A network model of depressive and anxiety symptoms: a statistical evaluation.

BACKGROUND: Although network analysis studies of psychiatric syndromes have increased in recent years, most have emphasized centrality symptoms and robust edges. Broadening the focus to include bridge symptoms within a systematic review could help to elucidate symptoms having the strongest links in network models of psychiatric syndromes. We conducted this systematic review and statistical evaluation of network analyses on depressive and anxiety symptoms to identify the most central symptoms and bridge symptoms, as well as the most robust edge indices of networks. METHODS: A systematic literature search was performed in PubMed, PsycINFO, Web of Science, and EMBASE databases from their inception to May 25, 2022. To determine the most influential symptoms and connections, we analyzed centrality and bridge centrality rankings and aggregated the most robust symptom connections into a summary network. After determining the most central symptoms and bridge symptoms across network models, heterogeneity across studies was examined using linear logistic regression. RESULTS: Thirty-three studies with 78,721 participants were included in this systematic review. Seventeen studies with 23 cross-sectional networks based on the Patient Health Questionnaire (PHQ) and Generalized Anxiety Disorder (GAD-7) assessments of clinical and community samples were examined using centrality scores. Twelve cross-sectional networks based on the PHQ and GAD-7 assessments were examined using bridge centrality scores. We found substantial variability between study samples and network features. 'Sad mood', 'Uncontrollable worry', and 'Worrying too much' were the most central symptoms, while 'Sad mood', 'Restlessness', and 'Motor disturbance' were the most frequent bridge centrality symptoms. In addition, the connection between 'Sleep' and 'Fatigue' was the most frequent edge for the depressive and anxiety symptoms network model. CONCLUSION: Central symptoms, bridge symptoms and robust edges identified in this systematic review can be viewed as potential intervention targets. We also identified gaps in the literature and future directions for network analysis of comorbid depression and anxiety.

Resting-state brain activity as a biomarker of chronic pain impairment and a mediator of its association with pain resilience.

Past cross-sectional chronic pain studies have revealed aberrant resting-state brain activity in regions involved in pain processing and affect regulation. However, there is a paucity of longitudinal research examining links of resting-state activity and pain resilience with changes in chronic pain outcomes over time. In this prospective study, we assessed the status of baseline (T1) resting-state brain activity as a biomarker of later impairment from chronic pain and a mediator of the relation between pain resilience and impairment at follow-up. One hundred forty-two adults with chronic musculoskeletal pain completed a T1 assessment comprising a resting-state functional magnetic resonance imaging scan based on regional homogeneity (ReHo) and self-report measures of demographics, pain characteristics, psychological status, pain resilience, pain severity, and pain impairment. Subsequently, pain impairment was reassessed at a 6-month follow-up (T2). Hierarchical multiple regression and mediation analyses assessed relations of T1 ReHo and pain resilience scores with changes in pain impairment. Higher T1 ReHo values in the right caudate nucleus were associated with increased pain impairment at T2, after controlling for all other statistically significant self-report measures. ReHo also partially mediated associations of T1 pain resilience dimensions with T2 pain impairment. T1 right caudate nucleus ReHo emerged as a possible biomarker of later impairment from chronic musculoskeletal pain and a neural mechanism that may help to explain why pain resilience is related to lower levels of later chronic pain impairment. Findings provide empirical foundations for prospective extensions that assess the status of ReHo activity and self-reported pain resilience as markers for later impairment from chronic pain and targets for interventions to reduce impairment. PRACTITIONER POINTS: Resting-state markers of impairment: Higher baseline (T1) regional homogeneity (ReHo) values, localized in the right caudate nucleus, were associated with exacerbations in impairment from chronic musculoskeletal pain at a 6-month follow-up, independent of T1 demographics, pain experiences, and psychological factors. Mediating role of ReHo values: ReHo values in the right caudate nucleus also mediated the relationship between baseline pain resilience levels and later pain impairment among participants. Therapeutic implications: Findings provide empirical foundations for research extensions that evaluate (1) the use of resting-state activity in assessment to identify people at risk for later impairment from pain and (2) changes in resting-state activity as biomarkers for the efficacy of treatments designed to improve resilience and reduce impairment among those in need.

