Elevated drug overdose mortality among Americans who visit Florida, 2003-2020.

OBJECTIVE: Florida state has played a conspicuous role in the current U.S. drug epidemic. Reports suggest that even non-Florida residents may suffer excessive overdose fatalities while visiting the state, possibly in connection to two sets of events: (1) the overprescribing of controlled substances, and more recently, (2) the exploitation of patients' insurance benefits by unscrupulous operators of substance use treatment facilities in Florida. To date, however, no research has examined the overdose fatalities of non-Florida residents inside Florida. METHODS: Death certificate data were used to calculate proportionate mortality ratios for overdoses among Florida residents and visitors. Deaths occurring in the rest of the USA were used as reference populations. RESULTS: Between 2003 and 2020, overdose mortality was slightly elevated for Florida residents within their home counties (106.7 (95% CI 105.8 to 107.5)) and in other Florida counties (113.0 (95% CI 110.0 to 116.0)). Significantly, this mortality was much higher among out-of-state visitors in Florida (163.1 (95% CI 157.5 to 168.8)). When analysed by year, greater overdose mortality among visitors coincided with years when drug prescribing in Florida was rampant, and with the advent of expanded insurance coverage for substance use treatment. During this more recent period (since 2014), overdose mortality was exceptionally high for out-of-state visitors in Palm Beach County, where reports of malpractice in the Florida treatment industry have been concentrated. CONCLUSIONS: Overdose mortality was disproportionately high among out-of-state visitors in Florida. The results suggest that the regulatory policies in Florida may be implicated in drug-related casualties of people who live in other parts of the USA.

The clashing nature of rebelliousness: Nontraditional attitudes and counter-normative behaviors show divergent associations with intelligence.

OBJECTIVE: Prior literature indicates that nontraditional attitudes are linked to higher intelligence. However, such attitudes in adolescence often accompany counter-normative, delinquent-type behaviors, which are themselves negatively linked with intelligence. This points to the possibility of suppression in the relationship between intelligence and nontraditional attitudes. METHOD: We analyzed a large community sample of 17 year olds (N = 3330) with data on intelligence, nontraditional attitudes, and a diverse collection of self- and teacher-reported counter-normative behaviors. Developmental questions for these relationships were examined through cross-sectional comparisons between the adolescents and their parents as well as longitudinal analysis of the adolescent sample across emerging adulthood. RESULTS: Youth who endorsed nontraditional attitudes had lower school grades, earlier age at first sex, heavier substance use, and were perceived as more oppositional by their teachers. Each of these problem behaviors was inversely related to intelligence. Accordingly, the positive correlation between nontraditional attitudes and intelligence was much weaker in adolescents as compared to their middle-aged parents. Longitudinal analyses revealed that the association between nontraditional attitudes and intelligence strengthens in early adulthood. CONCLUSIONS: Associations between intelligence and sociopolitical attitudes can be obscured even by seemingly distal psychological characteristics.

Perceptions of Divine Forgiveness, Religious Comfort, and Depression in Psychiatric Inpatients: A Mixed Methods Study.

Understanding how forgiveness relates to mental health outcomes may improve clinical care. This study assessed 248 adult psychiatric inpatients, testing associations of forgiveness, religious comfort (RC), religious strain (RS), and changes in depressive symptomatology from admission to discharge. Experiencing divine forgiveness and self-forgiveness was both directly associated with RC and inversely associated with RS. Using structural equation modeling, the path from divine forgiveness to depression through RC was significant, ß = - .106, SE = .046, z = - 2.290, p = .022, bootstrapped 95% CI = - .196 to - .015. Qualitative findings illustrated patients' changed perspectives on divine forgiveness during hospitalization.

Gratitude and patience moderate meaning struggles and suicidal risk in a cross-sectional study of inpatients at a Christian psychiatric hospital.

