Development and evaluation of a predictive algorithm and telehealth intervention to reduce suicidal behavior among university students.

BACKGROUND: Suicidal behaviors are prevalent among college students; however, students remain reluctant to seek support. We developed a predictive algorithm to identify students at risk of suicidal behavior and used telehealth to reduce subsequent risk. METHODS: Data come from several waves of a prospective cohort study (2016-2022) of college students (n = 5454). All first-year students were invited to participate as volunteers. (Response rates range: 16.00-19.93%). A stepped-care approach was implemented: (i) all students received a comprehensive list of services; (ii) those reporting past 12-month suicidal ideation were directed to a safety planning application; (iii) those identified as high risk of suicidal behavior by the algorithm or reporting 12-month suicide attempt were contacted via telephone within 24-h of survey completion. Intervention focused on support/safety-planning, and referral to services for this high-risk group. RESULTS: 5454 students ranging in age from 17-36 (s.d. = 5.346) participated; 65% female. The algorithm identified 77% of students reporting subsequent suicidal behavior in the top 15% of predicted probabilities (Sensitivity = 26.26 [95% CI 17.93-36.07]; Specificity = 97.46 [95% CI 96.21-98.38], PPV = 53.06 [95% CI 40.16-65.56]; AUC range: 0.895 [95% CIs 0.872-0.917] to 0.966 [95% CIs 0.939-0.994]). High-risk students in the Intervention Cohort showed a 41.7% reduction in probability of suicidal behavior at 12-month follow-up compared to high-risk students in the Control Cohort. CONCLUSIONS: Predictive risk algorithms embedded into universal screening, coupled with telehealth intervention, offer significant potential as a suicide prevention approach for students.

The role of self-compassion in loneliness during the COVID-19 pandemic: a group-based trajectory modelling approach.

Research has suggested an increase in loneliness during the COVID-19 pandemic, but much of this work has been cross-sectional, making causal inferences difficult. In the present research, we employed a longitudinal design to identify loneliness trajectories within a period of twelve months during the COVID-19 pandemic in Belgium (N = 2106). We were particularly interested in the potential protective role of self-compassion in these temporal dynamics. Using a group-based trajectory modelling approach, we identified trajectory groups of individuals following low (11.0%), moderate-low (22.4%), moderate (25.7%), moderate-high (31.3%), and high (9.6%) levels of loneliness. Findings indicated that younger people, women, and individuals with poor quality relationships, high levels of health anxiety, and stress related to COVID-19, all had a higher probability of belonging to the highest loneliness trajectory groups. Importantly, we also found that people high in two of the three facets of self-compassion (self-kindness and common humanity) had a lower probability of belonging to the highest loneliness trajectory groups. Ultimately, we demonstrated that trajectory groups reflecting higher levels of loneliness were associated with lower life satisfaction and greater depressive symptoms. We discuss the possibility that increasing self-compassion may be used to promote better mental health in similarly challenging situations.

Improving emotion regulation ability after brain injury: A systematic review of targeted interventions.

Emotion dysregulation is a common sequela after a brain injury, and it can have serious negative consequences for individuals, families, and the community. A systematic review of the literature was conducted to identify and evaluate interventions designed to improve emotion regulation ability in adults with acquired brain injury. Studies were identified on ProQuest, PsycInfo, ScienceDirect, Scopus, and Web of Science; last searched on 3 August 2023. A review protocol was prospectively registered on PROSPERO (CRD42020218175). Risk of bias was assessed using the Cochrane Risk-of-Bias tool (version 2). Sixteen studies were included in the review comprising one case series, five pilot studies, four pre-post studies, and six RCTs. There was a total of 652 participants across studies. Fourteen of the sixteen studies reported statistically significant improvements in at least one emotional functioning variable. Ten studies reported medium-large effect sizes. Limitations included inconsistency in the measurement, reporting of intervention outcomes and processes. Future directions are discussed.

Construct Validity and Measurement Invariance of the Difficulties in Emotion Regulation Scale - Short Form (DERS-SF): Further Evidence From Community and Student Samples.

