Emotional self-knowledge profiles and relationships with mental health indicators support value in 'knowing thyself'.

"Know thyself" may be indicated by a balanced high pairing of two emotional self-knowledge indicators: attention to emotions and emotional clarity. Closely associated but often evaluated separately, emotional clarity is consistently, inversely associated with psychopathology, while evidence regarding attention to emotions is less consistent. Variables of high/low emotional clarity and attention to emotions yielded four emotional self-knowledge profiles which were analyzed for associations with mental health indicators (depression and anxiety symptoms, self-esteem, self-schema, resiliency, transcendence) in n = 264 adolescents. Here we report regression models which show that compared with neither, both high (attention + clarity) show higher positive self-schema (B = 2.83, p = 0.004), more resiliency (B = 2.76, p = 0.015) and higher transcendence (B = 82.4, p < 0.001), while high attention only is associated with lower self-esteem (B = - 3.38, p < 0.001) and more symptoms (B = 5.82, p < 0.001 for depression; B = 9.37, p < 0.001 for anxiety). High attention only is associated with most severe impairment all indicators excepting transcendence. Profiles including high clarity suggest protective effects, and 'implicit' versus 'explicit' emotional awareness are discussed. Balanced vs. imbalanced emotional self-awareness profiles dissimilarly affect mental health, which have implications for treatment and policy.

Gender inequalities in the prevalence of low mood and related factors in schooled adolescents during the 2019-2020 school year: DESKcohort project.

BACKGROUND: Mood disorders are the second most prevalent mental disorders in childhood and adolescence. Many undiagnosed people manifest subthreshold symptoms, like low mood, and present worse prognoses than asymptomatic healthy subjects. The aim of this study was to estimate the prevalence of low mood, gender inequalities, and associated factors, in 12- to 18-year-old adolescents in the rural and medium-sized urban areas of Central Catalonia during the 2019-2020 academic year. METHODS: Cross-sectional study with data from a cohort of high-schooled students (2019-2020), with a convenience sample of 6428 adolescents from the Central region of Catalonia (48.3 % boys and 51.7 % girls). Prevalence of low mood was estimated by gender and exposure variables, and ratios were obtained using Poisson regression models, adjusting for several exposure variables one by one, and for all of them jointly. RESULTS: The prevalence of low mood was 18.6 %, with statistically significant differences between genders (11.6 %, 95 % CI: 10.5-12.8 in boys and 25.1 %, 95 % CI: 23.7-26.6 in girls). Being an immigrant, dieting, and daily tobacco smoking were only associated with low mood in girls, whereas risky alcohol consumption was only associated in boys. Sexual violence was found to account for 36.2 % of low mood problems in girls. LIMITATIONS: The main limitation of the study is its cross-sectional design, which means that no casual relationships can be extracted of this study. CONCLUSIONS: The prevalence of low mood varies between the sexes, highlighting the importance of developing gender-specific interventions to reduce its incidence in young people, considering the factors associated with this condition.

Anxiety and Depression: The Moderating Effects of Attention to Emotion and Emotional Clarity.

Anxiety and depression are the most common mental health problems. They often occur together and significantly affect well-being and daily functioning. However, it is unclear to what extent the two dimensions of meta-mood knowledge play a role in their comorbidity. Therefore, the aim of the current study was to examine the role of attention to emotion and emotional clarity in the relationship between anxiety and depression. A sample of 256 adults aged 32-66 years (M = 46.21, SD = 5.53; 82.03% women) completed questionnaires on anxiety, depression, and meta-mood knowledge. Results showed that emotional clarity buffered the relationship between anxiety and depression. In addition, all combinations of attention to emotion and emotional clarity showed a significant and positive relationship with anxiety and depression symptom severity, with one exception. Interestingly, there was no statistically significant relationship between anxiety and depression when attention to emotion was low and emotional clarity was high. This last condition was interpreted as beneficial rather than detrimental, which in turn could help promote psychological resilience to better cope with emotional difficulties. Given these findings, this study highlights the role of attention to emotion and emotional clarity in assessing anxiety and risk of comorbid depression.

