Psychological Assessment Research Articles

Enhancing perianal disease management with integrated physical and psychological approaches

This article provides a comprehensive analysis of the study by Hou et al , focusing on the complex interplay between psychological and physical factors in the post-operative recovery (POR) of patients with perianal diseases. The study sheds light on how illness perception, anxiety, and depression significantly influence recovery outcomes. Hou et al developed a predictive model that demonstrated high accuracy in identifying patients at risk of poor recovery. The article explores the critical role of pre-operative psychological assessment, highlighting the need for mental health support and personalized recovery plans in enhancing POR quality. A multidisciplinary approach, integrating mental health professionals with surgeons, anesthesiologists, and other specialists, is emphasized to ensure comprehensive care for patients. The study’s findings serve as a call to integrate psychological care into surgical practice to optimize outcomes for patients with perianal diseases.

Impact of surgery versus follow-up on psychological distress in patients with indeterminate pulmonary nodules: A prospective observational study.

To investigate whether surgery is more effective than follow-up in reducing psychological distress for patients with observable indeterminate pulmonary nodules (IPNs) and to assess if psychological distress can serve as a potential surgical indication for IPNs. This prospective observational study included 341 patients with abnormal psychometric results, as measured by the Hospital Anxiety and Depression Scale (HADS). Of these, 262 patients opted for follow-up and 79 chose surgery. Initial psychological assessments (HADS1) were conducted at enrollment following nodule detection, with a second assessment (HADS2) one year later. A comparative analysis of dynamic psychological changes (ΔHADS: HADS2-HADS1) between the follow-up and surgical groups was performed. Both groups showed reductions in HADS-A [-3 (IQR, -7 to -1) for follow-up and - 3 (IQR, - 6 to - 1) for surgery] and HADS-D scores [- 2 (IQR, - 4 to 0) for follow-up and - 3 (IQR, - 7 to 0) for surgery]. Univariate analysis revealed that the surgical group had a significantly greater reduction in HADS-D scores compared to the follow-up group (Z = - 2.08, P = 0.037), but there were no significant differences in the changes in HADS-A scores between the groups (Z = - 1.04, P = 0.300). However, in multivariable analysis, surgery did not significantly improve the alleviation of depressive symptoms compared to follow-up (β = - 0.72, 95% CI: - 1.57 to 0.14, P = 0.101). Within the surgical group, female patients reported less relief from anxiety than male patients (Z = - 2.32, P = 0.021), and symptomatic patients experienced less relief from both anxiety (Z = - 2.14, P = 0.032) and depression (Z = - 3.01, P = 0.003). Surgery does not provide additional psychological benefits over follow-up. This study does not support using psychological distress as a criterion for surgical intervention in IPNs from a psychological perspective. Trial registry ClinicalTrials.gov (NCT04857333).

Robust estimation of the latent trait in graded response models

Aberrant responses (e.g., careless responses, miskeyed items, etc.) often contaminate psychological assessments and surveys. Previous robust estimators for dichotomous IRT models have produced more accurate latent trait estimates with data containing response disturbances. However, for widely used Likert-type items with three or more response categories, a robust estimator for estimating latent traits does not exist. We propose a robust estimator for the graded response model (GRM) that can be applied to Likert-type items. Two weighting mechanisms for downweighting “suspicious” responses are considered: the Huber and the bisquare weight functions. Simulations reveal the estimator reduces bias for various test lengths, numbers of response categories, and types of response disturbances. The reduction in bias and stable standard errors suggests that the robust estimator for the GRM is effective in counteracting the harmful effects of response disturbances and providing more accurate scores on psychological assessments. The robust estimator is then applied to data from the Big Five Inventory-2 (Ober et al., 2021) to demonstrate its use. Potential applications and implications are discussed.