Pain Catastrophizing Dimensions Mediate the Relationship between Chronic Pain Severity and Depression.

BACKGROUND: Although past studies have found significant positive correlations of both pain severity and overall pain catastrophizing (PC) levels with depression in chronic pain samples, less is known about the extent to which specific PC dimensions (i.e., helplessness, magnification, rumination) explain links between pain severity and depression. AIM: This study assessed the relative importance of PC dimensions as mediators of relations between chronic pain severity and depression. DESIGN: A cross sectional study design was employed. METHOD: Mainland Chinese adults with chronic pain (n = 983) completed validated questionnaire measures of PC, depression, and chronic pain severity within a cross-sectional research design. RESULTS: Analyses indicated helplessness mediated the association between pain severity and depression while magnification partially mediated the association of helplessness with depression. Conversely, rumination did not make a significant contribution in the mediation model. CONCLUSIONS: The helplessness dimension of PC, in particular, may help to explain why people with more severe chronic pain are prone to co-occurring depression.

Testing links between unfavorable living conditions, fast life-history strategy adoption, and overeating: a four-wave longitudinal study.

Although overeating increases risk for chronic illness and premature mortality, evolutionary life-history theorists posit that such behaviors arise as a potential outcome of using fast life-history strategies to function in environments that are harsh or unpredictable. To test this premise, we examined links between harsh, unpredictable living conditions (HULC), the adoption of fast life-history (LH) strategies, and overeating among early adolescents using a four-wave longitudinal design. Participants were 2547 Chinese adolescents (1202 girls, 1345 boys) who completed baseline questionnaires assessing experiences of HULC, preferences for use of fast LH strategies, and overeating. Measures were re-administered in follow-ups 7, 13, and 20 months later. Analyses indicated HULC predicted increased use of fast LH strategies within each gender. However, fast LH strategy adoption contributed to increases in overeating only among girls. Findings supported specific tenets of life-history theory and underscored gender as an important consideration in understanding links between living conditions, the adoption of fast LH strategies, and risk for overeating. Interventions focused on reducing poverty and increasing stable, nurturing family, and community environments may aid in reducing overeating and obesity for adolescents.

Worldwide prevalence of mild cognitive impairment among community dwellers aged 50 years and older: a meta-analysis and systematic review of epidemiology studies.

BACKGROUND: Mild cognitive impairment (MCI) is the preclinical and transitional stage between healthy ageing and dementia that may be a potential 'target' for interventions designed to delay progression to dementia. In this systematic review and meta-analysis, we assessed the prevalence of MCI worldwide in community-dwelling adults aged 50 years and older. METHODS: PubMed, Web of Science, Embase and PsycINFO database searches were conducted from their respective inception dates to 1 September 2021. Data on the overall prevalence of MCI were synthesised using random effects models. RESULTS: A total of 66 articles covering 242,804 participants fulfilled study criteria for inclusion. The overall prevalence of MCI was 15.56% (95%CI: 13.24-18.03%). Prevalence rates of amnestic MCI and non-amnestic MCI were 10.03% (95%CI: 7.98-12.27%) and 8.72% (95%CI: 6.78-10.89%), respectively. The prevalence of MCI increased with age and decreased with education level. Subgroup and meta-regression analyses revealed that region of study site and male gender proportion per sample were significant correlates of MCI prevalence. CONCLUSION: The global prevalence of MCI among community dwellers is over 15% and is affected by age, gender, education level and region of study sites. Assessment and interventions targeting MCI within at-risk population subgroups should be considered toward the prevention of dementia.

