Sensitivity to Noise Following a Mild Traumatic Brain Injury: A Longitudinal Study.

OBJECTIVE: To describe changes in the prevalence and clinical correlates of noise sensitivity (NS) in mild traumatic brain injury (mTBI) across a 12-month period and to determine whether NS at an early stage of recovery has predictive value for later postconcussive symptoms. SETTING: A mixed urban and rural region of New Zealand. PARTICIPANTS: Data for 341 adults (201 males, 140 females; age range from 16 to 91 years) were extracted from a 1-year TBI incidence, and outcomes study was conducted in New Zealand. DESIGN: Secondary analysis of data from a community-based, longitudinal population study of an mTBI incidence cohort collected within 1 week of injury (baseline) and at 1, 6, and 12 months postinjury. MAIN MEASURES: Measures at baseline (within 2 weeks of the injury) and 1, 6, and 12 months included the Rivermead Post-concussion Symptoms Questionnaire and its NS item, the Hospital Depression and Anxiety Scale, and the computerized CNS-Vital Signs neurocognitive test. RESULTS: NS progressively declined postinjury, from 45% at baseline to 28% at 12 months. In turn, NS showed itself as a significant predictor of future postconcussive symptoms. CONCLUSION: Taken together with previous research, the findings of the current study indicate that NS may have clinical utility in flagging vulnerability to persistent postconcussive symptoms.

The association between health-related quality of life and noise or light sensitivity in survivors of a mild traumatic brain injury.

PURPOSE: Sensory impairment is a common aftereffect of mild traumatic brain injury (TBI); however, their influence upon treatment outcomes and quality of life has yet to be investigated. This study sought to determine the effects of noise and light sensitivity upon the quality of life of individuals diagnosed with a TBI. METHODS: A cross-sectional adult sample obtained from a longitudinal study (n = 293) provided measures of light and noise sensitivity and quality of life 12 months post injury. Sensitivities were taken from the Rivermead Post-concussion Symptoms Questionnaire, while quality of life was estimated using the Short-Form 36 health survey (SF-36). RESULTS: Approximately 42% of participants reported ongoing difficulties with noise and light sensitivity. Additionally, those reporting sensory difficulties also reported lower SF-36 domain and composite scores compared to those reporting no such symptoms. After controlling for known co-factors, hierarchical multiple regression analyses indicated that the combination of light and noise sensitivity explained between 8 and 35% of the variance in SF-36 scores. CONCLUSIONS: Light and noise sensitivity appear to degrade the quality of life of those with a mild TBI. Our findings challenge contemporary rehabilitation practices that tend to sideline sensory complaints and instead focus on the remediation of acute TBI symptoms.

Development of a mental health recovery module for the WHOQOL.

PURPOSE: The WHOQOL tools are widely used, multi-faceted, patient-rated, quality of life (QoL) measures, developed by the World Health Organization. The WHOQOL questionnaires are used to assess generic quality of life issues affected by all health problems. This study developed a module to use with the WHOQOL tools to improve their sensitivity to Health Related QoL issues relevant to mental health recovery. METHODS: Using a sequential mixed-methods approach, two research stages occurred. A qualitative stage invited 88 participants with experience of mental health recovery, into focus groups and importance rating activities, to identify candidate items for the new module. Following this, a quantitative stage involved 667 participants with, and without, mental health/addiction issues completing online or paper-based questionnaires to analyze which candidate items differentiated between those with and without mental health/addiction issues. Classical test theory and iterative Partial Credit Rasch Analysis were used to identify the most suitable candidate items for a reliable and valid mental health recovery module to be used with the WHOQOL tools. RESULTS: Seventeen candidate items captured important HRQoL facets relevant to mental health recovery. Rasch analysis removed 10 misfitting items. The final 7-item module, which demonstrated the best Rasch model fit, enquires about recovery beliefs, identifying strengths, self-awareness, acceptance, capacity to relate, feeling understood, and recovery progress. Ordinal-to-interval conversion tables have been developed to optimize measurement precision when using the module. CONCLUSIONS: Important HRQoL issues central to mental health recovery can be reliably evaluated by using the recovery module with the WHOQOL tools.

