Mental health and burnout during medical school: Longitudinal evolution and covariates.

BACKGROUND: Medical students' rate of depression, suicidal ideation, anxiety, and burnout have been shown to be higher than those of the same-age general population. However, longitudinal studies spanning the whole course of medical school are scarce and present contradictory findings. This study aims to analyze the longitudinal evolution of mental health and burnout from the first to the last year of medical school using a wide range of indicators. Moreover, biopsychosocial covariates that can influence this evolution are explored. METHOD: In an open cohort study design, 3066 annual questionnaires were filled in by 1595 different students from the first to the sixth year of the Lausanne Medical School (Switzerland). Depression symptoms, suicidal ideation, anxiety symptoms, stress, and burnout were measured along with biopsychosocial covariates. The longitudinal evolution of mental health and burnout and the impact of covariates were modelled with linear mixed models. RESULTS: Comparison to a same-aged general population sample shows that medical students reported significantly more depression symptoms and anxiety symptoms. Medical students' mental health improved during the course of the studies in terms of depression symptoms, suicidal ideation, and stress, although suicidal ideation increased again in the last year and anxiety symptoms remained stable. Conversely, the results regarding burnout globally showed a significant worsening from beginning to end of medical school. The covariates most strongly related to better mental health and less burnout were less emotion-focused coping, more social support, and more satisfaction with health. CONCLUSION: Both improvement of mental health and worsening of burnout were observed during the course of medical school. This underlines that the beginning and the end of medical school bring specific challenges with the first years' stressors negatively impacting mental health and the last year's difficulties negatively impacting burnout.

Embracing the Emotion in Emotional Intelligence Measurement: Insights from Emotion Theory and Research.

Emotional intelligence (EI) has gained significant popularity as a scientific construct over the past three decades, yet its conceptualization and measurement still face limitations. Applied EI research often overlooks its components, treating it as a global characteristic, and there are few widely used performance-based tests for assessing ability EI. The present paper proposes avenues for advancing ability EI measurement by connecting the main EI components to models and theories from the emotion science literature and related fields. For emotion understanding and emotion recognition, we discuss the implications of basic emotion theory, dimensional models, and appraisal models of emotion for creating stimuli, scenarios, and response options. For the regulation and management of one's own and others' emotions, we discuss how the process model of emotion regulation and its extensions to interpersonal processes can inform the creation of situational judgment items. In addition, we emphasize the importance of incorporating context, cross-cultural variability, and attentional and motivational factors into future models and measures of ability EI. We hope this article will foster exchange among scholars in the fields of ability EI, basic emotion science, social cognition, and emotion regulation, leading to an enhanced understanding of the individual differences in successful emotional functioning and communication.

How Speededness of a Reasoning Test and the Complexity of Mental Speed Tasks Influence the Relation between Mental Speed and Reasoning Ability.

Although previous research has consistently reported a positive association between mental speed and reasoning ability, it remains unclear whether the magnitude of this association depends on whether the reasoning test is administered with or without a time limit. In addition, it is unknown how mental speed task complexity affects the mental speed-reasoning association when the effects of time limitations in the reasoning test (labeled "speededness") are controlled for. The present study examined these questions in a sample of 200 participants who completed the time-limited Culture Fair Test (CFT) and a Hick task with three levels of complexity to measure mental speed. Results showed that the latent correlation between mental speed and reasoning was slightly lower when the effect of speededness in reasoning was statistically controlled for. However, for both controlled and uncontrolled reasoning, the correlation with mental speed was of medium size and statistically significant. When reasoning was controlled for the effects of speededness, only complexity-related mental speed aspects were correlated with reasoning, whereas basic mental speed aspects were correlated with the speededness factor and unrelated to reasoning. These findings demonstrate that time limitations in reasoning tests and complexity in mental speed tasks affect the magnitude of the mental speed-reasoning association.

Parallel Evolution of Pseudomonas aeruginosa during a Prolonged ICU-Infection Outbreak.

