Exploring the Cognitive Profiles of Haemodialysis Patients using Objective and Subjective Indicators: A Cross-sectional Observational Study.

BACKGROUND: Cognitive impairment is common in haemodialysis patients and associated with adverse health outcomes. Previous work focused primarily on neuropsychological tests, the gold standard measure of cognition. However, these tests reflect performance under optimal conditions rather than performance in everyday life. This study aims to assess both objective and subjective cognition in haemodialysis patients. METHODS: Adult haemodialysis patients completed measures of objective cognitive impairment (Montreal Cognitive Assessment), subjective cognitive complaints, mood and fatigue symptoms, and provided sociodemographic information. Clinical data such as comorbidity were extracted from patients' medical record. RESULTS: A total of 268 haemodialysis patients (mean age = 59.87 years; 42.5% female) participated. Only 25.0% of the sample had normal cognition, while the rest had either objective cognitive impairments or clinically significant cognitive complaints, or both (both objective impairments and subjective complaints: 26.1%; objective impairments without complaint: 38.4%; significant complaints without objective impairments: 10.4%). Lower education was associated with the presence of objective cognitive impairments, whereas depression was associated with the presence of clinically significant cognitive complaints. Patients who exhibited both objective cognitive impairments and significant cognitive complaints were more likely to have diabetes and higher dialysis dose (Kt/V). Patients with objective cognitive impairments but no significant complaints were significantly older. CONCLUSIONS: The cognitive burden of haemodialysis patients can be manifested as objective impairments and/or subjective complaints. When combined the two indicators may better represent the overall cognitive well-being in this population. There is a need to screen for cognitive difficulties and develop cognitive rehabilitative strategies in dialysis settings.

Foot self-care behaviour in primary care patients with diabetic foot ulcers: Structural equation modelling of psychological predictors.

Diabetic foot ulcers (DFUs) are one of the most prevalent and costly diabetes complications, associated with diminished quality of life and poor prognosis. Management of DFUs relies heavily on patients' foot self-care behaviour. This study aims to explore psychological determinants of this important behaviour among primary care patients. A total of 186 patients with active DFUs self-reported their illness perception, diabetes distress, self-efficacy, and foot self-care behaviour. Structural equation modelling was performed to examine interrelationships among measured variables. The final model demonstrated satisfactory fit, CFI = 0.933, TLI = 0.913, RMSEA = 0.050, SRMR = 0.073, χ2(95) = 132.256 (p = 0.004), and explained 51.1% of the variance of foot self-care. Illness threat perceptions (i.e., consequence, timeline, identity, concern, and emotion) had a direct positive effect on foot self-care behaviours, but also indirectly decreased foot self-care through increasing diabetes distress. Control perceptions (i.e., personal control, treatment control, and coherence) were not directly associated with foot self-care behaviours, but indirectly improved foot self-care by reducing diabetes distress and increasing foot care confidence. These findings suggest illness perceptions, diabetes distress, and self-care confidence as modifiable predictors to be targeted in self-management interventions for patients with DFUs.

The Impact of Interpretation Biases on Psychological Responses to the COVID-19 Pandemic: a Prospective Study.

BACKGROUND: This study investigates the longitudinal role of interpretation biases in the development and maintenance of health anxiety during the pandemic. Individual differences in behavioural responses to the virus outbreak and decision-making were also examined. METHODS: Two hundred seventy-nine individuals from a pre-pandemic study of interpretation bias and health anxiety completed an online survey during the third wave of the COVID-19 pandemic in Hong Kong. Participants' health anxiety, interpretation biases, and COVID-specific behaviours (i.e. practice of social distancing, adherence to preventive measures, information seeking), and health decision-making were assessed. RESULTS: Pre-pandemic tendencies to interpret ambiguous physical sensations as signals for illness did not predict health anxiety during the pandemic, b = -0.020, SE = 0.024, t = -0.843, p = .400, 99% CI [-0.082, 0.042], but were associated with a preference for risky treatment option for COVID-19, b = 0.026, SE = 0.010, Wald = 2.614, p = .009, OR = 1.026, 99% CI [1.001, 1.054]. Interpretation biases and health anxiety symptoms during the pandemic were associated with each other and were both found to be significant predictors of practice of social distancing, adherence to preventive measures, and information seeking behaviour. CONCLUSIONS: This study adds to the growing evidence of the role of interpretation biases in health anxiety and the way that people respond to the ongoing pandemic.

