Improving Prognostication in Pulmonary Hypertension Using AI-quantified Fibrosis and Radiologic Severity Scoring at Baseline CT.

Background There is clinical need to better quantify lung disease severity in pulmonary hypertension (PH), particularly in idiopathic pulmonary arterial hypertension (IPAH) and PH associated with lung disease (PH-LD). Purpose To quantify fibrosis on CT pulmonary angiograms using an artificial intelligence (AI) model and to assess whether this approach can be used in combination with radiologic scoring to predict survival. Materials and Methods This retrospective multicenter study included adult patients with IPAH or PH-LD who underwent incidental CT imaging between February 2007 and January 2019. Patients were divided into training and test cohorts based on the institution of imaging. The test cohort included imaging examinations performed in 37 external hospitals. Fibrosis was quantified using an established AI model and radiologically scored by radiologists. Multivariable Cox regression adjusted for age, sex, World Health Organization functional class, pulmonary vascular resistance, and diffusing capacity of the lungs for carbon monoxide was performed. The performance of predictive models with or without AI-quantified fibrosis was assessed using the concordance index (C index). Results The training and test cohorts included 275 (median age, 68 years [IQR, 60-75 years]; 128 women) and 246 (median age, 65 years [IQR, 51-72 years]; 142 women) patients, respectively. Multivariable analysis showed that AI-quantified percentage of fibrosis was associated with an increased risk of patient mortality in the training cohort (hazard ratio, 1.01 [95% CI: 1.00, 1.02]; P = .04). This finding was validated in the external test cohort (C index, 0.76). The model combining AI-quantified fibrosis and radiologic scoring showed improved performance for predicting patient mortality compared with a model including radiologic scoring alone (C index, 0.67 vs 0.61; P < .001). Conclusion Percentage of lung fibrosis quantified on CT pulmonary angiograms by an AI model was associated with increased risk of mortality and showed improved performance for predicting patient survival when used in combination with radiologic severity scoring compared with radiologic scoring alone. © RSNA, 2024 Supplemental material is available for this article.

Global pain levels before and during the COVID-19 pandemic.

Physical pain has trended upward globally over the last decade. Here, we explore whether the COVID-19 pandemic modified this alarming trend. We used data from 146 countries worldwide (510,247 respondents) to examine whether pain levels changed during the COVID-19 pandemic. Adjusted regressions across countries revealed that 33.3% of people were in pain in 2019, 32.8% in 2020, 32.5% in 2021, and 34.1% in 2022. The change in pain from 2019 to each of the pandemic years was not statistically significant. This suggests that, on average, there was no significant change in pain during the pandemic. However, from 2019 to 2020 there was a significant decline in pain among individuals over 55 years of age, those who were widowed, and those without children in the household. On a global scale, the COVID-19 pandemic was not associated with a significant change in pain levels. The concerning pre-pandemic elevation in global pain continued during this challenging period.

The effect of adverse employment circumstances on physical pain: Evidence from Australian panel data.

Physical pain is a common health problem with great public health implications. Yet evidence on whether adverse employment circumstances shape physical pain is limited. Using longitudinal data from 20 waves (2001-2020) from the Household, Income and Labour Dynamics of Australia Survey (HILDA; N = 23,748), a lagged design, Ordinary Least Squares (OLS) regressions as well as multilevel mixed effect linear regressions, we investigated the association between past accumulated unemployment and recent employment circumstances with physical pain. We found that adults who spent more years unemployed and looking for work subsequently reported greater physical pain (b = 0.034, 95% CI = 0.023, 0.044) and pain interference (b = 0.031, 95% CI = 0.022, 0.038) than those who spent fewer years unemployed. We also found that those experiencing overemployment (working full-time while wanting to work fewer hours) and underemployment (working part-time while wanting to work more hours) reported greater subsequent physical pain (overemployment: b = 0.024, 95% CI = 0.009, 0.039; underemployment: b = 0.036, 95% CI = 0.014, 0.057) and pain interference (overemployment: b = 0.017, 95% CI = 0.005, 0.028; underemployment: b = 0.026, 95% CI = 0.009, 0.043) than those content with their working hours. These results held after controlling for socio-demographic characteristics, occupation, and other health-related factors. These findings are consistent with recent work that suggested that psychological distress can influence physical pain. Understanding how adverse employment circumstances impact physical pain is crucial to the design of health promotion policies.