Self- but not other-mentalizing moderates the association between BPD symptoms and somatic complaints in community-dwelling adolescents.

OBJECTIVES: The aim of this study was to evaluate the potential moderator role of poor mentalization in the association between borderline personality disorder (BPD) traits and somatization, specifically focusing on the polarities of self- and other-mentalizing. DESIGN: This is a cross-sectional, general population study evaluating adolescents (n = 162, 61.3% female; ages 12-18, M = 14.63, SD = 1.02). The relationship between BPD traits and somatization was evaluated with self-mentalization (attention to emotions and clarity of emotions) and other-mentalizing as moderator variables. METHODS: One hundred sixty-two adolescents without serious mental health disorders were evaluated using self-report measures for borderline personality disorder traits (screening questionnaire for the Structured Clinical Interview for DSM-IV Personality Disorders (SCID-II), somatic symptoms using the Somatic Symptoms Questionnaire (SSQ), self-mentalizing using the Trait Meta-Mood Scale-24 (TMMS) and other-mentalizing using the Adolescent Mentalizing Interview (AMI)). Linear regressions were conducted to test the moderation effects of self- and other-mentalizing in the relationship between BPD symptoms and somatic complaints, controlling for age and sex. Moderation analysis was conducted using PROCESS version 3.5. RESULTS: The association between BPD symptoms and somatic complaints was moderated by a self-mentalizing dimension (emotional clarity) (b = -0.019, 95% CI = -0.0379 to -0.0002, p = .0476), but not other-mentalizing (b = 0.027, 95% CI = 0.000 to 0.053, p = .051). The effect of BPD symptoms on somatization disappears when emotional clarity is high, regardless the level of attention to emotions. CONCLUSIONS: Self-mentalizing appears to be an adaptive skill as it attenuates the relationship between BPD traits and somatization. Specifically, emotional clarity rather than simple attention to emotions is the aspect of self-mentalizing attenuating this association. These results support that self-mentalization is an important function in the management of body-associated emotions even in non-clinical levels of BPD traits. Findings suggest that strengthening self-mentalizing skills across development might contribute to resilience and salutogenesis.

Self- but Not Other-Dimensions of Mentalizing Moderate the Impairment Associated With Social Anxiety in Adolescents From the General Population.

Mentalizing, or social cognition, refers to the brain's higher order capacity that allows humans to be aware of one's own and others' mental states (e.g., emotions, feelings, intentions). While cognition in social anxiety has been broadly analyzed, there is a paucity of research regarding the role of social cognition. Moreover, mentalizing or social cognition research is traditionally focused on the understanding of others' mental states, rather than self-mentalizing. Finally, most studies analyze the role of social cognition in the development or maintenance of social anxiety, yet no study to date has analyzed whether social cognition moderates functional impairment associated with it. This study analyzes whether self- and other-mentalizing moderate the relationship between social anxiety and impairment in social and self-functioning. A sample of 262 adolescents from the non-clinical population was assessed on measures of social anxiety, self- and other- mentalization, indicators of social functioning (social competence and sociometric status), and indicators of self-functioning (depression and self-esteem). Multiple linear regressions were conducted to test possible moderation effects of self-mentalizing and other-mentalizing on the relationships between social anxiety and social and self-functioning. Results revealed that other-mentalizing does not moderate social- nor self-functioning, while self-mentalizing moderates the impairment of all of them. While impairment in social functioning is buffered by one dimension of self-mentalizing (emotional clarity; b = 0.003, p = 0.043 and b = 0.016, p = 0.008 for social competence and sociometric status, respectively), impairment in self-functioning is strengthened by the other dimension (attention to emotions; b = -0.007, p = 0.008 and b = 0.009, p = 0.047 for self-esteem and depression, respectively). Probing the moderation at the 16th, 50th, and 84th percentiles revealed that the negative imbalance between dimensions (i.e., high attention and low clarity) tended to exacerbate impairment most on all indicators, while the positive imbalance (i.e., low attention and high clarity) was usually the most buffering condition. This supports that "low-flying" or implicit mentalizing provides more resilience than explicit mentalizing (i.e., high attention and high clarity). Findings suggest that the work on emotional self-awareness should be stressed in the intervention of the social anxiety spectrum conditions in order to improve prevention, functioning, and ultimately, treatments, of people impaired by symptoms of social anxiety.