Clinical correlates of noise sensitivity in patients with acute TBI.

Primary objective: The impact of noise sensitivity (NS) on the daily functioning of people who have experienced a traumatic brain injury (mTBI) is an understudied area, particularly following mTBI. The primary objective of this cross-sectional study was to investigate clinical markers of NS in a sample of New Zealand adults following mTBI. Research design: Cross-sectional study. Methods and procedures: A community-based sample of 151 adults who had experienced a brain injury in the last two weeks completed assessments estimating cognitive functioning, postconcussion symptoms (including NS), and affective state. Results: Over half the sample (59%) reported some degree of NS. Exploratory statistical analyses indicated that NS was associated with being female, living in a rural area, number of previous brain injuries, cognitive flexibility scores, reaction time, perceptions of recovery, anxiety, and depression. Regression analyses revealed that anxiety was the dominant correlate of NS (B = .120, p < .001, 95% CI [0.069, 1.71]). Conclusions: As the first study to explore the correlates of NS following mild TBI, the findings have important clinical and research implications. The present findings suggest that treatment approaches targeting anxiety may be effective in reducing NS in people who have experienced a brain injury. Moreover, evidence is presented suggesting that NS is unlikely to reflect malingering, and should be treated as a genuine somatic symptom of brain injury.

Gambling and physical intimate partner violence: Results from the national epidemiologic survey on alcohol and related conditions (NESARC).

BACKGROUND AND OBJECTIVES: Links between intimate partner violence (IPV) and gambling problems are under researched in general population samples. Understanding these relationships will allow for improved identification and intervention. We investigated these relationships and sought to determine whether links were attenuated by axis I and II disorders. METHODS: This study examined data from waves 1 and 2 (N = 25,631) of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC); a nationally representative survey of U.S. adults. Gambling symptoms and other psychiatric disorders were measured at wave 1 by the Alcohol Use Disorder and Associated Disability Interview Schedule-DSM-IV Version (AUDADIS-IV). Physical IPV victimization and perpetration in the last 12 months were assessed 3 years later at wave 2 using items from the Conflict Tactics Scale-R. Binary logistic regression models were used to examine associations separately for males and females. RESULTS: Problem gambling was associated with increased odds of both IPV perpetration for males (OR = 2.62, 95%CI = 1.22-5.60) and females (OR = 2.87, 95%CI = 1.29-6.42), and with IPV victimization for females only (OR = 2.97, 95%CI = 1.31-6.74). Results were attenuated with inclusion of axis I and axis II disorders; links between gambling and IPV were weaker than those involving other mental health conditions. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: There are prospective associations with gambling problems and physical IPV which have implications for identification, spontaneous disclosure, and treatment seeking. The links between gambling problems and violence are complex and should not be considered independently of co-occurring mental health and substance use disorders. (Am J Addict 2018;27:7-14).

A process evaluation of the 'Aware' and 'Supportive Communities' gambling harm-minimisation programmes in New Zealand.