OBJECTIVE: Suicidal behavior is a leading cause of injury and death, so research identifying protective factors is essential. Research suggests gratitude and life hardships patience are character strengths that might protect against the deleterious association of struggles with ultimate meaning and suicide risk. However, no studies have evaluated their utility among people experiencing acute/severe mental health concerns. METHOD: We tested the protective function of gratitude and life hardships patience with cross-sectional data from adults (Mage  = 31.83 years; SD = 14.84; range = 18-82) hospitalized in a Christian psychiatric inpatient facility (Mstay  = 6.37 days, SD = 4.64). RESULTS: Gratitude and life hardships patience moderated the positive relation between meaning struggles and suicide risk. Specifically, gratitude and life hardships patience protected against meaning struggles as a risk factor for suicide through mechanisms separate from ameliorating depressive symptoms. CONCLUSIONS: Findings provide initial support for gratitude and patience interventions as an adjunct to standard psychiatric treatment for minimizing suicide risk.

Moral Injury and Spiritual Struggles in Military Veterans: A Latent Profile Analysis.

War-related traumas can lead to emotional, relational, and spiritual suffering. Drawing on two community samples of war zone veterans from diverse military eras (Study 1, N = 616 and Study 2, N = 300), the purpose of this study was to examine patterns of constellations between outcomes related to moral injury (MI) and common ways in which veterans may struggle with religion or spirituality, defined as divine, morality, meaning, interpersonal, and doubt. Results from latent profile analyses revealed three distinct classes across the samples, based on psychometrically validated instruments: (a) no MI-related outcomes or spiritual struggles (nondistressed group; Study 1 = 72.7%, Study 2 = 75.0%); (b) MI-related outcomes and equivalent or lower degrees of spiritual struggles relative to MI-related outcomes (psychological MI group; Study 1 = 19.2%, Study 2 = 17.0%); and (c) MI-related outcomes and salient struggles with religious faith or spirituality, both within their own profiles and compared to other groups (spiritual MI group; 8.1% and 8.0% in the two samples). When we compared severity of spiritual struggles within MI groups, turmoil with God or a higher power emerged as a defining feature of the spiritual MI group in both samples. In addition, secondary analyses revealed membership in this third group was linked with greater importance of religion or spirituality before military service, χ2 (1, N = 616 and 300) = 4.468-8.273. Overall, although more research is needed, these findings highlight the possible utility of differentiating between psychological and spiritual subtypes of MI according to war zone veterans' religious or spiritual backgrounds.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Daño moral y luchas espirituales en veteranos de guerra: Un análisis de perfil latente DAÑO MORAL Y LUCHAS ESPIRITUALES Los traumas relacionados con la guerra pueden llevar al sufrimiento emocional, relacional, y espiritual. Basado en dos muestras comunitarias de veteranos de la zona de guerra de diversas épocas militares (Estudio 1, N = 616 y Estudio 2, N = 300), el objetivo de este estudio fue examinar los patrones de las constelaciones entre los resultados relacionados con el daño moral (DM) y las formas comunes en las que los veteranos pueden lidiar con la religión y/o la espiritualidad, definidas como divinas, moralidad, significado, interpersonal, y duda. Los resultados de los análisis de perfiles latentes revelaron tres clases distintas, basadas en instrumentos validados psicométricamente, en todas las muestras, aquellas con: (a) Los resultados no relacionados con el DM o luchas espirituales (grupo sin malestar psicológico, Estudio 1 = 72.7%, Estudio 2 = 75.0); (b) Los resultados relacionados con el DM y grados equivalentes o más bajos de luchas espirituales en relación con los resultados relacionados con el DM (grupo de DM psicológico; Estudio 1 = 19.2%, Estudio 2 = 17.0); y (c) Los resultados relacionados con el DM y las luchas salientes con la fe religiosa y/o la espiritualidad, tanto dentro de sus propios perfiles como en comparación con otros grupos (grupo de DM espiritual; 8.1 y 8.0% en las dos muestras). Cuando comparamos la severidad de las luchas espirituales dentro de los grupos DM, la confusión con Dios o un poder superior emergió como una característica definitoria del grupo espiritual DM en ambas muestras. Además, los análisis secundarios revelaron que la pertenencia a este tercer grupo se relacionaba con una mayor importancia de la religión y/o la espiritualidad antes del servicio militar, χ2 (1, N = 616 y 300) = 4.468-8.273. En general, aunque se necesita más investigación, estos hallazgos resaltan la posible utilidad de diferenciar entre los subtipos psicológicos y espirituales de DM según los antecedentes religiosos y/o espirituales de los veteranos de la zona de guerra.

Synaptic Connectivity between Renshaw Cells and Motoneurons in the Recurrent Inhibitory Circuit of the Spinal Cord.

