Empathic Conversational Agent Platform Designs and Their Evaluation in the Context of Mental Health: Systematic Review.

BACKGROUND: The demand for mental health (MH) services in the community continues to exceed supply. At the same time, technological developments make the use of artificial intelligence-empowered conversational agents (CAs) a real possibility to help fill this gap. OBJECTIVE: The objective of this review was to identify existing empathic CA design architectures within the MH care sector and to assess their technical performance in detecting and responding to user emotions in terms of classification accuracy. In addition, the approaches used to evaluate empathic CAs within the MH care sector in terms of their acceptability to users were considered. Finally, this review aimed to identify limitations and future directions for empathic CAs in MH care. METHODS: A systematic literature search was conducted across 6 academic databases to identify journal articles and conference proceedings using search terms covering 3 topics: "conversational agents," "mental health," and "empathy." Only studies discussing CA interventions for the MH care domain were eligible for this review, with both textual and vocal characteristics considered as possible data inputs. Quality was assessed using appropriate risk of bias and quality tools. RESULTS: A total of 19 articles met all inclusion criteria. Most (12/19, 63%) of these empathic CA designs in MH care were machine learning (ML) based, with 26% (5/19) hybrid engines and 11% (2/19) rule-based systems. Among the ML-based CAs, 47% (9/19) used neural networks, with transformer-based architectures being well represented (7/19, 37%). The remaining 16% (3/19) of the ML models were unspecified. Technical assessments of these CAs focused on response accuracies and their ability to recognize, predict, and classify user emotions. While single-engine CAs demonstrated good accuracy, the hybrid engines achieved higher accuracy and provided more nuanced responses. Of the 19 studies, human evaluations were conducted in 16 (84%), with only 5 (26%) focusing directly on the CA's empathic features. All these papers used self-reports for measuring empathy, including single or multiple (scale) ratings or qualitative feedback from in-depth interviews. Only 1 (5%) paper included evaluations by both CA users and experts, adding more value to the process. CONCLUSIONS: The integration of CA design and its evaluation is crucial to produce empathic CAs. Future studies should focus on using a clear definition of empathy and standardized scales for empathy measurement, ideally including expert assessment. In addition, the diversity in measures used for technical assessment and evaluation poses a challenge for comparing CA performances, which future research should also address. However, CAs with good technical and empathic performance are already available to users of MH care services, showing promise for new applications, such as helpline services.

Investigating Pathways Linking of Women's Education Status and Empowerment to Intimate Partner Violence Among Married Women in Sri Lanka: A Structural Equation Modeling Approach.

In Sri Lanka, intimate partner violence (IPV) remains a major concern, particularly for married women. Women's education and empowerment are significant contributors to IPV. Despite this, there have been no recent studies exploring the complex relationship between education and multidimensions of empowerment in relation to IPV in Sri Lanka. Therefore, this research addresses this gap by exploring the complex pathways connecting married women's education and multidimensional empowerment to IPV. Using data from the 2019 Sri Lankan Women's Wellbeing Survey, this study included 1,165 married women. A path analysis based on structural equation modeling (SEM) was used to examine the complex interplay between distinct empowerment domains and IPV. The SEM results revealed both direct and indirect effects of women's education and empowerment on IPV experiences. Education is positively linked to age at marriage, employment status, and husbands' educational level, while inversely associated with accepting attitudes toward violence. Age at marriage plays a major role as a mediator, mediating the relationship between women's education and their involvement in decision-making, and the relationship between husbands' education and women's IPV experience. Moreover, the relationship between women's age at marriage and their IPV experiences was fully mediated by their decision-making ability, highlighting the importance of empowerment in decision-making. These findings underscore the need for targeted interventions that address the interconnected factors affecting IPV risk among married women in Sri Lanka, particularly focusing on education, empowerment, and marriage timing.

Investigating the role of women's education status and empowerment on accessing skilled birth attendance in Bangladesh: A structural equation modelling approach.

