around 2010 and widespread psychiatric epidemiological studies have since been conducted.ObjectivesWith an understanding of the extensive range of hikikomori circumstances as a spectrum, we aimed to quantitatively measure the severity of hikikomori in adolescent subjects, an age group considered particularly susceptible to the condition, and to identify factors associated with its severity.MethodsWe selected population demographics, socioeconomic data, and psycho-behavioral characteristics as factors related to hikikomori and explored their associations with hikikomori severity using cross-sectional analysis. Subjects were a patient group of middle school students examined as outpatients at a psychiatric clinic during adolescence for a chief complaint of hikikomori and a control group of middle school students matched for sex and age. Subjects’ parents completed a questionnaire pertaining to their child’s hikikomori symptoms and living environment along with the Child Behavior Checklist (CBCL). The data collected was then statistically analyzed.ResultsT-test results demonstrated that scores for all CBCL syndrome scales were significantly higher in the patient group, but no scores fell within the clinical range. Multiple regression analysis revealed that being anxious/depressed, somatic complaints, lack of communication between parents, and overuse of the Internet were statistical predictors of hikikomori severity.ConclusionsIt may be possible to prevent hikikomori from becoming severe if the above predictors are used to identify high-risk individuals requiring active intervention while hikikomori is at an early stage.DisclosureNo significant relationships.

Testing the clinical application of the child psychosis-risk screening system (CPSS)

IntroductionChildren in a prodromal state manifesting as truancy or social isolation (hikikomori) often complain of problems that are physical in nature and are subject to significant changes. We developed the Child Psychosis-Risk Screening System (CPSS) that incorporates childhood psycho-behavioral characteristics revealed through a retrospective survey of schizophrenia patients into its algorithm.ObjectivesOur research aimed to test the risk identification of pediatric and psychiatric clinic outpatients using the CPSS.MethodsWe conducted an epidemiological study involving 204 outpatients between the ages of 6 and 14 years who had been examined at a pediatric or psychiatric clinic using the CBCL and clinical data from medical charts. Logistic regression analysis and T-tests were performed using each clinical data variable to clarify the risk of the CPSS calculated from the CBCL data and contributing factors.ResultsThe results of the logistic regression analysis demonstrated that the diagnostic category (physical illness or DSM-5 diagnosis) and chief complaint did not contribute to differentiate between the high-risk and low-risk groups. Meanwhile, the environmental factors of “abuse” and “social isolation” did contribute to the discrimination of the two groups.ConclusionsThe fact that the diagnostic category during childhood does not contribute to the discrimination of the high- risk group warrants attention. It is possible that the high-risk group only had a latent endophenotype that had not yet manifested during this period. The factors suggested to have an association with the high-risk group may be reflecting activators and the dynamic state of the critical period for psychosis.DisclosureNo significant relationships.

Combined pattern of childhood psycho-behavioral characteristics in patients with schizophrenia: a retrospective study in Japan

BackgroundAlthough epidemiological and genetic studies have provided scientific evidence that places schizophrenia into the framework of early neurodevelopmental disorders, the psycho-behavioral characteristics of children that later go on to develop schizophrenia have not been sufficiently clarified. This study aimed to retrospectively identify characteristics specific to patients with schizophrenia during childhood via their guardians’ reporting of these characteristics.MethodsParticipants included 54 outpatients with schizophrenia in their twenties who fulfilled DSM-IV-TR criteria. Additionally, 192 normal healthy subjects participated as sex- and age-matched controls. The guardians of all participants were recruited to rate participants’ childhood characteristics from 6 to 8 years of age on a modified version of the Child Behavior Checklist (CBCL), which was used as a retrospective assessment questionnaire. Using t-tests, logistic regression, and Receiver Operating Characteristic (ROC) curve analysis, we estimated the psycho-behavioral characteristics specific to schizophrenia during childhood. Using the obtained logistic regression model, we prototyped a risk-predicting algorithm based on the CBCL scores.ResultsAmong the eight CBCL subscale t-scores, “withdrawn” (p = 0.002), “thought problems” (p = 0.001), and “lack of aggressive behavior” (p = 0.002) were each significantly associated with the later diagnosis of schizophrenia, although none of these mean scores were in the clinical range at the time of childhood. The algorithm of the logistic regression model, based on eight CBCL subscales, had an area under the ROC curve of 82.8% (95% CI: 76–89%), which indicated that this algorithm’s prediction of late development of schizophrenia has moderate accuracy.ConclusionsThe results suggest that according to guardian reports, participants showed psycho-behavioral characteristics during childhood, different to those of healthy controls, which could be predictive of the later development of schizophrenia. Our newly developed algorithm is available to use in future studies to further test its validity.