The impact of automatic enrolment on the mental health gap in pension participation: Evidence from the UK.

A large body of evidence shows that individuals with poor mental health have lower income over the lifespan but a dearth of evidence exists on how poor mental health affects savings behaviour. In this paper, we provide novel evidence of a mental health gap in pension participation in the UK using nationally representative longitudinal data from Understanding Society (UKHLS). Beginning in 2012, the UK government introduced automatic enrolment enabling us to assess the impact of one of the largest pension policy reforms in the world on this mental health gap. We measure mental health using the General Health Questionnaire (GHQ-12) which is a commonly used tool for measuring psychological distress. Prior to automatic enrolment, we find that male private sector employees with poor mental health are 3.7 percentage points less likely to participate in a workplace pension scheme while female private sector employees with poor mental health are 2.9 percentage points less likely to participate after controlling for key observables including age, education, race, marital status, number of children, occupation type, industry type, presence of a physical health condition and cognitive ability. The implementation of automatic enrolment removes the mental health gap in pension participation, equalising the pension participation rates of individuals with and without poor mental health in the private sector.

Hypoxia shapes the immune landscape in lung injury and promotes the persistence of inflammation.

Hypoxemia is a defining feature of acute respiratory distress syndrome (ARDS), an often-fatal complication of pulmonary or systemic inflammation, yet the resulting tissue hypoxia, and its impact on immune responses, is often neglected. In the present study, we have shown that ARDS patients were hypoxemic and monocytopenic within the first 48 h of ventilation. Monocytopenia was also observed in mouse models of hypoxic acute lung injury, in which hypoxemia drove the suppression of type I interferon signaling in the bone marrow. This impaired monopoiesis resulted in reduced accumulation of monocyte-derived macrophages and enhanced neutrophil-mediated inflammation in the lung. Administration of colony-stimulating factor 1 in mice with hypoxic lung injury rescued the monocytopenia, altered the phenotype of circulating monocytes, increased monocyte-derived macrophages in the lung and limited injury. Thus, tissue hypoxia altered the dynamics of the immune response to the detriment of the host and interventions to address the aberrant response offer new therapeutic strategies for ARDS.

Worker Stress, Burnout, and Wellbeing Before and During the COVID-19 Restrictions in the United Kingdom.

COVID-19 created a transformational shift in the working environment for much of the labour force, yet its impact on workers is unclear. This study uses longitudinal data to examine the wellbeing of 621 full-time workers assessed before (November 2019-February 2020) and during (May-June 2020) the first lockdown in the United Kingdom. We employ fixed effects analyses to investigate the impact of the restrictions and mandatory homeworking on cognitive, emotional, and psychological wellbeing. Within the sample, the rate of full-time homeworking increased from 2 to 74% between waves. We identify significant changes in 9 of the 15 measures assessed, with a general pattern of improvements in wellbeing during lockdown. Overall levels of stress, self-rated mental health, positive emotions and life and job satisfaction are not adversely affected by the restrictions. There is a reduction in the burnout symptoms of disengagement (-0.13 sd) and exhaustion (-0.20 sd) and in the frequency with which negative emotions are experienced at work (-0.15 sd). Workers feel more autonomous (+0.09 sd), closer to their co-workers (+0.10 sd), and more attached to their organisations (+0.19 sd). However, homelife satisfaction declines (-0.11 sd). These findings highlight the possibility that the COVID-19 pandemic and large-scale transition to homeworking was associated with unchanged or improved worker wellbeing. This study has important implications for governments and employers regarding a global shift to homeworking.

The influence of price and funding source disclosure on medication labels: Implications for intended adherence, perceived value and efficacy, and feelings of burden and guilt.

OBJECTIVES: To examine if informing people in free-at-the-point-of-use medical systems of the financial value of medicines, and priming them with the fact that the medication is funded by taxation, influences people's perceived value and efficacy of the medicines, feelings of burdensomeness and guilt, and intended adherence. DESIGN: An experiment was implemented to examine the impact of medication labelling featuring the presence (vs. absence) of the phrase 'funded by UK the taxpayer' and pricing information (absent vs. £20 vs. £200) on outcome measures. METHODS: A total of 257 UK participants (age: M = 29.10 years, SD = 9.15; 89 males, 167 females, one undisclosed) who were currently taking medication were recruited from an online participant pool (prolific academic). Participants viewed an image of a medication with the manipulated price and taxation message on the label. They then completed a number of measures to gauge perceived value and efficacy of the medicines, feelings of burdensomeness and guilt, and intended adherence. RESULTS: Findings point to both positive and negative consequences of such labelling of medication, with the taxpayer label increasing perceptions of value but also increasing feelings of guilt. The price labels demonstrated a positive effect on perceived value and intended adherence. CONCLUSIONS: Discussion of results is centred on potential policy implications, applied recommendations, and future directions for study.