BACKGROUND: The objective of this study was to investigate the associations between women's education and access to skilled birth attendant (SBA) services mediated by factors of women's empowerment and sociodemographic characteristics using a path analysis through a structural equation (SEM) modelling approach. METHODS: A sample of 4946 mothers from the most recent Bangladesh Demographic and Health Survey of 2017-18 was used in the SEM analysis. Accessing SBA service at childbirth was operationalized as utilizing SBA during last childbirth. After extracting the relevant variables and cleaning the original survey data, a subsample of 4,946 women were eligible for analysis in the current study. RESULTS: The SEM model revealed strong evidence of direct, indirect, and mediating effects of both education and empowerment of women in accessing SBA services. Educated women have more autonomy in decision making and are less susceptible to family violence and consequently are more likely to access SBA services during childbirth (ß = 0.094, p < 0.001). In addition, age at first marriage, media exposure, husband's education, healthcare accessibility, decision marking, and household wealth index mediated the relationship between education and SBA service use. CONCLUSION: Bangladesh, a country that needs to improve several societal and health indices to achieve the Sustainable Development Goals, need to prioritize women's education to increase accessibility to maternal healthcare services. Health education and mass-media-driven awareness may be potential interventions for LMICs to increase SBA coverage.

Comparing the prevalence and association between anxiety, depression and gastrointestinal symptoms in gastroparesis versus functional dyspepsia: A systematic review and meta-analysis.

OBJECTIVE: To determine the prevalence and associations between anxiety/depression, and gastrointestinal (GI) symptoms across gastroparesis and functional dyspepsia. METHODS: Twenty adult studies were identified through systematic searches of three databases (PubMed, CINAHL and PsycINFO) in September 2023. Meta-analysis was performed to estimate the pooled prevalence rates of anxiety and depression across gastroparesis and functional dyspepsia, and to determine whether the associations of anxiety/depression and gastrointestinal (GI) symptoms differ in gastroparesis versus functional dyspepsia. RESULTS: The overall pooled prevalence rate for anxiety was similar (χ2(1) = 2.45, p = .12) in gastroparesis (49%) and functional dyspepsia (29%). The overall pooled prevalence rate for depression in gastroparesis (39%), and functional dyspepsia (32%) was also similar (χ2(1) = 0.81, p = .37). No significant relationship between anxiety and GI symptoms (r = 0.11) or depression and GI symptoms (r = 0.16) was found in gastroparesis, whilst significant, though weak, positive relationships between anxiety and GI symptoms (r = 0.30) and depression and GI symptoms (r = 0.32) were found in functional dyspepsia. The association between GI symptoms and anxiety, but not depression, across gastroparesis and functional dyspepsia was found to be significant (χ2(1) = 5.22, p = .02). CONCLUSION: Contributing to ongoing debate as to whether gastroparesis and functional dyspepsia are interchangeable syndromes, this review found that anxiety and depression prevalence was similar in both conditions. Psychological assessment and the utilisation of effective and holistic care in both conditions is therefore warranted.

Impact of Intimate Partner Violence on mental health among married women in Sri Lanka: a study based on Women's Wellbeing Survey-2019.

BACKGROUND: Sri Lankan married women have been reported to experience higher rates of intimate partner violence (IPV). However, research on its impact on mental health and how socio-demographic factors contribute to this association is limited. Therefore, this study aimed to examine the impact of IPV on the mental health of married women in Sri Lanka. METHODS: In this study, data from 1611 married women who participated in the 2019 Sri Lankan Women's Wellbeing Survey were analyzed. Two binary outcomes were considered: married women's mental health and their suicidal ideation. Binary logistic regression models were used to assess the association between mental health and suicidal thoughts in relation to IPV while controlling for socio-demographic factors. RESULTS: The results revealed that married women who experienced any form of violence by their spouse had a higher risk of having poor mental health conditions [AOR = 2.88 (2.20, 3.78)] and suicidal thoughts [AOR = 5.84 (4.10, 8.32)] compared to those who did not experience IPV. CONCLUSIONS: IPV is a substantial contributor to poor mental health and suicidal thoughts among Sri Lankan married women. There is an urgent need for policy interventions, such as community awareness programs, counseling services and enhanced legal protections for victims.