Most knowledge about Pseudomonas aeruginosa pathoadaptation is derived from studies on airway colonization in cystic fibrosis; little is known about adaptation in acute settings. P. aeruginosa frequently affects burned patients and the burn wound niche has distinct properties that likely influence pathoadaptation. This study aimed to genetically and phenotypically characterize P. aeruginosa isolates collected during an outbreak of infection in a burn intensive care unit (ICU). Sequencing reads from 58 isolates of ST1076 P. aeruginosa taken from 23 patients were independently mapped to a complete reference genome for the lineage (H25338); genetic differences were identified and were used to define the population structure. Comparative genomic analysis at single-nucleotide resolution identified pathoadaptive genes that evolved multiple, independent mutations. Three key phenotypic assays (growth performance, motility, carbapenem resistance) were performed to complement the genetic analysis for 47 unique isolates. Population structure for the ST1076 lineage revealed 11 evolutionary sublineages. Fifteen pathoadaptive genes evolved mutations in at least two sublineages. The most prominent functional classes affected were transcription/two-component regulatory systems, and chemotaxis/motility and attachment. The most frequently mutated gene was oprD, which codes for outer membrane porin involved in uptake of carbapenems. Reduced growth performance and motility were found to be adaptive phenotypic traits, as was high level of carbapenem resistance, which correlated with higher carbapenem consumption during the outbreak. Multiple prominent linages evolved each of the three traits in parallel providing evidence that they afford a fitness advantage for P. aeruginosa in the context of human burn infection. IMPORTANCE Pseudomonas aeruginosa is a Gram-negative pathogen causing infections in acutely burned patients. The precise mechanisms required for the establishment of infection in the burn setting, and adaptive traits underpinning prolonged outbreaks are not known. We have assessed genotypic data from 58 independent P. aeruginosa isolates taken from a single lineage that was responsible for an outbreak of infection in a burn ICU that lasted for almost 2.5 years and affected 23 patients. We identified a core set of 15 genes that we predict to control pathoadaptive traits in the burn infection based on the frequency with which independent mutations evolved. We combined the genotypic data with phenotypic data (growth performance, motility, antibiotic resistance) and clinical data (antibiotic consumption) to identify adaptive phenotypes that emerged in parallel. High-level carbapenem resistance evolved rapidly, and frequently, in response to high clinical demand for this antibiotic class during the outbreak.

The relationship between medical students' empathy, mental health, and burnout: A cross-sectional study.

OBJECTIVE: To investigate how medical students' empathy is related to their mental health and burnout. METHODS: This cross-sectional study included 886 medical students from curriculum years 1-6. The cognitive, affective, and behavioural dimensions of empathy were measured with self-report questionnaires and an emotion recognition test. Regressions were used to test the relationship between the empathy dimensions, depressive symptoms, anxiety, and burnout as well as the influence of curriculum year and gender. RESULTS: Cognitive and behavioural empathy were significantly related to less mental health issues and burnout, whereas affective empathy was related to more mental health issues and burnout. Students in later curriculum years reported less mental health issues and burnout than students in earlier years, whereas no systematic difference could be observed for empathy. Female students reported more mental health issues and burnout as well as higher empathy, except for behavioural empathy for which male students scored higher. CONCLUSIONS: The cognitive, affective, and behavioural dimensions of empathy were differently related to the mental health and burnout of medical students. Students presenting mental health issues or burnout might have more difficulty to adapt their behaviour in social situations and keep a certain distance when taking others' perspective.

Assessing Emotional Intelligence Abilities, Acquiescent and Extreme Responding in Situational Judgment Tests Using Principal Component Metrics.

Principal Component Metrics is a novel theoretically-based and data-driven methodology that enables the evaluation of the internal structure at item level of maximum emotional intelligence tests. This method disentangles interindividual differences in emotional ability from acquiescent and extreme responding. Principal Component Metrics are applied to existing (Mayer-Salovey-Caruso Emotional Intelligence Test) and assembled (specifically, the Situational Test of Emotion Understanding, the Situational Test of Emotion Management, and the Geneva Emotion Recognition Test) emotional intelligence test batteries in an analysis of three samples (total N = 2,303 participants). In undertaking these analyses important aspects of the nomological network of emotional intelligence, acquiescent, and extreme responding are investigated. The current study adds a central piece of empirical validity evidence to the emotional intelligence domain. In the three different samples, theoretically predicted internal structures at item level were found using raw item scores. The validity of the indicators for emotional intelligence, acquiescent, and extreme responding was confirmed by their relationships across emotional intelligence tests and by their nomological networks. The current findings contribute to evaluating the efficacy of the emotional intelligence construct as well as the validity evidence surrounding the instruments that are currently designed for its assessment, in the process opening new perspectives for analyzing existing and constructing new emotional intelligence tests.