Self and Other Mentalizing Polarities and Dimensions of Mental Health: Association With Types of Symptoms, Functioning and Well-Being.

Research suggests that the ability to understand one's own and others' minds, or mentalizing, is a key factor for mental health. Most studies have focused the attention on the association between global measures of mentalizing and specific disorders. In contrast, very few studies have analyzed the association between specific mentalizing polarities and global measures of mental health. This study aimed to evaluate whether self and other polarities of mentalizing are associated with a multidimensional notion of mental health, which considers symptoms, functioning, and well-being. Additionally, the level or depth of mentalizing within each polarity was also analyzed. A sample of 214 adolescents (12-18 years old, M = 14.7, and SD = 1.7; 53.3% female) was evaluated on measures of self- (Trait Meta-Mood Scale or TMMS-24) and other- mentalizing (Adolescent Mentalizing Interview or AMI), multi-informed measures of psychopathology and functioning based on Achenbach's system, and measures of psychological well-being (self-esteem, happiness, and motivation to life goals). Results revealed no association between mentalizing polarities and higher-order symptom factors (internalizing, externalizing, and global symptoms or "p" factor). Self-mentalizing was associated with self-esteem (B = 0.076, p < 0.0005) and motivation to life goals (B = 0.209, p = 0.002), and other-mentalizing was associated to general, social and role functioning (B = 0.475, p < 0.0005; B = 0.380, p = 0.005; and B = 0.364, p = 0.004). This association between aspects of self-other mentalizing and self-other function has important implications for treatment and prevention. Deeper mentalizing within each polarity (i.e., comprehension beyond simple attention to one's own mental states, and mentalizing referred to attachment figures vs. mentalizing referred to the characters of a story) revealed stronger associations with functioning and well-being. Because mentalizing polarities are associated with functioning and well-being but not with symptoms, a new hypothesis is developed: mentalizing does not contribute to resiliency by preventing symptoms, but by helping to deal with them, thus improving functioning and well-being independently of psychopathology. These findings support that promoting mentalizing across development may improve mental health, even in non-clinical population.

Emotional Comprehension Is Not Related to Duration of Distress from Daily Life Events.

The main aim of this paper is to analyze to what extent insight (i.e., mentalization referring to one's own mental state) moderates recovering from daily life events. A total of 110 participants (84.5% women; mean age: M = 21.5; SD = 3.2) filled in the Trait Meta-Mood Scale (TMMS-24) and the Eysenck Personality Questionnaire (EPQ-R), and were interviewed about impairment derived from daily life events (everyday life stresses) during the past year. Multivariate regression models were adjusted for neuroticism, sex, and socioeconomic status to analyze whether different degrees of insight moderated the relationship between the intensity and the duration of emotional distress. Results showed that the global measure of insight did not moderate recovering from daily-life distress. Regarding the subdimensions, attention to emotional reactions was related to an increased duration of distress. Results showed that, against our hypothesis, deeper comprehension of emotional reactions, operationalized here as "true insight", was not associated to faster recovery. Limitations and recommendations for further studies are discussed considering these results.

Tools to assess the measurement properties of quality of life instruments: a meta-review.

