Screening for depression in the Serbian general population sample: an alternative to the traditional patient health questionnaire-9 cut-off score.

BACKGROUND: The Patient Health Questionnaire (PHQ-9) score ≥ 10 balances best sensitivity and specificity when detecting probable depression in patients. In the general population, different cut-offs are suggested. European studies on general populations validating the PHQ-9 against a diagnostic interview to detect depression are rare. METHODS: This was a cross-sectional observational epidemiological survey using multistage household probabilistic sampling to recruit a representative adult sample (N = 1203; age = 43.7 ± 13.6; 48.7% male). Mental disorders including current major depressive episode (MDE) were observer-rated (Mini International Neuropsychiatric Interview). The PHQ-9, quality of life (QoL), and loneliness were self-assessed. We performed validity and reliability tests of the PHQ-9 and receiver operating curve (ROC) analysis. RESULTS: The Serbian PHQ-9 was internally consistent and correlated in the expected directions with QoL and loneliness. At the cut-off score ≥ 8, sensitivity was .85 and specificity was .91. ROC analysis showed that the area under the curve was .95, indicating that the Serbian PHQ-9 can discriminate very well between persons with/without MDE. CONCLUSIONS: When the PHQ-9 is assessed against the structured diagnostic interview in the general population to detect depression, the cut-off of ≥8 balances best sensitivity and specificity.

Comorbidity among depression, anxiety and stress symptoms in naturalistic clinical samples: A cross-cultural network analysis.

Comorbidity between depression and anxiety is well-established across various settings and cultures. We approached comorbidity from the network psychopathology perspective and examined the depression, anxiety/autonomic arousal and stress/tension symptoms in naturalistic clinical samples from Serbia, Italy and Croatia. This was a multisite study in which regularized partial correlation networks of the symptoms, obtained via self-reports on the Depression Anxiety and Stress Scales-21 (DASS-21) in three cross-cultural, clinical samples (total N = 874), were compared with respect to centrality, edge weights, community structure and bridge centrality. A moderate degree of similarity in a number of network indices across the three networks was observed. While negative mood emerged to be the most central node, stress/tension nodes were the most likely bridge symptoms between depressive and anxiety/autonomic arousal symptoms. We demonstrated that the network structure and features in mixed clinical samples were similar across three different languages and cultures. The symptoms such as agitation, restlessness and inability to relax functioned as bridges across the three symptom communities explored in this study. Important theoretical and clinical implications were derived.

Common genetic and environmental bases of the mental disorders and personality traits: Special focus on the hierarchical model of psychopathology and NEO-PI-R facets.

OBJECTIVE: This study examined whether phenotypic correlations between psychopathological dimensions and personality traits of different hierarchical levels originate from common genetic and environmental sources of variance. METHOD: Participants were 386 monozygotic and 204 dizygotic twins. The Psychiatric Diagnostic Screening Questionnaire (PDSQ) was applied along with the Revised NEO Personality Inventory (NEO-PI-R). The results of the CFA confirmed the hypothesis of the internalizing and externalizing dimensions underlying PDSQ scales. RESULTS: The results indicated a significantly greater role of genetic compared to environmental factors in the relationship between internalizing psychopathology and personality traits. Facets of neuroticism showed positive genetic links with internalizing disorders, while negative genetic links were shown for all facets of extraversion except excitement-seeking, competence, self-discipline, achievement striving, actions, and trust. Lower-order personality traits were shown to be associated with internalizing disorders more intensively than the broader domains to which they belong, both at the phenotypic and genetic levels. CONCLUSIONS: High neuroticism, together with several facets from the domain of extraversion and conscientiousness seems to represent an increased genetic susceptibility to the disorders from the internalizing spectrum. Results also suggest that specific environmental factors which are not shared with personality traits contribute to the internalizing symptoms.

The anatomy of COVID-19-related conspiracy beliefs: Exploring their nomological network on a nationally representative sample.

