Psychosocial Outcome Variables Research Articles

Nature and success: Outdoor play is linked to school readiness

Backgroundand Purpose: Outdoor play is widely acknowledged for its benefits to physical health and psychological well-being, yet its relationship with school readiness remains understudied in preschoolers. To address this gap in the literature, this study investigated how outdoor play relates to cognitive and psychosocial development among a nationally representative sample of preschoolers. Materials and methodData on the duration of outdoor play (on weekdays and weekends) and specific cognitive and psychosocial outcome variables (i.e., early learning skills, self-regulation, social-emotional development, and flourishing) were collected via questionnaires provided to the caregivers of preschoolers. Logistic regressions were performed to examine the associations between outdoor play with cognitive and psychosocial outcomes while adjusting for covariates and calculate the odds ratio with 95 % confidence intervals (CI). ResultsAmong the 10,682 preschoolers (i.e., 3-5y) included in this study (i.e., 5558 boys, Mage = 3.98 ± 0.99 years), there was a lower percentage of preschoolers engaged in outdoor play for over 3 h per day on weekdays (33.39 %) compared to weekends (56.85 %). Outdoor play in preschoolers is positively associated with various domains of school readiness, and engaging in outdoor play for more than 3 h per day is associated with more beneficial outcomes. ConclusionThe findings of this cross-sectional study suggest that promoting outdoor play among preschoolers can be an effective strategy for enhancing cognitive, social, and emotional development in this age group although further intervention studies are required to buttress this assumption empirically.

Relationships and psychosocial aspects in inclusive secondary schools in Germany

ABSTRACT This study examines how the proportion of students with special educational needs (SEN) in class and their individual victimisation experiences may affect student-student and student-teacher relationships, social inclusion, and emotional well-being in school. The interaction of students’ SEN status and their victimisation experiences is also investigated. The convenience sample consists of 248 students (114 female, 134 male students) from the ages of 9 to 16 years (M = 11.53, SD = 1.43) enrolled in seven secondary schools in North Rhine-Westphalia, Germany. Results of hierarchical regression analyses revealed that a higher proportion of SEN in class was associated with lower ratings for student-teacher relationships, and that victimisation experiences were a significant predictor for student-student relationships and for social inclusion. Individual SEN status was related to lower ratings of social inclusion. Probing the interaction of SEN status and victimisation experiences on emotional well-being revealed non-significant simple slopes irrespective of SEN status. The corresponding statistical models yielded low to moderate variance explanations, indicating that the proportion of SEN in class, victimisation experiences, and individual SEN status may play a role in mental health related psychosocial outcome variables.

Mediators of Social Acceptance Among Emerging Adult Survivors of Childhood Cancer.

Purpose: Examine associations of social developmental factors (e.g., peer/parent social attachment, romantic relationships) and perceptions of social acceptance among emerging adult survivors of childhood cancer. Methods: A cross-sectional, within-group design was used. Questionnaires included the Multidimensional Body-Self Relations Questionnaire, Inventory of Parent and Peer Attachment, Adolescent Social Self-Efficacy Scale, Personal Evaluation Inventory, Self-Perception Profile for Adolescents, and demographics. Correlations were utilized to determine associations between general demographic, cancer-specific, and the psychosocial outcome variables. Peer and romantic relationship self-efficacy were assessed as potential mediators of social acceptance in three mediation models. Relationships between perceived physical attractiveness, peer attachment, parental attachment, and social acceptance were assessed. Results: Data were collected from N = 52 adult participants (Mage = 21.38 years, standard deviation = 3.11 years) diagnosed with cancer as a child. The first mediation model demonstrated a significant direct effect of perceived physical attraction on perceived social acceptance and retained significance after adjusting for indirect effects of the mediators. The second model demonstrated a significant direct effect of peer attachment on perceived social acceptance; however, significance was not retained after adjusting for peer self-efficacy, suggesting the relationship is partially mediated by peer relationship self-efficacy. The third model demonstrated a significant direct effect of parent attachment on perceived social acceptance; however, significance was not retained after adjusting for peer self-efficacy, suggesting the relationship is partially mediated by peer self-efficacy. Conclusion: Relationships between social developmental factors (e.g., parental and peer attachment) and perceived social acceptance are likely mediated by peer relationship self-efficacy in emerging adult survivors of childhood cancer.