COVID-19-related stigma and its sociodemographic correlates: a comparative study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is closely associated with physical and mental health problems; however, little is known about the severity of stigma caused by COVID-19 among its survivors. Thus, the aim of this study was to compare differences in stigma experiences of COVID-19 survivors versus healthy controls after the COVID-19 outbreak peak in China. METHODS: This cross-sectional study comprised 154 COVID-19 survivors and 194 healthy controls recruited through consecutive and convenience sampling methods, respectively. COVID-19 related stigma was measured by the Social Impact Scale (SIS). Stigma differences between the two groups were compared with analysis of covariance (ANCOVA) and a generalized linear model (GLM) was used to identify independent correlates of COVID-19-related stigma in this study. RESULTS: Compared with healthy controls, COVID-19 survivors reported more overall stigma (F(1,347) = 60.82, p < 0.001), and stigma in domains of social rejection (F(1,347) = 56.54, p < 0.001), financial insecurity (F(1,347) = 19.96, p < 0.001), internalized shame (F(1,347) = 71.40, p < 0.001) and social isolation (F(1,347) = 34.73, p < 0.001). Status as a COVID-19 survivor, having family members infected with COVID-19, being married, economic loss during the COVID-19 pandemic, and depressive symptoms were positively associated with higher overall stigma levels (all p values < 0.05). CONCLUSION: COVID-19-related stigma is commonly experienced among COVID-19 survivors even though the outbreak has been well-contained in China. Routine assessment of stigma experiences should be conducted on COVID-19 survivors and appropriate psychological assistance, public education, and anti-stigma campaigns and policies should be enforced to reduce stigma within this vulnerable subpopulation.

Physical activity and sleep differences between osteoarthritis, rheumatoid arthritis and non-arthritic people in China: objective versus self report comparisons.

BACKGROUND: Objectively measured differences in physical activity (PA) and sleep have been documented among people with osteoarthritis (OA) and rheumatoid arthritis (RA) compared to non-arthritic controls. However, it is not clear whether OA and RA subgroups also differ on these indexes or the extent to which distinct arthritis subgroups versus controls can be accurately identified on the basis of objective PA and sleep indexes compared to self-report responses on questionnaires. This study addressed these gaps. METHODS: This case-control study comprised Chinese adults with OA (N = 40) or RA (N = 40) diagnoses based on physician assessments as well as a control group of adults without chronic pain (N = 40). All participants wore a Sensewear Armband (SWA) for consecutive 7 days and completed the International Physical Activity Questionnaire Short Form-Chinese as well as Pittsburgh Sleep Diary to obtain objective and subjective PA and sleep data, respectively. RESULTS: There were no differences between the three groups on any self-report indexes of PA or sleep. Conversely, OA and RA subgroups displayed significantly lower PA levels and more sleep problems than controls did on a majority of SWA indexes, though arthritis subgroups were not differentiated from one another on these measures. Logistic regression analyses indicated four non-multicollinear SWA indexes (i.e., steps, active energy expenditure, vigorous activity, time awake after sleep onset) correctly identified the subgroup membership of 75.0-82.5% of participants with RA or OA while classification accuracy results were attenuated for controls. CONCLUSIONS: Where possible, objective measures should be used to assess PA and sleep of adults with OA and RA while particular self-report PA questionnaires should be used sparingly.

Factor Structure and Construct Validity of the Pain Resilience Scale Within Chinese Adult Chronic Musculoskeletal Pain Samples.

Recent U.S. studies of musculoskeletal pain have supported the structure and construct validity of the Pain Resilience Scale (PRS) as a pain-specific measure tapping capacities to regulate cognitions and emotions as well as behavioral perseverance despite ongoing pain. However, it is not clear whether psychometric support for the PRS extends to chronic musculoskeletal pain samples in other countries or whether PRS scores contribute to adaptation beyond the impact of general resilience. To address these gaps, the factor structure, construct validity, and incremental validity of the PRS were assessed in exploratory factor analysis (EFA; 417 women, 134 men) and confirmatory factor analysis (CFA; 421 women, 135 men) samples of Chinese adults with chronic musculoskeletal pain who completed back-translated versions of the PRS and a battery of self-report measures previously validated in Chinese samples. A 2-factor, EFA-derived version of the PRS featuring a 7-item cognitive/affective positivity subscale and a 3-item behavioral perseverance subscale had the best overall fit from several hypothesized alternatives. Derived PRS subscales had significant moderate correlations with conceptually related measures and low correlations with conceptually less-related background characteristics, respectively. PRS subscale scores, particularly cognitive and affective positivity, accounted for significant unique variance in functioning independent of general resilience.