Background: The Gambling Act 2003 mandated a public health strategy for preventing and minimising gambling harm in New Zealand. Aware Communities and Supportive Communities are two public health programmes subsequently implemented nationwide. These programmes differed from common health promotion initiatives such as media or education campaigns as they were community-action based (requiring community involvement in programme planning and delivery). We carried out a process evaluation to determine their implementation effectiveness and inform improvement and future programme planning. Methods: Our qualitative dominant mixed methods design comprised analysis of over a hundred implementer progress reports (submitted July 2010 - June 2013), a staff survey and a staff focus group interview. Results: The programmes demonstrated capacity to not only achieve expected outcomes (e.g. enhanced community awareness about harmful gambling), but also to enhance social sustainability at the community level (e.g. established trustful relationships) and achieve some programme sustainability (e.g. community ownership over ongoing programme delivery). Conclusions: The evaluation noted the potential for a sustainable gambling harm-minimisation model. Community-action based harm-minimisation programmes offer programme sustainability potential which in turn offers funding cost-effectiveness when there are continual public health outcomes beyond initial funding. Although resource intensive, the community-action based approach enables culturally appropriate public health programmes suitable for societies where specific ethnic groups have higher gambling risk. Recognition of such harm-minimisation programmes' contribution to social sustainability is important considering the potential for broader public health outcomes (e.g. better life quality, lesser social problems) within socially sustainable societies.

A national public health programme on gambling policy development in New Zealand: insights from a process evaluation.

BACKGROUND: In New Zealand, a public health programme on gambling policy development is part of a national gambling harm reduction and prevention strategy mandated by the Gambling Act 2003. Funded by the Ministry of Health, the programme directs workplace/organisational gambling policies, non-gambling fundraising policies, and local council policies on electronic gaming machines (EGMs). We carried out a process evaluation of this programme to identify practical information (e.g. advocacy approaches; challenges and ameliorating strategies) that can be used by programme planners and implementers to reinforce programme effectiveness and serve to guide similar policy-focused public health initiatives elsewhere. METHODS: Evaluation criteria, based on the programme's official service specifications, guided our evaluation questions, analysis and reporting. To identify informative aspects of programme delivery, we thematically analysed over 100 six-monthly implementer progress reports (representing 3 years of programme delivery) and transcript of a focus group with public health staff. RESULTS: Identified output-related themes included purposeful awareness raising to build understanding about gambling harms and the need for harm-reduction policies and stakeholder relationship development. Outcome-related themes included enhanced community awareness about gambling harms, community involvement in policy development, some workplace/organisational policy development, and some influences on council EGM policies. Non-gambling fundraising policy development was not common. CONCLUSIONS: The programme offers an unprecedented gambling harm reduction approach. Although complex (due to its three distinct policy focus areas targeting different sectors) and challenging (due to the extensive time and resources needed to develop relationships and overcome counteractive views), the programme resulted in some policy development. Encouraging workplace/organisational policy development requires increased awareness of costs to employers and society and appreciation of policy value. Although encouraging non-gambling fundraising policies will likely remain challenging, public debate on ethical aspects could stimulate policy consideration. Influencing council EGM policy decisions will remain important for minimising EGM accessibility among vulnerable communities. Public involvement in EGM policy decisions has strong implications for policy effectiveness. Given the expanding range of gambling activities (including online gambling) presently accessible to communities worldwide, both organisational and public policies (as advocated through the programme) are needed to minimise gambling harms.

The Effects of Pop-up Harm Minimisation Messages on Electronic Gaming Machine Gambling Behaviour in New Zealand.

In New Zealand a simple pop-up message feature that provides gambling session information and forces a break in play is mandatory on all electronic gaming machines in all venues (EGMs). Previous research has demonstrated small effects of more sophisticated pop-up messages tested predominantly in laboratory environments. The present research examined gambler engagement with and views on the New Zealand pop-up messages and on the relationship between pop-up messages and EGM expenditure. A sample of gamblers was recruited at casino and non-casino (pub) EGM venues. Most participants were aware of pop-up messages (57 %) and many saw them often (38 %). Among gamblers who reported seeing pop-up messages, half read the message content, and a quarter believed that pop-up messages helped them control the amount of money they spend on gambling. Participants who reported being likely to stop gambling in response to pop-up messages spent significantly less money on gambling when variables that were independently associated with EGM expenditure were controlled for. A modest harm minimisation effect of the pop-up message feature that has been operating in New Zealand for 5 years was evident. Suggestions for improvement of the harm minimisation potential of the current pop-up message feature are discussed.