Caregiver's perspective on psychosocial issues of paediatric cancer patients during COVID 19 pandemic lockdown.

Key points The unprecedented pandemic crisis has caused serious changes in the medical care for cancer patients, thereby mandating research studies to focus and understand the psychosocial issues faced by paediatric cancer patients during the pandemic lockdown in India.Paediatric cancer patients irrespective of diagnosis and treatment status were assessed for psychosocial issues (N = 103) and distress (n = 74).Caregivers were chosen as the primary respondents except for distress score in order to obtain data with better clarity and comprehension.The data was summarized using descriptive statistics; chi square analysis was adopted to find the association between psychosocial issues and outcome variables; multivariate logistic regression was used to find the predictors of treatment status and distress.Paediatric cancer patients experienced significant physical and psychological issues pertaining to the unprecedented pandemic lockdown and its associated changes with the cancer treatment and interruptions.

Diabetes Self-Management Education and Support to Improve Outcomes for Children and Young Adults With Type 1 Diabetes: An Umbrella Review of Systematic Reviews.

The objectives of this umbrella review were to describe various aspects of diabetes self-management education and support (DSMES)-related interventions and their effect on clinical, behavioral, and psychosocial outcomes among children and young adults with type 1 diabetes (T1DM) and identify gaps in current DSMES-related research. An umbrella review of systematic reviews on DSMES interventions was conducted in accordance with the PRISMA 2009 statement. Four international medical databases were searched for eligible review articles published in English in the last 10 years that dealt with children and youths with T1DM and were conducted in accordance with a priori protocol. Out of the 234 citations screened, only 8 systematic reviews representing 166 studies were considered eligible for further analysis. Glycemic management (A1C) is the most common outcome variable (108 studies). Common behavioral and psychosocial outcome variables examined are episodes of hypoglycemia (27 studies) and diabetic ketoacidosis (21 studies) and self-care behavior and generic quality of life (20 studies each). Several gaps in DSMES-related research studies are identified, including uneven geographical distribution of study population, methodological weaknesses in study designs, missing important outcome variables, use of nonstandardized assessment tools, and lack of assessment of the sustainability of effects. The effects of DSMES interventions on clinical, behavioral, and psychosocial outcomes are varied. The heterogeneity of implementation and evaluation makes it difficult to draw clear conclusions about elements of DSMES that are most effective. There is a need for long-term assessment of the psychosocial and behavioral outcomes using validated and generalizable instruments.

Health literacy impacts self-management, quality of life and fear of recurrence in head and neck cancer survivors

Little is known about whether health literacy is associated with affects certain key outcomes in head and neck cancer (HNC) survivors. We investigated (i) the socio-demographic and clinical profile of health literacy and (ii) associations among between health literacy and self-management behaviours, health-related quality of life (HRQL) and fear of recurrence (FoR) in HNC survivors. A population-based survey was conducted in Ireland. Health literacy was assessed using a validated single-item question. Socio-demographic, clinical and psychosocial outcome variables (FoR, self-management behaviours, HRQL) were collected. Multivariable linear regression was performed to estimate associations between health literacy and each psychosocial outcome. Three hundred ninety-five (50%) individuals responded to the survey. Inadequate health literacy was evident among 47% of the sample. In adjusted models, HNC survivors with inadequate health literacy had significantly lower levels of self-management behaviours in the domains of health-directed behaviour, positive and active engagement in life, self-monitoring and insight, constructive attitudes and approaches and skills and technique acquisition. Inadequate health literacy was independently associated with lower functional well-being and HNC disease-specific HRQL. FoR was also significantly higher among those with inadequate health literacy. HNC survivors with inadequate health literacy have lower levels of self-management behaviours, lower functional HRQL and increased FoR compared to those with adequate health literacy. Clinicians, healthcare providers and those developing interventions should consider how inadequate health literacy among HNC survivors might affect post-treatment outcomes when developing services and providing support for this group.

Change in Physical Activity, Sleep Quality, and Psychosocial Variables during COVID-19 Lockdown: Evidence from the Lothian Birth Cohort 1936.