Confirmatory validation of the patient health questionnaire - 4 (PHQ-4) for gastrointestinal disorders: A large-scale cross-sectional survey.

OBJECTIVE: Using the large Rome Foundation Global Epidemiology Survey dataset, the aim of this study was to evaluate the construct and convergent validity and internal consistency of the PHQ-4 across both gastrointestinal and non-gastrointestinal condition cohorts. Another aim was to provide descriptive information about the PHQ-4 including means, confidence intervals and percentage of caseness using a large representative sample. METHODS: A cross-sectional survey was conducted in 26 countries. Confirmatory factor and internal consistency analyses were conducted across subsamples of patients with gastrointestinal conditions (i.e., disorders of gut-brain interaction [DGBI; any DGBI, individual DGBI, and DGBI region], gastroesophageal reflux disease (GERD), coeliac disease, diverticulitis, inflammatory bowel disease (IBD), cancer anywhere in the gastrointestinal tract, peptic ulcer) and those without a gastrointestinal condition. Convergent validity was also assessed via a series of Pearson's correlation coefficients with PROMIS (physical and mental quality of life), and PHQ-12 (somatisation). RESULTS: Based on 54,127 participants (50.9% male; mean age 44.34 years) confirmatory factor analysis indicated acceptable to excellent model fits for the PHQ-4 across all subsamples and individual DGBI and DGBI region (Comparative Fit Index >0.950, Tucker-Lewis Index >0.950, Root Mean Squared Error of Approximation <0.05, and Standardised Root Mean Square Residual <0.05). The PHQ-4 was found to demonstrate convergent validity (Pearson's correlation coefficients >±0.4), and good internal consistency (Cronbach's α > 0.75). CONCLUSIONS: This study provides evidence that the PHQ-4 is a valid and reliable tool for assessing mental health symptomology in both gastrointestinal and non-gastrointestinal cohorts.

Budesonide Induces Favourable Histologic and Symptomatic Recovery in Patients with Non-responsive and Refractory Coeliac Disease When Given in an Open Capsule Format.

INTRODUCTION: Non-responsive coeliac disease (NRCD), where symptoms and enteropathy persist despite a prolonged gluten-free diet (GFD), is common. Refractory coeliac disease (RCD), characterised by malabsorption and extensive enteropathy, is rare but serious. In both, treatment options are limited. Topical budesonide may help and an open capsule format promoting proximal small intestinal delivery may be advantageous. AIM: To describe the effect of budesonide and its presentation on mucosal healing, symptoms, and tolerability in NRCD and RCD. METHODS: A retrospective cohort study of NRCD and RCD patients who received budesonide for enteropathy despite a strict GFD for over 12 months. Primary outcome was improvement in histology. Symptoms and adverse treatment effects were recorded. RESULTS: 50 patients with NRCD (n = 14; 86% F), RCD type 1 (n = 30; 60% F), and RCD type 2 (n = 6 based on aberrant duodenal T cells; 33% F) were identified. Common RCD symptoms were diarrhoea (68%), fatigue (40%), and weight loss (34%). 16 received closed capsule budesonide (CCB) 9 mg OD and 35 open capsule budesonide (OCB) 3 mg 3 times a day. Complete and partial mucosal healing was significantly higher after OCB compared to CCB (p < 0.001, Mann-Whitney U test). Symptom improvement was also significantly higher after OCB compared to CCB (p = 0.002, Mann-Whitney U test). Side effects were mild and self-limiting and were reported in 25% of both cohorts. CONCLUSION: OCB was well tolerated and associated with improvements in enteropathy (83%) and symptoms (90%) in NRCD and RCD. Our findings support OCB as the preferred 1st-line therapy for NRCD and RCD type 1.

Development and validation of a brain fog scale for coeliac disease.