The current study aimed to evaluate the psychometric properties of the Difficulties in Emotion Regulation Scale-Short Form (DERS-SF) in Iran, including testing its measurement invariance across sexes, as well as community and student populations. Two samples were recruited: a community sample of 583 participants (58.7% female; Mage = 33.55) and a university student sample of 409 participants (67.2% female; Mage = 24.48). Besides the DERS-SF, participants completed a battery of instruments online, measuring mentalizing capacity and borderline personality features. Confirmatory factor analyses supported the tenability of the five-factor model, excluding the awareness subscale. Except for the awareness subscale, acceptable to excellent internal consistencies were found for the DERS-SF and its subscales. The awareness-excluded DERS-SF was significantly and strongly associated with relevant constructs (|rs| = .49 to .59). This study also found evidence for configural, metric, and scalar invariance of the DERS-SF across sexes and community and student populations. Our findings extended the evidence for the validity and reliability of the DERS-SF and its awareness-excluded version by administering it in Iranian samples and supporting its cross-cultural applicability.

Assessing Emotion Regulation across Asian and Western Cultures: Psychometric Properties of Three Common Scales across Singaporean and Australian Samples.

Given the differences in emotion regulation across cultures, it is paramount to ensure that measures of emotion regulation measure the same construct and that conceptualizations of emotion regulation are valid across cultures. Therefore, the present study assessed the measurement invariance (alongside other psychometric properties) of three popular emotion regulation questionnaires, the Emotion Regulation Questionnaire (ERQ), Difficulties in Emotion Regulation Scale (DERS), and the Perth Emotion Regulation Competency Inventory (PERCI), across 434 Singaporeans and 489 Australians. Our study showed that all three questionnaires were measurement invariant, had excellent internal consistency, and relatively good concurrent validity with psychopathology and alexithymia across our Singaporean and Australian sample, justifying their use in comparing Asian and Western cultures. Our findings suggest that measures of emotion regulation have utility across both individualistic and collectivistic cultures. Our findings supports the use of these measures in cross-cultural research and provides support for the utility for personality assessments across cultures.

Cross-cultural adaptation and clinical application of the Perth Empathy Scale.

OBJECTIVE: Alterations of empathy have been observed in patients with various mental disorders. The Perth Empathy Scale (PES) was recently developed to measure a multidimensional construct of empathy across positive and negative emotions. However, its psychometric properties and clinical applications have not been examined in the Chinese context. METHODS: The Chinese version of the PES was developed and administered to a large Chinese sample (n = 1090). Factor structure, internal consistency, test-retest reliability, and convergent, discriminant, as well as concurrent validity were examined. Moreover, 50 patients with major depressive disorder (MDD) and 50 healthy controls were recruited to explore the clinical utility of the PES. RESULTS: Confirmatory factor analyses supported a theoretically congruent three-factor structure of empathy, namely Cognitive Empathy, Negative Affective Empathy and Positive Affective Empathy. The PES showed good to excellent internal consistency reliability, good convergent and discriminant validity, acceptable concurrent validity, and moderate to high test-retest reliability. Patients with MDD had significantly lower PES scores compared to healthy controls. Linear discriminant function comprised of the three factors correctly differentiated 71% of participants, which further verified the clinical utility of the PES. CONCLUSIONS: Our findings indicated that the Chinese version of the PES is a reliable and valid instrument to measure cognitive and affective empathy across negative and positive emotions, and could therefore be used in both research and clinical practice.

Further Silencing the Voiceless: The Role of Gatekeepers in Accessing Information About Self-Injury.

ABSTRACT: Gatekeepers play a pivotal role in protecting individuals under their care and are central to keeping people safe and away from harm. In the field of nonsuicidal self-injury (NSSI), a range of gatekeepers exist, including those who protect access to vulnerable research participants, those who protect school children, those charged with making decisions about funding priorities, and those in charge of clinical care for people who self-injure. The aim of this commentary is to outline the roles these different gatekeepers have in protecting access to research participants, access to NSSI knowledge, and access to clinical care for individuals who self-injure. We provide examples in which gatekeepers may present barriers and offer solutions for how to work with gatekeepers for mutual benefit.

Alexithymia as a risk factor for poor emotional outcomes in adults with acquired brain injury.