(1) Objectives: The COVID-19 pandemic has disproportionately affected the lives of older people. In this study, we examine changes in physical activity, sleep quality, and psychosocial variables among older people during COVID-19 lockdown. We build on cross-sectional studies on this topic by assessing change longitudinally. We also examined whether participant characteristics including demographic, cognitive, personality, and health variables were related to more positive or negative changes during lockdown. (2) Methods: 137 older participants (mean age 84 years) from the Lothian Birth Cohort 1936 study were included in the analysis. They completed the same questionnaires assessing physical activity, sleep quality, mental wellbeing, social support, loneliness, neighbourhood cohesion, and memory problems before (mostly 2 years earlier) and again during national lockdown. (3) Results: On average, levels of physical activity were reduced (those doing minimal physical activity increased from 10% to 19%) and perceived social support increased during lockdown (effect size drm = 0.178). More positive change in the psychosocial and behavioural outcome variables during lockdown was associated with personality traits (greater intellect, emotional stability, and extraversion) and having a higher general cognitive ability. Participants with a history of cardiovascular disease, more symptoms of anxiety, or who lived alone were more likely to experience negative changes in the outcome variables during lockdown. (4) Discussion: These results provide further insight into the experiences of older people during the COVID-19 pandemic and could help to identify those at greatest risk of negative psychosocial or behavioural changes during this time.

Describing the psychosocial profile and unmet support needs of parents caring for a child with a life-limiting condition: A cross-sectional study of caregiver-reported outcomes

Background: There is a lack of studies examining the prevalence and severity of psychosocial distress in parents caring for a child with life-limiting condition. More research is also needed to better understand the experience, support needs and quality-of-life of this population. Aim: To describe the experience and support needs of caring for children with life-limiting conditions and examine the level of distress and quality-of-life experienced by parents. Design: Cross-sectional, prospective, quantitative study guided by an advisory group. Participants completed a survey that included demographics and self-report outcome measures of unmet support needs, appraisal of caregiving, psychological distress and quality-of-life. Bivariate correlation analyses were performed to examine for associations between measures. Setting/participants: Parents currently caring for one or more children (⩽18 years) with a life-limiting condition and registered with a paediatric palliative care service (Australia). Results: In total, 143 parents (88% female) completed the questionnaire (36% RR). Compared with population norms, participants reported low quality-of-life, high carer burden and high psychological distress. Almost half (47%) of the sample met the criteria for one or more diagnoses of clinically elevated stress, anxiety or depression. There were significant associations between the psychosocial outcome variables; carer strain and depression had the strongest correlations with quality-of-life (r = –.63, p < .001, for both). Participants also reported multiple unmet needs related to emotional and practical support. Conclusions: This study contributes to the growing body of evidence on paediatric palliative care, specifically that parents caring for a child with a life-limiting condition report high levels of distress and burden, low quality-of-life and need more emotional and practical support targeted at their unmet needs. Paediatric palliative care services should routinely assess parent mental health and provide appropriate support.

Correction Workers' Burnout and Outcomes: A Bayesian Network Approach.

The present study seeks to demonstrate how Bayesian Network analysis can be used to support Total Worker Health® research on correction workers by (1) revealing the most probable scenario of how psychosocial and behavioral outcome variables in corrections work are interrelated and (2) identifying the key contributing factors of this interdependency relationship within the unique occupational context of corrections work. The data from 353 correction workers from a state department of corrections in the United States were utilized. A Bayesian Network analysis approach was used to probabilistically sort out potential interrelations among various psychosocial and behavioral variables. The identified model revealed that work-related exhaustion may serve as a primary driver of occupational stress and impaired workability, and also that exhaustion limits the ability of correction workers to get regular physical exercise, while their interrelations with depressed mood, a lack of work engagement, and poor work-family balance were also noted. The results suggest the importance of joint consideration of psychosocial and behavioral factors when investigating variables that may impact health and wellbeing of correction workers. Also, they supported the value of adopting the Total Worker Health® framework, a holistic strategy to integrate prevention of work-related injury and illness and the facilitation of worker well-being, when considering integrated health protection and promotion interventions for workers in high-risk occupations.