Perceived Ineffectiveness of Pharmacological Treatments for Dysmenorrhea.

Background: Dysmenorrhea affects most reproductive-aged women. Common dysmenorrhea treatments vary in their effectiveness across individuals. Little is known about factors associated with perceived treatment ineffectiveness. The objectives of this study were to describe the perceived ineffectiveness of common pharmacological treatments for dysmenorrhea and investigate factors associated with perceived treatment ineffectiveness. Materials and Methods: In this cross-sectional study, 678 women with dysmenorrhea (aged 14-42) provided data on perceived treatment ineffectiveness, dysmenorrhea symptom-based phenotypes, demographics, clinical factors, and psychobehavioral characteristics. We used Fisher's exact tests to compare treatment ineffectiveness across three symptom-based phenotypes. We used logistic regressions to explore associations of phenotype, demographic, clinical, and psychobehavioral correlates of perceived treatment ineffectiveness. Results: Percentages perceiving treatments as ineffective were 29.3%-35.6% nonsteroidal anti-inflammatory drugs, 49.9% acetaminophen, and 39.3% combined oral contraceptive pills (OCPs). Factors associated with perceived ineffectiveness varied across treatments and included symptom-based phenotypes, clinical, and psychobehavioral factors. For ibuprofen and acetaminophen, women with severe (vs. mild) pain phenotype and higher number of chronic pain conditions were more likely to perceive the treatments as ineffective. For OCPs, women with severe pain (vs. mild) phenotype, comorbid gynecological condition, less anxiety, and worse depressive symptoms were more likely to perceive the treatment as ineffective. Conclusion: A significant percentage of women reported ineffectiveness of dysmenorrhea treatments. Phenotypes, clinical, and psychobehavioral factors were associated with treatment ineffectiveness. Future research should test if symptom-based phenotypes are associated with treatment effectiveness in clinical trials and investigate other factors that affect dysmenorrhea treatment effectiveness, so treatments can be tailored to individuals.

Dysmenorrhea Symptom-Based Phenotypes: A Replication and Extension Study.

Dysmenorrhea is a prevalent pain condition among women and a risk factor for other chronic pain conditions. Individuals vary in dysmenorrhea pain severity, the number of painful sites, and co-occurring gastrointestinal symptoms. Three dysmenorrhea symptom-based phenotypes were previously identified using latent class analysis; however, there is a need to validate these in an independent sample, so they can be used in mechanistic and interventional research. There is also a need to further characterize dysmenorrhea symptom-based phenotypes in terms of demographic, clinical, and psychobehavioral characteristics so they can be used to inform precision dysmenorrhea treatment. The study objectives were to (a) determine whether the same dysmenorrhea symptom-based phenotypes would be found in a new sample; (b) determine whether including demographic, clinical, and psychobehavioral covariates in latent class analyses would change individuals' phenotype memberships; and (c) investigate relationships between dysmenorrhea symptom-based phenotypes and demographic, clinical, and psychobehavioral characteristics. This cross-sectional survey study included 678 women (aged 14-42 years) with dysmenorrhea. Participants reported dysmenorrhea symptom severity, demographic, clinical (comorbid chronic pain and gynecological conditions), and psychobehavioral characteristics (perceived stress, anxiety, depression, sleep disturbance, and pain catastrophizing). We used latent class analysis to identify symptom-based phenotypes. We compared analyses with and without covariates (i.e., demographic, clinical, and psychobehavioral characteristics) to determine if individuals' phenotype memberships changed. We then examined associations between phenotypes and demographic, clinical, and psychobehavioral characteristics. We reproduced three dysmenorrhea symptom-based phenotypes: the "mild localized pain" phenotype (characterized by mild abdominal cramps), the "severe localized pain" phenotype (characterized by severe abdominal cramps), and the "multiple severe symptoms" phenotype (characterized by severe pain at multiple locations and gastrointestinal symptoms). Analyses with and without covariates had little effect on individuals' phenotype membership. Race, comorbid chronic pain condition, endometriosis, and pain catastrophizing were significantly associated with the dysmenorrhea phenotypes. Findings provide a foundation to further study mechanisms of dysmenorrhea symptom heterogeneity and develop dysmenorrhea precision treatments. The three dysmenorrhea symptom-based phenotypes were validated in a second sample. Demographic, clinical, and psychobehavioral factors were associated with dysmenorrhea symptom-based phenotypes.