OBJECTIVE: This meta-review aims to discuss the methodological, research and practical applications of tools that assess the measurement properties of instruments evaluating health-related quality of life (HRQoL) that have been reported in systematic reviews. DESIGN: Meta-review. METHODS: Electronic search from January 2008 to May 2020 was carried out on PubMed, CINAHL, PsycINFO, SCOPUS, WoS, Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) database, Google Scholar and ProQuest Dissertations and Theses. RESULTS: A total of 246 systematic reviews were assessed. Concerning the quality of the review process, some methodological shortcomings were found, such as poor compliance with reporting or methodological guidelines. Regarding the procedures to assess the quality of measurement properties, 164 (66.6%) of reviewers applied one tool at least. Tool format and structure differed across standards or scientific traditions (ie, psychology, medicine and economics), but most assess both measurement properties and the usability of instruments. As far as the results and conclusions of systematic reviews are concerned, only 68 (27.5%) linked the intended use of the instrument to specific measurement properties (eg, evaluative use to responsiveness). CONCLUSIONS: The reporting and methodological quality of reviews have increased over time, but there is still room for improvement regarding adherence to guidelines. The COSMIN would be the most widespread and comprehensive tool to assess both the risk of bias of primary studies, and the measurement properties of HRQoL instruments for evaluative purposes. Our analysis of other assessment tools and measurement standards can serve as a starting point for future lines of work on the COSMIN tool, such as considering a more comprehensive evaluation of feasibility, including burden and fairness; expanding its scope for measurement instruments with a different use than evaluative; and improving its assessment of the risk of bias of primary studies. PROSPERO REGISTRATION NUMBER: CRD42017065232.

Video conference vs face-to-face group psychotherapy for distressed cancer survivors: A randomized controlled trial.

OBJECTIVE: This study assesses the effectiveness of face-to-face group positive psychotherapy for cancer survivors (PPC) compared to its online adaptation, online group positive psychotherapy for cancer survivors (OPPC), which is held via videoconference. A two-arm, pragmatic randomized controlled trial was conducted to examine the effects of both interventions on emotional distress, post-traumatic stress symptoms (PTSS), and post-traumatic growth (PTG) among cancer survivors and analyze attrition to treatment. METHODS: Adult women with a range of cancer diagnoses were invited to participate if they experienced emotional distress at the end of their primary oncological treatment. Emotional distress, PTSS, and PTG were assessed at baseline, immediately after treatment, and 3 months after treatment. Intention-to-treat analyses were carried out using general linear mixed models to test the effect of the interventions overtime. Logistic regressions were performed to test differential adherence to treatment and retention to follow-up. RESULTS: A total of 269 individuals participated. The observed treatment effect was significant in both modalities, PPC and OPPC. Emotional distress (b = -2.24, 95% confidence interval [CI] = -3.15 to -1.33) and PTSS (b = -3.25, 95% CI = -4.97 to -1.53) decreased significantly over time, and PTG (b = 3.08, 95% CI = 0.38-5.78) increased significantly. Treatment gains were sustained across outcomes and over time. Analyses revealed no significant differences between modalities of treatment, after adjusting for baseline differences, finding that OPPC is as effective and engaging as PPC. CONCLUSIONS: The OPPC treatment was found to be effective and engaging for female cancer early survivors. These results open the door for psycho-oncology interventions via videoconference, which are likely to lead to greater accessibility and availability of psychotherapy.

Method effects associated with negatively and positively worded items on the 12-item General Health Questionnaire (GHQ-12): results from a cross-sectional survey with a representative sample of Catalonian workers.