Nonacademic predictors of China medical licensing examination

BackgroundNational Medical Licensing Examination (NMLE) is the entrance exam for medical practice in China, and its general medical knowledge test (GMKT) evaluates abilities of medical students to comprehensively apply medical knowledge to clinical practice. This study aimed to identify nonacademic predictors of GMKT performance, which would benefit medical schools in designing appropriate strategies and techniques to facilitate the transition from medical students to qualified medical practitioners.MethodsIn 1202 medical students, we conducted the deletion-substitution-addition (DSA) and structural equation model (SEM) analyses to identify nonacademic predictors of GMKT performance from 98 candidate variables including early life events, physical conditions, psychological and personality assessments, cognitive abilities, and socioeconomic conditions. The candidate variables were assessed using psychometrically or cognitively validated and accepted instruments.ResultsWe identified seven nonacademic predictors for GMKT performance. Body mass index (BMI) and working memory reaction time showed direct negative effects on GMKT performance. Psychological and personality features (conscientiousness, state anxiety, and openness to experience) indirectly affected GMKT performance via BMI, while socioeconomic conditions (father’s education and mother’s occupation) indirectly affected GMKT performance by influencing psychological and personality features and further BMI.ConclusionThe identified nonacademic predictors for GMKT performance and their pathways may be useful for improving medical education by strengthening favorable and weakening, rectifying, or compensating unfavorable factors that are modifiable.

The ruminative cycle in smokers: on the relationship between cigarette smoking behaviour, rumination, difficulties in thought suppression, and emotion regulation

ABSTRACT To date, no study has investigated the relationship between smoking behavior, rumination, difficulties in emotion regulation and thought suppression. We aimed to investigate the relationship between cigarette consumption and regulatory strategies (e.g. rumination, thought suppression). Seventy-nine participants (39 females) ranging in age from 18 to 45 years (Mage = 24.05, SDage = 4.57), of whom 39 were non-smokers and 40 were regular smokers, were administered a multi-method psychological assessment, including questionnaires, behavioral tasks, and a modified version of the White Bear Paradigm. The results showed that smokers tended to spend more time than non-smokers thinking about certain mental contents, especially after a stressful situation (the latter triggered by laboratory-induced stress). We conclude that a multimethod assessment targeting smokers’ self-regulation attempts at both cognitive (i.e., thought suppression) and emotional levels could be useful to inform well-rounded interventions to break the “ruminative cycle”.

ALIENATION SYNDROME AND FALSE MEMORIES IN THE CONTEXT OF PSYCHOLOGY AND LAW: A literature review

The aim of this paper is to present the relationship between false memories and Parental Alienation Syndrome, using psychology and law as relevant premises to support the context of the subject. To this end, the methodology used was a literature review, as a way of gathering information on the subject. The theme was developed by selecting papers from electronic journal platforms, as well as complementary research sources such as books and laws. After reading the material, content analysis was undertaken, resulting in the creation of four categories as a way of facilitating understanding and development of the theme. The categories created were: custody disputes, false accusations of sexual abuse, psychological damage and psychological assessment. The results found show us the false memories have a direct influence on Parental Alienation Syndrome, as the alienator uses false information and distortions of untrue facts as a way of demoralizing the alienated person, such as accusations of sexual abuse. In this way, we can see how necessary the intervention of the judiciary and the expert psychologist is, who will carry out an accurate psychological assessment, with the aim of supporting the judge in making a decision that will safeguard the rights of the child or adolescent, especially the right to family life and avoid damage to their healthy development.

Psychological assessment of drug-resistant epilepsy patients: affective factors and social support

Bevezetés: Az epilepszia krónikus agyi betegség, amelynek kezelése elsősorban antiepileptikus gyógyszerekkel történik. Célkitűzés: Vizsgálatunk célja a gyógyszerrezisztens epilepsziás páciensek társas támogatásának feltérképezése, illetve az affektív tényezők, azon belül a depresszió és a szorongás vizsgálata és összehasonlítása volt az egészséges kontrollszemélyek állapotával. Módszer: Kutatásunkba összesen 34 vizsgálati személyt vontunk be (22 nő és 12 férfi; életkoruk: 21–66 év [M = 43,1, SD = 14,0]). A vizsgálatban 17 személy gyógyszerrezisztens epilepsziás páciens (13 nő és 4 férfi; életkoruk: 21–66 év [M = 46,6, SD = 13,5]) és 17 illesztett kontrollszemély (9 nő és 8 férfi; életkoruk: 23–59 év [M = 39,6, SD = 14,1]) vett részt. Az alkalmazott kérdőívek: Hospital Anxiety and Depression Scale (HADS), Caldwell-féle Társas Támogatás Skála (SDS). Eredmények: A vizsgált mintában a depresszió és a társas támogatás mértéke fordított összefüggést mutatott. A depresszió nagyobb mértéke szignifikáns kapcsolatban áll a kisebb társas támogatással: nehéz élethelyzetben (rs [15] = –0,498, p<0,003), gyakorlati támogatásban (rs [15] = –0,622, p<0,001), illetve azzal, hogy hány emberrel áll kapcsolatban a vizsgált személy (rs [15] = –0,513, p<0,002). A HADS-összpontszám alapján szignifikáns különbség mutatkozott a gyógyszerrezisztens epilepsziás és a kontrollszemélyek között (t [24,4] = 3,40, p = 0,002, d = 1,16). Megbeszélés: A szociális közeg megtartó és segítő szerepe alapvető jelentőségű a krónikus gyógyszerrezisztens epilepsziás betegek ellátásában. A társas támogatás hiányában a depresszió mértéke jelentős növekedést mutat, ami tovább rontja a páciensek életminőségét. Következtetés: Pilotkutatásunk eredményei rávilágítanak a probléma időszerűségére, így elősegítheti a gyógyszerrezisztens epilepsziás betegek részletes neuropszichológiai diagnosztikáját, ezáltal növelve a terápiás hatékonyságot. Orv Hetil. 2025; 166(1): 20–26.