The Prevalence of Burnout and its Associations with Demographic Correlates and Quality of Life among Psychiatric Nurses in China.

This study examined the prevalence of burnout and its association with quality of life (QOL) among psychiatric nurses in China.Ten psychiatric hospitals were included. Burnout and QOL were measured using standardized instruments. Altogether, 1449 nurses completed the assessment. The mean scores of emotional exhaustion (EE), depersonalization (DP) and personal accomplishment (PA) were 11.87 (SD = 6.72), 6.98 (SD = 5.71) and 22.06 (SD = 8.67), respectively. Of the participants, 59.8% (95% CI: 57-62%) experienced burnout; with 23.3% (95% CI: 21-25%) in EE, 14.6% (95% CI: 13-16%) in DP and 45.1% (95% CI: 43-48%) in PA. Psychiatric nurses who reported burnout had lower QOL in social (F (1, 1448) = 86.20, P < 0.001), physical (F (1, 1448) = 170.46, P < 0.001), psychological (F (1, 1448) = 205.63, P < 0.001), and environmental (F (1, 1448) = 120.24, P < 0.001) domains. Multiple logistic regression analysis revealed that alcohol users (P = 0.04; OR = 1.29, 95%CI: 1.01-1.64 in model 1 and P = 0.03; OR = 1.32, 95%CI: 1.04-1.69 in model 2) were significantly more susceptible to burnout, while senior nurses (P = 0.007; OR = 0.70, 95%CI: 0.53-0.91) and nurses with longer work experience (P = 0.02; OR = 0.70, 95%CI: 0.53-0.91) were less likely to develop burnout. Burnout is common in psychiatric nurses in China. In light of its negative impact on health and QOL, there is an urgent need for regular screening as well as effective preventive measures and interventions to reduce burnout within this at-risk occupational group.

Arthritis self-efficacy beliefs and functioning among osteoarthritis and rheumatoid arthritis patients: a meta-analytic review.

OBJECTIVES: The Arthritis Self-Efficacy Scale (ASES) is a widely used self-report measure of beliefs reflecting confidence in one's capacity to function despite pain and control pain or other symptoms of arthritis. Despite evidence linking higher ASES scores to lower levels of impairment, pain and emotional distress, numerous modest, non-significant associations have also been observed. In this meta-analysis, we evaluated overall associations between ASES scores and adjustment in RA and OA samples as well as potential moderators that may explain the heterogeneity in these associations. METHOD: Data from 48 samples that met all 10 inclusion criteria (N = 9222 patients) were subject to analyses. RESULTS: ASES scores had significant medium average effect sizes with functional impairment, pain severity and emotional distress but substantial heterogeneity was evident for each association. ASES-impairment associations were moderated by the diagnosis, ASES version and ASES subscale content: significantly larger effect sizes were found for studies that included RA patients, used the original 20-item ASES and assessed subscale content reflecting the pursuit of daily activities despite pain (i.e. functional self-efficacy) than for studies based exclusively on OA patients, the eight-item ASES and ASES pain control and other symptom subscales. Relations of ASES scores with pain severity and emotional distress were moderated by ASES version and subscale content, respectively. CONCLUSION: The ASES has significant overall associations with key areas of functioning. Moderator analyses of the measure provide empirically grounded suggestions for optimal use of the ASES within OA and RA patient samples.

Prevalence and correlates of fatigue and its association with quality of life among clinically stable older psychiatric patients during the COVID-19 outbreak: a cross-sectional study.

BACKGROUND: The pattern of fatigue in older psychiatric patients during the COVID-19 outbreak was unknown. This study examined the prevalence of fatigue and its association with overall quality of life (overall QOL) in clinically stable older patients with psychiatric disorders during the COVID-19 outbreak. METHODS: This was a multicenter, cross-sectional study. Fatigue, depressive symptoms, pain, insomnia symptoms, and overall QOL were assessed with standardized instruments. RESULTS: A total of 1063 patients were recruited. The prevalence of fatigue was 47.1% (95%CI: 44.1-50.1%). An analysis of covariance revealed that overall QOL was significantly lower in patients with fatigue compared to those without (P = 0.011). A multiple logistic regression analysis revealed that more severe depressive symptoms (OR = 1.15, P < 0.001), insomnia symptoms (OR = 1.08, P < 0.001) and pain (OR = 1.43, P < 0.001) were significantly associated with fatigue. CONCLUSIONS: Fatigue is common among clinically stable older patients with psychiatric disorders during the COVID-19 outbreak. Considering its negative impact on overall QOL, regular assessment of fatigue and appropriate treatment warrant attention in this subpopulation.