The Vienna psychosocial assessment procedure for bionic reconstruction in patients with global brachial plexus injuries.

BackgroundGlobal brachial plexopathies cause major sensory and motor deficits in the affected arm and hand. Many patients report of psychosocial consequences including chronic pain, decreased self-sufficiency, and poor body image. Bionic reconstruction, which includes the amputation and prosthetic replacement of the functionless limb, has been shown to restore hand function in patients where classic reconstructions have failed. Patient selection and psychological evaluation before such a life-changing procedure are crucial for optimal functional outcomes. In this paper we describe a psychosocial assessment procedure for bionic reconstruction in patients with complete brachial plexopathies and present psychosocial outcome variables associated with bionic reconstruction.MethodsBetween 2013 and 2017 psychosocial assessments were performed in eight patients with global brachial plexopathies. We conducted semi-structured interviews exploring the psychosocial adjustment related to the accident, the overall psychosocial status, as well as motivational aspects related to an anticipated amputation and expectations of functional prosthetic outcome. During the interview patients were asked to respond freely. Their answers were transcribed verbatim by the interviewer and analyzed afterwards on the basis of a pre-defined item scoring system. The interview was augmented by quantitative evaluation of self-reported mental health and social functioning (SF-36 Health Survey), body image (FKB-20) and deafferentation pain (VAS). Additionally, psychosocial outcome variables were presented for seven patients before and after bionic reconstruction.ResultsQualitative data revealed several psychological stressors with long-term negative effects on patients with complete brachial plexopathies. 88% of patients felt functionally limited to a great extent due to their disability, and all of them reported constant, debilitating pain in the deafferented hand. After bionic reconstruction the physical component summary scale increased from 30.80 ± 5.31 to 37.37 ± 8.41 (p-value = 0.028), the mental component summary scale improved from 43.19 ± 8.32 to 54.76 ± 6.78 (p-value = 0.018). VAS scores indicative of deafferentation pain improved from 7.8 to 5.6 after prosthetic hand replacement (p-value = 0.018). Negative body evaluation improved from 60.71 ± 12.12 to 53.29 ± 11.03 (p-value = 0.075). Vital body dynamics increased from 38.57 ± 13.44 to 44.43 ± 16.15 (p-value = 0.109).ConclusionsBionic reconstruction provides hope for patients with complete brachial plexopathies who have lived without hand function for years or even decades. Critical patient selection is crucial and the psychosocial assessment procedure including a semi-structured interview helps identify unresolved psychological issues, which could preclude or delay bionic reconstruction. Bionic reconstruction improves overall quality of life, restores an intact self-image and reduces deafferentation pain.

STRENGTH TRAINING FOR OLDER ADULTS: PSYCHOSOCIAL AND PHYSIOLOGICAL ADAPTATIONS

Resistance training (RT) has been shown to increase muscular strength and concurrently improve functional ability in older adults (OA). However, there is relatively little research available regarding the impact of RT on quality of life and psychosocial adaptations in OA. While there is myriad data available on the physiological adaptations to RT, there are comparably few studies focused on the psychological and social adaptations resulting from less traditional RT interventions. Therefore the aim of this review was to examine the impact of RT interventions on a variety of physiological and psychosocial outcome variables. As exercise prescription increasingly emphasizes multiple modalities, the examination of corresponding outcome variables needs to be equally robust in order to reflect the increasingly diverse approaches to exercise prescription and the varied adaptations that accompany them.

The effect of an education programme (MEDIAS 2 BSC) of non-intensive insulin treatment regimens for people with Type2 diabetes: a randomized, multi-centre trial.