Psychological Status and its Influencing Factors of Staff in a District of Shenzhen: A Retrospective Study.

Anxiety, depression, and sleep disorders, as psychological and emotional diseases, have serious impact on people's physical and mental health, and receive increasing academic attention. This study aimed to examine anxiety, depression, and sleep disorder of staff in a district of Shenzhen and to provide the basis for the development of targeted intervention measures to improve the psychological status of cadres. Based on the psychological evaluation data of staff cadres in a district of Shenzhen City obtained from January to December 2020, a stratified sampling method was adopted to randomly select two streets and three communities in each street. A total of six communities were selected as investigation units. All participants filled out the Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), and Pittsburgh Sleep Quality Index (PSQI). Chi-square test and multiple logistic regression analysis were performed using R4.2.0 statistical software. A total of 705 effective psychological assessment questionnaires were matched, and there were 71 (10.13%) positive results on SAS, 156 (22.13%) positive results on SDS, and 264 (37.45%) positive results on PSQI. Chi-square test results showed that the detection rates of anxiety and depression were significantly different among the staff cadres of different genders and different educational levels (p < 0.05). The detection rate of sleep disorder of government officials significantly differed among different age groups (p < 0.05). The logistic regression analysis showed that the detection rates of anxiety, depression, and sleep disorder of female cadres and workers were significantly higher than those of male cadres and workers (p < 0.05). The detection rates of anxiety and depression of the staff with bachelor's degree and graduate degree were significantly lower than those of the staff with a college degree or below (p < 0.05). The detection rates of anxiety and depression are different among staff of different genders and different education levels in a district of Shenzhen, where female staff and those with lower education levels have higher detection rates.

Psychological profiles associated with mental, cognitive and brain health in middle-aged and older adults

Psychological characteristics are associated with varying dementia risk and protective factors. To determine whether these characteristics aggregate into psychological profiles and whether these profiles differentially relate to aging health, we conducted a cross-sectional investigation in two independent middle-aged (51.4 ± 7.0 years (mean ± s.d.); N = 750) and older adult (71.1 ± 5.9 years; N = 282) cohorts, supplemented by longitudinal analyses in the former. Using a person-centered approach, three profiles emerged in both cohorts: those with low protective characteristics (profile 1), high risk characteristics (profile 2) and well-balanced characteristics (profile 3). Profile 1 showed the worst objective cognition in older age and middle age (at follow-up), and most rapid cortical thinning. Profile 2 exhibited the worst mental health symptomology and lowest sleep quality in both older age and middle age. We identified profile-dependent divergent patterns of associations that may suggest two distinct paths for mental, cognitive and brain health, emphasizing the need for comprehensive psychological assessments in dementia prevention research to identify groups for more personalized behavior-change strategies.