Adult Attachment and Personality as Predictors of Jealousy in Romantic Relationships.

Functional relationships between romantic jealousy and traits, such as neuroticism or adult attachment styles, are well-known. For the first time, we conducted a joint analysis of the Big Five traits and attachment dimensions as predictors of jealousy, which considered gender differences as well as differences in infidelity experiences and relationship status. In 847 participants, path modeling showed that higher neuroticism, lower agreeableness, and lower openness predicted higher romantic jealousy. The attachment dimensions "anxiety" and "depend" partly mediated the effect of neuroticism and fully mediated the effect of agreeableness on romantic jealousy. The direct and indirect relationships did not differ as a function of gender, relationship status, and infidelity experiences. These findings contribute to a better understanding of individual differences in romantic jealousy from a personality perspective.

Study protocol for the ETMED-L project: longitudinal study of mental health and interpersonal competence of medical students in a Swiss university using a comprehensive framework of empathy.

INTRODUCTION: Physician interpersonal competence is crucial for patient care. How interpersonal competence develops during undergraduate medical education is thus a key issue. Literature on the topic consists predominantly of studies on empathy showing a trend of decline over the course of medical school. However, most existing studies have focused on narrow measures of empathy. The first aim of this project is to study medical students' interpersonal competence with a comprehensive framework of empathy that includes self-reported cognitive and affective empathy, performance-based assessments of emotion recognition accuracy, and a behavioural dimension of empathy. The second aim of the present project is to investigate the evolution of mental health during medical school and its putative link to the studied components of interpersonal competence. Indeed, studies documented a high prevalence of mental health issues among medical students that could potentially impact their interpersonal competence. Finally, this project will enable to test the impact of mental health and interpersonal competence on clinical skills as evaluated by experts and simulated patients. METHODS AND ANALYSIS: This project consists of an observational longitudinal study with an open cohort design. Each year during the four consecutive years of the project, every medical student (curriculum years 1-6) of the University of Lausanne in Switzerland will be asked to complete an online questionnaire including several interpersonal competence and mental health measures. Clinical skills assessments from examinations and training courses with simulated patients will also be included. Linear mixed models will be used to explore the longitudinal evolutions of the studied components of interpersonal competence and mental health as well as their reciprocal relationship and their link to clinical skills. ETHICS AND DISSEMINATION: The project has received ethical approval from the competent authorities. Findings will be disseminated through internal, regional, national and international conferences, news and peer-reviewed journals.

Reduced emotion recognition from nonverbal cues in anorexia nervosa.

OBJECTIVE: Recent models of anorexia nervosa (AN) emphasise the role of reduced emotion recognition ability (ERA) in the development and maintenance of the disorder. However, methodological limitations impede conclusions from prior research. The current study tries to overcome these limitations by examining ERA with an audio-visual measure that focuses strictly on multimodal nonverbal cues and allows to differentiate between ERA for different emotion categories. METHOD: Forty women with AN and 40 healthy women completed the Geneva Emotion Recognition Test. This test includes 83 video clips in which 10 actors express 14 different emotions while saying a pseudo-linguistic sentence without semantic meaning. All clips contain multimodal nonverbal cues (i.e., prosody, facial expression, gestures, and posture). RESULTS: Patients with AN showed poorer ERA than the healthy control group (d = 0.71), particularly regarding emotions of negative valence (d = 0.26). Furthermore, a lower body weight (r = 0.41) and longer illness duration (ρ = -0.32) were associated with poorer ERA in the AN group. CONCLUSIONS: Using an ecologically valid instrument, the findings of the study support illness models emphasising poor ERA in AN. Directly addressing ERA in the treatment of AN with targeted interventions may be promising.