A self-management oriented education programme (MEDIAS2BSC) for people with Type2 diabetes who are on a non-intensive insulin treatment regimen was developed. In a randomized, multi-centre trial, the effect of MEDIAS2BSC was compared with an established education programme that acted as a control group. The primary outcome was the impact of MEDIAS2BSC on glycaemic control. Secondary outcomes included the incidence of severe hypoglycaemia, hypoglycaemia unawareness, diabetes-related distress, diabetes knowledge, quality of life and self-care behaviour. In total, 182 participants were randomized to the control group or MEDIAS2BSC [median age 64.0 (interquartile range 58.0-68.5) vs. 63.5 (57.0-70.0)years; HbA1c 62.8±12.7mmol/mol vs. 63.7±14.0mmol/mol; 7.9%±1.2% vs. 8.0%±1.3%]. After a 6-month follow-up, there was a mean decrease in HbA1c of 3.5mmol/mol (0.32%) in the control group and 6.7mmol/mol (0.61%) in MEDIAS2BSC. After adjusting for baseline differences and study centre, the mean difference between the groups was -3.3mmol/mol [95% confidence interval (CI) -0.54 to -5.90mmol/mol] [-0.30% (95% CI -0.05 to -0.54)] in favour of MEDIAS2BSC (P=0.018). There were no increases in severe hypoglycaemia or hypoglycaemia unawareness. The education programmes had no significant effects on psychosocial outcome variables. MEDIAS2BSC was more effective in lowering HbA1c than the control condition. MEDIAS2BSC is a safe educational tool that improves glycaemic control without increasing the risk for hypoglycaemia. (Clinical Trials Registry No; NCT 02748239).

Short-term and medium-term effects of grade retention in secondary school on academic achievement and psychosocial outcome variables

The objective of this paper was to examine how grade retention in secondary school would affect students’ academic achievement and psychosocial adjustment. Moreover, we investigated short-term and medium-term effects of grade retention on students’ outcomes. Propensity score matching was used to select a control group of promoted students who were similar to the retained students on a variety of characteristics. Furthermore, we used a type of comparison by which the outcome variables of the retained and promoted students were compared at different times while the grade and age-cohort were held equal between groups. We found three major results. With respect to school marks as an indicator of students’ academic achievement, this study showed that retaining students resulted in short-term benefits for the retained students but that the matched promoted students performed equally well in the medium-term. The results of standardized achievement tests additionally indicated that the students who were retained did not differ significantly from the students who were promoted. Regarding psychosocial outcomes, students differed only in self-concept (favouring the promoted students) but not in other ratings.

A Model of Privacy Control: Examining the Criteria That Predict Emerging Adults’ Likelihood to Reveal Private Information to Their Parents

The primary goal of this study was to establish a model of privacy control, stemming from Communication Privacy Management (CPM) theory, between the parent and the emerging adult child (N = 851) to predict the likelihood to reveal private information. Using Structural Equation Modeling (SEM), the study confirmed that the CPM criteria variables (culture, gender, context, motivation, and risk–benefit ratio) exert an influence on revealing private information. Three psychosocial outcome variables were also examined: rumination, stress, and well-being. Specifically, emerging adults reporting a communicatively open family relational culture, low levels of relational quality, and low levels of relational risk were more likely to reveal private information to their parents, while personal characteristics, perceived reciprocity, characteristics of the confidant, and stigma risks did not significantly affect the likelihood to reveal private information. The implications of the study suggest that predictors of privacy management center on the communication and relational factors between emerging adult children and their parents.

Positive predictive factors and subgroup analysis of clinically relevant improvement after anterior cervical decompression and fusion for cervical disc disease: a 10- to 13-year follow-up of a prospective randomized study

The main purpose of this 10- to 13-year follow-up of a prospective randomized study was to identify preoperative factors that predicted good long-term outcome after anterior cervical decompression and fusion (ACDF) with the Cloward procedure or the cervical intervertebral fusion cage. A second purpose was to investigate subgroup differences at the 10-year follow-up between patients with and without clinically relevant improvement (CRI) and between men and women. To evaluate clinically meaningful outcomes, good outcome was defined as CRI in neck-related pain intensity (≥ 30-mm improvement on a visual analog scale), and CRI in neck-specific disability (≥ 20% improvement in the neck disability index [NDI]) from preoperative measurements to the 10-year follow-up. A total of 73 patients (77% of the original study sample) completed questionnaires at least 10 years after ACDF. High preoperative neck-related pain intensity and preoperative nonsmoking status were predictors of CRI in neck-related pain intensity, and male sex was a predictor of CRI in neck-specific disability; however, no additional predictive factors were identified for good outcome after ACDF. The surgical procedure, number of operated levels, and radiological factors such as healing status did not influence the prediction models. Individuals without CRI in neck-specific disability (75%) and pain intensity (43%) reported a worse outcome for several psychosocial outcome variables compared with those with CRI. At the 10-year follow-up, women reported significantly greater neck- and arm-related pain intensity than men, and women also reported more disability and worse psychosocial status. Women reported CRI on the NDI less frequently than men (p = 0.01). Preoperative predictive factors of good outcome 10-13 years after ACDF included initial high neck-related pain intensity, nonsmoking status at the time of surgery, and male sex. There were greater improvements in pain intensity than in neck-specific disability, and the latter showed a greater association with psychosocial factors. These results suggest the need for multimodal postoperative rehabilitation for patients who do not have a satisfactory outcome after ACDF.