Validation of the WHOQOL-BREF quality of life questionnaire for general use in New Zealand: confirmatory factor analysis and Rasch analysis.

PURPOSE: The present study validated the abbreviated version of the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire for general use in New Zealand. METHODS: A random postal sample from the national electoral roll was used, and 808 questionnaires were returned. Psychometric properties of the instrument were assessed, including tests of the four-domain factor structure using confirmatory factor analysis and Rasch analysis. RESULTS: Goodness-of-fit from the confirmatory factor analysis were good, and the overall conclusion of the Rasch analysis supported the confirmatory factor analysis (CFA) findings after dealing with problems of threshold ordering, local dependency, and differential item functioning (DIF). CONCLUSIONS: The WHOQOL-BREF is valid for general use in New Zealand. In the future work, the WHOQOL-BREF domain scores should either be analyzed using non-parametric statistics or data should be fitted to the Rasch model to derive interval person estimates.

Hearing every footstep: noise sensitivity in individuals following traumatic brain injury.

Noise sensitivity is an important and under-researched symptom that can result from traumatic brain injury (TBI). Interpretative phenomenological analysis (IPA) was used to analyse the experiences of noise sensitivity of six individuals with TBI. The results revealed four major themes through which participants described a process of having to find information for themselves to understand what they were experiencing and their changed relationship with sounds. The participants also described feeling overwhelmed as they struggled to cope with the changes to their lives and being able to plan and take some control over their lives. The findings are of importance for both health professionals involved in rehabilitation and individuals recovering from TBI.

Brief Report: Investigating Temporal Factors in the Context of Parenting an Autistic Child.

The current study was a secondary analysis of cross-sectional data collected in New Zealand. Parents (n = 291) of an autistic child completed an online survey that included temporal/demographic questions relating to the parent and child, and parent ratings of the child's core ASD symptoms, their parenting stress, and psychological well-being. Child and parent ages were related to ASD core symptoms, parenting stress, and psychological well-being, the parent-child age gap was not. Diagnostic delay was only positively associated with parent depression and negatively associated with child communication impairment. Findings indicated that temporal variables can be predictive of parent well-being and child autism symptoms. The findings suggest that focusing interventions on communication abilities may have positive impacts parental mental health.

Bringing the past into the present: Control by exteroceptive stimuli and key-peck location in a concurrent-chains procedure.

We recently found that initial-link stimuli signaling trial outcomes (signals) in a concurrent-chains procedure exerted imperfect control during initial and terminal links. Here, we conducted a follow-up experiment to investigate further such imperfect control. Five pigeons worked on a concurrent-chains procedure in which one alternative led to a terminal link ending in a smaller-sooner reinforcer delivery, and the other in a larger-later reinforcer. During initial links of some trials, compound stimuli (signals) signaled the trial outcome. We assessed control by signal dimensions in Conflicting trials, in which the dimensions signaled conflicting outcomes. Unlike our previous experiment, signals remained present during terminal links. During initial links, preference favored the signaled key in Signaled trials, and the key signaled by the dimension exerting stronger control in Conflicting trials, suggesting strong signal control. Initial-link choice also depended on trial outcomes; preference was overall biased towards the smaller-sooner key. Terminal-link responding was primarily controlled by the key peck producing terminal-link entry, although some weak signal control was also evident. Thus, signal control during initial and terminal links was enhanced, and control by key-peck location during terminal links persisted, when signals remained present during terminal links. This suggests that our previous findings were partly related to temporal separation between signals and trial outcomes, and to history effects producing strong control by key-peck location.

Machine learning with a snapshot of data: Spiking neural network 'predicts' reinforcement histories of pigeons' choice behavior.