How Multidimensional Is Emotional Intelligence? Bifactor Modeling of Global and Broad Emotional Abilities of the Geneva Emotional Competence Test.

Drawing upon multidimensional theories of intelligence, the current paper evaluates if the Geneva Emotional Competence Test (GECo) fits within a higher-order intelligence space and if emotional intelligence (EI) branches predict distinct criteria related to adjustment and motivation. Using a combination of classical and S-1 bifactor models, we find that (a) a first-order oblique and bifactor model provide excellent and comparably fitting representation of an EI structure with self-regulatory skills operating independent of general ability, (b) residualized EI abilities uniquely predict criteria over general cognitive ability as referenced by fluid intelligence, and (c) emotion recognition and regulation incrementally predict grade point average (GPA) and affective engagement in opposing directions, after controlling for fluid general ability and the Big Five personality traits. Results are qualified by psychometric analyses suggesting only emotion regulation has enough determinacy and reliable variance beyond a general ability factor to be treated as a manifest score in analyses and interpretation. Findings call for renewed, albeit tempered, research on EI as a multidimensional intelligence and highlight the need for refined assessment of emotional perception, understanding, and management to allow focused analyses of different EI abilities.

Loneliness and Well-Being During the Covid-19 Pandemic: Associations with Personality and Emotion Regulation.

The present study examined how neuroticism, extraversion, and emotion regulation were related to loneliness and well-being during 6 weeks of major public life restrictions in the Covid-19 pandemic in Switzerland. Cross-sectional results from 466 participants showed that neuroticism and emotion regulation strategies were associated with higher loneliness and lower well-being. However, in contrast to prior research, associations of extraversion with loneliness and well-being were weak and were qualified by interactions with emotion regulation. For introverts, maladaptive cognitive strategies such as rumination or catastrophizing were related to higher levels of loneliness. For extraverts, emotion suppression was related to lower levels of affective well-being. Individuals with low maladaptive regulation reported higher well-being the longer the public life restrictions were in place at the time of study participation. These findings suggest that first, extraversion may lose some of its protective value for loneliness and well-being when opportunities to engage in social activities are limited; second, that loneliness and well-being do not decrease over 6 weeks of public life restrictions; and third, that future studies should further investigate the moderating role of emotion regulation on the link between personality, loneliness, and well-being.

Experimental phasing with vanadium and application to nucleotide-binding membrane proteins.

The structure determination of soluble and membrane proteins can be hindered by the crystallographic phase problem, especially in the absence of a suitable homologous structure. Experimental phasing is the method of choice for novel structures; however, it often requires heavy-atom derivatization, which can be difficult and time-consuming. Here, a novel and rapid method to obtain experimental phases for protein structure determination by vanadium phasing is reported. Vanadate is a transition-state mimic of phosphoryl-transfer reactions and it has the advantage of binding specifically to the active site of numerous enzymes catalyzing this reaction. The applicability of vanadium phasing has been validated by determining the structures of three different protein-vanadium complexes, two of which are integral membrane proteins: the rabbit sarcoplasmic reticulum Ca2+-ATPase, the antibacterial peptide ATP-binding cassette transporter McjD from Escherichia coli and the soluble enzyme RNAse A from Bos taurus. Vanadium phasing was successful even at low resolution and despite severe anisotropy in the data. This method is principally applicable to a large number of proteins, representing six of the seven Enzyme Commission classes. It relies exclusively on the specific chemistry of the protein and it does not require any modifications, making it a very powerful addition to the phasing toolkit. In addition to the phasing power of this technique, the protein-vanadium complexes also provide detailed insights into the reaction mechanisms of the studied proteins.

Accuracy in Judging Others' Personalities: The Role of Emotion Recognition, Emotion Understanding, and Trait Emotional Intelligence.