Information needs and sources of information among people with depression and anxiety: a scoping review.

BACKGROUND: Previous studies have identified substantial unmet information needs in people with depression and anxiety. Sufficient information about the disorder, treatment, available services, and strategies for self-management is essential as it may influence quality of care and patients' quality of life. This scoping review aimed to provide a broad overview of information needs of people with depression and anxiety as well as the sources that they use to seek this information. METHODS: We included all primary research published in English that investigated information needs or information sources in people with depression or anxiety, with no restrictions imposed on the study design, location, setting, or participant characteristics. Six electronic databases (MEDLINE, Embase, PsycINFO, CINAHL, LISTA, Web of Science) and the grey literature (Google and Google Scholar) were searched for relevant studies published up to November 2021. Two reviewers independently screened articles and extracted data. Narrative synthesis was performed to identify key themes of information needs and information sources. Factors associated with information needs/sources such as demographic variables and symptom severity were also identified. RESULTS: Fifty-six studies (comprising 8320 participants) were included. Information needs were categorised into seven themes, including general facts, treatment, lived experience, healthcare services, coping, financial/legal, and other information. The most frequently reported needs in both people with depression and anxiety were general facts and treatment information. Subclinical samples who self-reported depressive/anxious symptoms appeared less interested in treatment information than patients with clinical diagnoses. Information sources were summarised into five categories: health professionals, written materials, media, interpersonal interactions, and organisational resources. Health professionals and media (including the internet) were the most frequently adopted and preferred sources. Although few studies have examined factors associated with information needs and information sources, there is preliminary evidence that symptom severity and disease subtypes are related to information needs/sources, whereas findings on demographic factors were mixed. CONCLUSIONS: Information needs appear to be high in people with depression and anxiety. Future research should examine differences between subgroups and associated factors such as the treatment course. Personalised information provision strategies are also needed to customise information according to individual needs and patient profiles. TRIAL REGISTRATION: The protocol of this scoping review was registered on Open Science Framework (OSF; link: https://doi.org/10.17605/OSF.IO/DF2M6 ).

The role of subjective cognitive complaints in self-management among haemodialysis patients: a cross-sectional study.

BACKGROUND: Subjective cognitive complaints refer to self-experienced difficulties with everyday cognitive tasks. Although there has been a fair amount of research on cognitive impairments and cognitive complaints in end-stage renal disease, the practical implications of these complaints remain unclear. The current study aims to examine the associations of cognitive complaints with sociodemographic and clinical variables, mood, as well as key patient-reported outcomes, i.e., self-efficacy, self-management skills, and treatment adherence. METHODS: A total of 305 haemodialysis patients (mean age = 53.97 years, 42.6% female) completed the Kidney Disease Quality of Life Cognitive Function subscale, a brief measure of cognitive complaints. The recommended cut-off point of 60 was used to identify probable cognitive impairment. Measures of self-efficacy, self-management skills (i.e., symptom coping, health monitoring, health service navigation), treatment adherence, and mood symptoms were also administered. Between-group comparisons and correlational analyses were performed to examine associations of cognitive complaints with sociodemographic, clinical, and health behaviour variables. Mediation analyses were also conducted to investigate the mediating role of self-efficacy on the relationship between cognitive complaints and treatment adherence. RESULTS: Nearly a quarter (23.0%) of haemodialysis patients reported cognitive complaints indicative of clinical impairments. Risk of probable impairments was higher for patients with hypertension, diabetes, those diagnosed with end-stage renal disease at an older age, and those with shorter time on dialysis. Subjective cognitive complaints (both rates of probable impairments as per cut-off and continuous scores) were significantly associated with lower disease and treatment self-efficacy, poorer self-management skills, lower treatment adherence, as well as higher symptoms of distress. Mediation analysis indicated that treatment self-efficacy mediated the relationship between cognitive complaints and treatment adherence. CONCLUSIONS: The current study demonstrated the clinical characteristics of haemodialysis patients who report cognitive complaints indicative of probable cognitive impairments and showed the associations of these complaints with self-management outcomes. Future studies should adopt more comprehensive measures of cognitive complaints and longitudinal designs to confirm the current findings.

Understanding visual attention to face emotions in social anxiety using hidden Markov models.