OBJECTIVES: The outbreak of the COVID-19 pandemic was followed by the widespread proliferation of conspiracy beliefs (CBs) regarding the origin and harmfulness of the virus and a high level of hesitancy to vaccinate. We aimed to test a series of hypotheses on the correlates of CBs and vaccination, including socio-demographic factors, personality dispositions, somatic health, stressful experiences during pandemics, and psychological distress. METHOD: The sample (N = 1203), was based on a multistage probabilistic household sampling representative of the general population. The subjects were randomly split into two approximately equal subgroups, enabling cross-validation. Based on the findings in the exploratory, the SEM model was tested in the confirmatory subsample. RESULTS: The correlates of CBs were Disintegration (proneness to psychotic-like experiences), low Openness, lower education, Extraversion, living in a smaller settlement and being employed. The correlates of vaccination were older age, CBs and larger places of living. Evidence on the role of stressful experiences and psychological distress in CBs/vaccination was not found. The findings of moderately strong and robust (cross-validated) paths, leading from Disintegration to CBs and from CBs to vaccination were the most important ones. DISCUSSION: Conspiratorial thinking tendencies-related to health-related behaviour such as vaccination-appear to be, to a considerable extent, manifestations of the mechanisms that are part of our stable, broad, trait-like thinking/emotional/motivational/behavioural tendencies, primarily proneness to psychotic-like experiences & behaviours.

Mental health in the second year of the COVID-19 pandemic: protocol for a nationally representative multilevel survey in Serbia.

INTRODUCTION: The COVID-19 pandemic is likely to have a prolonged impact on mental health (MH); however, the long-term MH effects of the COVID-19 pandemic remain unknown. The Serbian national survey-CoV2Soul.RS-was launched to document the MH status of the Serbian population following the COVID-19 pandemic and to contribute to an international evidence base about MH prevalence rates during different phases of the pandemic. METHODS AND ANALYSIS: This cross-sectional study was designed to collect a nationally representative sample (N=1200; age 18-65 years; estimated start/end-June/November 2021) using multistage probabilistic household sampling. Trained staff will conduct in-person diagnostic interviews. A battery of self-report instruments will be administered to assess the quality of life (QoL), general distress and associated protective and harmful psychological and societal factors. Analyses will be conducted to delineate the prevalence rates of MH disorders, how MH conditions and QoL vary with respect to sociodemographic variables, personality, health status and traumatic events during the COVID-19 pandemic, and to test how these relations depend on geographical region. Moreover, this study was designed to explore mechanisms linking personality and the perception of pandemic consequences and associated distress. Prevalence rates of MH disorders will be calculated using descriptive statistics. For additional analyses, we will use correlations, analysis of variance and regression analyses. The hierarchical structure of the data will be explored using multilevel random coefficient modelling. Structural equation modelling will be used to investigate the indirect effects of personality on distress through relevant variables. ETHICS AND DISSEMINATION: Ethical Committees of the Faculty of Medicine (1322-VII/31) and Faculty of Philosophy in Belgrade (02-33/273) and Faculty of Philosophy in Novi Sad (05-27, br.893/1) approved the protocol. Only respondents able to provide informed consent will participate in the study. Research reports will be submitted to peer-reviewed journals and the results will be placed on the website www.cov2soul.rs to be available to funders, researchers, policy-makers and interested laypeople, and will be advertised through social media. TRIAL REGISTRATION NUMBER: NCT04896983.

Are we still uncertain about the latent structure of intolerance of uncertainty: Results from factor mixture modeling in a Serbian sample.

BACKGROUND: Intolerance of uncertainty (IU) is a transdiagnostic risk factor for emotional disorders. Exploring the nature of IU might allow us to understand better a difference between pathological and normal worry processes. For that purpose, factor mixture modeling (FMM) can be used to test the latent structure of IU across a categorical-dimensional spectrum. METHOD: In the current study, FMM was used to examine the structure of IU in a sample of 1440 (Mage = 19.71, SD = 1.14) university students in Serbia. A Serbian Intolerance of Uncertainty Scale-11 was used. RESULTS: Results suggest that IU has four latent classes, named as Low IU, Moderate-Low IU, Moderate-High IU and High IU. The Low IU and High IU classes significantly differed in levels of positive and negative affect (NA), symptoms of depression (D), anxiety (A), stress (A), depressive cognitive bias and anxiety sensitivity (AS). Moderate-Low IU and Moderate-High classes had higher symptoms than Low IU class, but lower than High IU class. The Moderate-Low IU and Moderate-High IU classes differed in symptoms of D, A, S, and in levels of AS and NA. LIMITATIONS: This study was cross-sectional and included only non-clinical sample. CONCLUSION: The latent structure of IU tested on a Serbian sample can be described in terms of hybrid latent structure The cut-off scores of ≤ 19 and ≥ 26 can be used to detect those who are non-vulnerable or at risk for IU-related psychopathology.