The ability to accurately judge others' personality and the ability to accurately recognize others' emotions are both part of the broader construct of interpersonal accuracy (IPA). However, little research has examined the association between these two IPA domains. Little is also known about the relationship between personality judgment accuracy and other socio-emotional skills and traits. In the present study, 121 participants judged eight traits (Big Five, intelligence, cooperativeness, and empathy) in each of 30 targets who were presented either in a photograph, a muted video, or a video with sound. The videos were 30 second excerpts from negotiations that the targets had engaged in. Participants also completed standard tests of emotion recognition ability, emotion understanding, and trait emotional intelligence. Results showed that personality judgment accuracy, when indexed as trait accuracy and distinctive profile accuracy, positively correlated with emotion recognition ability and was unrelated to emotion understanding and trait emotional intelligence. Female participants were more accurate in judging targets' personality than men. These results provide support for IPA as a set of correlated domain-specific skills and encourage further research on personality judgment accuracy as a meaningful individual difference variable.

Speeded reasoning moderates the inverse relationship between autistic traits and emotion recognition.

LAY ABSTRACT: Autistic people typically have difficulty recognizing other people's emotions and to process nonverbal cues in an automatic, intuitive fashion. This usually also applies to people who-regardless of an official diagnosis of autism-achieve high values in autism questionnaires. However, some autistic people do not seem to have any problems with emotion recognition. One explanation may be that these individuals are able to compensate for their lack of intuitive or automatic processing through a quick conscious and deliberate analysis of the emotional cues in faces, voices, and body movements. On these grounds, we assumed that the higher autistic people's ability to reason quickly (i.e. to make quick logical inferences), the fewer problems they should have with determining other people's emotions. In our study, we asked workers on the crowdsourcing marketplace MTurk to complete a questionnaire about their autistic traits, to perform emotion recognition tests, and to complete a test of the ability to reason under time constraints. In our sample of 217 people, we found the expected pattern. Overall, those who had higher values in the autism questionnaire scored lower in the emotion recognition tests. However, when reasoning ability was taken into account, a more nuanced picture emerged: participants with high values both on the autism questionnaire and on the reasoning test recognized emotions as well as individuals with low autistic traits. Our results suggest that fast analytic information processing may help autistic people to compensate problems in recognizing others' emotions.

Improving emotion recognition in anorexia nervosa: An experimental proof-of-concept study.

OBJECTIVE: Previous research has found increasing evidence for difficulties in emotion recognition ability (ERA) and social cognition in anorexia nervosa (AN), and recent models consider these factors to contribute to the development and maintenance of the disorder. However, there is a lack of experimental studies testing this hypothesis. Therefore, the present proof-of-concept study examined whether ERA can be improved by a single session of a computerized training in AN, and whether this has short-term effects on eating disorder symptoms. METHOD: Forty inpatients (22.20 ± 7.15 years) with AN were randomly assigned to receive a single session of computerized training of ERA (TERA) or a sham training (training the recognition of different types of clouds). ERA, self-reported eating disorder symptoms, and body mass index (BMI) were assessed within 3 days before and after training. RESULTS: After training, both groups showed improved ERA, reduced self-reported eating disorder symptoms, and an increased BMI. As compared to patients in the control group, patients who received TERA showed greater improvements in ERA and self-reported eating disorder symptoms. DISCUSSION: ERA can be effectively trained in patients with AN. Moreover, short-term improvements in self-reported eating disorder symptoms provide tentative support for the hypothesis that difficulties in ERA contribute to the maintenance of AN, and that specific trainings of ERA hold promise as an additional component in AN treatment. Future studies are needed to replicate these findings in larger samples, and to investigate long-term effects and transfer into real-world settings.

A meta-analysis of the relationship between emotion recognition ability and intelligence.

The ability to recognise others' emotions from nonverbal cues (emotion recognition ability, ERA) is measured with performance-based tests and has many positive correlates. Although researchers have long proposed that ERA is related to general mental ability or intelligence, a comprehensive analysis of this relationship is lacking. For instance, it remains unknown whether the magnitude of the association varies by intelligence type, ERA test features, as well as demographic variables. The present meta-analysis examined the relationship between ERA and intelligence based on 471 effect sizes from 133 samples and found a significant mean effect size (controlled for nesting within samples) of r = .19. Different intelligence types (crystallized, fluid, spatial, memory, information processing speed and efficiency) yielded similar effect sizes, whereas academic achievement measures (e.g. SAT scores) were unrelated to ERA. Effect sizes were higher for ERA tests that simultaneously present facial, vocal, and bodily cues (as compared to tests using static pictures) and for tests with higher reliability and more emotions. Results were unaffected by most study and sample characteristics, but effect size increased with higher mean age of the sample. These findings establish ERA as sensory-cognitive ability that is distinct from, yet related to, intelligence.