Lessons From the UK's Lockdown: Discourse on Behavioural Science in Times of COVID-19.

In recent years behavioural science has quickly become embedded in national level governance. As the contributions of behavioural science to the UK's COVID-19 response policies in early 2020 became apparent, a debate emerged in the British media about its involvement. This served as a unique opportunity to capture public discourse and representation of behavioural science in a fast-track, high-stake context. We aimed at identifying elements which foster and detract from trust and credibility in emergent scientific contributions to policy making. With this in mind, in Study 1 we use corpus linguistics and network analysis to map the narrative around the key behavioural science actors and concepts which were discussed in the 647 news articles extracted from the 15 most read British newspapers over the 12-week period surrounding the first hard UK lockdown of 2020. We report and discuss (1) the salience of key concepts and actors as the debate unfolded, (2) quantified changes in the polarity of the sentiment expressed toward them and their policy application contexts, and (3) patterns of co-occurrence via network analyses. To establish public discourse surrounding identified themes, in Study 2 we investigate how salience and sentiment of key themes and relations to policy were discussed in original Twitter chatter (N = 2,187). In Study 3, we complement these findings with a qualitative analysis of the subset of news articles which contained the most extreme sentiments (N = 111), providing an in-depth perspective of sentiments and discourse developed around keywords, as either promoting or undermining their credibility in, and trust toward behaviourally informed policy. We discuss our findings in light of the integration of behavioural science in national policy making under emergency constraints.

Daily emotional well-being during the COVID-19 pandemic.

The COVID-19 outbreak has become one of the largest public health crises of our time. Governments have responded by implementing self-isolation and physical distancing measures that have profoundly impacted daily life throughout the world. In this study, we aimed to investigate how people experience the activities, interactions, and settings of their lives during the pandemic. The sample (N = 604) was assessed in Ireland on the 25 March 2020, following the closure of schools and non-essential businesses. We examined within-person variance in emotional well-being and how people spend their time. We found that while most time was spent in the home (74%), time spent outdoors (8%) was associated with markedly raised positive affect and reduced negative emotions. Exercising, going for walks, gardening, pursuing hobbies, and taking care of children were the activities associated with the greatest affective benefits. Home-schooling children and obtaining information about COVID-19 were ranked lowest of all activities in terms of emotional experience. These findings highlight activities that may play a protective role in relation to well-being during the pandemic, the importance of setting limits for exposure to COVID-19-related media coverage, and the need for greater educational supports to facilitate home-schooling during this challenging period.

Over the Cuckoo's Nest: Does Experiencing Electroconvulsive Therapy Change Your Mind? A Mixed Methods Study of Attitudes and Impact of Electroconvulsive Therapy on Patients and Their Relatives.

OBJECTIVE: Electroconvulsive therapy (ECT) is an effective treatment for major depressive disorder, but some aspects remain controversial. Few studies have taken an in-depth mixed methods approach toward the study of attitudes, and there are no significant studies that explore the change of attitudes before and after treatment. The aim was to compare attitudes of patients and their relatives before and after ECT using quantitative and qualitative methods. METHODS: One hundred twenty-three participants were recruited. Forty-one patient/relative participants were recruited from 2 accredited ECT centers along with 82 age- and sex-matched general population controls. A validated 22-item survey about attitudes toward ECT was administered. Patient/relative participants completed the survey before treatment with ECT and engaged in a repeat survey and a semistructured interview 1 month after completion of ECT. Control participants completed the survey on a single occasion. RESULTS: Control versus pre-ECT surveys and pre-ECT versus post-ECT surveys both demonstrated statistically and clinically significant positive attitudinal differences (Cohen d = 1.37, P < 0.001; Cohen d = 1.2, P < 0.001). These differences were maintained for both the patient and relative pre/post subgroups (Cohen d = 1.15, P < 0.001; Cohen d = 1.33, P < 0.001). Qualitative analysis identified 13 attitudinal transitions in cognition, emotion, and imagery domains. CONCLUSIONS: This is the first study to examine a change in attitudes toward ECT of patients, their relatives, and with controls using mixed methods. The findings suggest a 2-phase positive attitudinal change, in which accurate information (phase 1) and experiential learning (phase 2) are both key components. These findings address stigma through accurate knowledge and experiential learning, with a positive outcome through changed attitudes.