Emotional disorders are pervasive in the acquired brain injury (ABI) population, adversely affecting quality of life and rehabilitation. This study aimed to explore the unique associative effects of alexithymia as measured by the Perth Alexithymia Questionnaire (PAQ; i.e., difficulty identifying positive/negative feelings, difficulty describing positive/negative feelings, and externally orientated thinking), on emotional outcomes as measured by the Depression Anxiety Stress Scale-21 (DASS-21) and Mayo-Portland Adaptability Inventory (MPAI-4) Adjustment index, in 83 adults with ABI. The addition of alexithymia to hierarchical multiple regression models (controlling for demographic, injury-related, and functional outcome variables) yielded statistically significant changes in R2 for all emotional outcome measures (i.e., Depression, Anxiety, Stress, and Adjustment). Difficulty identifying negative feelings was found to be a significant unique predictor of Depression (ß = .43 p = <.001), Anxiety (ß = .40, p <.001), Stress (ß = .49, p <.001), and Adjustment (ß = .26, p = .001). Externally oriented thinking was found to be a significant unique predictor of Adjustment (ß = -.15, p = .033). These findings strengthen the argument that alexithymia, especially difficulties identifying negative feelings, may be an important risk factor for psychological distress in ABI and should be considered during early rehabilitation.

Assessing Alexithymia across Asian and Western Cultures: Psychometric Properties of the Perth Alexithymia Questionnaire and Toronto Alexithymia Scale-20 in Singaporean and Australian Samples.

Alexithymia refers to difficulties identifying feelings (DIF), describing feelings (DDF), and externally orientated thinking (EOT). Originally conceptualized by American psychiatrists, some researchers have since questioned the validity and application of this construct in Asian cultures. However, to date, there is little empirical work formally assessing the invariance of alexithymia across Asian and Western cultures. The present study aimed to help address this gap, by examining the psychometric properties and measurement invariance of two alexithymia measures, the Perth Alexithymia Questionnaire (PAQ) and Toronto Alexithymia Scale-20 (TAS-20), across samples from Singapore (n = 434) or Australia (n = 489). The same theoretically congruent factor structure was supported across both samples; this structure was fully invariant across samples for the PAQ, and partially invariant for the TAS-20. Both measures had good internal consistency and concurrent validity across samples, except the TAS-20 EOT subscale which had low internal consistency and factor loadings in both samples. The Singaporean sample reported higher DIF and DDF for positive emotions than the Australian sample. Overall, our results support the cross-cultural validity and application of the alexithymia construct. The PAQ and TAS-20 both appear to have good utility in this respect, though the PAQ may provide a more detailed facet-level profile.

Parental Assistance with Emotion Regulation Moderates Link Between COVID-19 Stress and Child Mental Health.

OBJECTIVE: The COVID-19 pandemic has severely impacted children's mental health. All children have not been affected equally, however, and whether parental emotion socialization might buffer or exacerbate the impact of COVID-19 on children's mental health remains an important question. METHOD: During the first peak of the COVID-19 pandemic in the U.S. N = 200 parents of children ages 0-17 (52.5% female) completed questionnaires related to parental assistance with children's emotion regulation, symptomatology, and exposure to COVID-19-related stress. Parents were 74% Non-Hispanic/Latino/a White, 13% Asian, 4.5% Hispanic/Latino/a, 4% Black/African American, 2.5% Native American, and 1.5% bi/multiracial; 0.5% of participants preferred not to state their race/ethnicity. In a series of linear regression analyses, we examined whether parental assistance with children's execution of emotion regulation strategies - across a variety of prototypically-adaptive and -maladaptive strategies - moderates the association between children's exposure to COVID-19-related stress and symptomatology. RESULTS: Results suggest that parental assistance with the execution of prototypically-adaptive strategies (i.e., acceptance, problem solving, behavioral disengagement) and prototypically-maladaptive strategies (i.e., suppression, rumination) may buffer or exacerbate, respectively, the impact of COVID-19-related stress on youth mental health. CONCLUSIONS: Though interpretation of findings is constrained by limitations inherent in collecting data during a pandemic, results highlight the importance of supporting parents - who play a critical role of supporting children - during public health emergencies that affect family life. Interventions designed to improve child wellbeing during the ongoing pandemic may benefit from training parents to assist their children with specific emotion regulation strategies.

Alexithymia in nonviolent offenders.