A novel framework for entertainment robots in personalized elderly care using adaptive emotional resonance technologies

The aging population suffers from some difficult aspects, such as loneliness, dementia, and lack of meaning, which diminish their enjoyment of life. This work presents a novel model using robotics and artificial intelligence to create entertainment robots that can adapt their interaction based on the elderly’s emotion. The model is implemented through the use of the multimodal emotion recognition technology that holds the facial expression, voice tone, physiological expressions, and body postures. Supported by the emotional resonance algorithm and personalization features, these robots can deliver emotional resonance that corresponds to the user’s mood. With time, this model may learn and provide better feedback. Ethical factors are also taken into account. The robot handles multimedia content, natural language processing, and gentle movements that enhance interaction. The trial involved 20 elderly users, which showed effective outcomes of mood and engagement. Standardized psychological assessments, such as the Geriatric Depression Scale (GDS) and the Quality of Life in Alzheimer’s Disease (QOL-AD) scale, revealed that participants exhibited a 2.1-point decrease in GDS scores, indicating a reduction in depressive symptoms, and a 3.8-point increase in QOL-AD scores. This framework, is thus, a promising tool in transforming elderly care

Retraction notice to "Psychological assessment of the effects of treatment with phytoestrogens on postmenopausal women: a randomized, double-blind, crossover, placebo-controlled study": [Fertility and Sterility 85 (2006) 972-978

Retraction notice to "Psychological assessment of the effects of treatment with phytoestrogens on postmenopausal women: a randomized, double-blind, crossover, placebo-controlled study": [Fertility and Sterility 85 (2006) 972-978

Promoting inclusive education and special needs support through psychological and educational frameworks

This review paper explores the critical role of psychological and educational frameworks in promoting inclusive education for students with special needs. It examines key psychological theories, such as cognitive-behavioral and developmental models, which help educators understand and address the diverse challenges faced by students with disabilities. Additionally, it highlights the importance of psychological assessments and interventions in identifying and supporting learning disabilities and mental health issues. The review also discusses educational frameworks, including Universal Design for Learning (UDL) and Response to Intervention (RTI), as effective strategies for fostering inclusive learning environments. Furthermore, the paper identifies significant challenges in implementing inclusive education, such as resource limitations, lack of teacher training, and societal biases. It recommends improving inclusive education through teacher development, policy reform, community collaboration, and technological integration. By integrating psychological and educational frameworks, schools can better meet the needs of all learners, ensuring equal access to quality education. Keywords: Inclusive Education, Psychological Frameworks, Special Needs Support, Universal Design for Learning (UDL), Response to Intervention (RTI), Educational Frameworks.

Learned Helplessness, Resilience, and Time Perspective in Ukrainian and Israeli Citizens Amid Prolonged Warfare: Social and Neurobehavioral patterns

The incessant, incomprehensible war in Ukraine and Israel inevitably determines everyday uncertainty and chronic stress, which significantly affect the mental health, well-being and functioning of the civilian population. This study examines the problem of studied helplessness, resilience and understanding of life in the context of the perception of a temporary perspective among Ukrainian and Israeli citizens. The study highlights the possibility of using the “Unified Framework for Integrated Psychological Assessment and Intervention,” which combines metacognitive, neuropsychological and psychodynamic approaches. This framework is proposed as the most important strategy for meeting the complex psychological needs of people in war-affected areas. By applying this comprehensive framework, mental health professionals can develop more thoughtful and effective support systems, increase resilience, encourage future-­oriented thinking, and mitigate feelings of helplessness, ultimately improving the well-being of a person living in a prolonged environment.

Psycho-Social Morbidity And Its Determinants Among Geriatric Population In A Rural Field Practice Area –A Cross –Sectional Study

Introduction: One in four older adults worldwide, suffer from mental health disorders such as depression, anxiety, and dementia, according to the WHO. Studies indicate high rates of depression, anxiety, and dementia among older adults, emphasizing the need for comprehensive healthcare strategies. Addressing psychosocial morbidities through early identification and intervention is crucial for improving the quality of life for elderly individuals in India.The objective of the present study is to study the prevalence and determinants of psychosocial morbidity in elderly patients in the geriatric clinicTop of ForBottom of Form Methodology : This is a cross-sectional community based study conducted in a rural field practice area of Government Vellore Medical College,Vellore, Tamil Nadu, India. The study population constituted of individuals aged &gt;60 years .The study used a sample size of 91. P value ≤ 0.05 was considered as the level of significance for the statistical tests. Depression and dementia were screened using standardized scales, and data analysis was performed using SPSS. Results :About 39 (42.8%) were habituated to alcohol. 47 (51.65%) sometimes faced social maladjustment and 3 (3. 2%) always live with social maladjustments. 41[45.1%] reported anxiety. Dementia was diagnosed in 25.3% and 56% of the people reported depression according to a psychological assessment. Conclusion:Early identification and intervention for mental health conditions, along with programs promoting social engagement and healthy lifestyles, are crucial in enhancing the quality of life for the growing elderly population.