Theoretical models propose that attentional biases might account for the maintenance of social anxiety symptoms. However, previous eye-tracking studies have yielded mixed results. One explanation is that existing studies quantify eye-movements using arbitrary, experimenter-defined criteria such as time segments and regions of interests that do not capture the dynamic nature of overt visual attention. The current study adopted the Eye Movement analysis with Hidden Markov Models (EMHMM) approach for eye-movement analysis, a machine-learning, data-driven approach that can cluster people's eye-movements into different strategy groups. Sixty participants high and low in self-reported social anxiety symptoms viewed angry and neutral faces in a free-viewing task while their eye-movements were recorded. EMHMM analyses revealed novel associations between eye-movement patterns and social anxiety symptoms that were not evident with standard analytical approaches. Participants who adopted the same face-viewing strategy when viewing both angry and neutral faces showed higher social anxiety symptoms than those who transitioned between strategies when viewing angry versus neutral faces. EMHMM can offer novel insights into psychopathology-related attention processes.

Prevalence and trajectories of subjective cognitive complaints and implications for patient outcomes: A prospective study of haemodialysis patients.

OBJECTIVES: Cognitive impairment is common in haemodialysis patients and is associated with increased hospitalization and mortality. However, subjective cognitive complaints (SCCs), the self-experienced difficulties in everyday cognitive activities, remain poorly understood. This study examined the prevalence and course of SCCs in haemodialysis patients and its longitudinal associations with sociodemographic, clinical and patient-reported variables. DESIGN: Observational prospective study with baseline and 12-month follow-up assessment. METHODS: Based on a validated cut-off point on the Kidney Disease Quality of Life Cognitive Function subscale, haemodialysis patients (N = 159; 40.3% female, mean age 53.62) were classified into cognitive complaint trajectories: (1) resilient (60.4%; no/low SCCs throughout); (2) persistent (8.8%; stable high SCCs); (3) deterioration (17.6%; from no/low to high SCCs); and (4) recovery (13.2%; from high to no/low SCCs). Sociodemographic/clinical characteristics, self-efficacy, self-management skills, adherence, mood and biochemical assays were measured at both assessments and compared among trajectories using mixed ANOVAs. RESULTS: Interaction effects indicated significant improvements in the recovery group in clinical outcomes (i.e., decreased phosphorus and calcium-phosphorus product), self-efficacy and mood over time. Group effects indicated significantly poorer self-efficacy, self-management skills and adherence in the persistent group than other trajectories across both assessments. None of the sociodemographic/clinical characteristics was associated with SCC trajectories. CONCLUSIONS: The extent of SCCs vary over time across haemodialysis patients. Routine screening of SCCs in dialysis settings may help identifying patients at risk of poor self-management and worse prognosis. Strategies that compensate for cognitive lapses may mitigate the perceived cognitive burden of this population.

Subjective cognitive complaints in end-stage renal disease: a systematic review and meta-analysis.

Cognitive impairment is common in patients with end-stage renal disease (ESRD) and is associated with compromised quality of life and functional capacity, as well as worse clinical outcomes. Most previous research and reviews in this area were focused on objective cognitive impairment, whereas patients' subjective cognitive complaints (SCCs) have been less well-understood. This systematic review aimed to provide a broad overview of what is known about SCCs in adult ESRD patients. Electronic databases were searched from inception to January 2022, which identified 221 relevant studies. SCCs appear to be highly prevalent in dialysis patients and less so in those who received kidney transplantation. A random-effects meta-analysis also shows that haemodialysis patients reported significantly more SCCs than peritoneal dialysis patients (standardised mean difference -0.20, 95% confidence interval -0.38 to -0.03). Synthesis of longitudinal studies suggests that SCCs remain stable on maintenance dialysis treatment but may reduce upon receipt of kidney transplant. Furthermore, SCCs in ESRD patients have been consistently associated with hospitalisation, depression, anxiety, fatigue, and poorer quality of life. There is limited data supporting a strong relation between objective and subjective cognition but preliminary evidence suggests that this association may be domain-specific. Methodological limitations and future research directions are discussed.

The effects of efficacy framing in news information and health anxiety on coronavirus-disease-2019-related cognitive outcomes and interpretation bias.