Effects of trait fear of pain on event-related potentials during word cue presentations that signal potential pain.

People who are especially afraid of pain may display attention biases that increase their risk for developing chronic pain following an injury. However, specific neurophysiological mechanisms underlying associations between elevated trait fear of pain levels and environmental cues that signal potential pain experiences are not well understood. To address this gap, event-related potentials (ERPs) were recorded among 39 high pain-fearful (H-FOP) and 36 low pain-fearful (L-FOP) adults exposed to potentially painful somatosensory stimulation cued by sensory pain words versus non-painful stimulation cued by neutral words. H-FOP group members displayed slower reaction times in judging somatosensory stimulation and rated stimulation to be more intense than L-FOP group members did. H-FOP group members also exhibited comparatively earlier peak latencies of P2 and N2 components during word cue presentations as well as weaker P3 amplitudes in processing non-painful stimulation cued by sensory pain words. These findings suggested that, among the high trait pain-fearful, exposure to word cues signaling potential pain results in the allocation of fewer cognitive resources toward processing somatosensory stimuli that are not actually painful.

Identifying At-Risk Subgroups for Acute Postsurgical Pain: A Classification Tree Analysis.

Objective: Acute postsurgical pain is common and has potentially negative long-term consequences for patients. In this study, we evaluated effects of presurgery sociodemographics, pain experiences, psychological influences, and surgery-related variables on acute postsurgical pain using logistic regression vs classification tree analysis (CTA). Design: The study design was prospective. Setting: This study was carried out at Chongqing No. 9 hospital, Chongqing, China. Subjects: Patients (175 women, 84 men) completed a self-report battery 24 hours before surgery (T1) and pain intensity ratings 48-72 hours after surgery (T2). Results: An initial logistic regression analysis identified pain self-efficacy as the only presurgery predictor of postoperative pain intensity. Subsequently, a classification tree analysis (CTA) indicated that lower vs higher acute postoperative pain intensity levels were predicted not only by pain self-efficacy but also by its interaction with disease onset, pain catastrophizing, and body mass index. CTA results were replicated within a revised logistic regression model. Conclusions: Together, these findings underscored the potential utility of CTA as a means of identifying patient subgroups with higher and lower risk for severe acute postoperative pain based on interacting characteristics.

Trait-based food-cravings are encoded by regional homogeneity in the parahippocampal gyrus.

Food cravings can reflect an intense trait-like emotional-motivational desire to eat palatable food, often resulting in the failure of weight loss efforts. Studies have linked trait-based food-cravings to increased risk of overeating. However, little is known about resting-state neural mechanisms that underlie food cravings. We investigated this issue using resting-state functional magnetic resonance imaging (fMRI) to test the extent to which spontaneous neural activity occurs in regions implicated in emotional memory and reward motivation associated with food cravings. Spontaneous regional activity patterns correlating to food cravings were assessed among 65 young healthy women using regional homogeneity analysis to assess temporal synchronization of spontaneous activity. Analyses indicated that women with higher scores on the Food Cravings Questionnaire displayed increased local functional homogeneity in brain regions involved in emotional memory and visual attention processing (i.e., parahippocampal gyrus and fusiform gyrus) but not reward. In view of parahippocampal gyrus involvement in hedonic learning and incentive memory encoding, this study suggests that trait-based food cravings are encoded by emotional memory circuits.

Approach and inhibition responses to external food cues among average-weight women who binge eat and weight-matched controls.