Renshaw cells represent a fundamental component of one of the first discovered neuronal circuits, but their function in motor control has not been established. They are the only central neurons that receive collateral projections from motor outputs, yet the efficacy of the excitatory synapses from single and converging motoneurons remains unknown. Here we present the results of dual whole-cell recordings from identified, synaptically connected Renshaw cell-motoneuron pairs in the mouse lumbar spinal cord. The responses from single Renshaw cells demonstrate that motoneuron synapses elicit large excitatory conductances with few or no failures. We show that the strong excitatory input from motoneurons results from a high probability of neurotransmitter release onto multiple postsynaptic contacts. Dual current-clamp recordings confirm that single motoneuron inputs were sufficient to depolarize the Renshaw cell beyond threshold for firing. Reciprocal connectivity was observed in approximately one-third of the paired recordings tested. Ventral root stimulation was used to evoke currents from Renshaw cells or motoneurons to characterize responses of single neurons to the activation of their corresponding presynaptic cell populations. Excitatory or inhibitory synaptic inputs in the recurrent inhibitory loop induced substantial effects on the excitability of respective postsynaptic cells. Quantal analysis estimates showed a large number of converging inputs from presynaptic motoneuron and Renshaw cell populations. The combination of considerable synaptic efficacy and extensive connectivity within the recurrent circuitry indicates a role of Renshaw cells in modulating motor outputs that may be considerably more important than has been previously supposed. SIGNIFICANCE STATEMENT: We have recently shown that Renshaw cells mediate powerful shunt inhibition on motoneuron excitability. Here we complete a quantitative description of the recurrent circuit using recordings of excitatory synapses between identified motoneuron and Renshaw cell pairs. We show that the excitation is highly effective as a result of a high probability of neurotransmitter release onto multiple release sites and that efficient neurotransmission is maintained at physiologically relevant firing rates in motoneurons. Our results also show that both excitatory and inhibitory connections exhibit considerable convergence of inputs. Because evaluation of the determinants of synaptic strength and the extent of connectivity constitute fundamental parameters affecting the operation of the recurrent circuit, our findings are critical for informing any future models of motor control.

Nitric oxide-mediated modulation of the murine locomotor network.

Spinal motor control networks are regulated by neuromodulatory systems to allow adaptability of movements. The present study aimed to elucidate the role of nitric oxide (NO) in the modulation of mammalian spinal locomotor networks. This was investigated with isolated spinal cord preparations from neonatal mice in which rhythmic locomotor-related activity was induced pharmacologically. Bath application of the NO donor diethylamine NONOate (DEA/NO) decreased the frequency and modulated the amplitude of locomotor-related activity recorded from ventral roots. Removal of endogenous NO with coapplication of a NO scavenger (PTIO) and a nitric oxide synthase (NOS) blocker [nitro-l-arginine methyl ester (l-NAME)] increased the frequency and decreased the amplitude of locomotor-related activity. This demonstrates that endogenously derived NO can modulate both the timing and intensity of locomotor-related activity. The effects of DEA/NO were mimicked by the cGMP analog 8-bromo-cGMP. In addition, the soluble guanylyl cyclase (sGC) inhibitor ODQ blocked the effects of DEA/NO on burst amplitude and frequency, although the frequency effect was only blocked at low concentrations of DEA/NO. This suggests that NO-mediated modulation involves cGMP-dependent pathways. Sources of NO were studied within the lumbar spinal cord during postnatal development (postnatal days 1-12) with NADPH-diaphorase staining. NOS-positive cells in the ventral horn exhibited a rostrocaudal gradient, with more cells in rostral segments. The number of NOS-positive cells was also found to increase during postnatal development. In summary, we have shown that NO, derived from sources within the mammalian spinal cord, modulates the output of spinal motor networks and is therefore likely to contribute to the fine-tuning of locomotor behavior.

Spinal premotor interneurons controlling antagonistic muscles are spatially intermingled.

