Self-report Measures Of Depression Research Articles

Development of a self-report measure of cognitive change: assessment of interpretability in two samples, people with HIV and people without HIV.

The overall aim of this study was to develop a method of measuring change in cognitive ability from the person's perspective. Cognitive change items came from an item pool that was used to develop the Communicating Cognitive Concerns Questionnaire (C3Q). The change items were administered to a test sample of 211 people with HIV + and a sample of 484 people drawn from the general population (HIV- sample). Rasch analysis was used to identify items that formed a linear continuum and correlations with measures of related constructs were used to support the interpretability of the new measure. Eleven of the original 12 change items fit the unidimensional Rasch model in both samples with a near similar ordering of the items. The average value for cognitive change of the HIV + sample was greater than that of the HIV- sample. Values on C3Q-Change correlated most highly (> 0.7) with current self-reported cognitive status and measures of depression and anxiety (> 0.6). The lowest correlation was with performance-based cognitive ability (r = 0.2). The items of C3Q-Change fit a strong measurement model and related to converging constructs in an expected way. Further work needs to be done to assess the meaning of self-reported cognitive change in relationship to measured change and to examine sources of differential item functioning.

Psychometric properties of the Cognitive Appraisal Inventory for Patients with Chronic Pain in Mexican population

Introduction. Cognitive assessment is the process whereby individuals assess the effect an adverse circumstance has on their well-being (primary assessment) and their ability to cope with it (secondary assessment), which is closely related to the emotional and behavioral response they show as a result. Objective. To determine the validity and internal consistency of the Spanish version of the Cognitive Assessment Inventory (CAI) for patients with chronic pain for Mexican population. Method. A total of 191 adults with chronic pain completed the Spanish version of the CAI, as well as self-report measures of disability, daily activities, anxiety, and depression. Results. The confirmatory factor analysis for each type of primary cognitive assessment included in the CAI yielded models with satisfactory goodness of fit and Cronbach’s α indices (loss/damage: CMIN/DF = 1.132, NFI = .935, CFI = .992, AGFI = .939, SRMR = .046, RMSEA = .026, α = .73; threat: CMIN/DF = 1.132, NFI = .935, CFI = .992, AGFI = .939, SRMR = .046, RMSEA = .026, α = .81; and challenge: CMIN/DF = 1.567, NFI = .939, CFI = .977, AGFI = .926, SRMR = .044, RMSEA = .055, α = .86). Cognitive assessments of loss/harm and threat were positively associated with the degree of disability, depression, and anxiety, and negatively associated with the performance of daily activities. The opposite occurred with the cognitive assessment of challenge. Discussion and conclusion. The Spanish version of the CAI is a valid, quick, easy, and reliable tool for evaluating the primary cognitive assessment of pain, a construct closely related to physical disability and emotional suffering in response to this experience, which may be modified through brief cognitive interventions.

Longitudinal Associations Between Relationship Quality and Depression Among Youth with Intellectual Disabilities: A Latent Change Perspective.

This study investigates associations between initial levels and change in the quality of the relationships youth with intellectual disabilities (ID) share with their parents and teachers, and changes in their levels of depression over time. A sample of 395 youth with mild (48.3%) and moderate (51.7%) ID, aged between 11 and 22 (M = 15.69), were recruited in Canada (n = 142) and Australia (n = 253). Youth completed self-report measures of relationship quality and depression twice over a one-year period. Initial levels of warmth (β = - .109) and conflict (β = - .302) predicted decreases in depression. Increases in warmth predicted decreases in depression (β = - .179), while increases in conflict predicted increases in depression (β = .268). Discrepancies between youth relationships with their parents and teachers predicted decreases in depression (βwarmth = - .732; βconflict = - .608).

Psychotic experiences, emotion regulation, and suicidal ideation among Chilean adolescents in the general population.