Identifying Social Withdrawal (Hikikomori) Factors in Adolescents: Understanding the Hikikomori Spectrum

Hikikomori is a Japanese term for social withdrawal, ranging from complete inability to venture outdoors to preferring to stay inside. The prevalence of hikikomori is high, up to 1.2% of the Japanese population, but only few studies have examined its emergence in adolescents. Therefore, we sought to identify environmental and psycho-behavioral characteristics related to hikikomori during adolescence. Parents of middle school students who underwent psychiatric outpatient treatment for hikikomori (n = 20) and control group parents (n = 88) completed the Child Behavior Checklist to evaluate their child’s psycho-behavioral characteristics and novel scales to evaluate environmental characteristics and hikikomori severity. Scores for all eight Child Behavior Checklist subscales were significantly higher in the experimental group. Multiple regression analysis revealed that “anxious/depressed,” “somatic complaints,” “lack of communication between parents” and “overuse of the Internet” were significant predictors of hikikomori severity. These findings can help identify individuals who are at risk of developing hikikomori.

The impact of the Type D Personality pattern on prehospital delay in patients suffering from acute myocardial infarction.

BackgroundThe Type D Personality (TDP) has been specifically linked to acute myocardial infarction (AMI). However, the impact on prehospital delay of AMI patients is unclear. The aim of this study was to assess the relationship between TDP and pre-hospital delay time (PHT) in a Chinese population.MethodsA total of 256 AMI patients (47 women and 209 men) were taken from the Multicenter Delay in Patients Experiencing AMI in Shanghai (MEDEA FAR-EAST) study. Sociodemographic and psycho-behavioral characteristics were assessed by bedside interviews and questionnaires. TDP was evaluated according to the Type D Personality Scale (DS14) subdivided in social inhibition (SI) and negative affectivity (NA). Based on a significant interaction analysis of TDP and sex on PHT, all analyses were stratified by sex.ResultsPHT of female patients with TDP were substantially shorter compared to non-TDP female patients (108 vs. 281 min, P=0.029). In male patients, no effect of TDT on PHT was found. Spearman correlation analysis suggests that NA was negatively correlated with PHT (r=−0.358, P=0.014). Further age-adjusted logistic regression analyses showed that female patients with TDP were generally less likely to prehospital delay compared with non-TDP patients (OR =0.28; 95% CI, 0.08–0.98) and had a lower risk of PHT >360 minutes (OR =0.10; 95% CI, 0.01–0.91). However, statistical significance disappeared after adjustment for psychological factors (anxiety, depression, suboptimal wellbeing, cardiac denial and stress event).ConclusionsTDP is associated with less prehospital delay in female patients during AMI—an effect which may be particularly mediated by NA.

Impact of generalized anxiety disorder (GAD) on prehospital delay of acute myocardial infarction patients. Findings from the multicenter MEDEA study.