Elaborate behaviours are produced by tightly controlled flexor-extensor motor neuron activation patterns. Motor neurons are regulated by a network of interneurons within the spinal cord, but the computational processes involved in motor control are not fully understood. The neuroanatomical arrangement of motor and premotor neurons into topographic patterns related to their controlled muscles is thought to facilitate how information is processed by spinal circuits. Rabies retrograde monosynaptic tracing has been used to label premotor interneurons innervating specific motor neuron pools, with previous studies reporting topographic mediolateral positional biases in flexor and extensor premotor interneurons. To more precisely define how premotor interneurons contacting specific motor pools are organized, we used multiple complementary viral-tracing approaches in mice to minimize systematic biases associated with each method. Contrary to expectations, we found that premotor interneurons contacting motor pools controlling flexion and extension of the ankle are highly intermingled rather than segregated into specific domains like motor neurons. Thus, premotor spinal neurons controlling different muscles process motor instructions in the absence of clear spatial patterns among the flexor-extensor circuit components.

The spinal cord contains circuits of nerve cells that control how the body moves. Within these networks are interneurons that project to motor neurons, which innervate different types of muscle to contract: flexors (such as the biceps), which bend, or 'flex', the body's joints, and extensors (such as the triceps), which lead to joint extension. These motor signals must be carefully coordinated to allow precise and stable control of the body's movements. Previous studies suggest that where interneurons are placed in the spinal cord depends on whether they activate the motor neurons responsible for flexion or extension. To test if these findings were reproducible, Ronzano, Skarlatou, Barriga, Bannatyne, Bhumbra et al. studied interneurons which flex and extend the ankle joint in mice. In collaboration with several laboratories, the team used a combination of techniques to trace how interneurons and motor neurons were connected in the mouse spinal cord. This revealed that regardless of the method used or the laboratory in which the experiments were performed, the distribution of interneurons associated with flexion and extension overlapped one another. This finding contradicts previously published results and suggests that interneurons in the spinal cord are not segregated based on their outputs. Instead, they may be positioned based on the signals they receive, similar to motor neurons. Understanding where interneurons in the spinal cord are placed will provide new insights on how movement is controlled and how it is impacted by injuries and disease. In the future, this knowledge could benefit work on how neural circuits in the spinal cord are formed and how they can be regenerated.

Moral injury and ICD-11 complex PTSD (CPTSD) symptoms among treatment-seeking veterans in the United Kingdom.

OBJECTIVE: Military veterans often encounter events with chronic or repeated traumas of an interpersonal nature that might lead to emotional, relational, and spiritual suffering. Research is needed to assess whether and/or how emerging conceptions of moral injury (MI) align with existing trauma-related conditions. METHOD: Focusing on 173 veterans from the United Kingdom who had recently pursued mental health treatment, we examined associations between self- and other-directed outcomes related to MI and the World Health Organization's International Classification System for Diseases, 11th version (ICD-11), criteria for posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) in two ways. RESULTS: First, drawing on validated tools for assessing MI and PTSD/CPTSD, analyses of variance revealed 57.2% of veterans in the sample who possibly met criteria for CPTSD reported greater MI related to perpetration- and betrayal-based events compared to those with and without possible PTSD. Second, latent profile analysis revealed two distinct classes based on symptom severity of MI and CPTSD. Specifically, when we examined the six symptom clusters for CPTSD dimensionally, four in five veterans endorsed high levels of distress related to all indicators of MI and CPTSD symptoms compared to a group with lower scores. CONCLUSIONS: Overall, the two sets of findings suggest the special relevance of MI among veterans who are struggling with CPTSD. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Narcissism and unprovoked aggression.

It is widely accepted that narcissists become aggressive when they experience ego-threat. However, there is surprisingly little empirical research on the relationship between narcissism and aggression. Equivocal findings suggest that aggression in narcissists either occurs only in response to provocation, or regardless of provocation. One-hundred and thirty-seven collegiate men completed the Narcissistic Personality Inventory followed by a sham aggression paradigm, which afforded them the opportunity shock, or refrain entirely from shocking an ostensible opponent confederate. Participants were identified as "unprovoked aggressors," "retaliatory aggressors," or "nonaggressors" contingent on when and if they chose to administer electrical shocks to the confederate. Results indicated that participants who were high on narcissistic traits were more likely to be unprovoked aggressors than their low narcissism counterparts. Results are discussed in relation to threatened egotism theory and call for more research on narcissism, aggression, and the moderating effect of provocation.

Are secret relationships hot, then not? Romantic secrecy as a function of relationship duration.

