Social network responses to victims of potentially traumatic events: A systematic review using qualitative evidence synthesis.

BACKGROUND: A substantial number of qualitative studies examined how adult victims of potentially traumatic events (PTEs) experienced support provided by family members, friends, colleagues, and other significant others in the informal network. Importantly, the large majority of qualitative studies focused on the perceived support of victims of specific events such as sexual offences, partner violence, homicide, accidents and disasters. Although it is likely that across specific PTEs there are similarities as well as differences in experienced support from the informal network, to date no systematic review synthesized the results of qualitative studies on support from the informal network following various types of PTEs. The aim of the present systematic review is to fill this gap in the scientific knowledge, which is also highly relevant for victim services, policymakers, and the informal network. METHODS: A literature search of qualitative studies was conducted using the electronic databases of PubMed, Web of Science, CINAHL, Psych INFO, Scopus, Criminal Justice Abstracts and Picarta. The quality of the identified studies was assessed with the Consolidated Criteria for Reporting Qualitative research (COREQ) checklist, followed by analysis of the results of the identified studies using Qualitative Evidence Synthesis. FINDINGS: Seventy-five papers were included in the synthesis, involving 2799 victims of PTEs such as accidents, disasters, homicide, intimate partner violence (IPV), and sexual offences. Saturation was only achieved for IPV. Overall, four major categories of perceived social support were identified, namely, support perceived as supportive, supportive but insufficient, unsupportive, and absent from informal support providers, which included friends, family, neighbors, (if applicable) offender's family, religious group members, work/school colleagues, fellow victims, the local community, and the social network in general. Across the PTE groups, there were similarities in experiencing positive forms of support (particularly empathy and sharing experiences) as well as negative forms of support (abandonment, avoidance, lack of empathy, and not experiencing support despite victim's request for help). There were also differences across PTE groups, in particular, victims of sexual and intimate partner violence mentioned a number of other supportive (mobilizing support, no unsupportive responses) and non-supportive (e.g., justification or normalization of violence and minimizing responses) responses. CONCLUSIONS: The review showed that different actors within the social informal network can play an important role in providing support after victims experience violence, homicide, accidents, and disasters. However, the review revealed that the large majority of qualitative studies were aimed at victims of IPV, and only for this type of PTE was saturation achieved. This indicates that, although this synthesis identified several similarities and differences, it is still too early to draw more definitive conclusions on similarities and differences in experienced social support after various PTEs and that future qualitative studies focusing on other PTEs are much needed.

Measurement Equivalence and Convergent Validity of a Mental Health Rating Scale.

Emotional and behavioral problems among children and adolescents may be studied using the Strengths and Difficulties Questionnaire, containing five subscales, based on ratings by parents, teachers, or adolescents themselves. We investigate two measurement issues using data from a longitudinal sample of 8,806 participants aged 7 to 9 years and 11 to 13 years from the Bergen Child Study in Bergen, Norway. First, convergent validity of parent and teacher ratings is studied using a multitrait-multimethod approach. Second, longitudinal measurement equivalence is studied using confirmatory factor analysis, which requires us to deal with the considerable attrition. The multitrait-multimethod indicates not only good convergent validity but also considerable method variance for parents and teachers. The reliability and validity of some subscales are relatively low. Attrition analysis indicates that attrition is not missing completely at random, but estimation assuming missing at random makes no real difference. We conclude that assuming missing completely at random is acceptable. Comparing ratings by parents and teachers results in partial scalar equivalence. In addition, all subscales exhibit (partial) longitudinal scalar measurement equivalence. We recommend using latent variable modeling and not summated scales for longitudinal modeling using the Strengths and Difficulties Questionnaire.

Using the realist perspective to link theory from qualitative evidence synthesis to quantitative studies: Broadening the matrix approach.

BACKGROUND: This study describes an approach for the use of a specific type of qualitative evidence synthesis in the matrix approach, a mixed studies reviewing method. The matrix approach compares quantitative and qualitative data on the review level by juxtaposing concrete recommendations from the qualitative evidence synthesis against interventions in primary quantitative studies. However, types of qualitative evidence syntheses that are associated with theory building generate theoretical models instead of recommendations. Therefore, the output from these types of qualitative evidence syntheses cannot directly be used for the matrix approach but requires transformation. This approach allows for the transformation of these types of output. METHOD: The approach enables the inference of moderation effects instead of direct effects from the theoretical model developed in a qualitative evidence synthesis. Recommendations for practice are formulated on the basis of interactional relations inferred from the qualitative evidence synthesis. In doing so, we apply the realist perspective to model variables from the qualitative evidence synthesis according to the context-mechanism-outcome configuration. FINDINGS: A worked example shows that it is possible to identify recommendations from a theory-building qualitative evidence synthesis using the realist perspective. We created subsets of the interventions from primary quantitative studies based on whether they matched the recommendations or not and compared the weighted mean effect sizes of the subsets. The comparison shows a slight difference in effect sizes between the groups of studies. The study concludes that the approach enhances the applicability of the matrix approach.