Factor mixture modeling of anxiety sensitivity: Support for the three-class solution in a Serbian sample.

Anxiety sensitivity (AS) is an established transdiagnostic risk factor for emotional disorders. It is defined as the fear of anxiety sensations that arises from beliefs that those sensations can have harmful consequences on cognitive, physical, and social functioning. Thus, AS is usually considered a multidimensional construct comprised of the following dimensions: Cognitive, Physical, and Social concerns. Some studies have questioned its continuous latent structure providing taxometric evidence for its categorical nature. However, more advanced factor mixture modeling (FMM) has offered support for a hybrid, dimensional-categorial latent structure of AS. In other words, 3 qualitatively different classes were identified, with a 3-factor model within each class. In the current study, FMM was used in 2 independent Serbian samples: an adult convenient community (Facebook) sample (N = 359) and a young treatment-seeking sample (N = 342). The obtained results are fairly in line with the most recent work targeting the nature of the AS construct, using the Anxiety Sensitivity Index-3 (ASI-3). By model fit, especially comparing the 2- and 3-class solution in Sample 1, and testing external validity in Sample 2, the empirical evidence supports the 3-class solution, with classes labeled as Normative AS, Moderate AS, and High AS. Important theoretical and practical questions were raised and discussed in the article. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

The Dimensions of Ruminative Thinking: One for All or All for One.

The Ruminative Thought Scale (RTS) was developed to measure the ruminative thinking style, presumably common to various psychopathological disorders. However, prior factor-analytic research was inconclusive regarding unidimensionality versus multidimensionality of the RTS. The present study was conducted on a large, heterogeneous Serbian sample ( N = 838). A subsample was retested 6 months later providing information about symptoms of depression and various anxiety symptoms. Results showed that a bifactor model of the RTS (representing one general and four group factors) had a better fit than the second-order and one-factor models. The subscale scores were not prospective predictors of symptoms of depression and anxiety, over and above the contribution of the total score. The RTS is a reliable transdiagnostic measure of repetitive thinking. Although there is some clustering of more homogeneous items, there is not enough evidence to support interpretation of the subscales.

Neurocognitive profile of HIV-positive adults on combined antiretroviral therapy: A single-centre study in Serbia.

The advent of combined antiretroviral therapy (cART) has prolonged the life expectancy of HIV + individuals and decreased the incidence of HIV-associated dementia. However, milder forms of neurocognitive impairment remain common and are often associated with poor daily functioning and lower medication adherence. This paper presents a research aimed at exploring the cognitive status differences between HIV + subjects (N = 39) on cART therapy and a group of demographically comparable healthy subjects (N = 39) in Serbia. The significance of differences between the HIV + group and the healthy control group in performance in six cognitive domains was tested using the multivariate analysis of variance. Results showed a lower performance of the HIV + group in the domains of attention/working memory, and learning. HIV-related clinical variables were not significantly associated with cognitive performance. An older age in HIV + patients was significantly related to a lower performance in all six cognitive domains, as opposed to healthy subjects, implying a synergistic interaction between HIV and aging, resulting in accentuated cognitive difficulties. Our findings suggest that even with the absence of a subjective experience of cognitive deficits and with a good basic control of the illness, a certain degree of cognitive deficit can be observed in the tested group.

The Looming Maladaptive Style Questionnaire: Measurement invariance and relations to anxiety and depression across 10 countries.

The Looming Maladaptive Style Questionnaire (LMSQ) is a self-report measure designed to assess the looming cognitive style, a tendency to interpret threats as rapidly approaching and increasing in magnitude. To date, no systematic evaluation on the psychometric properties of the LMSQ across diverse cultural contexts has been done. In the present research, the measurement invariance of the LMSQ test scores was examined in 10 countries (N=4000). Confirmatory factor analysis suggested that a two-factor model (i.e., physical looming and social looming) fitted the data well across countries. Partial measurement invariance was established for the LMSQ scores across the countries whereas full measurement invariance was achieved across gender. Meta-analytic structural equation modeling was applied to examine the unique contributions of the two looming factors to anxiety and depression symptoms. Results indicated that the test scores underlying two looming factors were crucial and valid predictors of symptoms. The LMSQ shows promise as a measure with cross-cultural generalizability and opens new avenues for its use in diverse cultural settings.

Stress and resolution in mothers of children with cerebral palsy.