The Intersection of Psychology and Islamic Law: Addressing Mental Health in Legal Decision-Making Processes

The intersection of psychology and Islamic law presents critical insights into how mental health considerations can inform legal decision-making processes. This paper examines the integration of psychological principles within Islamic jurisprudence, particularly in the context of mental health disorders and their impact on legal responsibility and justice. It explores how Islamic law addresses the mental state of individuals involved in legal matters, including criminal cases, family law, and inheritance disputes. The study highlights the role of psychological assessments in determining culpability, capacity, and the overall fairness of legal decisions in accordance with Islamic principles. Additionally, the paper discusses the ethical and practical challenges faced by legal practitioners when balancing mental health considerations with Islamic legal rulings. Through an interdisciplinary approach, the research aims to offer recommendations for a more nuanced and compassionate application of Islamic law, ensuring that mental health issues are adequately recognized in the legal system while upholding justice and human dignity.

The Relationship Between Childhood Trauma and Borderline Personality Disorder: The Mediator Effect of Insecure Attachment

Childhood trauma is a major cause of borderline personality disorder. Research shows that most patients diagnosed with borderline personality disorder report unhappy or shadowy childhood experiences in psychological assessments. Attachment may be one of the important mechanisms by which childhood trauma affects borderline personality disorder. Attachment styles have a strong influence on people. People with insecure attachment styles often show distrust of others and extreme language and behaviour. This is also a core symptom of borderline personality disorder. The aim of this study was to investigate whether insecure adult attachment styles mediate borderline personality disorder as a result of childhood trauma. In addition, a secure attachment style may have a positive effect on alleviating or even treating Borderline Personality Disorder. This study will investigate this aspect. It is hoped that this research will advance researchers' understanding of the impact of childhood trauma on Borderline Personality Disorder and its mechanisms, and provide theoretical and empirical support for interventions aimed at reducing Borderline Personality Disorder caused by childhood trauma.

The Educational Psychology Consultation and assessment role with bilingual learners through the lens of Gaelicmedium Education service delivery

The Educational Psychology Consultation and assessment role with bilingual learners through the lens of Gaelicmedium Education service delivery

Hepatitis C Virus Infection in Hemodialysis Patients in the Era of Direct-Acting Antiviral Treatment: Observational Study and Narrative Review.

Background and Objectives: Hepatitis C virus (HCV) infection is a major global public health concern, particularly in hemodialysis (HD) patients. This study aims to evaluate the demographic, clinical, and laboratory characteristics of HCV-positive patients undergoing HD and assess the long-term impact of direct-acting antivirals (DAAs) on patient outcomes. Moreover, a narrative review aims to summarize the current knowledge regarding HCV treatment in HD patients. The search in the PubMed, Google Scholar, and Scopus databases identified 48 studies relevant to our topic, 18 regarding clinical history and 29 related to HCV treatment. Methods: A retrospective analysis was performed on 165 HD patients from Bihor County HD centers, Romania, between 2014 and 2024. The cohort was divided into two groups: 54 patients who tested positive for HCV and 111 controls who were HCV-negative. Data collected from GPs included demographic information, comorbidities, laboratory parameters, and psychological assessments. Outcomes were evaluated at over 5 years after DAA treatment. A literature review was conducted using PubMed and Google Scholar to identify relevant studies on HCV in HD patients from 1989 to 2024. Results: Laboratory results showed similar parameters across groups, except for lower serum cholesterol levels in the HCV-positive DAA-treated group vs. HCV-positive non-treated ones (155.607 mg% vs. 170.174 mg%, p = 0.040) and increased ALT levels when comparing the same groups (29.107 vs. 22.261, p = 0.027), whereas comorbidities did not differ significantly. The incidence of malignancies was significantly higher among HCV-positive compared to HCV-negative patients (20.3% vs. 8.1%, p = 0.023), mainly among those treated with DAAs, highlighted by the multivariate analysis. Cardiovascular disease remains the leading cause of mortality regardless of HCV status or the use of antiviral therapy. Psychological assessments revealed more severe depression in HCV-positive patients compared to their HCV-negative counterparts. Conclusions: HCV infection in the hemodialysis population typically follows a subclinical course. At over five years after DAA therapy, the results indicate a stabilization of the liver function and the absence of major complications. However, the incidence of malignancies remains high in HCV-positive patients.