Measurement equivalence in mixed mode surveys.

Surveys increasingly use mixed mode data collection (e.g., combining face-to-face and web) because this controls costs and helps to maintain good response rates. However, a combination of different survey modes in one study, be it cross-sectional or longitudinal, can lead to different kinds of measurement errors. For example, respondents in a face-to-face survey or a web survey may interpret the same question differently, and might give a different answer, just because of the way the question is presented. This effect of survey mode on the question-answer process is called measurement mode effect. This study develops methodological and statistical tools to identify the existence and size of mode effects in a mixed mode survey. In addition, it assesses the size and importance of mode effects in measurement instruments using a specific mixed mode panel survey (Netherlands Kinship Panel Study). Most measurement instruments in the NKPS are multi-item scales, therefore confirmatory factor analysis (CFA) will be used as the main analysis tool, using propensity score methods to correct for selection effects. The results show that the NKPS scales by and large have measurement equivalence, but in most cases only partial measurement equivalence. Controlling for respondent differences on demographic variables, and on scale scores from the previous uni-mode measurement occasion, tends to improve measurement equivalence, but not for all scales. The discussion ends with a review of the implications of our results for analyses employing these scales.

Updated meta-analysis of classical fear conditioning in the anxiety disorders.

The aim of the current study was twofold: (1) to systematically examine differences in fear conditioning between anxiety patients and healthy controls using meta-analytic methods, and (2) to examine the extent to which study characteristics may account for the variability in findings across studies. Forty-four studies (published between 1920 and 2013) with data on 963 anxiety disordered patients and 1,222 control subjects were obtained through PubMed and PsycINFO, as well as from a previous meta-analysis on fear conditioning (Lissek et al.). Results demonstrated robustly increased fear responses to conditioned safety cues (CS-) in anxiety patients compared to controls during acquisition. This effect may represent an impaired ability to inhibit fear in the presence of safety cues (CS-) and/or may signify an increased tendency in anxiety disordered patients to generalize fear responses to safe stimuli resembling the conditioned danger cue (CS+). In contrast, during extinction, patients show stronger fear responses to the CS+ and a trend toward increased discrimination learning (differentiation between the CS+ and CS-) compared to controls, indicating delayed and/or reduced extinction of fear in anxiety patients. Finally, none of the included study characteristics, such as the type of fear measure (subjective vs. psychophysiological index of fear), could account significantly for the variance in effect sizes across studies. Further research is needed to investigate the predictive value of fear extinction on treatment outcome, as extinction processes are thought to underlie the beneficial effects of exposure treatment in anxiety disorders.

Collinear Latent Variables in Multilevel Confirmatory Factor Analysis: A Comparison of Maximum Likelihood and Bayesian Estimations.

Because variables may be correlated in the social and behavioral sciences, multicollinearity might be problematic. This study investigates the effect of collinearity manipulated in within and between levels of a two-level confirmatory factor analysis by Monte Carlo simulation. Furthermore, the influence of the size of the intraclass correlation coefficient (ICC) and estimation method; maximum likelihood estimation with robust chi-squares and standard errors and Bayesian estimation, on the convergence rate are investigated. The other variables of interest were rate of inadmissible solutions and the relative parameter and standard error bias on the between level. The results showed that inadmissible solutions were obtained when there was between level collinearity and the estimation method was maximum likelihood. In the within level multicollinearity condition, all of the solutions were admissible but the bias values were higher compared with the between level collinearity condition. Bayesian estimation appeared to be robust in obtaining admissible parameters but the relative bias was higher than for maximum likelihood estimation. Finally, as expected, high ICC produced less biased results compared to medium ICC conditions.

Analyzing indirect effects in cluster randomized trials. The effect of estimation method, number of groups and group sizes on accuracy and power.