BACKGROUND: Brain fog is a subjective cognitive impairment commonly reported in coeliac disease. A standardised tool to define and assess it is an important unmet need. AIMS: To develop a patient-informed tool to assess brain fog in coeliac disease to support clinical care, research and drug development. METHODS: A pilot online study defined patient descriptors of brain fog. A second study evaluated the factor structure and performance of the scale across two-time points ('Now' and in the 'Past week'). One month later, participants were invited to repeat the study with two online cognitive processing tests, the Stroop task and the trail making test. RESULTS: Among adults with treated coeliac disease, 37 (91.9% F) participated in the pilot study and 510 (88.8% F) in the second study of whom 99 repeated the study 1 month later with 51 completing cognitive testing. The most common brain fog descriptors were 'difficulty focusing', 'difficulty thinking' and 'difficulty finding the right words and communicating'. The 12-item scale reflects 'cognitive impairment' and 'somatic and affective experience' and demonstrates strong psychometric properties. It tracked with patients report of brain fog being present or absent across two-time points. It did not significantly correlate with the cognitive tests. CONCLUSION: The brain fog assessment and severity scale is the first patient-informed clinical outcomes assessment tool measuring brain fog in coeliac disease. It is brief and validated for two time-based formats. Further research coupling it with biomarker discovery is needed to confirm its validity as a predictor of cognitive performance.

Factors associated with married women's attitude toward intimate partner violence: A study on 20 low-and middle-income countries.

Intimate Partner Violence (IPV) is a global problem and has been reported to be significantly higher for women in Low and Middle-Income Countries (LMICs). The researchers analyzed Demographic and Health Survey (DHS) data of married women in 20 LMICs to examine those most vulnerable to accepting IPV by investigating associated risk factors. The researchers revealed a higher level of acceptance of IPV among illiterate women from poorer households in remote areas. Using these findings, the authors provide insight into ensuring and enhancing the living standards of these vulnerable women by making education more readily accessible.

Factors and consequences associated with intimate partner violence against women in low- and middle-income countries: A systematic review.

Intimate Partner Violence (IPV) is a global public health issue, with notably high prevalence rates observed within Low-and Middle-Income Countries (LMICs). This systematic review aimed to examine the risk factors and consequences associated with IPV against women in LMICs. Following PRISMA guidelines, we conducted a systematic review using three databases: Web of Science, ProQuest Central, and Scopus, covering the period from January 2010 to January 2022. The study included only peer-reviewed journal articles in English that investigated IPV against women in LMICs. Out of 167 articles screened, 30 met the inclusion criteria, comprising both quantitative and mixed-method studies. Risk factors of IPV were categorised as: demographic risk factors (23 studies), family risk factors (9 studies), community-level factors (1 studies), and behavioural risk factors (14 studies), while consequences of IPV were categorised as mental health impacts (13 studies), physical impacts (5 studies), and societal impacts (4 studies). In this study, several risk factors were identified including lower levels of education, marriage at a young age, poor wealth indices, rural residential areas, and acceptance of gender norms that contribute to the prevalence of IPV in LMICs. It is essential to address these factors through effective preventive policies and programs. Moreover, this review highlights the necessity of large-scale, high-quality policy-driven research to further examine risk factors and consequences, ultimately guiding the development of interventions aimed at preventing IPV against women in LMICs.

The epidemiology and psychological comorbidity of disorders of gut-brain interaction in Australia: Results from the Rome Foundation Global Epidemiology Study.