OBJECTIVE: Recent studies into the factorial structure of the 12-item version of the General Health Questionnaire (GHQ-12) have shown that it was best represented by a single substantive factor when method effects associated with negatively worded (NW) items are considered. The purpose of the present study was to examine the presence of method effects, and their relationships with demographic covariates, associated with positively worded (PW) and/or NW items. DESIGN: A cross-sectional, observational study to compare a comprehensive set of confirmatory factor models, including method effects associated with PW and/or NW items with GHQ-12 responses. SETTING: Representative sample of all employees living in Catalonia (Spain). PARTICIPANTS: 3050 participants (44.6% women) who responded the Second Catalonian Survey of Working Conditions. RESULTS: A confirmatory factor analysis showed that the best fitting model was a unidimensional model with two additional uncorrelated method factors associated with PW and NW items. Furthermore, structural equation modelling (SEM) revealed that method effects were differentially related to both the sex and age of the respondents. CONCLUSION: Individual differences related to sex and age can help to identify respondents who are prone to answering PW and NW items differently. Consequently, it is desirable that both the constructs of interest as well as the effects of method factors are considered in SEM models as a means of avoiding the drawing of inaccurate conclusions about the relationships between the substantive factors.

Hypermentalizing in Social Anxiety: Evidence for a Context-Dependent Relationship.

Social anxiety (SA) means fear of scrutiny and of others' negative evaluation, thus indicating that hypermentalizing (HMZ) (i.e., the over-attribution of intentions and thoughts to others) might be the most common error of social cognition in SA. However, evidence for this is weak. One explanation is that HMZ is not stable in SA, but rather context-dependent. The first aim of the current study was testing this hypothesis. The second aim was analyzing whether the association between SA and HMZ is moderated by a negative self-image. One-hundred and thirteen young adults (85.8% females; M = 21.1 years old; SD = 2.7) were assessed on measures of SA, HMZ, and self-image. Given the over-representation of females, conclusions may not be safely extrapolated to males. Results revealed that HMZ is associated with SA only in the self-referential social situation [B = 2.68 (95% CI: 0.72-4.65), p = 0.007]. This supports that HMZ is not global in SA (i.e., a stable cognitive style), but rather is active only in some contexts. Implications for the conceptualization and treatment of SA are discussed. Contrary to predictions, neither self-esteem, nor positive or negative self-schema moderated the association between SA and self-referential HMZ. This contradicts findings in the field of paranoid delusion and requires replication, including measures of implicit self-esteem.

To know or not to know? Mentalization as protection from somatic complaints.

Somatization processes are usually associated with a lack of insight or with emotional unawareness, especially in adolescents where the ability for self-reflection is beginning to mature. However, the extent to which different levels of insight explain variations in somatization remains understudied. This study aimed to evaluate whether high-level emotional awareness (comprehension) but not low-level awareness (only attention) is needed to psychologically cope with suffering, thus leading to lower somatization. Specific predictions were: 1) High attention along with High comprehension will be associated with significantly lower frequency of somatic complaints than other combinations (Low attention and Low comprehension, or High attention but Low comprehension); 2) In absence of comprehension, no attention will be more optimal than attention only, because only-attention might work as an amplificatory of suffering without the possibility of processing it. Self-reports of meta-cognitive processes, somatization, and control variables were obtained from 264 adolescents from a non-clinical population (54.5% female; aged 12-18, M = 14.7, SD = 1.7). In line with expectations, results revealed significant differences in the effects of insight positions on somatization: Attention+Comprehension (M = 4.9, SE = 0.9) < Nothing (M = 7.1, SE = 0.3) < Only attention (M = 8.9, SE = 0.7). Compared to Nothing, Attention+comprehension was associated with significantly reduced somatic complaints (B = -2.2, p = 0.03, 95% CI -4,1 to 0.2). However, Only attention was associated with increased somatic complaints compared to the other two conditions (B = 1.8, p = 0.03, 95% CI 0.2 to 3.4; B = 4, CI 95% 1.6-6.3, p = 0.001, respectively). This highlights the role of higher-order awareness (i.e., comprehension or clarity) in the processing of suffering and stresses its value in the adaptive coping of emotional distress.

Beyond diagnosis: Mentalization and mental health from a transdiagnostic point of view in adolescents from non-clinical population.