Cluster randomized trials assess the effect of an intervention that is carried out at the group or cluster level. Ajzen's theory of planned behavior is often used to model the effect of the intervention as an indirect effect mediated in turn by attitude, norms and behavioral intention. Structural equation modeling (SEM) is the technique of choice to estimate indirect effects and their significance. However, this is a large sample technique, and its application in a cluster randomized trial assumes a relatively large number of clusters. In practice, the number of clusters in these studies tends to be relatively small, e.g., much less than fifty. This study uses simulation methods to find the lowest number of clusters needed when multilevel SEM is used to estimate the indirect effect. Maximum likelihood estimation is compared to Bayesian analysis, with the central quality criteria being accuracy of the point estimate and the confidence interval. We also investigate the power of the test for the indirect effect. We conclude that Bayes estimation works well with much smaller cluster level sample sizes such as 20 cases than maximum likelihood estimation; although the bias is larger the coverage is much better. When only 5-10 clusters are available per treatment condition even with Bayesian estimation problems occur.

Facing off with Scylla and Charybdis: a comparison of scalar, partial, and the novel possibility of approximate measurement invariance.

Measurement invariance (MI) is a pre-requisite for comparing latent variable scores across groups. The current paper introduces the concept of approximate MI building on the work of Muthén and Asparouhov and their application of Bayesian Structural Equation Modeling (BSEM) in the software Mplus. They showed that with BSEM exact zeros constraints can be replaced with approximate zeros to allow for minimal steps away from strict MI, still yielding a well-fitting model. This new opportunity enables researchers to make explicit trade-offs between the degree of MI on the one hand, and the degree of model fit on the other. Throughout the paper we discuss the topic of approximate MI, followed by an empirical illustration where the test for MI fails, but where allowing for approximate MI results in a well-fitting model. Using simulated data, we investigate in which situations approximate MI can be applied and when it leads to unbiased results. Both our empirical illustration and the simulation study show approximate MI outperforms full or partial MI In detecting/recovering the true latent mean difference when there are (many) small differences in the intercepts and factor loadings across groups. In the discussion we provide a step-by-step guide in which situation what type of MI is preferred. Our paper provides a first step in the new research area of (partial) approximate MI and shows that it can be a good alternative when strict MI leads to a badly fitting model and when partial MI cannot be applied.

A Meta-View of Multivariate Statistical Inference Methods in European Psychology Journals.

We investigated the extent and nature of multivariate statistical inferential procedures used in eight European psychology journals covering a range of content (i.e., clinical, social, health, personality, organizational, developmental, educational, and cognitive). Multivariate methods included those found in popular texts that focused on prediction, group difference, and advanced modeling: multiple regression, logistic regression, analysis of covariance, multivariate analysis of variance, factor or principal component analysis, structural equation modeling, multilevel modeling, and other methods. Results revealed that an average of 57% of the articles from these eight journals involved multivariate analyses with a third using multiple regression, 17% using structural modeling, and the remaining methods collectively comprising about 50% of the analyses. The most frequently occurring inferential procedures involved prediction weights, dichotomous p values, figures with data, and significance tests with very few articles involving confidence intervals, statistical mediation, longitudinal analyses, power analysis, or meta-analysis. Contributions, limitations and future directions are discussed.

Determinants of seclusion after aggression in psychiatric inpatients.

Some aggressive incidents in psychiatric wards result in seclusion, whereas others do not. We used the Staff Observation Aggression Scale-Revised and the mental health trust's database to identify determinants that predicted seclusion after aggression. These consisted of demographic, diagnostic, contextual, and aggression characteristics and were analyzed in a multilevel logistic regression. This showed associations between seclusion and aggression for the following: younger age, involuntary status, history of previous aggression, physical or dangerous violence, aggression being directed against objects, and a more severe incident. Thus, seclusion after aggression appears to be mainly predicted by aggression itself.

Robustness of parameter and standard error estimates against ignoring a contextual effect of a subject-level covariate in cluster-randomized trials.

In experimental research, it is not uncommon to assign clusters to conditions. When analysing the data of such cluster-randomized trials, a multilevel analysis should be applied in order to take into account the dependency of first-level units (i.e., subjects) within a second-level unit (i.e., a cluster). Moreover, the multilevel analysis can handle covariates on both levels. If a first-level covariate is involved, usually the within-cluster effect of this covariate will be estimated, implicitly assuming the contextual effect to be equal. However, this assumption may be violated. The focus of the present simulation study is the effects of ignoring the inequality of the within-cluster and contextual covariate effects on parameter and standard error estimates of the treatment effect, which is the parameter of main interest in experimental research. We found that ignoring the inequality of the within-cluster and contextual effects does not affect the estimation of the treatment effect or its standard errors. However, estimates of the variance components, as well as standard errors of the constant, were found to be biased.

Do implementation intentions help to eat a healthy diet? A systematic review and meta-analysis of the empirical evidence.