Psychotic experiences are associated with increased risk for suicide. Despite this well-established finding, very little is known about factors that contribute to this relationship. The current study investigated the relationship between psychotic experiences, emotion regulation, and suicidal ideation among 1,590 Chilean adolescents in the general population. Participants completed self-report measures of psychotic experiences (Community Assessment of Psychic Experiences), emotion regulation (Emotion Regulation Questionnaire), depression (Patient Health Questionnaire-9), and suicidal ideation (Columbia Suicide Severity Rating Scale). Statistical analyses included Mann-Whitney U tests, point-biserial correlations, logistic regression, and moderation analyses. Results suggest that paranoid ideation, bizarre experiences, and perceptual abnormalities were moderately associated with suicidal ideation. Additionally, greater expressive suppression and cognitive reappraisal were associated with suicidal ideation. Results from the logistic regression indicate that paranoid ideation, perceptual abnormalities, and expressive suppression have the strongest relationship with suicidal ideation, even when controlling for depression and relevant demographic variables. Additionally, paranoid ideation interacted with expressive suppression to predict suicidal ideation, with expressive suppression having the strongest relationship with suicidal ideation when paranoid ideation was low to moderate. Taken together, these findings support the broader literature suggesting that emotion regulation might be a transdiagnostic risk factor for suicidal ideation. Additional longitudinal research is needed to examine whether expressive suppression and other maladaptive emotion regulation strategies serve as a mechanism for suicidal ideation both in the general population and among individuals with psychotic experiences.

Mental health risk factors for shift work disorder in paramedics: A longitudinal study

ObjectivesDepression and anxiety are prominent in paramedics, as is the prevalence of shift work disorder (SWD), a circadian sleep condition comorbid with mental health disorders. However, the role of mental health risk factors for SWD is largely unknown. This study investigated whether mental health levels in recruit paramedics before shift work predicted greater risk of SWD at 6-months into their career and explored whether shift and sleep factors mediated this relationship. DesignA longitudinal study. SettingVictoria, Australia. ParticipantsRecruit paramedics were assessed at baseline (n = 101; ie, pre-shift work) and after 6-months (n = 93) of shift and emergency work. MeasurementsAt both time points, participants completed self-reported measures of depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder Questionnaire-7), and SWD (SWD-Screening Questionnaire). Participants also filled a sleep and work diary for 14-days at each timepoint. ResultsAfter 6-months of emergency work 21.5% of paramedics had a high SWD risk. Logistic regression models showed baseline depression predicted 1.24-times greater odds for SWD at 6-months. Through Lavaan path analysis we found shift and sleep variables did not mediate the relationship between baseline mental health and SWD risk. Baseline depression was associated with increased sleepiness levels following paramedics’ major sleep periods at 6-months. Pre-existing depression levels also predicted greater perceived nightshift workload. ConclusionsOur results highlight depression symptoms before emergency work are a risk factor for SWD within 6-months of work. Depression represents a modifiable risk factor amenable to early interventions to reduce paramedics’ risk of SWD.

Cognitive impairment in people with multiple sclerosis: Perception vs. performance – factors that drive perception of impairment differ for patients and clinicians

BackgroundNeurologists’ perceptions of the presence of cognitive impairment (CI) in people with multiple sclerosis (PwMS) may not always align with findings of objective cognitive assessment. The accuracy of self-reported CI in PwMS can also be highly variable across individuals, and may not align with objective measurement of cognitive disturbances. Research suggests that additional factors impact perceived cognitive ability, such as depression and fatigue. Objective cognitive screening regardless of patient or neurologist perception has been recommended but still is often limited in routine care. Moreover, comprehensive neuropsychological assessment is even less routinely done. ObjectiveTo explore how neurologists’ perceptions of PwMS’ CI compare to the perception of the patient by determining whether PwMS and their clinicians are accurate in detecting the presence and degree of CI as defined by a multi-domain validated computerized test battery in PwMS, as well as investigate what factors influence perception of CI in each group. MethodsPwMS completed a computerized multi-domain cognitive testing battery, and self-reported measures of disease impact (MSIS-29), fatigue (MFIS), and depression (BDI-II). Disability was assessed by the clinician using the Expanded Disability Status Scale (EDSS). Clinicians and patients also provided an estimation of cognitive deficits along a Likert scale. ResultsIn this cohort of PwMS (N=202, age range: 20 to 88, gender: 71% female), their level of accuracy in detecting attention deficits (k = -.028, p = .010) was low but statistically significant. In contrast, clinicians’ accuracy in detecting global CI (k = -.037, p < .001) and a number of specific domain deficits was moderate. Fatigue (p < .001) and cognitive performance (p = .012) significantly predicted patient perceived cognitive deficits. Clinician perceived cognitive performance was significantly predicted by multiple factors: cognitive scores (p < .001), physical disability (p = .011), age (p = .021), and depression (p = .038). ConclusionThe need to objectively screen for CI in PwMS, regardless of perception, can be aided by a better understanding of the agreement and discrepancies between the patient and clinician regarding perceived cognitive disturbances and the presence of CI defined by a multi-dimensional objective screening battery.