BACKGROUND: Alexithymia is a trait involving difficulties processing emotions. Existing data suggest it is associated with violent offending. In violent offender programmes, therefore, violent offenders are screened for alexithymia and it is attended to if necessary. No studies have, however, examined alexithymia levels in nonviolent offenders and it is, therefore, unknown whether it is also a criminogenic factor in this population. AIMS: To investigate alexithymia levels among incarcerated nonviolent offenders and compare them with a community comparison group. METHOD: The 20-item Toronto Alexithymia Scale was used to compare the alexithymia levels of 67 incarcerated nonviolent offenders with a group of 139 people from the general public living in the community. RESULTS: Alexithymia levels did not differ between the groups. CONCLUSION: It appears that alexithymia is not a criminogenic factor for nonviolent offenders and screening of such offenders appears unnecessary.

Assessing alexithymia in forensic settings: Psychometric properties of the 20-item Toronto Alexithymia Scale among incarcerated adult offenders.

BACKGROUND: Alexithymia is a trait involving difficulty identifying feelings (DIF), difficulty describing feelings (DDF) and externally orientated thinking (EOT). It is a risk factor for criminal behaviour. It is commonly assessed with the Toronto Alexithymia Scale (TAS-20), but the psychometrics of the TAS-20 have not been tested across the range of offender populations, and it has been suggested it might be unsuitable in incarcerated offenders. AIM: To establish the psychometrics of the TAS-20 among incarcerated offenders. METHODS: Factorial validity was examined using confirmatory factor analyses, and the invariance of this factor structure was tested against a published community sample. Reliability coefficients were calculated. RESULTS: One hundred and forty six incarcerated offenders were recruited. The factor structure of the TAS-20 was invariant across the samples. The intended factor structure composed of DIF, DDF and EOT factors performed well overall (with a reverse-scored method factor added), but six EOT items had low factor loadings. The total scale score and DIF and DDF subscales had acceptable reliability, but EOT did not. CONCLUSIONS: Our results suggest that the TAS-20 functions similarly in offender and community samples. Its total scale score, and DIF and DDF subscale scores can be used confidently, but the assessment of externally oriented thinking may not be adequate with this scale alone. In sum, the TAS-20 can facilitate robust assessment of alexithymia in closed criminal justice settings as well as in the wider community.

What is alexithymia? Using factor analysis to establish its latent structure and relationship with fantasizing and emotional reactivity.

OBJECTIVE: There is ongoing uncertainty about the structure and definition of alexithymia. Conceptually, alexithymia has traditionally been defined as a multidimensional trait with four components: difficulty identifying feelings, difficulty describing feelings, externally orientated thinking, and difficulty fantasizing. However, some authors suggest that difficulty fantasizing might not be a component, and others suggest low emotional reactivity is a fifth component. In this study, we sought to clarify this issue using factor analysis. METHOD: In a sample of adults (N = 508), we administered a comprehensive battery of psychometric measures and analyzed their latent structure using exploratory factor analysis. RESULTS: Subscales assessing difficulty identifying feelings, difficulty describing feelings, and externally orientated thinking all loaded well together on the alexithymia factor. However, none of the subscales assessing aspects of difficulty fantasizing (i.e., daydreaming frequency, vividness, content, or use of daydreams to regulate emotions) loaded on the alexithymia factor. Similarly, no emotional reactivity subscales loaded on the alexithymia factor, and alexithymia was associated with higher (not lower) levels of emotional reactivity for negative emotions. CONCLUSIONS: Difficulty fantasizing and low emotional reactivity are not components of the latent alexithymia construct. The traditional four-component definition of alexithymia likely warrants refinement to a more parsimonious three-component solution.

The Emotion Regulation Questionnaire: Psychometric Properties in General Community Samples.

The Emotion Regulation Questionnaire (ERQ) is a 10-item self-report measure of 2 emotion regulation strategies, cognitive reappraisal and expressive suppression. It is a widely used measure of emotion regulation, but its factor structure has rarely been examined outside of university student samples, and some authors have recently questioned its factorial validity in general community samples. In this study, we examine the psychometric properties of the ERQ (original English version) in 3 Australian general community samples (N = 300, 400, 348). Confirmatory factor analyses in each sample demonstrated that the traditional 2-factor model (comprised of cognitive reappraisal and expressive suppression factors) was replicable and an excellent fit to the data. In all samples, ERQ cognitive reappraisal (α = .89-.90) and expressive suppression (α = .76-.80) scores had acceptable to excellent levels of internal consistency reliability. As expected, cognitive reappraisal scores were significantly negatively correlated with psychological distress and alexithymia, whereas expressive suppression scores were significantly positively correlated with psychological distress and alexithymia. We conclude that, similar to previous findings in student samples, the ERQ has strong psychometric properties in general community samples and can therefore be used confidently regardless of participants' student status.