An accumulated body of choice research has demonstrated that choice behavior can be understood within the context of its history of reinforcement by measuring response patterns. Traditionally, work on predicting choice behaviors has been based on the relationship between the history of reinforcement-the reinforcer arrangement used in training conditions-and choice behavior. We suggest an alternative method that treats the reinforcement history as unknown and focuses only on operant choices to accurately predict (more precisely, retrodict) reinforcement histories. We trained machine learning models known as artificial spiking neural networks (SNNs) on previously published pigeon datasets to detect patterns in choices with specific reinforcement histories-seven arranged concurrent variable-interval schedules in effect for nine reinforcers. Notably, SNN extracted information from a small 'window' of observational data to predict reinforcer arrangements. The models' generalization ability was then tested with new choices of the same pigeons to predict the type of schedule used in training. We examined whether the amount of the data provided affected the prediction accuracy and our results demonstrated that choices made by the pigeons immediately after the delivery of reinforcers provided sufficient information for the model to determine the reinforcement history. These results support the idea that SNNs can process small sets of behavioral data for pattern detection, when the reinforcement history is unknown. This novel approach can influence our decisions to determine appropriate interventions; it can be a valuable addition to our toolbox, for both therapy design and research.

Stress and distress in New Zealand parents caring for a child with autism spectrum disorder.

The aim of this cross-sectional study was to identify predictors of the mental health of parents of a child with autism spectrum disorder (ASD). A convenience sample of 658 parents residing in New Zealand completed an online questionnaire. Participants responded to questions probing parent and child characteristics, child ASD severity (the Autism Impact Measure: AIM), parenting stress (the Autism Parenting Stress Index: APSI), and parent mental health (the General Health Questionnaire: GHQ-28). The results indicated that the majority of the parents in our sample have reached clinical levels of psychiatric distress, in particular anxiety. Parent and child characteristics were poor predictors of parental mental health problems. Parenting stress, however, was found to be a significant predictor, also acting as a mediator variable between child ASD symptom severity and parental mental health problems. Our findings are interpreted in relation to their significance to clinical practice.

Can binaural beats facilitate autonomic recovery following exposure to an acute stressor?

BACKGROUND AND PURPOSE: Binaural beats are seen as a new type of 'digital-drug'. The aim of this study was to determine if binaural beats could facilitate physiological recovery from a mental stressor. MATERIALS AND METHODS: 92 adults were exposed five times each to a 2-min mental stressor and a subsequent 4-min rest period containing silence or 1-of-4 examples of binaural beats (2, 5, 10, and 24 Hz). Physiological recovery across the five rest periods, as measured using skin conductance, heart rate, and breathing, were compared using one-way analysis of variance. RESULTS: Binaural beats were linked to enhanced physiological recovery relative to silence. However, the expected pattern of results whereby lower frequency binaural beats would be associated with greater physiological recovery, was not observed. CONCLUSION: Our findings do not support a relationship between binaural beats and systematic changes in emotional states as measured physiologically. On the basis of our results the acute administration of binaural beats in primary care to lower sympathetic arousal cannot yet be considered an evidence-based practice.

Generalizability theory distinguishes between state and trait anxiety.

Accurate distinction between state and trait anxiety is necessary for assessment and monitoring of individual anxiety levels over time and developing effective interventions to reduce anxiety. Generalizability theory (G-theory) is a suitable method to distinguish between state and trait and to evaluate reliability of test scores and sources of measurement error in the assessment of affective conditions. We applied G-theory to the widely used 40-item State and Trait Anxiety Inventory (STAI) completed by 139 participants on three occasions separated by 2-week intervals. The results show that both subscales of the STAI demonstrated excellent reliability for test scores in measuring trait anxiety with high generalizability of scores across occasions and persons (G = 0.84-0.92). The most dynamic aspects of state anxiety were identified in both subscales including satisfaction, nervousness, feelings of pleasure, perceived failure, calmness, feeling inadequate, and sensitivity to disappointments and this informed the development of a more sensitive state anxiety scale presented here. The STAI trait subscale and the proposed sensitive state subscale can be used to more accurately distinguish between state and trait anxiety. The most dynamic aspects of anxiety identified using G-theory are more amenable and need to be considered as the primary target of interventions aiming at reducing anxiety. More comprehensive assessment of state anxiety may benefit from the development of a longer scale informed by G-theory. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Affected Others Responsivity to Gambling Harm: An International Taxonomy of Consumer-Derived Behaviour Change Techniques.