BACKGROUND: The Rome Foundation Global Epidemiology Study on the disorders of gut-brain interaction (DGBI) was used to assess the national prevalence of all 22 DGBI, the percentage of respondents meeting diagnostic criteria for at least one DGBI, and the rates of comorbid anxiety, depression, and somatization in Australia and 25 other countries. METHODS: The survey was conducted in Australia and 25 other countries through the Internet and included the Rome IV Diagnostic Questionnaire and an in-depth supplemental questionnaire. KEY RESULTS: Two thousand thirty-six Australian adults completed the survey nationwide: mean age 47.34 ± 17.00 years, 50.15% males. Overall, 38.67% of Australians met criteria for at least one DGBI, with unspecified functional bowel disorder (8.01%) and then functional constipation (7.71%) being the most prevalent. For those Australians with at least one DGBI, rates of anxiety, depression, and somatization where high (26.58%, 28.96%, and 63.10%, respectively), with functional chest pain having the highest rates of anxiety (55.00%) and depression (57.50%), and irritable bowel syndrome (mixed) having the highest somatization rate (75.86%). The odds of having a DGBI increased with greater anxiety (OR: 1.09, CI 95%: 0.97, 1.23), depression (OR: 1.17, CI 95%: 1.04, 1.32), and somatization (OR: 1.17, CI 95%: 1.14, 1.20) symptom severity. CONCLUSIONS AND INFERENCES: The current study represents the most comprehensive epidemiological exploration of DGBI and mental health in Australia to date, including their prevalence and distributions across sex and age, associations between DGBI and anxiety, depression, and somatization. The findings warrants future comparisons between population characteristics and health care systems differences in order to reduce the burden of DGBI and mental illness worldwide.

Impact of chronic kidney disease on illness perceptions, coping, self-efficacy, psychological distress and quality of life.

Chronic kidney disease (CKD) negatively impacts psychological well-being and quality of life (QoL). Underpinned by the Common Sense Model (CSM), this study evaluated the potential mediating role of self-efficacy, coping styles and psychological distress on the relationship between illness perceptions and QoL in patients living with CKD. Participants were 147 people with stage 3-5 kidney disease. Measures included eGFR, illness perceptions, coping styles, psychological distress, self-efficacy and QoL. Correlational analyses were performed, followed by regression modelling. Poorer QoL was associated with greater distress, engagement in maladaptive coping, poorer illness perceptions and lower self-efficacy. Regression analysis revealed that illness perceptions predicted QoL, with psychological distress acting as a mediator. The proportion of variance explained was 63.8%. These findings suggest that psychological interventions are likely to enhance QoL in CKD, if they target the mediating psychological processes associated with illness perceptions and psychological distress.

Exploring the Impact of Trauma and Psychosocial Processes on the Quality of Life in Individuals Living with Inflammatory Bowel Disease.

BACKGROUND AND AIMS: Post traumatic stress disorder (PTSD) is common in individuals with inflammatory bowel diseases (IBD). Living with a medical condition has been linked to the development of PTSD and to adversely impact patient outcomes. The aim of this study is to extend the common sense model (CSM) and evaluate trauma as an additional psychosocial process in the relationship between IBD symptoms and quality of life (QoL). METHOD: A cross-sectional online study exploring trauma and IBD was performed. RESULTS: 68 (32.2%) of the sample met the criteria for PTSD. Of this trauma group, 37 (54.4%) reported IBD related trauma, 21 (30.9%) reported non-IBD related trauma and 10 (14.7%) did not identify the trauma type. A structural equation model (SEM) based upon the CSM was found to have an excellent fit (χ2 (3)=1.10, p=0.35, RMSEA=0.02, SRMR=0.02, CFI=1.00, GFI=0.99). Results showed that trauma symptoms partially mediated the relationship between illness perceptions and QoL and fully mediated the relationship between maladaptive coping and QoL. CONCLUSION: This study extended the CSM and found that trauma symptoms functioned as a mediator between IBD activity and QoL. These results highlight the need for a holistic approach including psychological assessment and intervention in IBD.

Effectiveness of the conservation areas on the Mornington Peninsula for the common resident shorebird species using citizen science data.

Conservation areas are critical for biodiversity conservation, but few citizen science studies have evaluated their efficiency. In the absence of thorough survey data, this study assessed which species benefit most from conservation areas using citizen science bird counts extracted from the Atlas of Living Australia. This was accomplished by fitting temporal models using citizen science data taken from ALA for the years 2010-2019 using the INLA approach. The trends for six resident shorebird species were compared to those for the Australian Pied Oystercatcher, with the Black-fronted Dotterel, Red-capped Dotterel, and Red-kneed Dotterel exhibiting significantly steeper increasing trends. For the Black-fronted Dotterel, Masked Lapwing, and Red-kneed Dotterel, steeper rising trends were recorded in conservation areas than in other locations. The Dotterel species' conservation status is extremely favourable. This study demonstrates that, with some limits, statistical models can be used to track the persistence of resident shorebirds and to investigate the factors affecting these data.