Anxiety has been identified as a cardiac risk factor. However, less is known about the impact of generalized anxiety disorder (GAD) on prehospital delay during an acute myocardial infarction (AMI). This study assessed the impact of GAD on prehospital delay and delay related cognition and behavior. Data were from the cross-sectional Munich examination of delay in patients experiencing acute myocardial infarction (MEDEA) study with a total of 619 ST-elevated myocardial infarction (STEMI) patients. Data on socio-demographic, clinical and psycho-behavioral characteristics were collected at bedside. The outcome was assessed with the Generalized Anxiety Disorder scale (GAD-7). A GAD-7 score greater than or equal to 10 indicates general anxiety disorder. A total of 11.47% (n = 71) MI patients suffered from GAD. GAD was associated with decreased odds of delay compared to patients without GAD (OR 0.58, 95% CI 0.35-0.96), which was more significant in women (112 vs. 238min, p = 0.02) than in men (150 vs. 198min, p = 0.38). GAD was highly correlated with acute anxiety (p = 0.004) and fear of death (p = 0.005). Nevertheless, the effect remained significant after controlling for these two covariates. GAD patients were more likely to perceive a higher cardiovascular risk (OR 2.56, 95% CI 1.37-4.76) in 6months before MI, which leads to the higher likelihood of making self-decision to go to the hospital (OR 2.68, 95% CI 1.48-4.85) in the acute phase. However, GAD was also highly associated with impaired psychological well-being, stress and fatigue (p < 0.0001). In AMI patients, GAD was independently associated with less prehospital delay, but led to an impaired psychological state.

Is denial a maladaptive coping mechanism which prolongs pre-hospital delay in patients with ST-segment elevation myocardial infarction?

ObjectiveDuring an acute myocardial infarction, patients often use denial as a coping mechanism which may provide positive mood regulating effects but may also prolong prehospital delay time (PHD). However, empirical evidences are still sparse. MethodsThis cross-sectional study included 533 ST-elevated myocardial infarction (STEMI) patients from the Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study. Data on sociodemographic, clinical and psycho-behavioral characteristics were collected at bedside. The outcome was assessed using the Cardiac Denial of Impact Scale (CDIS) with the median split as cutoff point. A total of 206 (41.8%) STEMI patients were thus classified as deniers. ResultsDeniers were less likely to suffer from major depression (p=0.04), anxiety (p=0.01) and suboptimal well-being (p=0.01) compared to non-deniers during the last six months prior to STEMI. During STEMI, they were less likely to perceive severe pain strength (p=0.04) and racing heart (p=0.02). Male deniers were also less likely to perceive shortness of breath (p=0.03) and vomiting (p=0.01). Denial was not associated with overall delay time. However, in the time window of 3 to 24h, denial accounted for roughly 40min extra delay (356 vs. 316.5min p=0.02 n=196). ConclusionsDenial not only contributes to less suffering from acute heart related symptoms and negative affectivity but also leads to a clinically significant delay in the prevalent group.

아동의 음성문제와 음성 관련 행동특성에 대한 부모 및 담임교사의 인식

The study examined that parents and teachers were aware of what extents behavioral characteristics were related to the children's voice problems. The voice samples of 89 children in the ages of 3 to 5 were collected and their voice quality were graded by G scale of GRBAS. The parents and teachers of the children were asked to complete the questionnaire composed of the pediatric Voice Handicap Index (pVHI) and the psycho- and voice behavioral characteristics of their children. The results are as follows. First, there were no significant differences in both pVHI and behavioral characteristics of their children by G scale. However, significant differences were shown in the behavioral characteristics between parents and teachers, but no difference in pVHI between them. In addition, there was a significant correlation between the psycho-behavioral characteristics and the voice behavioral characteristics in both parents and teachers. These results represent that parents and teachers are not aware of the presence of their children's voice problems and such voice problems are affected by behavioral characteristics associated with the use of voice.

The psycho-behavioral correlates of a drive to be toned among female university students

Maladaptive psycho-behavioral concomitants of an increased drive for muscularity among men are well-documented (Pope et al., 1997). In recent years, media outlets aimed at women have promoted the idea that the ideal female physique is toned and strong, with sculptured abs. We suggest that the male drive to become muscular and the female drive to become toned are similar. However, less is known regarding the psycho-behavioral characteristics of women attempting to become toned. Our qualitative study examined women's beliefs and attitudes towards female muscularity. Twenty-two female university students ages 18 to 32 participated in focus groups addressing what it means for a woman to be toned and the physique enhancement strategies used by women today. Participants frequently indicated that being “in shape” is a feminine body ideal and being toned equates to empowerment and self-worth. Participants noted that weight-training and replacing meals with protein shakes or food supplements were typical physique enhancing strategies. We suggest that the drive to be toned can lead to women employing self-destructive physique enhancing strategies similar to those utilized by men who demonstrate an obsessive drive to become muscular. Therefore, researchers examining female body image concerns should be cognisant of muscle-enhancing attitudes and behaviors.