Despite laboratory evidence linking impulsivity to binge-eating (BE) among people with obesity, it is unclear whether such inhibitory control deficits extend to average-weight persons who binge eat or influence actual calories consumed when such opportunities present. Towards clarifying these issues, women with higher (n = 31) and lower (n = 31) BE levels engaged in a visual Go/No-Go task comprising images of high-calorie foods, low-calorie foods, and household objects, after which they completed a self-report battery in an environment conducive to snacking. Analyses indicated these groups did not differ in task-based false alarm rates (i.e., responding when response inhibition was required) but the higher BE group reported more trait-based impulsivity, was faster and more accurate in responding to "Go" trials involving high-calorie food images, and was more likely to eat at least one snack during post-task questionnaire completion. Within the entire sample, faster "Go" trial reaction times and higher false alarm rates across image types predicted higher post-task calorie intake levels while BE status and trait impulsivity did not. In sum, average weight women who binge eat were more responsive to high calorie food cues but showed no evidence of behavioral inhibitory control deficits compared to weight-matched controls.

Pain beliefs and problems in functioning among people with arthritis: a meta-analytic review.

In this meta-analysis, we evaluated overall strengths of relation between beliefs about pain, health, or illness and problems in functioning (i.e., functional impairment, affective distress, pain severity) in osteoarthritis and rheumatoid arthritis samples as well as moderators of these associations. In sum, 111 samples (N = 17,365 patients) met inclusion criteria. On average, highly significant, medium effect sizes were observed for associations between beliefs and problems in functioning but heterogeneity was also inflated. Effect sizes were not affected by arthritis subtype, gender, or age. However, pain belief content emerged as a significant moderator, with larger effect sizes for studies in which personal incapacity or ineffectiveness in controlling pain was a content theme of belief indices (i.e., pain catastrophizing, helplessness, self-efficacy) compared to those examining locus of control and fear/threat/harm beliefs. Furthermore, analyses of longitudinal study subsets supported the status of pain beliefs risk factors for later problems in functioning in these groups.

Impulse control and restrained eating among young women: Evidence for compensatory cortical activation during a chocolate-specific delayed discounting task.

Theory and associated research indicate that people with elevated restrained eating (RE) scores have higher risk for binge eating, future bulimic symptom onset and weight gain. Previous imaging studies have suggested hyper-responsive reward brain area activation in response to food cues contributes to this risk but little is known about associated neural impulse control mechanisms, especially when considering links between depleted cognitive resources related to unsuccessful RE. Towards illuminating this issue, we used a chocolate-specific delayed discounting (DD) task to investigate relations between RE scores, behavior impulsivity, and corresponding neural impulse control correlates in a functional magnetic resonance imaging (fMRI) study of 27 young women. Specifically, participants were required to choose between more immediate, smaller versus delayed, larger hypothetical chocolate rewards following initial consumption of a chocolate. As predicted, RE scores were correlated positively with behavior impulse control levels. More critically, higher RE scores were associated with stronger activation in impulse control region, the dorsal-lateral prefrontal cortex (DLPFC) during the completion of difficult decision trials reflecting higher cognitive demands and resource depletion relative to easy decision trials. Exploratory analyses revealed a positive correlation between RE scores and activity in a reward system hub, the right striatum. Moreover, a positive correlation between left DLPFC and striatum activation was posited to reflect, in part, impulse control region compensation in response to stronger reward signal among women with RE elevations. Findings suggested impulse control lapses may contribute to difficulties in maintaining RE, particularly when cognitive demands are high.

Attention Disengagement Difficulties among Average Weight Women Who Binge Eat.

In this study, we assessed biases in attention disengagement among average-weight women with binge-eating (n = 33) and non-eating disordered controls (n = 31). Participants engaged in a spatial cueing paradigm task wherein they first observed high-calorie food, low-calorie food, or neutral images and then had to quickly locate targets in either the same or a different location. Within both groups, reaction times (RTs) were longer to valid-cued trials (i.e. target appearing in location of preceding cue) than to invalid-cued trials (i.e. targets appearing in location different from initial location), reflecting a general inhibition of return (IOR) effect. However, RT findings also indicated that women with BE had significantly more difficulty disengaging from high-calorie food images than did controls, even though neither group had disengagement problems related to other image types. Selective attention disengagement difficulties related to high-calorie food images suggested that increased reward sensitivity to such cues is related to binge eating risk. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.