Initial evaluation of the Optimal Health Program for people with diabetes: 12-month outcomes of a randomised controlled trial.

OBJECTIVE: This study aimed to evaluate if a new Mental health IN DiabeteS Optimal Health Program (MINDS OHP) compared with usual care in adults with Type 1 and Type 2 diabetes would improve psychosocial outcomes including self-efficacy and quality of life.Design and Main Outcome Measures This initial randomised controlled trial evaluated MINDS OHP compared with usual care. Participants were recruited through outpatient clinics and community organisations. The intervention group received nine sessions with assessments over twelve months. Primary outcomes were self-efficacy and quality of life. Secondary outcomes included diabetes distress and anxiety. RESULTS: There were 51 participants in the control group (mean age = 52) and 55 in the intervention group (mean age = 55). There were significant main effects of time in general self-efficacy, diabetes distress, diabetes self-efficacy, and illness perceptions, however no significant between-group differences in primary or secondary outcomes. Post-hoc analyses revealed MINDS OHP improved diabetes self-efficacy for participants with mild to severe depression and anxiety, with a small effect. CONCLUSION: Initial evaluation found MINDS OHP was associated with improved diabetes self-efficacy for adults with diabetes, for people with mild to severe levels of distress, with small effect. Further research is required to explore whether this disease-specific, collaborative care-focused intervention benefits the mental health of people with diabetes.

Extending the Common Sense Model to Explore the Impact of Visceral Sensitivity on Quality of Life in Inflammatory Bowel Disease.

BACKGROUND: Inflammatory bowel disease is associated with poor quality of life. The aim of the cross-sectional study was to extend the common sense model to explore the impact of inflammatory bowel disease activity on quality of life and the potential mediating roles of illness perceptions, visceral sensitivity, coping styles, acceptance, and psychological distress. METHODS: A total of 141 inflammatory bowel disease patients (86 with Crohn's disease and 55 with ulcerative colitis; 74 males, 65 females, and 2 gender non-specific, mean age 40.43 years) from 2 metropolitan hospital inflammatory bowel disease outpatient clinics participated. Measures included disease activity (Crohn's Disease Activity Index, Simple Clinical Colitis Activity Index), illness perceptions (Brief Illness Perceptions Questionnaire), visceral sensitivity (Visceral Sensitivity Index), coping styles (Brief Coping Operations Preference Enquiry), acceptance (Acceptance and Action Questionnaire-II), psychological distress (Depression, Anxiety, and Stress Scale), and European Health Interview Survey-Quality of Life (EUROHIS-QoL). RESULTS: A structural equation model of the extended common sense model was found to have a good fit (χ2(10) = 10.07, P = .43, root mean square error of approximation = 0.01, standardized root mean residual = 0.04, comparative index fit = 1.00, Tucker-Lewis index = 1.00, goodness-of-fit = 0.98). After controlling for irritable bowel syndrome diagnosis, the impact of disease activity on quality of life was statistically mediated by illness perceptions, maladaptive coping styles, and psychological distress. In addition, visceral sensitivity bordered on influencing the impact of disease activity and illness perceptions on quality of life through psychological distress. CONCLUSIONS: This study demonstrates that together with illness perceptions and coping styles, visceral sensitivity plays an important role in an individual's adaption to living with inflammatory bowel disease.

Longitudinal assessment of the common sense model before and during the COVID-19 pandemic: A large coeliac disease cohort study.