Job stress and depression among Malaysian anti-drug professionals: The moderating role of job-related coping strategies.

Depression can cause negative consequences to workers' health and social functioning, such as poor work productivity, mental disorders, and suicide. Existing studies have argued that job stress is closely related to depression in many professions. Yet, information on how coping strategies play a significant role in the relationships among Malaysian anti-drug professionals is still scarce. Thus, the aim of this study was to examine to what extent coping strategies moderate the relationship between job stress and depression among Malaysian anti-drug professionals. A total of 3,356 National Antidrug Agency (NADA) officers aged between 21 and 59 years completed online self-report measures of depression, job stress, and job-related control coping and avoidant coping behaviors. The results showed that job stress was strongly correlated with depression, and both coping strategies were found to significantly moderate the correlations. The correlations between stress and depression were stronger among participants who had higher levels of avoidant coping or those who had lower levels of control coping. To conclude, this study highlights the importance of considering job stress and coping behaviors to understand anti-drug professionals' mental health during this challenging COVID-19 pandemic.

Subjective Report, Objective Neurocognitive Performance, and "Invisible Symptoms" in Multiple Sclerosis.

Self- and informant-report measures are often useful in predicting objective cognitive performance; however, the relationship between these reports and mood, anxiety, and fatigue requires further examination. Additionally, it remains unclear as to how these factors might be associated with objective neurocognitive performance. Eighty-six persons with multiple sclerosis (PwMS; F = 65, M = 21) completed a comprehensive neuropsychological battery that included objective neurocognitive measures, subjective reports of neurocognitive function with the Multiple Sclerosis Neuropsychological Screening Questionnaire (MSNQ) Self-Report (MSNQ-S) and Informant-Report (MSNQ-I), and self-report measures of anxiety, depression, and fatigue. Hierarchical linear regressions were conducted with depression, anxiety, the interaction between depression and anxiety, cognitive fatigue, and physical fatigue as predictors. Outcome variables included the MSNQ-S, MSNQ-I, each of five neurocognitive composites, and global intraindividual variability (IIV). Although greater cognitive fatigue was associated with greater reported cognitive dysfunction, it was not associated with objective neurocognitive impairment. Greater depression predicted poorer performance on measures of processing speed and verbal memory, though the effects became non-significant once accounting for anxiety. The interaction between depression and anxiety predicted greater neurocognitive IIV; those with high levels of depression and anxiety demonstrated greater dispersion of scores. Cognitive fatigue may skew one's perception of their cognition, though it is not associated with objective impairment. However, co-occurring depression and anxiety were associated with greater variability which is a marker of poorer neurocognitive integrity. Our findings highlight the importance of accounting for depression, anxiety, and cognitive fatigue in PwMS, given that they are all potentially modifiable factors.

Co-occurring depression and obsessive-compulsive disorder: A dimensional network approach

BackgroundDepressive and obsessive-compulsive (OCD) symptoms often co-occur and a number of possible explanations for this co-occurrence have been explored, including shared biological and psychosocial risk factors. Network approaches have offered a novel hypothesis for the link between depression and OCD: functional inter-relationships across the symptoms of these conditions. The few network studies in this area have relied largely on item, rather than process-level constructs, and have not examined relationships dimensionally. MethodsNetwork analytic methods were applied to data from 463 treatment-seeking adults with OCD. Patients completed self-report measures of OCD and depression. Factor analysis was used to derive processes (i.e., nodes) to include in the network. Networks were computed, and centrality, bridge, and stability statistics examined. ResultsNetworks showed positive relations among specific OCD and depressive symptoms. Obsessions (particularly repugnant thoughts), negative affectivity, and cognitive-somatic changes (e.g., difficulty concentrating) were central to the network. Unique relations were observed between symmetry OCD symptoms and cognitive-somatic changes. No direct link between harm-related OCD symptoms and depression was observed. ConclusionsOur results bring together prior findings, suggesting that both negative affective and psychomotor changes are important to consider in examining the relationship between OCD and depression. Increased consideration of heterogeneity in the content of OCD symptoms is key to improving clinical conceptualizations, particularly when considering the co-occurrence of OCD with other disorders.