Affected others impacted by someone else's gambling utilise numerous behaviour change strategies to minimise gambling-related harm but knowledge on what these strategies are and how they are implemented is limited. This study aimed to develop a comprehensive data-driven taxonomy of the types of self-help strategies used by affected others, and to categorize these into high-level behaviour change techniques (BCTs). Two taxonomies were developed using an inductive and deductive approach which was applied to a dataset of online sources and organised into the Rubicon model of action phases. These taxonomies were family-focused (how to reduce the impact of gambling harm on families) and gambler-focused (how to support the gambler in behaviour change). In total, 329 online sources containing 3536 different strategies were identified. The family-focused classification contained 16 BCTs, and the most frequent were professional support, financial management and planned consequences. The gambler-focused classification contained 11 BCTs, and the most frequent were feedback on behaviours, professional support and financial management. The majority of family- and gambler-focused BCTs fell under the actional phase of the Rubicon model. Grounded in lived experience, the findings highlight the need for intervention and resource development that includes a wide range of specific techniques that affected others can utilise.

The Cold Shoulder or a Shoulder to Cry on? Mechanisms of Formal and Informal Social Support in the ASD Parenting Context.

The underlying mechanisms by which social support exerts its (typically) positive effects on parental wellbeing are still being investigated in the autism spectrum disorder (ASD) context. Parents (n = 674) of a child with ASD responded to questions probing parenting stress, parent psychological health, their child's ASD symptoms, and the types of social supports they were currently utilising. Hierarchical multiple linear regression analyses examined whether social support moderated or mediated (or neither) the relationships between: (a) parent-rated child ASD symptoms and parenting stress, and (b) parenting stress and parent psychological health. The main findings were that none of the mediating models reached statistical significance, while 7/20 moderation analyses were significant, though significance was dependent upon how social support was operationalised.

The Types and Functions of Social Supports Used by Parents Caring for a Child With Autism Spectrum Disorder.

The challenges faced by parents caring for a child with Autism Spectrum Disorder (ASD) can amplify parenting stress, though the impacts of these challenges can be alleviated by social supports. A sample of 674 parent volunteers completed a survey probing the types of social supports currently being used, what function (i.e., tangible, emotional, financial, informational) they judged them to perform, and how each of the utilised supports reduced parenting stress and was considered helpful. Results indicated that informal social supports and social media were perceived as more helpful than formal supports, which were typically perceived in a neutral manner by parents. Overall, the study indicates that addressing the support needs of parents of a child with ASD remains a priority.

Stimulus control depends on the subjective value of the outcome.

Stimuli that provide information about likely future reinforcers tend to shift behavior, provided a reliable relation between the stimulus and the reinforcer can be discriminated. Stimuli that are apparently more reliable exert greater control over behavior. We asked how the subjective value (measured in terms of preference) of reinforcers associated with stimuli influences stimulus control. Five pigeons worked on a concurrent chains procedure in which half of all trials ended in a smaller reinforcer sooner, and the other half in a larger reinforcer later. In Signaled trials, the color and flash duration on the keys in the initial link signaled the outcome of the trial. In Conflicting probe trials, the color and the flash duration signaled conflicting information about the outcome of the trial. Choice in Signaled trials shifted toward the signaled outcome, but was never exclusive. In Conflicting probe trials, control was divided idiosyncratically between the 2 stimulus dimensions, but still favored the outcome with the higher subjective value. Thus, stimulus control depends not only on the perceived reliability of stimuli, but also on the subjective value of the outcome.