Within the coronavirus-disease-2019 (COVID-19) pandemic, disease-related information is omnipresent in the media, whereas information about how to manage the pandemic is less often covered. Under the context where threat is present, this study investigated whether and how the strength of efficacy framing (i.e., the perspective adopted by a communicating text that emphasizes one's possibilities to cope with an external threat) of COVID-19-related news, as well as its interaction with trait health anxiety under the COVID-19 context, related to people's COVID-19-related cognitive outcomes. One hundred and ninety-three participants reported demographics, trait health anxiety, and COVID-19-related behaviors (e.g., precautionary measures, information-seeking behaviors). They then either read high-efficacy (n = 112; e.g., cure rate) or low-efficacy (n = 81; e.g., mortality rate) information about COVID-19. Afterward, their tendency to interpret illness- and COVID-19-related information more negatively, and other COVID-19-related cognitions (e.g., risk perception, behavioral change intentions) were assessed. High-efficacy framing resulted in lower-risk perception and marginally weaker COVID-19-related interpretation bias, compared with low-efficacy framing. There was some evidence of an interaction with health anxiety such that high-efficacy framing, compared with low-efficacy framing, was associated with greater intention to adopt protective behaviors, particularly for individuals with higher levels of health anxiety. Media framing of COVID-19 information affects how people respond to the pandemic; a high-efficacy communication style might more effectively encourage healthy behaviors than a low-efficacy narrative, particularly for people who are already anxious about their health. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The effects of attentional and interpretation biases on later pain outcomes among younger and older adults: A prospective study.

BACKGROUND: Studies examining the effect of biased cognitions on later pain outcomes have primarily focused on attentional biases, leaving the role of interpretation biases largely unexplored. Also, few studies have examined pain-related cognitive biases in elderly persons. The current study aims to fill these research gaps. METHODS: Younger and older adults with and without chronic pain (N = 126) completed an interpretation bias task and a free-viewing task of injury and neutral scenes at baseline. Participants' pain intensity and disability were assessed at baseline and at a 6-month follow-up. A machine-learning data-driven approach to analysing eye movement data was adopted. RESULTS: Eye movement analyses revealed two common attentional pattern subgroups for scene-viewing: an "explorative" group and a "focused" group. At baseline, participants with chronic pain endorsed more injury-/illness-related interpretations compared to pain-free controls, but they did not differ in eye movements on scene images. Older adults interpreted illness-related scenarios more negatively compared to younger adults, but there was also no difference in eye movements between age groups. Moreover, negative interpretation biases were associated with baseline but not follow-up pain disability, whereas a focused gaze tendency for injury scenes was associated with follow-up but not baseline pain disability. Additionally, there was an indirect effect of interpretation biases on pain disability 6 months later through attentional bias for pain-related images. CONCLUSIONS: The present study provided evidence for pain status and age group differences in injury-/illness-related interpretation biases. Results also revealed distinct roles of interpretation and attentional biases in pain chronicity. SIGNIFICANCE: Adults with chronic pain endorsed more injury-/illness-related interpretations than pain-free controls. Older adults endorsed more illness interpretations than younger adults. A more negative interpretation bias indirectly predicted pain disability 6 months later through hypervigilance towards pain.

Evaluating Rates and Determinants of COVID-19 Vaccine Hesitancy for Adults and Children in the Singapore Population: Strengthening Our Community's Resilience against Threats from Emerging Infections (SOCRATEs) Cohort.

COVID-19 vaccines are crucial for achieving sufficient immunisation coverage to manage the pandemic, but vaccine hesitancy persists. This study aimed to investigate the prevalence and determinants of vaccine hesitancy in adults and in parents for vaccinating their children using an integrated social cognition model. A community-based cohort in Singapore [N = 1623] completed a survey (wave 25) between June and July 2021 which measured their risk perceptions, distress, trust, vaccination beliefs, and vaccine intentions/behaviours. Results indicated low rates of hesitancy (9.9%) for own vaccination, with most concerns citing side effects, safety, and hasty development. Remaining respondents were vaccinated (69%) or intended to vaccinate (21%). The multivariable model (non-vaccinated respondents) indicated that, living with people in poor health, subjective norm, moral norm, benefits, and necessity of vaccination were associated with lower vaccine hesitancy (R2 Cox & Snell: 51.4%; p < 0.001). Hesitancy rates were higher for children's vaccination (15.9%), with male gender, lower perceived vaccine benefits, high COVID-19 risk perceptions, vaccination concerns, and necessity beliefs associated with higher odds of parental vaccine hesitancy (R2 Cox & Snell = 36.4%; p < 0.001). While levels of vaccine acceptance are high, more targeted messages are needed. For adults' vaccination, more emphasis should be on benefits and social gains, while for parental hesitancy, messages related to safety should be prioritised.