Partialing alters interpersonal correlates of negative affective symptoms and traits: A circumplex illustration.

Negative affective symptoms (e.g., anxiety, depression, and anger) are correlated and have parallel associations with outcomes, as do related personality traits (i.e., facets of neuroticism), often prompting statistical control (i.e., partialing) to determine independent effects. However, such adjustments among predictor variables can alter their construct validity. In three studies, the interpersonal circumplex (IPC) and a related analytic approach (i.e., Structural Summary Method) were used to evaluate changes in interpersonal correlates of negative affective characteristics resulting from partialing. Samples of undergraduates (Sample 1 n=3283; Sample 2=688) and married couples (n=300 couples) completed self-report (three samples) and partner rating (sample 3) measures of anxiety, depression and anger, and IPC measures of interpersonal style. Anxiety, depression, and anger had expected interpersonal correlates across samples. Partialing depression eliminated interpersonal correlates of anxiety. When anxiety was controlled, depression measures were more strongly associated with submissiveness and less closely associated with low warmth. Adjustments involving anger magnified differences in dominance versus submissiveness associated with the negative affects. Removal of overlap among negative affective measures via partialing alters their interpersonal correlates, potentially complicating interpretation of adjusted associations.

Relationship between change in social evaluation learning and mood in early antidepressant treatment: A prospective cohort study in primary care.

Antidepressants are proposed to work by increasing sensitivity to positive versus negative information. Increasing positive affective learning within social contexts may help remediate negative self-schema. We investigated the association between change in biased learning of social evaluations about the self and others, and mood during early antidepressant treatment. Prospective cohort assessing patients recruited from primary care in South West England at four timepoints over the first 8 weeks of antidepressant treatment (n = 29). At each timepoint, participants completed self-report measures of depression (Beck Depression Inventory II (BDI-II) and Patient Health Questionnaire 9 (PHQ-9)), anxiety (Generalised Anxiety Disorder Questionnaire 7 (GAD-7)), and a computerised task measuring learning of social evaluations about the self, a friend and a stranger. We did not find evidence that learning about the self was associated with a reduction in PHQ-9 (b = 0.08, 95% CI: -0.05, 0.20, p = 0.239) or BDI-II scores (b = 0.10, 95% CI: -0.18, 0.38, p = 0.469). We found some weak evidence that increased positive learning about the friend was associated with a reduction in BDI-II scores (b = 0.30, 95% CI: -0.02, 0.62, p = 0.069). However, exploratory analyses indicated stronger evidence that increased positive learning about the self (b = 0.18, 95% CI: 0.07, 0.28, p = 0.002) and a friend (b = 0.22, 95% CI: 0.10, 0.35, p = 0.001) was associated with reductions in anxiety. Change in social evaluation learning was associated with a reduction in anxiety but not depression. Antidepressants may treat anxiety symptoms by remediating negative affective biases towards socially threatening information directed towards the self and close others. However, our findings are based on exploratory analyses within a small sample without a control group and are therefore at risk of type 1 errors and order effects. Further research with larger samples is required.

Measuring a Patient's understanding of their prognosis: An exploratory analysis.

In patients with cancer across the illness trajectory, treatment decisions are often influenced by one's perception of their prognosis (i.e., curability of disease, life expectancy, quality of life). However, research on how patients understand their prognosis (i.e., prognostic understanding) has been limited by simplistic measurement tools that fail to capture the complexity of the construct. This study describes the initial development of a measure of prognostic understanding: the Prognostic Understanding Perceptions Scale (PUPS) for use in patients with advanced cancer. An initial pool of 16 candidate items were developed through semi-structured interviews with 15 experts (oncology, psycho-oncology and palliative care professionals) and 30 advanced cancer patients. We investigated the dimensionality, internal item structure, item difficulty and item discrimination of the item pool using exploratory factor analysis (EFA), classical test theory (CTT) and item response theory (IRT) analyses. Convergent and divergent validity were based on correlations between PUPS, terminal illness acknowledgement, and self-report measures of depression, anxiety, hopelessness, and death acceptance. The final measure was comprised of nine items encompassing three factors (perceived curability, illness trajectory, treatment options), yielding strong psychometric properties. These results provide preliminarily support for PUPS as a multifaceted measure of prognostic understanding developed for use in patients with advanced cancer. Preliminary findings also highlight the potential utility of the PUPS for clinical settings, as a means of enhancing communication between patients and physicians.