Assessing Public Attitudes to Electroconvulsive Therapy: Validation of the Modified ECT Attitudes Questionnaire Using a Systematic Analysis.

INTRODUCTION: Electroconvulsive therapy (ECT) is an established treatment for major depressive disorder, yet it remains controversial. Attitudes toward ECT have been studied in members of the public and service users, with diverse findings. There is no systematically validated scale to quantify attitudes. OBJECTIVES: The aim of this study was to validate a scale measuring attitudes toward ECT using a systematic analysis. METHODS: Validation consisted of 3 stages: item generation, theoretical analysis, and psychometric analysis. A total of 196 members of the public were surveyed, and the findings were used to perform principal component analysis, Cronbach alpha (CA), and interitem correlation. RESULTS: The Modified ECT Attitudes Questionnaire (EAQ) is a 22-item participant-rated questionnaire (0-44) consisting of 2 principal components: "moral and ethical perceptions of ECT" and "ECT as a last resort treatment." There was adequate reliability for the total EAQ (CA, 0.873) and each of the components (component 1 CA, 0.907; component 2 interitem correlation, 0.389). Among the 196 members of the public, the mean score was 20.4 (SD, 8.4), which equates to 46% positive responses. Component 1 elicited 39% positive responses; component 2 elicited 52% positive responses. The emotion components of attitudes elicited particularly negative responses. CONCLUSIONS: The EAQ is a validated and reliable scale for the measurement of attitudes toward ECT. Application of this scale to 196 members of the public indicates that negative attitudes are rooted in individuals' moral and ethical objections to ECT, particularly the emotion components of such attitudes. This scale can be applied to other groups, including service users, to further characterize attitudes that underlie the stigma toward ECT.

Underemployment and psychological distress: Propensity score and fixed effects estimates from two large UK samples.

BACKGROUND: The share of workers who work part-time because full-time jobs are not available remains larger compared to the period prior to the 2008 crisis. For part-time workers, being available to work more hours than offered may have negative mental health implications. METHOD: Drawing on two nationally representative British surveys, we tested whether working less than 30 hours per week while preferring to work longer hours (underemployment) is associated with increased psychological distress. Distress was assessed using responses to the 12-item General Health Questionnaire in both samples. RESULTS: In the National Child Development Study (N = 6,295), propensity score estimates indicated that the hours-underemployed workers experienced higher levels of psychological distress (ß = 0.25, p <0.001) than full-time workers matched on observable characteristics, including prior distress levels. Fixed effects estimates using 18 years of the British Household Panel Survey (N = 8,665) showed that transitioning from full-time employment to underemployment predicted an increase in distress levels (ß = 0.19, p <0.01). Conversely, transitioning from underemployment to full-time employment forecasted a reduction in distress (ß = -0.18, p <0.001). On average, job earnings and perceptions of job security explained a small (≈ 10%) portion of the potential psychological impact of hours-underemployment. CONCLUSIONS: These findings highlight the possibility that underemployment among part-time workers may have detrimental psychological consequences. Policy interventions geared towards improving career opportunities for part-time workers would potentially ameliorate losses in psychological well-being experienced by this group.

IL4Rα Signaling Abrogates Hypoxic Neutrophil Survival and Limits Acute Lung Injury Responses In Vivo.

