A cross-cultural study of different facets of dissociation: Validity and relationship with childhood trauma.

BACKGROUND: Dissociative symptoms are often conceptualized as a response to childhood trauma. However, most previous studies did not consider dissociation as a multidimensional phenomenon and only focused on English-speaking samples. OBJECTIVES: To establish the cross-cultural validity of dissociation and examine the relationship of childhood trauma with different specific dissociative symptoms across two different samples. PARTICIPANTS AND SETTING: Data from two surveys were analyzed (N = 781 Chinese-speaking adults and N = 468 English-speaking adults). METHODS: Participants completed the Childhood Trauma Subsection of the Brief Betrayal Trauma Survey and the Multiscale Dissociation Inventory (MDI) in their respective languages. We first established the measurement invariance of the MDI across the samples. Then, we examined the correlations between childhood trauma and different dimensions of dissociation. RESULTS: The six-factor structure of MDI achieved configural, metric and scalar invariance across the samples. In both samples, childhood trauma was significantly correlated with all facets of dissociation (rs = 0.227 to 0.450, p < .001), after controlling for age and gender. While depersonalization (r = 0.450) had the strongest correlation with childhood trauma in the Chinese-speaking sample, memory disturbance (r = 0.333) had the strongest correlation with childhood trauma in the English-speaking sample. CONCLUSIONS: Dissociation is a valid, multidimensional construct associated with childhood trauma across cultures. Yet, social and cultural factors might influence this relationship. Further studies on the complex relationship between childhood trauma and different specific dissociative symptoms, as well as possible moderators, are needed.

The impact of social isolation on functional disability in older people: A multi-cohort study.

OBJECTIVES: We assessed the relationship between social isolation and functional disability in older people. DESIGN: Comparison of longitudinal cohort studies. SETTING AND PARTICIPANTS: Harmonised longitudinal datasets from the United States, England, European countries, Japan, Korea, China and Hong Kong. METHODS: Social isolation was operationalised as a composite score with five domains, such as marital status, living alone, and social contact with others. Functional disability was defined as whether the cohort participant had any difficulty in activities of daily living (ADL). In each dataset, we used robust Poisson regression models to obtain the relative risks (RRs) and the corresponding 95 % confidence intervals (CI). We combined the RRs to synthesize a pooled estimate using meta-analysis with random-effects models. RESULTS: Overall, the social isolation composite score was not associated with ADL disability (pooled RR = 1.05, 95 % CI [0.97-1.14], n = 40,119). Subgroup analysis suggested social isolation composite score was associated with ADL disability in Asian regions (pooled RR = 1.09, 95 % CI [1.02, 1.16], but not in Western regions (pooled RR = 1.01, 95 % CI [0.96, 1.07]). The relationships between different domains of social isolation and ADL disability were heterogeneous, except that no participation in any social clubs or religious groups was consistently associated with ADL disability (pooled RR = 1.12, 95 % CI [1.04, 1.21]). CONCLUSION: Targeting social isolation may prevent decline in functional abilities in older adults, providing an avenue to active and healthy ageing. Nonetheless, interventions tackling social isolation should tailor to the unique cultural and social underpinnings. A limitation of the study is that reverse causality could not be ruled out definitively.

Reliability and Mental Health Correlates of a Single-Item Measure of Self-Rated Mental Health (SRMH) in the Chinese Context.

The use of single-item measures of self-rated mental health (SRMH) has been increasingly valued in epidemiologic research. However, little is known about the reliability and mental health correlates of SRMH in Chinese populations. This study examined the reliability and mental health correlates of SRMH in three Chinese samples. We analyzed data collected from two convenience samples of Chinese adults from Hong Kong and/or Taiwan (Sample 1: N = 205; Sample 2: N = 377), and a random sample of Taiwan psychiatric inpatients (Sample 3: N = 100). Our results showed that the single-item measure of SRMH had moderate to good test-retest reliability (intraclass correlation [ICC] = 0.75) in Sample 1 and acceptable reliability between the self-report and interviewer-administered versions (ICC = 0.58) in Sample 3. It had a high positive correlation with self-esteem and a moderately high negative correlation with depression. It also had a consistently negative correlation with borderline personality disorder symptoms and post-traumatic stress disorder symptoms. The SRMH score was also associated with psychiatric service usage. These findings contribute to the body of knowledge regarding the use of a single-item measure of SRMH to assess overall self-perceived mental health in Chinese communities.