Fulfilling or failing to fulfill narrative developmental themes: An indicator of living into the good life in late adolescence

Late-stage adolescents face developmental themes pivotal to establishing the foundation for a good life. Narrating represents a compelling technique to examine how some succeed while others fail to accomplish these themes. In this study, 239 Danish high school students’ life chapters were coded for narrative developmental themes related to identity integration, self-direction, empathy, and intimacy. Participants also completed self-report measures of identity disturbance, empathy, and depression. Variability in fulfillment of the developmental themes indicated the degree to which adolescents were living the good life. Regression analyses showed that fulfilled developmental themes of identity (storied and self-report) and storied intimacy were associated with lowered depression. The findings are discussed including ways to support adolescents as they prepare for the good life.

A-11 Cognitive Fatigue Predicts Subjective Report of Cognitive Functioning Over and Above Depression and Anxiety in Persons with Multiple Sclerosis

Abstract Objective: Self-and informant-reports may be used to evaluate perceived neurocognitive functioning, such as with the Multiple Sclerosis Neuropsychological Screening Questionnaire (MSNQ). However, these measures may be influenced by depression, anxiety, and fatigue. This study aims to further examine the potential influence of affect and fatigue on MSNQ scores. Method: 86 persons with Multiple Sclerosis (PwMS) (F = 65,M = 21) completed a comprehensive neuropsychological battery that included self-report measures of anxiety, depression, fatigue, and self-reported neurocognitive function with the MSNQ-Self-Report (MSNQ-S) and MSNQ-Informant-Report (MSNQ-I). Hierarchical regressions were conducted with MSNQ-S and MSNQ-I as outcome variables and with depression, anxiety, cognitive fatigue, and physical fatigue as predictors. Predicted full-scale IQ (FSIQ) was included as a covariate. Results: The model including only FSIQ and depression showed that depression was positively correlated with the MSNQ-S, F(2,82) = 15.12, p &amp;lt; 0.001, ∆R2 = 0.15. When including anxiety in the model, depression was still positively associated with the MSNQ-S, F(3,81) = 4.57, p = 0.04, as was anxiety, F(3,81) = 8.07, p = 0.006, ∆R2 = 0.07. However, when including cognitive fatigue, the relationships between the MSNQ-S and depression and anxiety were no longer significant, though cognitive fatigue was positively correlated with MSNQ-S scores, F(5,79) = 71.32, p &amp;lt; 0.001, ∆R2 = 0.35. The MSNQ-I was not correlated with the affective measures or physical fatigue, though there was a positive relationship between the MSNQ-I and cognitive fatigue, F(5,79) = 14.58, p &amp;lt; 0.001, ∆R2 = 0.14. Conclusions: Findings suggest that cognitive fatigue impacts subjective report of neurocognitive impairment for both patients and informants. Notably, when accounting for cognitive fatigue, affective disturbance was no longer significantly associated with reported neurocognitive functioning, which highlights the importance of examining fatigue and mood in PwMS.

The role of psychosocial factors in explaining sex differences in major depression and generalized anxiety during the COVID-19 pandemic

BackgroundUnderstanding how pandemics differentially impact on the socio-protective and psychological outcomes of males and females is important to develop more equitable public health policies. We assessed whether males and females differed on measures of major depression and generalized anxiety during the COVID-19 the pandemic, and if so, which sociodemographic, pandemic, and psychological variables may affect sex differences in depression and anxiety.MethodsParticipants were a nationally representative sample of Irish adults (N = 1,032) assessed between April 30th to May 19th, 2020, during Ireland’s first COVID-19 nationwide quarantine. Participants completed self-report measures of anxiety (GAD-7) and depression (PHQ-9), as well as 23 sociodemographic pandemic-related, and psychological variables. Sex differences on measures of depression and anxiety were assessed using binary logistic regression analysis and differences in sociodemographic, pandemic, and psychological variables assessed using chi-square tests of independence and independent samples t-tests.ResultsFemales were significantly more likely than males to screen positive for major depressive disorder (30.6% vs. 20.7%; χ2 (1) = 13.26, p < .001, OR = 1.69 [95% CI = 1.27, 2.25]), and generalised anxiety disorder (23.3% vs. 14.4%; χ2 (1) = 13.42, p < .001, OR = 1.81 [95% CI = 1.31, 2.49]). When adjusted for all other sex-varying covariates however, sex was no longer significantly associated with screening positive for depression (AOR = 0.80, 95% CI = 0.51, 1.25) or GAD (AOR = 0.97, 95% CI = 0.60, 1.57).ConclusionObserved sex-differences in depression and anxiety during the COVID-19 pandemic in the Republic of Ireland are best explained by psychosocial factors of COVID-19 related anxiety, trait neuroticism, lower sleep quality, higher levels of loneliness, greater somatic problems, and, in the case of depression, increases in childcaring responsibilities and lower trait consciousnesses. Implications of these findings for public health policy and interventions are discussed.