Internetbasiertes „e-Training“ als Bewegungs­intervention zur Gesundheitsförderung: Ergebnisse aus 2 Interventionsstudien

Internet-based interventions open a chance to improve the sustainability of rehabilitation in general and of exercise therapy in particular. The internet can be the sole intervention component on the one hand as well as a supportive tool for a traditional "Face-to-Face" intervention on the other hand. In this article, 2 studies in the setting of health promotion are outlined. Those studies evaluated an e-Training program in different administration forms. Study 1: 90 adults with a sedentary lifestyle were randomized into 3 treatment groups: Group fitness ("Face-to-Face"), individually supervised training ("Face-to-Face") and e-Training (internet-based). The respective intervention took place across 3 months and each continued for a maintenance phase of 4 months. Muscular fitness, sports activities and health-related quality of life were assessed at 3 points in time: right before the intervention, after the first 3 months, and finally, after the maintenance -phase. Study 2: 509 adults with a high self-rated risk of recurrent back pain participated in the intervention "Rückengesundheit ERlangen", which lasted for 6 months: a combined program with its content delivered "Face-to-Face" and via e-Training. The analysis was conducted in a pre-post design without control group. Several psychosocial outcome variables were assessed (e.g., fear-avoidance beliefs/FABQ-D) and the cardio-pulmonary endurance capacity. In study 1 and in study 2, significant improvements over time in all intervention groups were measured in nearly all of the dependent variables, with the exception of the physical component summary of health-related quality of life (HRQL) (SF-36) in study 1, as well as its mental component summary (SF-36) and the endurance capacity in study 2. In study 1, the graphical comparison (confidence interval) of e-Training with the "Face-to-Face" interventions shows a similar efficacy of both of them. A gender-specific evaluation reveals that the mental component of HRQL in women is significantly more improved by the group fitness intervention than by e-Training. Study 2 shows significant positive changes in the pre-post comparison regarding psychosocial risk factors of the chronification of back pain and for men significant improvements of the endurance capacity. However, no causal link could be established because of the -limitation of the study design.

Epidemiology and Impact of Scarring After Burn Injury

The purpose of this study was to perform a systematic review of the existing literature on the incidence of hypertrophic scarring and the psychosocial impact of burn scars. In a comprehensive literature review, the authors identified 48 articles published since 1965 and written in English which reported the incidence and risk factors for hypertrophic scarring or assessed outcomes related to scarring. Most studies had important methodological limitations limiting the generalizability of the findings. In particular, the absence of standardized valid measures of scarring and other outcome variables was a major barrier to drawing strong conclusions. Among studies on hypertrophic scarring, the prevalence rate varied between 32 and 72%. Identified risk factors included dark skin, female gender, young age, burn site on neck and upper limb, multiple surgical procedures, meshed skin graph, time to healing, and burn severity. With regard to psychosocial outcomes, two studies compared pediatric burn survivors with a nonburn comparison group on a body image measure; neither study found differences between groups. Across studies, burn severity and location had a modest relationship with psychosocial outcome variables. Psychosocial variables such as social comfort and perceived stigmatization were more highly associated with body image than burn characteristics. To advance our knowledge of the epidemiology of scars and the burden of scars, future studies need to implement more rigorous methodologies. In particular, standardized valid measures of scarring and other outcomes should be developed. This process could be facilitated by an international collaboration among burn centers.