Assessing Emotional Reactivity: Psychometric Properties of the Perth Emotional Reactivity Scale and the Development of a Short Form.

The Perth Emotional Reactivity Scale (PERS) is a 30-item self-report measure of trait levels of emotional reactivity. In this article, we examine the psychometric properties of the PERS subscale and composite scores in an adult community sample (N = 428), and develop an 18-item short form of the measure (PERS-S). The PERS and PERS-S are designed to assess the typical ease of activation, intensity, and duration of one's emotional responses, and do so for positive and negative emotions separately. Our confirmatory factor analyses supported that the PERS and PERS-S both had the same theoretically congruent factor structure, and that all subscale and composite scores displayed high internal consistency reliability. Correlations with scores from established measures of psychopathology and emotion regulation also supported the validity of PERS and PERS-S scores. Our data therefore suggest that the PERS-S subscale and composite scores retain the psychometric strengths of their longer PERS counterparts. We conclude that both forms of the measure have good utility. Clinical and research applications are discussed.

A case study of the neuropsychological outcomes following microsurgery, conventional radiotherapy and stereotactic radiotherapy for an adult's recurrent craniopharyngioma.

OBJECTIVE: To examine the neuropsychological outcomes for an adult patient, 2 years after receiving microsurgery and conventional radiotherapy for a recurrent craniopharyngioma; and the impact of a further intervention, stereotactic radiotherapy, on this level of neuropsychological functioning. PARTICIPANT: JD, a 30 year old male whose recurrent craniopharyngioma had 2 years earlier been treated with two operations and conventional radiotherapy. DESIGN: JD was assessed (using standardized clinical tests) before and after a course of stereotactic radiotherapy. RESULTS: Prior to stereotactic radiotherapy (and 2 years after microsurgery and conventional radiotherapy) JD's IQ was intact, but considerable impairments were present in executive functioning, memory, theory of mind and processing speed. Fifteen months after stereotactic radiotherapy, all neuropsychological domains remained largely static or improved, supporting the utility of this treatment option in the neuropsychological domain. However, deficits in executive functioning, memory and processing speed remained. CONCLUSION: These findings suggest that, even after multiple treatments, substantial cognitive impairments can be present in an adult patient with a recurrent craniopharyngioma. This profile of deficits underlines the inadequacy of relying purely on IQ as a marker for cognitive health in this population and emphasizes the need to include neuropsychological impairments as a focus of rehabilitation with these patients.

Alexithymia or general psychological distress? Discriminant validity of the Toronto Alexithymia Scale and the Perth Alexithymia Questionnaire.

BACKGROUND: Alexithymia is an important transdiagnostic risk factor for emotion-based psychopathologies. However, it remains unclear whether alexithymia questionnaires actually measure alexithymia, or whether they measure emotional distress. Our aim here was to address this discriminant validity concern via exploratory factor analysis (EFA) of the 20-item Toronto Alexithymia Scale (TAS-20) and the Perth Alexithymia Questionnaire (PAQ). METHOD: United States general community adults (N = 508) completed the TAS-20, PAQ, and the Depression Anxiety Stress Scales-21 (DASS-21). EFA was used to examine the latent dimensions underlying these measures' scores. RESULTS: Our EFA extracted two higher-order factors, an "alexithymia" factor and a "general distress" factor (i.e., depression, anxiety, stress). All PAQ scores loaded cleanly on the alexithymia factor, with no cross-loadings on the distress factor. However, for the TAS-20, Difficulty Identifying Feelings (DIF) facet scores cross-loaded highly on the distress factor. LIMITATIONS: Our sample consisted of general community adults; future work in clinical settings will be useful. CONCLUSIONS: Our data indicate that the PAQ has good discriminant validity. However, the TAS-20 appears to have significant discriminant validity problems, in that much of the variance in its DIF facet reflects people's current levels of distress, rather than alexithymia. The TAS-20, which has traditionally been the most widely used alexithymia questionnaire, may therefore not be the optimal alexithymia tool. Our findings add to the body of evidence supporting the validity and utility of the PAQ and suggest that, moving forward, it is a superior option to the TAS-20 for alexithymia assessments.