An increasing volume of evidence suggests that mentalization (MZ) can be an important factor in the transition from mental health to mental illness and vice versa. However, most studies are focused on the role of MZ in specific disorders. This study aims to evaluate the relationship between MZ and mental health as a trans-diagnostic process. A sample of 172 adolescents aged 12 to 18 years old (M = 14.6, SD = 1.7; 56.4% of girls) was assessed on measures of MZ, psychopathology and psychological functioning from a multimethod and multi-informant perspective. Contrary to predictions, MZ was not associated with general psychopathology and comorbidity, even when explored from a broad, trans-diagnostic perspective. However, we observed a robust association linking MZ to functioning and well-being across many dimensions, involving social, role and several psychological indicators of adjustment and mental health. These results suggest that MZ may contribute to mental health beyond symptoms, not so much associated with psychopathology, but rather resilience and well-being.

Tools to assess the measurement properties of quality of life instruments: a meta-review protocol.

INTRODUCTION: Using specific tools to assess the measurement properties of health status instruments is recommended both to standardise the review process and to improve the methodological quality of systematic reviews. However, depending on the measurement standards on which these tools are developed, the approach to appraise the measurement properties of instruments may vary. For this reason, the present meta-review aims to: (1) identify systematic reviews assessing the measurement properties of instruments evaluating health-related quality of life (HRQoL); (2) identify the tools applied to assess the measurement properties of HRQoL instruments; (3) describe the characteristics of the tools applied to assess the measurement properties of HRQoL instruments; (4) identify the measurement standards on which these tools were developed or conform to and (5) compare the similarities and differences among the identified measurement standards. METHODS AND ANALYSIS: A systematic review will be conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols Guidelines. Electronic search will be carried out on bibliographic databases, including PubMed, Cumulative Index to Nursing and Allied Health Literature, Psychological Information, SCOPUS, Web of Science, COSMIN database and ProQuest Dissertations & Theses Global, being limited by time (2008-2018) and language (English). Descriptive analyses of different aspects of tools applied to evaluate the measurement properties of HRQoL instruments will be presented; the different measurement standards will be described and some recommendations about the methodological and research applications will be made. ETHICS AND DISSEMINATION: Ethical approval is not necessary for systematic review protocols. The results will be disseminated by its publication in a peer-reviewed journal and presented at a relevant conference. PROSPERO REGISTRATION NUMBER: CRD42017065232.

Three risk of bias tools lead to opposite conclusions in observational research synthesis.

OBJECTIVES: The aim of this study was to assess the agreement and compare the performance of three different instruments in assessing risk of bias (RoB) of comparative cohort studies included in a health psychology meta-analysis. STUDY DESIGN AND SETTING: Three tools were applied to 28 primary studies included in the selected meta-analysis: the Newcastle-Ottawa Scale, quality of cohort studies (Q-Coh), and risk of bias in nonrandomized studies of interventions (ROBINS-I). RESULTS: Interrater agreement varied greatly from tool to tool. For overall RoB, 75% of the studies were rated as low RoB with the Newcastle-Ottawa Scale, 11% of the studies with Q-Coh, and no study was found to be at low RoB using ROBINS-I. No influence of quality ratings on the meta-analysis results was found for any of the tools. CONCLUSION: Assessing RoB using the three tools may lead to opposite conclusions, especially at low and high levels of RoB. Domain-based tools (Q-Coh and ROBINS-I) provide a more comprehensive framework for identifying potential sources of bias, which is essential to improving the quality of future research. Both further guidance on the application of RoB tools and improvements in the reporting of primary studies are necessary.

Childhood behavioral inhibition is associated with impaired mentalizing in adolescence.