Are secret romances alluring or aversive? One theory suggests that romantic secrecy increases obsessive preoccupation with romantic partners and thereby enhances romantic relationships. Another theory suggests that romantic secrecy is burdensome and thereby undermines romantic relationships. We sought to rectify these conflicting perspectives by examining romantic secrecy and relationship duration using a large, Internet-based sample (N = 564). We predicted that romantic secrecy would have a positive influence in newer romantic relationships (obsessive preoccupation theory) and a negative influence in older romantic relationships (burden theory). In contrast, the obtained results indicate that romantic secrecy is a burden to both new and old romantic relationships.

Spiritual struggles and mental health outcomes in a spiritually integrated inpatient program.

BACKGROUND: Persons contending with serious mental health difficulties often experience struggles with religious faith and/or spirituality that may also demand clinical attention. However, research has not examined the relative importance of specific forms of spiritual struggles in mental health status or treatment outcomes of psychiatric patients. METHODS: Focusing on 217 adults who completed a spiritually integrated inpatient program, this study examined (1) which struggles in Exline et al.'s (2014) framework (Divine, Morality, Ultimate Meaning, Interpersonal, Demonic, and Doubting) represented the most salient indicators of major depressive disorder (MDD) symptomatology and positive mental health (PMH) and (2) whether alleviation of these struggles predicted improvements in patients' mental health status over the treatment period. RESULTS: Greater severity of spiritual struggles was generally associated with worse MDD symptomatology and less PMH at intake and discharge. However, when weighing the role of varying forms of struggles, issues with ultimate meaning emerged as a salient indicator of mental health status at the two assessments as well as longitudinal changes in both MDD symptomatology and PMH. LIMITATIONS: This sample was recruited from acute stabilization units in a single spiritually integrated behavioral health center with a general affiliation with Christianity. Hence, treatment periods were relatively brief in some cases and findings might not generalize to other psychiatric programs or settings. CONCLUSIONS: Findings highlight the utility of assessing prominent forms of spiritual distress for planning and delivering psychosocial interventions, particularly with respect to issues related to a perceived absence of ultimate meaning in life.

Egos inflating over time: a cross-temporal meta-analysis of the Narcissistic Personality Inventory.

A cross-temporal meta-analysis found that narcissism levels have risen over the generations in 85 samples of American college students who completed the 40-item forced-choice Narcissistic Personality Inventory (NPI) between 1979 and 2006 (total n=16,475). Mean narcissism scores were significantly correlated with year of data collection when weighted by sample size (beta=.53, p<.001). Since 1982, NPI scores have increased 0.33 standard deviation. Thus, almost two-thirds of recent college students are above the mean 1979-1985 narcissism score, a 30% increase. The results complement previous studies finding increases in other individualistic traits such as assertiveness, agency, self-esteem, and extraversion.

On being eager and uninhibited: narcissism and approach-avoidance motivation.

This article demonstrates the validity and utility of conceptualizing narcissistic personality in terms of relative approach-avoidance motivation. Across three studies (N = 1,319), narcissism predicted high approach and low avoidance motivation. That is, narcissists reported being strongly motivated to approach desirable outcomes but only weakly motivated to avoid negative outcomes. Relative approach-avoidance motivation was shown to be useful in terms of explaining behavioral tendencies associated with narcissism (i.e., functional and dysfunctional impulsivity) and distinguishing different "flavors" of narcissism (i.e., overt and covert narcissism). Discussion focuses on how approach-avoidance motivation may be used to explain prior findings in the narcissism literature and generate novel future hypotheses.

Beauty is mostly in the eye of the beholder: olfactory versus visual cues of attractiveness.

Olfaction is an important determinant of attractiveness, possibly even more so than vision when judgments are made by women. However, research that directly compares these cues using actual stimuli (e.g., t-shirt odors) is lacking. In this study, 44 women rated the attractiveness of t-shirt odors and facial photographs of 21 men either independently (i.e., first rated t-shirts, then rated photographs) or together (i.e., made overall ratings on the basis of t-shirts and photographs presented simultaneously). Photograph ratings were far more predictive of overall attractiveness than were t-shirt ratings. This was true for female participants who were fertile or infertile (i.e., using hormonal birth control). Body odor only predicted overall attractiveness when fertile women made the ratings.

Structural Relationships Among the Revised Reinforcement Sensitivity Theory and Grandiose and Vulnerable Narcissism.