OBJECTIVE: This systematic review and meta-analysis examined whether implementation intentions are an effective tool to help people put their intentions to eat a healthy diet into practice. Additionally, it was investigated whether the quality of the outcome measures and the quality of the control conditions that are used in these studies influence implementation intentions' effectiveness. METHODS: Twenty three empirical studies investigating the effect of implementation intentions on eating behavior were included. In assessing the empirical evidence, a distinction was made between studies that aim to increase healthy eating (i.e., eating more fruits) and studies that aim to diminish unhealthy eating (i.e., eating fewer unhealthy snacks). RESULTS: Implementation intentions are an effective tool for promoting the inclusion of healthy food items in one's diet (Cohen's d=.51), but results for diminishing unhealthy eating patterns are less strong (Cohen's d=.29). For studies aiming to increase healthy eating, it was found that higher quality outcome measures and lower quality control conditions tended to yield stronger effects. CONCLUSION: Implementation intentions are somewhat more effective in promoting healthy eating than in diminishing unhealthy eating, although for some studies promoting healthy eating effect sizes may have been inflated due to less than optimal control conditions.

Intraindividual variability in adolescents' perceived relationship satisfaction: the role of daily conflict.

A daily diary method was used to examine the daily dynamics of adolescent conflict and perceived relationship satisfaction with mothers, fathers, and best friends among a sample of 72 Dutch adolescents (M = 15.59 years). Multilevel analyses revealed that perceived relationship satisfaction with mothers, fathers, and best friends was lower on days on which conflict occurred with mothers, fathers, and best friends than on days on which no conflict occurred. More specifically, perceived relationship satisfaction was highest in a particular relationship on days when no conflict occurred, second highest on days on which constructive conflict occurred, and lowest on days on which unconstructive conflict occurred. Whereas in adolescents' relationships with their parents, conflict and perceived relationship satisfaction were not found to be related to each other one day later, conflict with their best friends-and especially unconstructive conflict-was found to be related to higher perceived relationship satisfaction one day later.

Clustering of health-compromising behavior and delinquency in adolescents and adults in the Dutch population.

OBJECTIVE: This study investigates the clustering of a broad range of health-compromising and delinquent behaviors. We examine whether these behaviors belong to a single but broad cluster, 'risk-taking behavior', and whether the nature and degree of clustering in adolescents differs from that in adults. METHOD: A representative sample (N=4395) of the Dutch population aged 12 to 40 (overall response rate 67%), was asked about various health-compromising behaviors, such as alcohol consumption, smoking, illegal drug use, unsafe sexual behavior, physical inactivity, poor nutrition (such as skipping breakfast and not eating fruit and vegetables), poor sleep behavior, unlawful traffic behavior, and delinquent and aggressive behavior. Data were collected from fall 2005 to spring 2006 using internet questionnaires and face-to-face computer-assisted interviews. RESULTS: No single broad cluster was found. Instead, there were several separate but interrelated clusters. The contents of these clusters differed between age groups. For young adolescents (12-15) two clusters were identified: Alcohol and Delinquency. For older adolescents (16-18) and adults (19-40) three clusters were identified: Alcohol, Delinquency and Health. CONCLUSION: The findings of this study support a more integrated approach to promoting healthier lifestyles, and suggest that the behavior targets of integrated prevention programs should be different for adolescents and adults.

The health-related quality of life of obese persons seeking or not seeking surgical or non-surgical treatment: a meta-analysis.

BACKGROUND: This meta-analysis examined differences in health-related quality of life (HRQoL) between seekers of surgical and non-surgical treatment, and non-treatment seekers, over and above differences that are explained by weight, age, and gender. METHODS: Our literature search focused on the 'Impact of Weight on Quality of Life-Lite' (IWQOL-Lite) and the 'Short Form-36' (SF-36) questionnaires. Included were studies published between 1980 and April 2006 providing pre-treatment descriptive statistics of adult overweight, obese or morbidly obese persons. Excluded were elderly and ill patient groups. RESULTS: 54 articles, with a total number of nearly 100,000 participants, met the inclusion criteria. Persons seeking surgical treatment demonstrated the most severely reduced HRQoL. IWQOL-Lite scores showed larger differences between populations than SF-36 scores. After adjustment for weight, the population differences on the IWQOL disappeared. In contrast, the differences on the SF-36 between the surgical treatment seeking population and the other populations were maintained after adjustment for weight. CONCLUSION: The IWQOL-Lite questionnaire predominantly reflects weight-related HRQoL, whereas the SF-36 mostly reflects generic HRQoL that is determined by both weight and other factors. Our meta-analysis provides reference values that are useful when explaining or evaluating obesity-specific (IWQOL-Lite) or generic (SF-36) HRQoL, weight, and demographic characteristics of obese persons seeking or not seeking surgical or non-surgical treatment.