Recent advances suggest that impairment in social cognition (SC) may play a role in the development of social anxiety (SA). However, very few studies have analyzed whether SA fosters poorer social-cognitive development as it leads to social avoidance. This study aimed to analyze whether retrospectively assessed behavioral inhibition (BI) (i.e., an early form of SA) in childhood is associated with a deficit in social cognition operationalized as impairment of mentalizing (MZ) in adolescence. A sample of 256 adolescents (range: 12-18 years; mean age: 14.7 years; SD = 1.7) from general population were assessed for MZ capacities and retrospective BI through self-report and interview measures. Results comparing three groups of adolescents with different levels of childhood BI (low, moderate or high) and controlling for concurrent SA and depression reveal that the higher the level of BI, the lower the level of MZ. These results were consistent for almost all mentalization measures, including when both extreme (i.e., high vs. low BI) and non-extreme (i.e., high vs. moderate BI) were compared in both self-report and interview measures and in both dimensions of MZ (i.e., MZ referred to others' and to own mental states). These findings support that childhood forms of SA are associated to deficit in SC in adolescence. A possible bi-directional relationship between SA and SC, and the role that it may play in the pathway to clinical SA are discussed.

Instruments to assess patient comfort during hospitalization: A psychometric review.

AIM: To analyse the psychometric properties and the utility of instruments used to measure patient comfort, physical, social, psychospiritual and/or environmental, during hospitalization. BACKGROUND: There are no systematic reviews nor psychometric reviews of instruments used to measure comfort, which is considered an indicator of quality in health care associated with quicker discharges, increased patient satisfaction and better cost-benefit ratios for the institution. DESIGN: Psychometric review. DATA SOURCES: MEDLINE, CINAHL, PsycINFO, Web of Knowledge, ProQuest Thesis&Dissertations, Google. REVIEW METHODS: We limited our search to studies published between 1990-2015. The psychometric analysis was performed using the COnsensus-based Standards for the selection of health status Measurement INstruments (COSMIN), along with the Quality Criteria for Measurement Properties. The utility of the instruments was assessed according to their cost-efficiency, acceptability and educational impact. Protocol registration in PROSPERO, CRD42016036290. RESULTS: Instruments reviewed showed moderate methodological quality and their utility was poorly reported. Thus, we cannot recommend any questionnaire without reservations, but the Comfort Scale, the General Comfort Questionnaire and their adaptations in adults and older patients, the Psychosocial Comfort Scale and the Incomfort des Patients de Reanimation are the most recommendable instruments to measure comfort. CONCLUSIONS: The methodology of the studies should be more rigorous and authors should adequately report the utility of instruments. This review provides a strategy to select the most suitable instrument to assess patient comfort according to their psychometric properties and utility, which is crucial for nurses, clinicians, researchers and institutions.

Benefits of the humidified low-flow oxygen therapy in infants with mild-moderate bronchiolitis.

AIMS AND OBJECTIVES: To investigate the clinical benefits of using humidification in low-flow oxygen therapy. Specific objectives were to investigate via an assessment of the number of nasal lavages whether humidification can help to decrease the nasal mucus viscosity, to determine whether it can relieve feeding difficulties by comparing the weight gain in infants, to ascertain whether it can relieve respiratory distress by assessing the heart and respiratory rates and contribute to improved clinical outcomes, measured by the length of stay and oxygen requirements. BACKGROUND: There is no evidence to support the use of humidification in low-flow oxygen therapy as a usual clinical practice in the management of bronchiolitis. DESIGN: A controlled quasi-experimental study. METHODS: A total of 97 infants were included, aged ≤6 months, with bronchiolitis, low-flow oxygen therapy and bronchodilators nebulised with hypertonic saline 3%. Data from the control group (nonhumidified) were gathered from 2010-2012 (49 infants), and data from the group with humidification from 2012-2014 (48 infants). Linear and Poisson regressions were performed adjusting for relevant characteristics of patients. RESULTS: Humidification was shown to be associated with significant reductions in the number of nasal lavages in infants with Sant Joan de Déu Bronchiolitis Scores of BROSJOD≤7, in the heart rate of infants with mixed bronchodilators treatment, and in the length of stay and oxygen requirements of infants with Score BROSJOD≤5. No differences in weight and respiratory rate were found. CONCLUSIONS: Humidification in low-flow oxygen therapy is an effective nursing intervention to improve the clinical outcomes of infants with mild-moderate bronchiolitis. RELEVANCE TO CLINICAL PRACTICE: Humidifying the nasal mucosa can help to reduce the need for professional procedures, oxygen requirements and hospitalisation length. Further research into the economic savings involved is recommended.