The Climate Change Worry Scale (CCWS) and Its Links with Demographics and Mental Health Outcomes in a Polish Sample.

Developing valid and reliable measures of psychological responses to climate change is of high importance, as this facilitates our understanding of people's psychological responses, including their pro-environmental behavior. Recently, the Climate Change Worry Scale (CCWS) was introduced. This study aimed to develop the first Polish version of the CCWS and explore its psychometric properties. Our sample comprised 420 Polish adults aged 18-70, with a mean age of 26.20 (standard deviation = 10.61) years. The CCWS's factor structure was assessed with confirmatory factor analysis. McDonald's omega and Cronbach's alpha coefficients were computed to assess internal consistency reliability. Pearson correlations between climate change worry (CCW) and experience of climate change (i.e., an individual's level of perception of being affected by climate change), pro-environmental behavior, ill-being (i.e., anxiety and depression symptoms), and well-being were calculated. Our results support the strong factorial validity of the CCWS, conforming to its intended one-factor solution, with excellent internal consistency reliability for the total scale score (i.e., McDonald's omega and Cronbach's alpha values of 0.93). We noted large positive correlations between CCW and experiences of climate change, as well as pro-environmental behavior, and medium positive correlations with psychopathology symptoms. CCW scores were not associated with well-being. As the CCWS represents a measure of a specific manifestation of worry, we also examined its discriminant validity against more general psychological distress markers, and it evidenced strong validity in this regard. Overall, the Polish version of the CCWS appears to have strong psychometric properties, and will therefore be a useful tool to use in research on psychological responses to climate change.

Mapping Emotion Regulation Patterns Within the Alternative Model of Personality Disorders Personality Traits.

Personality pathology is associated with emotional problems that are potentially attributable to problematic emotion regulation strategy patterns. We evaluated the emotion regulation strategies associated with the pathological personality traits in the Alternative Model of Personality Disorders (AMPD). A total of 504 participants completed measures of AMPD traits and strategy usage, which were analyzed using hierarchical regressions and latent profile analysis (LPA). Regression results demonstrated that each trait was associated with a unique strategy pattern: negative affect with emotional overengagement, detachment with socialemotional avoidance, antagonism with emotional externalization/avoidance, disinhibition with emotional avoidance and overengagement, and psychoticism with strategies linked to psychotic/dissociative experiences. The LPA identified three profiles with heightened AMPD traits: an internalizing/distressed profile, an externalizing/distressed profile, and a schizoid-schizotypal profile; each had a unique strategy pattern that varied depending on trait composition. This research highlights the relevance of emotion regulation strategy patterns in the assessment, conceptualization, and treatment of personality pathology.

Empathy and Autism: Establishing the Structure and Different Manifestations of Empathy in Autistic Individuals Using the Perth Empathy Scale.

PURPOSE: There is a common mischaracterisation that autistic individuals have reduced or absent empathy. Measurement issues may have influenced existing findings on the relationships between autism and empathy, and the structure of the empathy construct in autism remains unclear. METHODS: The present study sought to address these gaps by examining the structure and psychometric properties of the Perth Empathy Scale (PES) in autistic individuals (N = 239) compared to non-autistic individuals (N = 690). RESULTS: Our moderated non-linear factor analysis revealed that the multidimensional empathy construct manifested similarly in autistic and non-autistic individuals, with the PES displaying good validity and reliability. Moreover, the results revealed that autistic individuals reported reduced cognitive empathy and reduced affective empathy for positive and negative emotions. However, there was greater heterogeneity of empathic tendencies in the autistic sample, indicating that these mean differences may not be generalisable for all autistic individuals. CONCLUSION: The present study highlights that the PES is suitable for assessing empathy across autistic and non-autistic individuals. This work with the PES also provides greater nuance to our understanding of empathy and autism, and based on these findings, we propose the empathy heterogeneity hypothesis of autism as a new way of describing empathy in autism.