The Geneva Emotional Competence Test (GECo): An ability measure of workplace emotional intelligence.

Emotional intelligence (EI) has been frequently studied as a predictor of work criteria, but disparate approaches to defining and measuring EI have produced rather inconsistent findings. The conceptualization of EI as an ability to be measured with performance-based tests is by many considered the most appropriate approach, but only few tests developed in this tradition exist, and none of them is designed to specifically assess EI in the workplace. The present research introduces the Geneva Emotional Competence test (GECo)-a new ability EI test measuring emotion recognition (assessed using video clips of actors), emotion understanding, emotion regulation in oneself, and emotion management in others (all assessed with situational judgment items of work-related scenarios). For the situational judgment items, correct and incorrect response options were developed using established theories from the emotion and organizational field. Five studies (total N = 888) showed that all subtests had high measurement precision (as assessed with Item Response Theory), and correlated in expected ways with other EI tests, cognitive intelligence, personality, and demographic variables. Further, the GECo predicted performance in computerized assessment center tasks in a sample of professionals, and explained academic performance in students incrementally above another ability EI test. Because of its theory-based scoring, good psychometric properties, and focus on the workplace, the GECo represents a promising tool for studying the role of four major EI components in organizational outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The nomological network of emotion knowledge and emotion understanding in adults: evidence from two new performance-based tests.

Emotion understanding, which can broadly be defined as expertise in the meaning of emotion, is a core component of emotional intelligence and facilitates better intra- and interpersonal outcomes. However, to date only very few standard tests to measure emotion understanding in healthy adults exist. Here, we present two new performance-based tests that were developed and are scored based on componential emotion theory and large-scale cross-cultural empirical findings. These instruments intend to measure facets of emotion understanding that are not included in existing tests. The first test (Geneva EMOtion Knowledge test - Blends; GEMOK-Blends) measures the ability to understand and label emotional experiences of a target person from a description of emotion features covering five emotion components (appraisal, feeling, action tendencies, expression, and physiology) embedded in a written vignette. The second test (GEMOK-Features) measures semantic knowledge about which features from each component are characteristic of emotion episodes described by a specific emotion label. In four studies, we found evidence for the good internal consistency and construct validity of these tests. Both tests were positively correlated with other emotional abilities and cognitive ability and showed meaningful associations with a variety of personality and demographic variables.

Amygdala structure and core dimensions of the affective personality.

While biological models of human personality propose that socio-affective traits and skills are rooted in the structure of the amygdala, empirical evidence remains sparse and inconsistent. Here, we used a comprehensive assessment of the affective personality and tested its association with global, local, and laterality measures of the amygdala structure. Results revealed three broad dimensions of the affective personality that were differentially related to bilateral amygdala structures. Dysfunctional and maladaptive affective traits were associated with a global size and local volume reduction of the amygdala, whereas adaptive emotional skills were linked to an increased size of the left amygdala. Furthermore, reduced asymmetry in the bilateral global amygdala volume was linked to higher affective instability and might be a potential precursor of psychiatric disorders. This study demonstrates that structural amygdala measures provide a neural basis for all major dimensions of the human personality related to adaptive and maladaptive socio-affective functioning.

Intelligence and Sensory Sensitivity as Predictors of Emotion Recognition Ability.

The ability to recognize emotions from nonverbal cues (emotion recognition ability, ERA) is a core component of emotional intelligence, which has recently been conceptualized as a second-stratum factor of intelligence (MacCann et al., 2014). However, only few studies have empirically investigated the link between ERA, intelligence, and other mental abilities. The present study examined the associations between ERA, fluid intelligence, and sensory sensitivity in a sample of 214 participants. Results showed that both fluid intelligence and sensory sensitivity explained unique portions of variance in ERA. These findings suggest that future studies on ERA should include intelligence measures to assess the incremental validity of ERA above and beyond intelligence.