The role of loneliness and negative schemas in the moment-to-moment dynamics between social anxiety and paranoia.

Social anxiety and paranoia often co-occur and exacerbate each other. While loneliness and negative schemas contribute to the development of social anxiety and paranoia separately, their role in the development of the two symptoms co-occurring is rarely considered longitudinally. This study examined the moment-to-moment relationship between social anxiety and paranoia, as well as the effects of loneliness and negative schemas on both experiences individually and coincidingly. A total of 134 non-clinical young adults completed experience sampling assessments of momentary social anxiety, paranoia, and loneliness ten times per day for six consecutive days. Participants' negative-self and -other schemas were assessed with the Brief Core Schema Scale. Dynamic structural equation modelling revealed a bidirectional relationship between social anxiety and paranoia across moments. Loneliness preceded increases in both symptoms in the next moment. Higher negative-self schema was associated with a stronger link from paranoia to social anxiety; whereas higher negative-other schema was associated with a stronger link from social anxiety to paranoia. Our findings support the reciprocal relationship between social anxiety and paranoia. While loneliness contributes to the development of social anxiety and paranoia, negative self and other schemas appear to modify the relationships between the two symptoms.

Persistence and clinical consequences of post-traumatic and dissociative symptoms in people with depressive symptoms: a one-year follow-up study.

BACKGROUND: Recent studies found that post-traumatic and dissociative symptoms are common in people with depressive symptoms. Although a trauma-related subtype of depression has been proposed, little is known about the persistence and clinical consequences of these symptoms. OBJECTIVE: This one-year follow-up study investigated the persistence and clinical consequences of post-traumatic and dissociative symptoms in people with depressive symptoms. METHODS: We analyzed longitudinal data from an international sample of people self-reporting depressive emotions (N = 152) (mean Patient Health Questionnaire-9 score = 17.27; SD = 6.31). RESULTS: More than half (58.4%) of participants with baseline post-traumatic stress disorder (PTSD) still met the criteria for PTSD after one year. Participants with dissociative symptoms at baseline were significantly more likely to report lifetime psychiatric hospitalization (31.2% vs 14.7%), past-year use of psychiatric hospitalization (10.4% vs 0%) and emergency services (16.9% vs 4%) than those without dissociative symptoms. All post-traumatic and dissociative symptom clusters were cross-sectionally (r = .286 to .528, p < .001) and longitudinally (r = .181 to .462, p < .001) correlated with depressive symptoms. A sense of current threat (ß = .146, p < .05) and negative self-concept (ß = .173, p < .05) at baseline significantly predicted depressive symptoms after one year. CONCLUSIONS: These findings contribute to the increasing body of knowledge regarding the PTSD/dissociation-depression comorbidity. Given their persistence and clinical consequences, we recommend that post-traumatic and dissociative symptoms be regularly screened for in clinical settings. The existence of a possible trauma-related subtype of depression should receive more attention in both research and clinical practice.

Post-traumatic and dissociative symptoms are common in people with depressive symptoms.These symptoms generally persist over one year and predict more depressive symptoms at follow-up.Trauma-related symptoms should be regularly screened for in clinical settings.

The age-based digital divide in an increasingly digital world: A focus group investigation during the COVID-19 pandemic.