Parental resolution of diagnosis represents coming to terms with and accepting the diagnosis of a serious condition in their child. As risk factors for achieving resolution, we investigated: a child's functional status, cumulative stress, and maternal depression. The current study tested the hypothesis that mothers who are unresolved to their child's diagnosis would have considerably higher levels of risk factors, compared to resolved mothers. We also examined whether the observed risk factors could predict the resolution status. Maternal resolution was assessed by means of the Reaction to Diagnosis Interview. The sample consisted of 100 mothers of children aged 2-7, diagnosed with cerebral palsy. The results showed that unresolved mothers had children with poorer functional status, experienced more stressful life events, and were more depressed compared to resolved ones. The functional status of a child and maternal depression were shown to be significant resolution predictors. Importantly, they were more successful in predicting the resolved than the unresolved status. Further research is needed in order to investigate more extensively the unresolved parental status.

Situational and respondent-level motives for drinking and alcohol-related aggression: a multilevel analysis of drinking events in a sample of Canadian university students.

Situational drinking motives (i.e., motives specific to the drinking situation) as well as respondent-level drinking motives (i.e., usual drinking motives across drinking situations) were examined in terms of their relations with aggression experienced by university students. Secondary, multi-level analyses were conducted on the Canadian Campus Survey (CCS), a national survey of 40 Canadian universities conducted between March 1 and April 30, 2004 (N=6,282). For their three most recent drinking events, students reported their motive for drinking (i.e., situational motive) and whether they had an argument/fight. Respondent-level drinking motives were computed by averaging motives across drinking events. Drinking to cope at the situational-level increased the likelihood of aggression. Respondent-level enhancement motives also increased the risk of aggression. Aesthetic motives were important at both situational and respondent levels decreasing the risk for alcohol-related aggression. Gender did not moderate these relations. These results suggest that prevention programming might benefit from a focus on altering drinking motives, or their underlying causes, in order to reduce alcohol-related aggression among young adults.

Where, with whom, and how much alcohol is consumed on drinking events involving aggression? Event-level associations in a Canadian national survey of university students.

BACKGROUND: Epidemiological research using event-level data can provide a better understanding of the association between alcohol consumption, characteristics of drinking contexts, and the likelihood of aggressive behavior. The present research assessed whether alcohol intake and characteristics of the drinking context were associated with the likelihood of aggression within individuals across 3 drinking events based on a national sample of university students, taking into account individual characteristics and university level variables. Additionally, we determined whether individual characteristics, particularly drinking pattern, were associated with alcohol-related aggression controlling for drinking event characteristics, and whether relations of aggression to alcohol and drinking contexts differed by gender. METHODS: Secondary analyses of the 2004 Canadian Campus Survey (CCS), a national survey of 6,282 university students (41% response rate) at 40 Canadian universities, were conducted. Respondents were asked about their three most recent drinking events, including whether they were in an argument or fight with someone, number of drinks consumed, and characteristics of the drinking context as well as their usual drinking frequency and heavy episodic drinking. We used multi-level analyses to account for the nested structure of the data (i.e., drinking events nested within individuals who were nested within universities). RESULTS: The number of drinks consumed was positively associated with aggression. Drinking contexts found to be positively associated with aggression included being at a party, at a fraternity/sorority and/or residence, at three or more drinking places (versus 1 or 2), and having a partner present whereas having a meal reduced the likelihood of aggression. A significant interaction was found between gender and being at a party, with a significant effect found for women but not for men. CONCLUSIONS: These results support experimental evidence indicating a direct role of alcohol in aggression and point to characteristics of the drinking context that might be targeted in future prevention initiatives.

Role of motivation to respond to provocation, the social environment, and trait aggression in alcohol-related aggression.

Little attention has been paid to the motivation to respond to provocation and to the interaction between this motivation, alcohol, the drinking environment, and individual characteristics. Undergraduates at six Canadian universities (N = 1,232) read three vignettes describing conflict situations with social environmental manipulations while imagining themselves as either sober or intoxicated. Self-ratings assessed likelihood of assertive and aggressive responses and motivational indices of anger, offensiveness of the instigator's actions, and importance to respond to the provocation. Respondents also completed a measure of trait aggression. Multi-group structural equation models supported the hypothesis that perceived likelihood of reactive aggression is influenced by perceived alcohol intoxication, gender, trait aggression, social environmental factors, and motivation to respond to the provocation. In addition, a number of interactions were found among the predictors. These results provide insight into the types of factors that may influence aggression in drinking situations.