Deployment-related stress and trauma in Dutch soldiers returning from Iraq. Prospective study.

BACKGROUND: Some questionnaire studies have shown increased mental health problems, including probable post-traumatic stress disorder (PTSD), in soldiers deployed to Iraq. AIMS: To test prospectively whether such problems change over time and whether questionnaires provide accurate estimates of deployment-related PTSD compared with a clinical interview. METHODS: Dutch infantry troops from three cohorts completed questionnaires before deployment to Iraq (n=479), and about 5 months (n=382, 80%) and 15 months (n=331, 69%) thereafter. Post-traumatic stress disorder was evaluated by questionnaire and clinical interview. RESULTS: There were no group changes for general distress symptoms. The rates of PTSD for each cohort were 21, 4 and 6% based on questionnaires at 5 months. The deployment-related rates of PTSD based on the clinical interview were 4, 3 and 3%. CONCLUSIONS: There was a specific effect of deployment on mental health for a small minority. Questionnaires eliciting stress symptoms gave substantial overestimations of the rate of PTSD.

Theory of mind in schizophrenia: meta-analysis.

BACKGROUND: Mentalising impairment (an impaired ability to think about people in terms of their mental states) has frequently been associated with schizophrenia. AIMS: To assess the magnitude of the deficit and analyse associated factors. METHOD: Twenty-nine studies of mentalising in schizophrenia (combined n=1518), published between January 1993 and May 2006, were included to estimate overall effect size. Study descriptors predicted to influence effect size were analysed using weighted regression-analysis techniques. Separate analyses were performed for symptom subgroups and task types. RESULTS: The estimated overall effect size was large and statistically significant (d=-1.255, P<0.0001) and was not significantly affected by sample characteristics. All symptom subgroups showed significant mentalising impairment, but participants with symptoms of disorganisation were significantly more impaired than the other subgroups (P<0.01). CONCLUSIONS: This meta-analysis showed significant and stable mentalising impairment in schizophrenia. The finding that patients in remission are also impaired favours the notion that mentalising impairment represents a possible trait marker of schizophrenia.

Take care! The evaluation of a team-based burnout intervention program for oncology care providers.

In this quasi-experimental study among staff of 29 oncology wards, the authors evaluated the effects of a team-based burnout intervention program combining a staff support group with a participatory action research approach. Nine wards were randomly selected to participate in the program. Before the program started (Time 1), directly after the program ended (Time 2), and 6 months later (Time 3), study participants filled out a questionnaire on their work situation and well-being. Results of multilevel analyses showed that staff in the experimental wards experienced significantly less emotional exhaustion at both Time 2 and Time 3 and less depersonalization at Time 2, compared with the control wards. Moreover, changes in burnout levels were significantly related to changes in the perception of job characteristics over time.

Daily negative interactions and mood among patients and partners dealing with multiple sclerosis (MS): the moderating effects of emotional support.

Negative interactions with intimate partners may have adverse consequences for well-being, especially for individuals dealing with chronic illness. However, it is not clear whether negative interactions affect both dimensions of positive and negative well-being and factors that may moderate this effect have not been well-described. The aim of the present study was to examine the association between daily received negative responses from the partner and end-of-day positive and negative mood in patients with multiple sclerosis (MS) and their intimate partners. Further, the moderating role of receiving emotional support from the partner on the same day was examined. Sixty-one MS patients and their intimate partners were approached via one MS centre and the neurology department of one hospital in the Netherlands and completed computerized diaries for 14 days. Both partners filled out diaries at the end of each day, recording received negative responses, emotional support and end-of-day positive and negative mood. In line with a domain specific model, patients or partners who reported receiving negative responses on a day had higher end-of-day negative mood, whereas received negative responses were unrelated to end-of-day positive mood. Further, for both patients and partners, the adverse effect of received negative responses on end-of day mood was moderated by receiving emotional support on the same day.

Variation in long-term care needs assessors' willingness to support clients' requests for admission to a residential home: a vignette study.

OBJECTIVE: The purpose of this study is to determine what client, needs assessor, and agency factors explain variation in decision making by long-term care needs assessors concerning clients requesting admission to a residential home. METHOD: Hypothetical case vignettes were sent to needs assessors allocating services for the elderly. Multilevel logistic regression analysis provided random and fixed effects. RESULTS: The authors found random effects of the level of needs assessors are negligible, of the level of agencies small though statistically significant, clients receiving largest relative share of the variance. The amount of care already present appeared most important in the decision. Needs assessors were willing to support their clients' wishes only when they were clearly motivated. Policy implications considering the tension between clients' preferences and equity are discussed.