Long-term outcome and prognosis of dissociative disorder with onset in childhood or adolescence

BackgroundIn the majority of cases short-term treatment outcome of juvenile dissociative disorder is rather favourable. In contrast, the long-term course seems to be less positive, but meaningful results are still fragmentary. The aim of this follow-up study is to bridge this gap to some extent describing the long-term outcome of juvenile dissociative disorder in a clinical sample. To our knowledge there is no comparable other long-term follow-up study which is based on a case definition according to actual classification systems using standardized interviews for individual assessment of the patients at the time of follow-up.MethodsThe total study group was made up of all patients treated for dissociative disorder at our department for child and adolescent psychiatry between 1983 and 1992 (N = 62). Two of these former patients committed suicide during the follow-up period (3%). We got information on the clinical course of 27 former patients (44%). 17 out of these 27 former patients were female (63%). The mean age of onset of dissociative disorder was11.7 years and the mean follow-up time was 12.4 years. Most of the patients were reassessed personally (n = 23) at a mean age of 24.8 years using structured interviews covering dissociative disorders, other Axis I disorders and personality disorders (Heidelberg Dissociation Inventory HDI; Expert System for Diagnosing Mental Disorders, DIA-X; Structured Clinical Interview for DSM-IV, SCID-II). Social adjustment was assessed by a semi-structured interview and by patient self report (Social Adjustment Scale – Self Report, SAS-SR). Psychosocial outcome variables were additionally assessed in 36 healthy controls (67% female, mean age = 22.9 years).ResultsAt the time of follow-up investigation 82.6% of the patients met the criteria for some form of psychiatric disorder, while 26.1% were still suffering from dissociative disorder. A total of 56.5% presented with an Axis I disorder (especially anxiety, dissociative and somatoform disorders). Personality disorders were seen in 47.8% (especially borderline, obsessive-compulsive and negativistic personality disorders). More dissociative symptoms and inpatient treatment in childhood or adolescence were significantly related to a lower level of psychosocial adjustment in adulthood.ConclusionTreatment strategies have to consider that in a significant portion of young patients initial recovery may not be stable over time. Limitations of the study refer to the small sample size and the low rate of former patients taking part in the follow-up investigation.

Psychosocial vulnerability predicts psychosocial outcome after an organ transplant: Results of a prospective study with lung, liver, and bone-marrow patients

Objective The pretransplant medical evaluation of transplantation candidates includes an assessment of psychosocial data. This study investigates psychosocial vulnerability as a predictor of posttransplant outcome. Methods Seventy-six patients were assessed prior to lung, liver, or bone-marrow transplant. Pretransplant vulnerability markers were cognitive beliefs (sense of coherence and optimism), affect (anxiety and depression), and external resources (social support). In addition, psychosocial functioning was assessed by professionals. Quality of life, general life satisfaction, need for counseling, and survival rate were assessed 12 months after transplant. Results Pretransplant variables explain 21–40% of the variance in posttransplant psychosocial outcome variables. Cognitive beliefs predict mental quality of life; affect (depression) and social support predict life satisfaction; and expert-rated psychosocial functioning predicts life satisfaction and need for counseling. Conclusion The multidimensional vulnerability model is suitable for predicting posttransplant psychosocial outcome. Patients with high pretransplant vulnerability should receive ongoing psychosocial counseling.

An Exploratory Study about Inaccuracy and Invalidity in Adolescent Self-Report Surveys

Using Add Health data, the authors provide evidence that some adolescents gave inaccurate and/or invalid responses on a self-administered questionnaire. Further analyses show that these adolescents were much more likely to report extreme levels on psychosocial and behavioral outcome variables. A distinction was made between inaccurate responders (e.g., inaccurate/false responses due to carelessness or confusion) and jokesters (e.g., intentional false responses). The findings show that the jokesters showed considerably more pronounced distorting effects on some psychosocial and behavioral outcome variables than the inaccurate responders did. The authors suggest that although this jokester effect may not seriously bias the results in studies that focus on large groups, for research focusing on some special subgroups (e.g., adoption groups, immigrant groups, disability groups), this effect could pose a serious challenge for the validity of research findings.