OBJECTIVE: Psychosocial factors likely play a substantial role in the well-being of those living with coeliac disease, especially during the COVID-19 pandemic, however, little research has examined well-being in this cohort using an integrated socio-cognitive model. This study had two aims: (1) Examine changes in gastrointestinal symptoms, psychosocial factors, and well-being outcomes (i.e., psychological distress, quality of life [QoL]) associated with the pandemic, (2) Examine the interrelationship of these variables across timepoints using the Common Sense Model (CSM). METHODS: 1697 adults with coeliac disease (Time 1, pre-pandemic; 83.1% female, mean age = 55.8, SD = 15.0 years) and 674 follow-up participants (Time 2, pandemic; 82.8% female, mean age = 57.0, SD = 14.4 years) completed an online questionnaire. Hypotheses were tested using repeated measures MANOVA and cross-lagged panel model analyses. RESULTS: Participants reported improved QoL, and reduced gastrointestinal symptoms, negative illness perceptions and maladaptive coping from pre-pandemic to during the pandemic. There was no significant change in pain catastrophising or psychological distress. Cross-lagged effects showed gastrointestinal symptoms to predict negative illness perceptions, which in turn were predictive of poorer outcomes across all variables except pain catastrophising. Consistent with the CSM, there was a reciprocal relationship between illness perceptions and QoL over time. Maladaptive coping and pain catastrophising demonstrated limited predictive utility. CONCLUSION: The COVID-19 pandemic appears to have had a small beneficial effect across several indices of well-being among adults with coeliac disease. Cross-lagged relationships highlight illness perceptions as a predictor of well-being outcomes and a potential target for psychosocial interventions.

Development and Validation of the Gastrointestinal Unhelpful Thinking Scale (GUTs): A Brief Self-Report Measure for Clinical and Research Settings.

This article describes the development and validation of the Gastrointestinal Unhelpful Thinking scale. The purpose of the research was to develop the Gastrointestinal Unhelpful Thinking scale to assess in tandem the primary cognitive-affective drivers of brain-gut dysregulation, gastrointestinal-specific visceral anxiety, and pain catastrophizing. The research involved 3 phases which included undergraduate and community samples. In the first phase, an exploratory factor analysis revealed a 15-item 2-factor (visceral sensitivity and pain catastrophizing) scale (N= 323), which then was confirmed in the second phase: N = 399, χ2(26) = 2.08, p = .001, Tucker-Lewis Index = 0.94, comparative fit index = 0.96, standardized root mean square residual = 0.05, and root mean square error of approximation = 0.07. Demonstrating convergent validity, Gastrointestinal Unhelpful Thinking scale total and subscales were strongly correlated with the modified Manitoba Index, Irritable Bowel Syndrome Symptom Severity Scale scores, Visceral Sensitivity Index, and the Pain Catastrophizing Scale. A third phase (N = 16) established test-retest reliability for the Gastrointestinal Unhelpful Thinking scale (total and subscales). The test-retest reliability correlation coefficient for the Gastrointestinal Unhelpful Thinking scale total score was .93 (p < .001) and for the subscales was .86 (p < .001) and .94 (p < .001), respectively. The Gastrointestinal Unhelpful Thinking scale is a brief psychometrically valid measure of visceral anxiety and pain catastrophizing that can be useful for both clinicians and researchers who wish to measure these thinking patterns and relate them to changes in gastrointestinal and psychological symptoms.

Extending the Common Sense Model to Explore the Impact of the Fear of COVID-19 on Quality of Life in an International Inflammatory Bowel Disease Cohort.

The aim of this cross-sectional study was to use an extended common sense model (CSM) to evaluate the impact of fear of COVID-19 on quality of life (QoL) in an international inflammatory bowel disease cohort. An online study involving 319 adults (75% female, mean (SD) 14.06 (15.57) years of symptoms) completed the Gastrointestinal Symptom Rating Scale, Brief Illness Perceptions Questionnaire, Fear of Contracting COVID-19 Scale, Brief-COPE, Depression, Anxiety and Stress Scale, and the EUROHIS-QOL. The extended CSM had an excellent fit (χ2 (9) = 17.06, p = .05, χ2/N = 1.90, RMSEA = 0.05, SRMR = 0.04, CFI = .99, TLI = .97, GFI = 0.99), indicating the influence of gastrointestinal symptoms on QoL was mediated by illness perceptions, fear of COVID-19, adaptive and maladaptive coping, and psychological distress. Interventions targeting the fear of COVID-19 in the context of an individual's perceptions will likely enhance QoL during the pandemic.