Making high-quality measures available in diverse contexts-The psychometric properties of the Revised Child Anxiety and Depression Scale in a Norwegian sample.

Recent initiatives have recommended the Revised Child Anxiety and Depression Scale (RCADS) for use in research and as patient-reported outcome in health care globally. We aimed to investigate, for the first time, whether the psychometric properties of the anxiety and depression youth self-report measures, RCADS-47 and RCADS-25, generalize to a Norwegian setting. We examined gender and age differences in symptomatology among 592 children (mean age 10.7years), and conducted a psychometric investigation of the internal reliability, structural validity, measurement invariance and convergent validity of the RCADS-47 and RCADS-25 youth versions. Girls reported higher levels of anxious and depressive symptoms than boys, but no age differences were observed. Reliability coefficients for the RCADS-47 and RCADS-25 scales indicated good internal consistency. Structural validity for RCADS-47 and RCADS-25 was supported by confirmatory factor analyses results. For both measures, strong gender-based measurement invariance was present. Convergent validity of the RCADS-47 and RCADS-25 with other well-established self-report measures for anxiety (Multidimensional Anxiety Scale for Children) and depression (The Short Mood and Feelings Questionnaire) was supported. The RCADS-47 and RCADS-25 youth versions are valid and reliable instruments for measuring symptoms of anxiety and depression in a Norwegian setting. The results add to the evidence supporting RCADS's cross-cultural validity.

Attention impairment in motor functional neurological disorders: a neuropsychological study.

Our objective was to assess cognitive functioning across multiple cognitive domains using a standardised neuropsychological battery in patients with motor functional neurological disorders (mFND). Thirty patients with clinically established mFND and 30 age-, sex- and education-matched control subjects underwent a thorough neuropsychological assessment evaluating (1) attention including processing speed, (2) executive functions including working memory, (3) short-term memory, (4) speech and language and (5) visuospatial functions. Performance validity tests (PVT) and self-report measures of depression, anxiety and cognitive complaints were included in the assessment. Only patients with valid test performance were included in the analysis. Three patients scored below the cut-off scores in PVT. Patients performed significantly worse than controls in the following areas: (1) the attention domain which included a slow processing speed (p = 0.005, Cohen's d = 0.89), (2) executive functions (p = 0.01, Cohen's d = 0.88) and (3) speech and language domains (p = 0.025, Cohen's d = 0.77). Patients with mFND showed greater intra-individual variability in cognitive performance (p = 0.005, Cohen's d = 0.94). Cognitive impairments were independent of depressive symptoms, which were higher in mFND patients. This study revealed both subjective and objective cognitive impairment in patients with mFND. The neuropsychological profile in mFND was characterised primarily by attentional impairment including a slow processing speed and a high intra-individual variability in cognitive performance. Cognitive impairment was associated with a valid test performance, highlighting that the deficits observed were not likely to be explained by a lack of effort in the patient group. Attention is considered to play a key role in mFND pathophysiology, and the results suggest that such impairments are objectively measurable.

The three-year outcome of emotional symptoms in clinically referred youth with ADHD and their relationship to neuropsychological functions