Developing an AI-based Explainable Expert Support System for Art Therapy

Sketch-based drawing assessments in art therapy are widely used to understand individuals’ cognitive and psychological states, such as cognitive impairments or mental disorders. Along with self-reported measures based on questionnaires, psychological drawing assessments can augment information regarding an individual’s psychological state. Interpreting drawing assessments demands significant time and effort, particularly for large groups such as schools or companies, and relies on the expertise of art therapists. To address this issue, we propose an artificial intelligence (AI)-based expert support system called AlphaDAPR to support art therapists and psychologists in conducting large-scale automatic drawing assessments. In Study 1, we first investigated user experience in AlphaDAPR . Through surveys involving 64 art therapists, we observed a substantial willingness (64.06% of participants) in using the proposed system. Structural equation modeling highlighted the pivotal role of explainable AI in the interface design, affecting perceived usefulness, trust, satisfaction, and intention to use. However, our interviews unveiled a nuanced perspective: while many art therapists showed a strong inclination to use the proposed system, they also voiced concerns about potential AI limitations and risks. Since most concerns arose from insufficient trust, which was the focal point of our attention, we conducted Study 2 with the aim of enhancing trust. Study 2 delved deeper into the necessity of clear communication regarding the division of roles between AI and users for elevating trust. Through experimentation with another 26 art therapists, we demonstrated that clear communication enhances users’ trust in our system. Our work not only highlights the potential of AlphaDAPR to streamline drawing assessments but also underscores broader implications for human-AI collaboration in psychological domains. By addressing concerns and optimizing communication, we pave the way for a symbiotic relationship between AI and human expertise, ultimately enhancing the efficacy and accessibility of psychological assessment tools.

Biological links between psychological factors and adolescent depression: childhood trauma, rumination, and resilience

BackgroundThe psychosocial factors play an important role in the development of depression in adolescents. we used metabolomics techniques to explore the links among childhood trauma, rumination, resilience, and adolescent depression.MethodsWe selected 57 adolescent depression patients and 53 healthy adolescents. The Childhood Trauma Questionnaire (CTQ), Hamilton Depression Scale (HAMD), Resilience Scale (CD-RISC), and Redundant Thinking Response Scale (RRS) were employed for the purpose of psychological assessment. The patients were regrouped according to their scores using the 27% high-low grouping method. Blood specimens were collected from all adolescents and metabolic data were obtained using LC–MS.ResultsWe found no statistically significant difference between the groups in terms of age, gender, and body mass index (BMI). HAMD, CTQ, and RRS scores were significantly higher in the adolescent depression group (MDD) than in the adolescent healthy control group (HC), and CD-RISP scores were significantly lower than in the HC group (P < 0.001). There were significant differences between the low childhood trauma group (LCT) and high childhood trauma group (HCT), the low rumination group (LRR) and high rumination group (HRR), and the low resilience group (LPR) and high resilience group (HPR) (P < 0.001). RRS, CTQ and HAMD scores were positively correlated, RRS and CTQ scores were positively correlated, CD-RIS was negatively correlated with HAMD, RRS and CTQ scores (P < 0.01). More importantly, we found that DHEAS and LPA (22:6) were identified as significant differential metabolites in both the depressed and normal groups, as well as in the high and low childhood trauma groups. N-Acetyl-L-aspartic acid and DHEAS were identified as significant differential metabolites in both the depressed and normal groups, as well as in the high and low childhood rumination groups. Pseudouridine and LPA(22:6) were identified as significant differential metabolites in both the depressed and normal groups, as well as in the high and low childhood resilience groups.ConclusionPsychological factors (childhood trauma, rumination, resilience) are biologically linked to the development of depression in adolescents. The impact of rumination on adolescent depression may be associated with DHEA. The impact of childhood trauma and resilience on adolescent depression may be associated with LPA (22:6).