Methodological quality is underrated in systematic reviews and meta-analyses in health psychology.

OBJECTIVES: In this paper, we compile and describe the main approaches proposed in the literature to include methodological quality (MQ) or risk of bias (RoB) into research synthesis. We also meta-review how the RoB of observational primary studies is being assessed and to what extent the results are incorporated in the conclusions of research synthesis. STUDY DESIGN AND SETTING: Electronic databases were searched for systematic reviews or meta-analyses related to health and clinical psychology. A random sample of 90 reviews published between January 2010 and May 2016 was examined. RESULTS: A total of 46 reviews (51%) performed a formal assessment of the RoB of primary studies. Only 17 reviews (19%) linked the outcomes of quality assessment with the results of the review. CONCLUSION: According to the previous literature, our results corroborate the lack of guidance to incorporate the RoB assessment in the results of systematic reviews and meta-analyses. Our recommendation is to appraise MQ according to domains of RoB to rate the degree of credibility of the results of a research synthesis, as well as subgroup analysis or meta-regression as analytical methods to incorporate the quality assessment.

Positive psychotherapy for distressed cancer survivors: Posttraumatic growth facilitation reduces posttraumatic stress.

There is increasing evidence that positive life changes, such as posttraumatic growth (PTG), can result from the experience of coping with cancer. However, no interventions have been specifically designed to facilitate the development of PTG in cancer. In this article, we describe and assess the results of Positive Psychotherapy for Cancer (PPC) survivors. It aims to facilitate PTG as a way of achieving significant reductions in the symptoms of emotional distress and posttraumatic stress. In addition, the corroboration of this PTG facilitation is assessed using interpersonal indicators. Method: We allocated 126 consecutive survivors of cancer with high levels of emotional distress and who were seeking psychological support to either an experimental group (PPC) or a waiting list group. Results: The PPC group obtained significantly better results after treatment than the control group, showing reduced distress, decreased posttraumatic symptoms, and increased PTG. The benefits were maintained at 3 and 12 months' follow-up. Participants' PTG was correlated to the PTG that their significant others attributed to them, corroborating PTG facilitation. Conclusions: PPC appears to promote significant long-term PTG and can reduce emotional distress and posttraumatic stress in cancer survivors. In addition, PTG facilitation induced by PPC is corroborated by significant others.

ANTECEDENTES/OBJETIVO: La evidencia científica muestra la importante presencia de cambios vitales positivos, como el crecimiento postraumático (CPT), tras afrontar un cáncer. Sin embargo, ninguna intervención ha sido específicamente diseñada para facilitar el CPT en pacientes con cáncer. En este artículo, se describen y evalúan los resultados de la Psicoterapia Positiva dirigida a supervivientes de Cáncer (PPC), diseñada para facilitar el CPT como vía para reducir el malestar emocional y estrés postraumático. Utilizamos indicadores interpersonales para validar la autenticidad del CPT. Método: Ciento veintiséis supervivientes de cáncer con elevados niveles de malestar emocional fueron consecutivamente asignados al grupo experimental (PPC) o al grupo de lista de espera. Resultados: El grupo de PPC obtuvo significativamente mejores resultados después del tratamiento que el grupo control, mostrando una reducción del malestar psicológico, de los síntomas de estrés postraumático y un incremento del CPT. Los beneficios se mantuvieron a los 3 y 12 meses. El CPT fue corroborado por los seres queridos de los participantes. Conclusiones: La PPC parece promover de forma significativa el CPT y reduce el malestar emocional y el estrés postraumático en supervivientes de cáncer. Además, la facilitación de CPT inducido por la PPC es corroborada por los seres queridos.