Rationale: Acute respiratory distress syndrome is defined by the presence of systemic hypoxia and consequent on disordered neutrophilic inflammation. Local mechanisms limiting the duration and magnitude of this neutrophilic response remain poorly understood. Objectives: To test the hypothesis that during acute lung inflammation tissue production of proresolution type 2 cytokines (IL-4 and IL-13) dampens the proinflammatory effects of hypoxia through suppression of HIF-1α (hypoxia-inducible factor-1α)-mediated neutrophil adaptation, resulting in resolution of lung injury. Methods: Neutrophil activation of IL4Ra (IL-4 receptor α) signaling pathways was explored ex vivo in human acute respiratory distress syndrome patient samples, in vitro after the culture of human peripheral blood neutrophils with recombinant IL-4 under conditions of hypoxia, and in vivo through the study of IL4Ra-deficient neutrophils in competitive chimera models and wild-type mice treated with IL-4. Measurements and Main Results: IL-4 was elevated in human BAL from patients with acute respiratory distress syndrome, and its receptor was identified on patient blood neutrophils. Treatment of human neutrophils with IL-4 suppressed HIF-1α-dependent hypoxic survival and limited proinflammatory transcriptional responses. Increased neutrophil apoptosis in hypoxia, also observed with IL-13, required active STAT signaling, and was dependent on expression of the oxygen-sensing prolyl hydroxylase PHD2. In vivo, IL-4Ra-deficient neutrophils had a survival advantage within a hypoxic inflamed niche; in contrast, inflamed lung treatment with IL-4 accelerated resolution through increased neutrophil apoptosis. Conclusions: We describe an important interaction whereby IL4Rα-dependent type 2 cytokine signaling can directly inhibit hypoxic neutrophil survival in tissues and promote resolution of neutrophil-mediated acute lung injury.

Adolescent mental health and unemployment over the lifespan: Population evidence from Sweden.

RATIONALE: Symptoms of mental health problems have been shown to predict adverse labour market outcomes including unemployment, but no studies have used sibling models to examine the relationship between clinically diagnosed psychiatric conditions in adolescence and subsequent unemployment. OBJECTIVE: This study used extensive Swedish registry data to investigate the link between psychiatric conditions diagnosed during military conscription and unemployment over two decades. Further, we identified whether this relation was amplified during an economic downturn and tested whether it was affected by adjustment for unobserved family characteristics using sibling fixed-effects models. METHOD: Psychiatric conditions were diagnosed by psychologists and psychiatrists at military conscription in sample of 929,191 Swedish men (mean age = 18.4 years) between 1969 and 1989. The average number of days unemployed per year was observed from 1992 to 2012, using the records of the Swedish Public Employment Services. RESULTS: After adjustment for physical health and childhood socioeconomic status those diagnosed with any psychiatric condition experienced approximately an additional 10 days per year unemployment compared to others. Alcohol (16 days unemployment) and other substance use disorders (17 days) were the strongest predictors of exposure to future unemployment, followed by personality disorders (10 days), neurotic and adjustment conditions (nine days), and depressive disorders (six days). Family background factors accounted for approximately half of the observed relationship between mental health conditions and unemployment. Psychiatric conditions interacted with macroeconomic conditions such that those with pre-existing alcohol-related, and neurotic and adjustment disorders were disproportionately more likely to become unemployed following the 1990s crisis in Sweden. CONCLUSIONS: Adolescent mental health conditions forecast an elevated risk of unemployment, which endures over the life course and is amplified in times of economic uncertainty. Investment in youth mental health services and alcohol and substance use prevention programs may yield economic benefits by reducing unemployment.

The intra-day dynamics of affect, self-esteem, tiredness, and suicidality in Major Depression.

Despite growing interest in the temporal dynamics of Major Depressive Disorder (MDD), we know little about the intra-day fluctuations of key symptom constructs. In a study of momentary experience, the Experience Sampling Method captured the within-day dynamics of negative affect, positive affect, self-esteem, passive suicidality, and tiredness across clinical MDD (N= 31) and healthy control groups (N= 33). Ten symptom measures were taken per day over 6 days (N= 2231 observations). Daily dynamics were modeled via intra-day time-trends, variability, and instability in symptoms. MDD participants showed significantly increased variability and instability in negative affect, positive affect, self-esteem, and suicidality. Significantly different time-trends were found in positive affect (increased diurnal variation and an inverted U-shaped pattern in MDD, compared to a positive linear trend in controls) and tiredness (decreased diurnal variation in MDD). In the MDD group only, passive suicidality displayed a negative linear trend and self-esteem displayed a quadratic inverted U trend. MDD and control participants thus showed distinct dynamic profiles in all symptoms measured. As well as the overall severity of symptoms, intra-day dynamics appear to define the experience of MDD symptoms.

The Great Recession and subjective well-being: How did the life satisfaction of people living in the United Kingdom change following the financial crisis?