BACKGROUND AND OBJECTIVES: Previous research has identified numerous benefits of information and communication technology (ICT) on the well-being of older adults. However, it has been increasingly recognized that older adults do not necessarily catch up with the rapidly digitalized society, known as the 'age-based digital divide'. The progress of digitalization has been accelerated during the COVID-19 pandemic, which may have widened the digital divide. This study aimed to gain a better understanding of their living experience and concerns about digital exclusion during the pandemic. The perceptions of older adults in Hong Kong, a highly digitalized, metropolitan city, towards the digital age and its impact on their daily living during the COVID-19 pandemic were explored. RESEARCH DESIGN AND METHODS: We conducted 12 focus group interviews with 77 community-dwelling older adults during the COVID-19 pandemic. Data were analyzed using thematic analysis, applying both organization, reduction, and refinement. RESULTS: Four themes were identified: 1) Diversified means to access community information; 2) Facilitated daily living through the usage of ICTs; 3) Concerns about age-related decline in function; and 4) Fear of digital exclusion and accelerated digitalization during the pandemic. The results indicate that ICT provided numerous benefits to the daily life of older adults, but our participants also expressed concerns about age-related losses and the fear of digital exclusion due to the ongoing digitalization of society. DISCUSSION AND IMPLICATIONS: Our findings indicated that older adults do not necessarily benefit from technological innovations, which are becoming more pervasive during the pandemic. To create age-friendly environments that cater to the needs of all members of society in the digital age, policymakers and service providers should provide diverse choices for older adults, rather than relying solely on one-size-fits-all technological solutions.

Moment-to-moment affective dynamics in schizophrenia and bipolar disorder.

BACKGROUND: Affective disturbances in schizophrenia and bipolar disorder may represent a transdiagnostic etiological process as well as a target of intervention. Hypotheses on similarities and differences in various parameters of affective dynamics (intensity, successive/acute changes, variability, and reactivity to stress) between the two disorders were tested. METHODS: Experience sampling method was used to assess dynamics of positive and negative affect, 10 times a day over 6 consecutive days. Patients with schizophrenia (n = 46) and patients with bipolar disorder (n = 46) were compared against age-matched healthy controls (n = 46). RESULTS: Compared to controls, the schizophrenia group had significantly more intense momentary negative affect, a lower likelihood of acute changes in positive affect, and reduced within-person variability of positive affect. The bipolar disorder group was not significantly different from either the schizophrenia group or the healthy control group on any affect indexes. Within the schizophrenia group, level of depression was associated with weaker reactivity to stress for negative affect. Within the bipolar disorder group, level of depression was associated with lower positive affect. CONCLUSIONS: Patients with schizophrenia endured a more stable and negative affective state than healthy individuals, and were less likely to be uplifted in response to happenings in daily life. There is little evidence that these affective constructs characterize the psychopathology of bipolar disorder; such investigation may have been limited by the heterogeneity within group. Our findings supported the clinical importance of assessing multiple facets of affective dynamics beyond the mean levels of intensity.

18-month trajectories of delusional dimensions in young adults: Relationship with reasoning biases and worry.

BACKGROUND: It has been argued that what differentiates delusional ideation from full-blown delusions (indicating need for care) is not the number of beliefs, but the experiential dimensions such as conviction, distress, and preoccupation. However, how these dimensions evolve over time and affect outcomes is under-researched. While delusional conviction and distress are associated with reasoning biases and worry respectively in clinical samples, how these processes predict trajectories of delusional dimensions in the general population remains unclear. METHOD: Young adults (age 18-30) were screened for delusional ideation on the Peters et al. Delusions Inventory. Participants with at least one delusional ideation were randomly selected for a 4-wave assessment (6-month apart). Trajectories of delusional dimensions were separately identified by latent class growth analyses, then compared on baseline levels of jumping-to-conclusions bias, belief inflexibility, worry, and meta-worry. RESULTS: The longitudinal sample consisted of 356 individuals (drawn from a community sample of 2,187). For each of the three dimensions (conviction, distress, and preoccupation), four-group linear models were identified-high stable, moderate stable, moderate decreasing, and low stable. The high stable group exhibited worse emotional and functional outcomes at 18 months than the other three groups. Worry and meta-worry predicted group differences, and notably differentiated the moderate decreasing groups from the moderate stable groups. Contrary to hypothesis, jumping-to-conclusions bias was milder in the high/moderate stable groups than the low stable group for conviction. CONCLUSIONS: Distinct trajectories of delusional dimensions were predicted by worry and meta-worry. Differences between the decreasing and stable groups carried clinical implications. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

The co-occurrence of multidimensional loneliness with depression, social anxiety and paranoia in non-clinical young adults: A latent profile analysis.