The interrelation between interpretation biases, threat expectancies and pain-related attentional processing.

BACKGROUND: Few studies examining the effect of pain-related threat on eye movements have incorporated a measure of interpretation bias. However, theories suggest that interpretation biases also play an important role in the anticipation of harm in situations where pain could be imminent. The current study investigates the association between interpretation biases and pain-related threat expectancies and their associations with eye movements to pain-related imagery. METHODS: Healthy adults' (N = 91) fear of pain, emotional functioning and interpretation biases were assessed prior to a threat manipulation where they were given either threatening or reassuring information about an upcoming cold pressor task. Participants were then asked to freely view scene images that were either pain-related or neutral. RESULTS: We used a data-driven machine learning method to analyse eye movements. We identified an explorative (i.e. greater dispersal of eye fixations) and a focused eye movement pattern subgroup (i.e. mainly focusing on foreground information) for scene viewing in the sample. Participants with more negative interpretation biases expected that the cold pressor task would be more harmful, and those with higher levels of anticipated harm used a more explorative strategy when viewing injury scene images. Subsequent analysis confirmed an indirect effect of interpretation biases on eye movements through expected bodily harm. No difference in eye movements was found between participants given threatening and reassuring information. CONCLUSIONS: Interpretation biases may play a prominent role in threat-related attentional processing. By adopting a novel eye movement analysis approach, our results revealed interesting associations among interpretations, threat expectancies and eye movements. SIGNIFICANCE: Negative interpretation biases may be associated with greater threat expectancies for an upcoming experimental pain task. Anticipation of bodily harm may induce a stimulus non-specific hypervigilant style of scanning of pain-related scenes.

Interpretation biases and visual attention in the processing of ambiguous information in chronic pain.

BACKGROUND: Theories propose that interpretation biases and attentional biases might account for the maintenance of chronic pain symptoms, but the interactions between these two forms of biases in the context of chronic pain are understudied. METHODS: To fill this gap, 63 participants (40 females) with and without chronic pain completed an interpretation bias task that measures participants' interpretation styles in ambiguous scenarios and a novel eye-tracking task where participants freely viewed neutral faces that were given ambiguous pain/health-related labels (i.e. 'doctor', 'patient' and 'healthy people'). Eye movements were analysed with the Hidden Markov Models (EMHMM) approach, a machine-learning data-driven method that clusters people's eye movements into different strategy subgroups. RESULTS: Adults with chronic pain endorsed more negative interpretations for scenarios related to immediate bodily injury and long-term illness than healthy controls, but they did not differ significantly in terms of their eye movements on ambiguous faces. Across groups, people who interpreted illness-related scenarios in a more negative way also focused more on the nose region and less on the eye region when looking at patients' and healthy people's faces and, to a lesser extent, doctors' faces. This association between interpretive and attentional processing was particularly apparent in participants with chronic pain. CONCLUSIONS: In summary, the present study provided evidence for the interplay between multiple forms of cognitive biases. Future studies should investigate whether this interaction might influence subsequent functioning in people with chronic pain.

Pain-related attentional processes: A systematic review of eye-tracking research.

Biases in the way that people direct their attention towards or away from pain-related information are hypothesised to contribute to the onset and severity of pain-related disorders. This systematic review summarised 24 eye-tracking studies (N = 1424) examining effects of chronic pain, stimulus valence, individual differences in pain-related constructs such as fear of pain and pain catastrophising, and experimentally-induced pain or pain-related threat on attentional processing of visual stimuli. The majority of studies suggest that people with and without chronic pain do not differ in their eye movements on pain-related stimuli, although there is preliminary evidence that gaze biases vary across subtypes of chronic pain and may be evident only for certain stimuli. In contrast, participants with and without chronic pain exhibit a general tendency to allocate more first fixations and total fixations upon pain-related compared to neutral stimuli. Fear of pain was found to have limited effects on eye movements, whereas the tendency to catastrophise about pain, the anticipation of pain, and actual experimental pain stimulation have had stronger associations with eye movements, although results have been mixed. Methodological limitations and future research directions are discussed.