The financial crisis of 2007/08 precipitated a severe global economic downturn, typically referred to as the Great Recession. However, in the United Kingdom this period has been marked by limited change in national indicators of subjective well-being. We assessed the life satisfaction change in response to the Great Recession in a sample of British adults (N = 8,661). We first show that on average the life satisfaction change across the sample was limited. However, average effects may mask substantial amounts of heterogeneity in the data. We therefore explore beyond this average effect to determine whether there were disproportionate changes (losses and gains) in life satisfaction in key sub-groups of the population. We found that individuals experiencing unemployment, who lost income, were sick or disabled, experienced the greatest well-being reductions. Contrastingly the life satisfaction of many individuals did not greatly change following the Great Recession and for some it may have even improved. Our work highlights vulnerable groups that may need additional help during recession periods and also cautions against the over reliance on average measures of well-being.

The scarring effect of unemployment on psychological well-being across Europe.

Past unemployment may have a pervasive psychological impact that occurs across nations. We investigate the association between unemployment events across working life and subsequent psychological well-being across 14 European countries. Additionally, we consider the influence of between-country differences in labour market institutions and conditions on the cross-country well-being effects of unemployment. Data detailing life-long employment trajectories and contemporary life conditions are drawn from the Survey of Health, Ageing and Retirement in Europe. The well-being impact of unemployment is modeled using linear, multi-level specifications. Each six-month spell of past unemployment is found to predict reduced quality of life and life satisfaction after the age of 50, having adjusted for a broad range of individual and country-specific covariates. In contrast, the impact of past unemployment on depression is explained by individual demographic factors. We identify the first comparative long-term evidence that unemployment welfare scarring may be a broad, international phenomenon.

Central bank interest rate decisions, household indebtedness, and psychiatric morbidity and distress: Evidence from the UK.

BACKGROUND: Central banks set economy-wide interest rates to meet exclusively economic objectives. There is a strong link between indebtedness and psychiatric morbidity at the individual level, with interest rates being an important factor determining ability to repay debt. However, no prior research has explored whether central bank interest rate changes directly influence mental health, nor whether this varies by levels of indebtedness. METHODS: We use British data (N = 93,255) to explore whether the Bank of England base-rate affected how perceived burden of non-mortgage debt (low, medium, and high) influenced psychiatric morbidity. Psychiatric morbidity was measured using the General Health Questionnaire (GHQ-12). Our primary outcome measure was a binary indicator of "psychiatric caseness" (>3 on a 0-12 scale). We also used the GHQ-12 as a continuous measure of distress. RESULTS: When interest rates are high (low) there is an increased (decreased) risk of psychiatric morbidity only among those with a high debt burden (b = 0.026, p =  0.02). This result was robust to alternative explanations. Thus a 1 percentage point base-rate increase is associated with a 2.6% increase that someone with a high debt burden will experience psychiatric morbidity. LIMITATIONS: Our study uses subjective indicators of debt burden. We were unable to determine the mechanism behind our effect. CONCLUSIONS: Changes in central bank interest rates to meet economic objectives pose a threat to mental health. Mental health support is needed for those in debt and central banks may need to consider how their decisions influence population mental health.

Can Early Intervention Improve Maternal Well-Being? Evidence from a Randomized Controlled Trial.

OBJECTIVE: This study estimates the effect of a targeted early childhood intervention program on global and experienced measures of maternal well-being utilizing a randomized controlled trial design. The primary aim of the intervention is to improve children's school readiness skills by working directly with parents to improve their knowledge of child development and parenting behavior. One potential externality of the program is well-being benefits for parents given its direct focus on improving parental coping, self-efficacy, and problem solving skills, as well as generating an indirect effect on parental well-being by targeting child developmental problems. METHODS: Participants from a socio-economically disadvantaged community are randomly assigned during pregnancy to an intensive 5-year home visiting parenting program or a control group. We estimate and compare treatment effects on multiple measures of global and experienced well-being using permutation testing to account for small sample size and a stepdown procedure to account for multiple testing. RESULTS: The intervention has no impact on global well-being as measured by life satisfaction and parenting stress or experienced negative affect using episodic reports derived from the Day Reconstruction Method (DRM). Treatment effects are observed on measures of experienced positive affect derived from the DRM and a measure of mood yesterday. CONCLUSION: The limited treatment effects suggest that early intervention programs may produce some improvements in experienced positive well-being, but no effects on negative aspects of well-being. Different findings across measures may result as experienced measures of well-being avoid the cognitive biases that impinge upon global assessments.