BackgroundFurther knowledge is needed regarding long-term outcome of emotional symptoms, and the interplay between these symptoms and neuropsychological functioning in youth with attention deficit hyperactivity disorder (ADHD).ObjectiveWe aimed to explore the effect of performance-based neurocognitive functions and parent-rated behavioral executive functioning (EF) on self-rated and parent-rated internalizing symptoms longitudinally in clinically referred youth with ADHD (n = 137; mean age = 12.4 years). We also aimed to examine the change in self-rated emotional symptoms in the ADHD group and a Control group (n = 59; mean age = 11.9 years).MethodAt baseline, and three years later, parents completed rating scales of their child’s ADHD symptoms (Swanson Nolan Pelham Scale, Version IV – SNAP-IV), emotional symptoms (Five To Fifteen Questionnaire, Strengths, and Difficulties Questionnaire), and EF (Behavior Rating Inventory of Executive Function). At the same time, the child completed self-report measures of Anxiety, Depression, and Anger Inventories (the Beck Youth Inventories) and neurocognitive measures (Conner’s Continuous Performance Test, Version II (CPT-II), Working Memory and Processing Speed composites (Wechsler Intelligence Scales). Statistical analyses were linear and logistic mixed models.ResultsUsing longitudinal data, parent- and self-ratings of emotional symptoms were associated with parent-ratings of EF behavior in youth with ADHD. Plan/organizing deficits were associated with Anxiety and Anger over and above other metacognitive subscales, while Emotional Control was related to Anger over and above other behavior regulation subscales. In the ADHD group, Anger symptoms improved across measuring points. When controlling for age, Anxiety, and Depression symptoms were largely stable in both groups, however at higher levels in the ADHD group. The differences in anxiety and depression symptoms across groups decreased over time.ConclusionsThe current study emphasizes the importance of identification, monitoring, and treatment of emotional symptoms, and behavioral aspects of EF in youth with ADHD.

Opioid and Alcohol Misuse in Veterans with Chronic Pain: A Risk Screening Study

In United States military veterans, chronic pain represents a risk factor for opioid and alcohol misuse, yet few studies have examined interactions among chronic pain, opioid prescription, and opioid and alcohol misuse. Previous work found substantial risk of co-morbid alcohol and opioid misuse in a community sample of opioid-prescribed individuals with chronic pain, a finding expanded upon here. Specifically, 211 veterans assessed within a chronic pain treatment service for opioid-prescribed individuals completed self-report measures of opioid misuse, alcohol misuse, pain intensity, depression, pain catastrophizing, and post-traumatic stress symptoms (PTS). Based on the substance misuse measures, 32% (n = 68) were misusing neither opioids nor alcohol, 23% (n = 48) were misusing both opioids and alcohol, 40% (n = 84) were misusing opioids alone, and 5% (n = 11) were misusing alcohol alone. Group comparisons indicated that individuals not misusing either substance were less distressed in comparison to those who were misusing opioids alone or both substances. The latter groups differed in PTS. Overall, misuse frequencies mirrored previous work, with approximately 1 of 3 misusing opioids and approximately 1 of 5 misusing both substances. There is a need for increased focus on both polysubstance misuse and the development of integrated treatment. PerspectiveOpioid and alcohol misuse was examined in 211 Veterans prescribed opioids for chronic pain. In total, 32% were not misusing either, 23% were misusing both, 40% were misusing opioids, and 5% were misusing alcohol. Veterans not misusing either were generally less disabled and distressed compared to those misusing opioids or both.

Mediating role of depression in the association between alexithymia and nonsuicidal self-injury in a representative sample of adolescents in Taiwan

BackgroundNock’s (2009) integrated theoretical model suggests that specific intrapersonal vulnerability factors caused by distal risk factors contribute to the development of nonsuicidal self-injury (NSSI). Alexithymia and depression have been found to predict NSSI. Based on Nock’s model, alexithymia plays a distal risk factor role to increase the risk of depression—an intrapersonal vulnerability factor—and further increase the risk of NSSI. However, small or unrepresentative samples in past studies limit the generalizability of the results. This study examined the roles of depression and alexithymia in predicting NSSI, as well as the mediating effect of depression in the relation between alexithymia and NSSI in a large representative sample of adolescents in Taiwan.MethodsUsing a cross-sectional study design, a large representative sample of 2,170 senior high school students in Taiwan was assessed by self-report measures of alexithymia, depression, and NSSI. Mediation analyses were performed to examine whether the relation between alexithymia and NSSI was mediated by depression. The questionnaires were administered in classrooms.ResultsResults showed that alexithymia positively predicted NSSI (β = 0.23, p < .001) and depression can also positively predict NSSI (β = 0.41, p < .001). Additionally, the association between alexithymia and NSSI was fully mediated by depression.ConclusionsThis study data provided evidence for the mediating role of depression between alexithymia and NSSI, which can be explained by Nock’s (2009) integrated theoretical model. The implications of the findings for future research and intervention were discussed.