Introduction: Loneliness is a negative experience arising from a mismatch between perceived and actual social relationships. Several dimensions of loneliness have been suggested, namely intimate, relational and collective loneliness. Loneliness has been linked to poorer mental health, with its co-occurrence with depression, social anxiety, and paranoia most widely reported. While expressions of these symptoms are heterogeneous across individuals in the non-clinical population, it remains unclear how these symptoms co-occur with one another and with various dimensions of loneliness. It is also of interest how trait factors such as core schemas about self/others may moderate these relationships between loneliness and co-occurring symptoms. Methods: A demographically diverse sample of young adults was recruited from multiple sources. The validated sample consisted of 2,089 participants (68.4% female), who completed an online survey consisting of questionnaires assessing levels of multidimensional loneliness, depression, social anxiety, paranoia, core schemas, and demographic characteristics. Latent profile analysis (LPA) was used to identify distinct profiles of loneliness and the three symptoms. Positive and negative core schemas about self and others were modeled as predictors of these profiles. Results: Five distinct profiles were identified. Profile 1 had low levels across all symptoms and dimensions of loneliness (n = 1,273, 60.9%). Profiles 2-5 were elevated on dimensions of loneliness, and were heightened in depression (n = 189, 9.0%), social anxiety (n = 206, 9.9%), paranoia (n = 198, 9.5%), and all symptoms (n = 223, 10.7%), respectively. Relative to Profile 1, the other four profiles scored higher on negative-self (adjusted ORs = 1.36-1.49, ps < 0.001) and negative-other schemas (adjusted ORs = 1.24-1.44, ps < 0.001), and lower on positive-self (adjusted ORs = 0.82-0.85, ps < 0.001) and positive-other schemas (adjusted ORs = 0.81-0.90, ps < 0.001). Conclusion: More marked intimate, relational and collective loneliness were evident across profiles that had heightened depression, social anxiety and/or paranoia, suggesting that loneliness may serve as a general risk factor for these psychopathologies. Our findings shed light on the heterogeneity of the co-occurrence of loneliness and various mental health difficulties in non-clinical young adults. Core schemas are suggested to be putative psychological mechanisms underlying their co-occurrence and even development.

Mobile Application Use and Loneliness among Older Adults in the Digital Age: Insights from a Survey in Hong Kong during the COVID-19 Pandemic.

Existing literature on the associations between use of mobile applications (i.e., mobile apps) and loneliness among older adults (OAs) has been mainly conducted before the outbreak of the COVID-19 pandemic. Since mobile apps have been increasingly used by OAs during the pandemic, subsequent effects on social and emotional loneliness need updated investigation. This paper examines the relationship between mobile app use and loneliness among Hong Kong's OAs during the pandemic. In our research, 364 OAs with current use experience of mobile apps were interviewed through a questionnaire survey conducted during July and August 2021, which assessed the use frequency and duration of 14 mobile app types and levels of emotional and social loneliness. The survey illustrated communication (e.g., WhatsApp) and information apps were the most commonly used. Emotional loneliness was associated with the use of video entertainment (frequency and duration), instant communication (duration), and information apps (duration). Association between video entertainment apps' use and emotional loneliness was stronger among older and less educated OAs. Our findings highlight the distinctive relationships between different types of apps and loneliness among Hong Kong's OAs during the pandemic, which warrant further exploration via research into post-pandemic patterns and comparative studies in other regions.

A network analysis on the relationship between loneliness and schizotypy.

BACKGROUND: Schizotypy is a multidimensional personality trait related to the heightened risk for the development of schizophrenia spectrum disorders. While it has been suggested that loneliness may be associated with schizotypy in general, whether it relates to the specific schizotypal traits differentially remains unknown. Besides, as loneliness often co-occurs with depression and anxiety, it is important to delineate its relationship with schizotypy in consideration of these co-occurring emotional disturbances. METHODS: A demographically diverse sample of young people was obtained from multiple sources. The validated sample consisted of 2089 participants (68.4% female, age range: 18-30). The structural relationship between loneliness and schizotypy was modelled using a network analytic approach. The Gaussian graphical model with loneliness and nine schizotypal traits as nodes was first estimated without, and then with adjustment for the levels of depressive and anxiety symptoms. Edges were estimated as unique associations between nodes. RESULTS: 'Suspiciousness', 'odd beliefs or magical thinking', 'no close friends', 'constricted affect' and 'excessive social anxiety' were linked to loneliness directly. Loneliness was found to be more strongly associated with 'suspiciousness' and 'no close friends' than other schizotypal traits. After adjustment for the levels of depressive and anxiety symptoms, the above direct edges remained robust. LIMITATIONS: The use of cross-sectional data indicated only undirected associations between variables. CONCLUSIONS: Loneliness was more strongly linked to some schizotypal traits than others, with the relationships maintaining above and beyond the effects of anxiety and depression. These findings warrant further investigation of the specific relationships between loneliness and individual schizotypal traits.