Research shows that grandiosity and vulnerability are distinct aspects of narcissism. The Contemporary Clinical Model (CCM) of narcissism suggests that individuals fluctuate between grandiose narcissism (GN) and vulnerable narcissism (VN). The authors examine the relative contributions of the Behavioral Approach System (BAS), the Behavioral Inhibition System (BIS), and the Fight-Flight-Freeze System (FFFS) in the Revised Reinforcement Sensitivity Theory of Personality (r-RST) to GN and VN. Few studies examine the r-RST, and even fewer examine the VN and GN distinction. To remain consistent with the CCM, structural equation modeling was used to account for individuals' relative levels of VN and GN. Across two independent samples (Ns = 854 and 258), results indicated that GN is associated with higher BAS scores and that VN is associated with higher BIS scores. Relations among GN, VN, and FFFS were inconsistent between samples. Implications of the r-RST results are interpreted within the context of the CCM.

Segregation of glutamatergic and cholinergic transmission at the mixed motoneuron Renshaw cell synapse.

In neonatal mice motoneurons excite Renshaw cells by releasing both acetylcholine (ACh) and glutamate. These two neurotransmitters activate two types of nicotinic receptors (nAChRs) (the homomeric α7 receptors and the heteromeric α*ß* receptors) as well as the two types of glutamate receptors (GluRs) (AMPARs and NMDARs). Using paired recordings, we confirm that a single motoneuron can release both transmitters on a single post-synaptic Renshaw cell. We then show that co-transmission is preserved in adult animals. Kinetic analysis of miniature EPSCs revealed quantal release of mixed events associating AMPARs and NMDARs, as well as α7 and α*ß* nAChRs, but no evidence was found for mEPSCs associating nAChRs with GluRs. Bayesian Quantal Analysis (BQA) of evoked EPSCs showed that the number of functional contacts on a single Renshaw cell is more than halved when the nicotinic receptors are blocked, confirming that the two neurotransmitters systems are segregated. Our observations can be explained if ACh and glutamate are released from common vesicles onto spatially segregated post-synaptic receptors clusters, but a pre-synaptic segregation of cholinergic and glutamatergic release sites is also possible.

The Dark Triad Traits from a Life History Perspective in Six Countries.

Work on the Dark Triad traits has benefited from the use of a life history framework but it has been limited to primarily Western samples and indirect assessments of life history strategies. Here, we examine how the Dark Triad traits (i.e., psychopathy, Machiavellianism, and narcissism) relate to two measures of individual differences in life history strategies. In Study 1 (N = 937), we replicated prior observed links between life history strategies, as measured by the Mini-K, and the Dark Triad traits using samples recruited from three countries. In Study 2 (N = 1032), we measured life history strategies using the Consideration of Future Consequences Scale and correlated it with the Dark Triad traits in samples recruited from three additional countries. While there was some variability across participants' sex and country, the results were generally consistent in that psychopathy and (to a lesser extent) Machiavellianism were related to faster life history strategies and narcissism was related to slower life history strategies. These results add cross-cultural data and the use of two measures of life history speed to understand the Dark Triad traits from a life history perspective.

God imagery and affective outcomes in a spiritually integrative inpatient program.

Religion and/or spirituality (R/S) can play a vital, multifaceted role in mental health. While beliefs about God represent the core of many psychiatric patients' meaning systems, research has not examined how internalized images of the divine might contribute to outcomes in treatment programs/settings that emphasize multicultural sensitivity with R/S. Drawing on a combination of qualitative and quantitative information with a religiously heterogeneous sample of 241 adults who completed a spiritually integrative inpatient program over a two-year period, this study tested direct/indirect associations between imagery of how God views oneself, religious comforts and strains, and affective outcomes (positive and negative). When accounting for patients' demographic and religious backgrounds, structural equation modeling results revealed: (1) overall effects for God imagery at pre-treatment on post-treatment levels of both positive and negative affect; and (2) religious comforts and strains fully mediated these links. Secondary analyses also revealed that patients' generally experienced reductions in negative emotion in God imagery over the course of their admission. These findings support attachment models of the R/S-mental health link and suggest that religious comforts and strains represent distinct pathways to positive and negative domains of affect for psychiatric patients with varying experiences of God.