Efficacy of Motivational Interviewing in Treating Co-occurring Psychosis and Substance Use Disorder: A Systematic Review and Meta-Analysis.

Objective: A wealth of evidence has supported the efficacy of motivational interviewing (MI) in reducing substance use as well as other addictive behaviors. In view of the common co-occurrence of substance use disorder among individuals with schizophrenia spectrum disorders, there has been increased attention to applying MI in psychological interventions for individuals with co-occurring psychosis and substance use disorder. This review aims to synthesize the evidence on the efficacy of MI interventions (either as a stand-alone intervention or in combination with other psychological interventions) in reducing substance use and psychotic symptoms.Data Sources: MEDLINE, PsycINFO, EMBASE, CENTRAL, and CINAHL were searched using keywords related to "psychosis," "substance addiction," and "motivational interviewing" to identify studies published in English from 1984 to May 2021.Study Selection: Of 1,134 articles identified in the literature, we selected 17 studies for review: 5 studies examined stand-alone MI ("MI-pure"), and 13 studies assessed MI as a major treatment component ("MI-mixed").Data Extraction: Demographics of participants, intervention characteristics, and outcome data were extracted by the first author and checked by the second author. Random-effects models were used for substance use and psychotic symptom outcomes.Results: MI-pure interventions did not significantly reduce severity of substance use (g = 0.06, P = .81) or psychotic symptoms (g's for 2 individual studies = 0.16, P = .54; and 0.01, P = .96). The effect of MI-mixed interventions on substance use decrease was statistically significant but small in size (g = 0.15, P = .048), whereas the effect on psychotic symptom improvement was not significant (g = 0.11, P = .22).Conclusions: With the caveat that only a small number of comparisons were available for the review on MI-pure interventions, the efficacy of MI in treating co-occurring psychosis and substance use disorder was heterogeneous and modest.

Efficacy of Phase 1 of Life Goals Programme on symptom reduction and mood stability for bipolar disorder.

BACKGROUND: Life Goals Programme (LGP) was developed as a psychological intervention for bipolar disorder, with its structured 6-session psychoeducation phase (Phase 1) targeting understanding of the disorder, medication adherence, early warning signs, and coping with symptoms and triggers. The present study tested the efficacy of Phase 1 of the LGP on symptom recovery and moment-by-moment mood stability, as well as medication adherence and quality of life. METHODS: Adults with bipolar disorder were randomly allocated to the LGP condition (six weekly group sessions) or the waitlist condition (six weeks of standard care, followed by the same LGP intervention). Participants were assessed before and after treatment, and at 6-month follow up. Waitlist participants were additionally assessed at baseline. Assessment included a clinical interview (SCID, MADRS, YMRS, and HAM-A), self-reported questionnaires, and 6-day experience sampling assessment on a mobile device. RESULTS: 64 out-patients with bipolar disorder (44 Bipolar I and 20 Bipolar II subtypes) participated in this study. LGP was well received and attended. Following LGP, there were significant improvements in knowledge about illness and level of anxiety, which were of large effect sizes and sustained at 6-month follow-up. Experience sampling assessment revealed small but significant improvements in moment-by-moment mood stability. Improvement in medication adherence was significant at 6 months and was of a moderate-to-large effect size. Changes in anxiety and mood stability were significantly greater following LGP than standard care. LIMITATIONS: Our results warrant further testing against active control. CONCLUSIONS: There was a robust improvement in emotional regulation following the 6-week LGP.