The Association of Childhood Maltreatment, Sex, and Hair Cortisol Concentrations With Trajectories of Depressive and Anxious Symptoms Among Adult Psychiatric Inpatients.

OBJECTIVE: Depression and anxiety symptoms are commonly observed among clinical populations, especially among women and maltreated individuals. Few investigations have, however, assessed the existence of distinct symptoms trajectories among clinical populations and how these relate to childhood maltreatment, sex differences, and stress physiology indexed by hair cortisol concentrations (HCCs). The current study a) identified distinct depression and anxious trajectories in a sample of psychiatric inpatients followed up prospectively from their admission to a psychiatric emergency service, and b) examined whether HCC, childhood maltreatment, and sex independently and jointly predict these trajectories. METHODS: Adult inpatients (n = 402; 55% women) were recruited upon admission to psychiatric emergency service (T1) during which HCC (reflecting cortisol secretion for the last 3 months), childhood maltreatment, and depression and anxiety symptoms were assessed. Symptoms were reevaluated when patients were discharged from the hospital (T2), admitted to outpatient clinics (T3), and 12 months later or at the end of outpatient treatment (T4). RESULTS: Three trajectories were identified for depression and anxiety symptoms. Among men, higher HCC predicted higher odds of evincing chronic depressive symptoms compared with a low stable trajectory (odds ratio [OR] = 3.46, 95% confidence interval [CI] = 1.43-8.40). Greater childhood maltreatment among men predicted higher chances of exhibiting chronic anxious symptoms than the low stable (OR = 1.47, 95% CI = 1.07-2.02) and the high decreasing trajectories (OR = 0.70, 95% CI = 0.51-0.95). Opposite findings were noted for women. CONCLUSIONS: Childhood maltreatment and HCC should be further investigated as predictors of anxious and depressive trajectories, during which sex-specific associations ought to be considered.

Further validation of the Cognitive Biases Questionnaire for psychosis.

BACKGROUND: Cognitive biases are recognized as important treatment targets for reducing symptoms associated with severe mental disorders. Although cognitive biases have been linked to symptoms in most studies, few studies have looked at such biases transdiagnostically. The Cognitive Bias Questionnaire for psychosis (CBQp) is a self-reported questionnaire that assesses cognitive biases amongst individuals with a psychotic disorder, as well as individuals with other severe mental disorders. The current study aims to validate a French version of the CBQp and to explore transdiagnostic cognitive biases in individuals with psychotic disorders, individuals with depression, and in healthy controls. METHODS: The CBQp was translated into French following a protocol based on international standards. Discriminant validity and internal consistency were determined for total score and each subscale score. Confirmatory factor analyses were performed to test construct validity. Finally, cluster analyses were conducted to investigate cognitive biases across diagnostic groups. RESULTS: Our results were similar to those of the original authors, with the one-factor solution (assessment of a general thinking bias) being the strongest, but the two-factor solution (assessing biases within two themes relating to psychosis) and the five-factor solution (assessment of multiple distinct biases) being clinically more interesting. A six-cluster solution emerged, suggesting that individuals with similar diagnoses score differently on all cognitive biases, and that individuals with different diagnoses might have similar cognitive biases. CONCLUSIONS: The current findings support the validity of the French translation of the CBQp. Our cluster analyses overall support the transdiagnostic presence of cognitive biases.

Psychosocial Profiles of Patients Admitted to Psychiatric Emergency Services: Results from the Signature Biobank Project.

OBJECTIVES: Patients admitted to psychiatric emergency services (PES) are highly heterogenous. New tools based on a transdiagnosis approach could help attending psychiatrists in their evaluation process and treatment planning. The goals of this study were to: (1) identify profiles of symptoms based on self-reported, dimensional outcomes in psychiatric patients upon their admission to PES, (2) link these profiles to developmental variables, that is, history of childhood abuse (CA) and trajectories of externalizing behaviours (EB), and (3) test whether this link between developmental variables and profiles was moderated by sex. METHODS: In total, 402 patients were randomly selected from the Signature Biobank, a database of measures collected from patients admitted to the emergency of a psychiatric hospital. A comparison group of 92 healthy participants was also recruited from the community. Symptoms of anxiety, depression, alcohol and drug abuse, impulsivity, and psychosis as well as CA and EB were assessed using self-reported questionnaires. Symptom profiles were identified using cluster analysis. Prediction of profile membership by sex, CA, and EB was tested using structural equation modelling. RESULTS: Among patients, four profiles were identified: (1) low level of symptoms on all outcomes, (2) high psychotic symptoms, (3) high anxio-depressive symptoms, and (4) elevated substance abuse and high levels of symptoms on all scales. An indirect effect of CA was found through EB trajectories: patients who experienced the most severe form of CA were more likely to develop chronic EB from childhood to adulthood, which in turn predicted membership to the most severe psychopathology profile. This indirect effect was not moderated by sex. CONCLUSION: Our results suggest that a transdiagnostic approach allows to highlight distinct clinical portraits of patients admitted to PES. Importantly, developmental factors were predictive of specific profiles. Such transdiagnostic approach is a first step towards precision medicine, which could lead to develop targeted interventions.

Stigma associated with parental depression or cancer: Impact on spouse and offspring's cortisol levels and socioemotional functioning.

Stress associated with caring for a mentally ill spouse can adversely affect the health status of caregivers and their children. Adding to the stress of caregiving is the stigma often placed against spouses and children of people with mental illness. Contrary to mental illness, many physical disorders such as cancer may be less stigmatized (expect pulmonary cancer). In this study, we measured externalized and internalized stigma, as well as psychological (depressive symptoms and stressful life events) and physiological (basal salivary cortisol levels) markers of stress in 115 spouses and 154 children of parents suffering from major depressive disorder, cancer, or no illness (control group). The results show that spouses and children from families with parental depression present significantly more externalized stigma than spouses and children from families with parental cancer or no illness, although we find no group differences on internalized stigma. The analysis did not show a significant group difference either for spouses or their children on depressive symptomatology, although spouses from the parental depression group reported greater work/family stress. Finally, we found that although for both spouses children the awakening cortisol response was greater on weekdays than on weekend days, salivary cortisol levels did not differ between groups. Bayes factor calculated on the null result for cortisol levels was greater than 100, providing strong evidence for the null hypothesis H0. Altogether, these results suggest an impact of stigma toward mental health disorder on psychological markers of stress but no impact of stigma on physiological markers of stress. We suggest that these results may be due to the characteristics of the families who participated in the present study.

Comorbidity Profiles of Psychotic Patients in Emergency Psychiatry.

Objectives: Individuals with psychotic symptoms presenting to emergency psychiatry often have comorbid symptoms, such as substance misuse, depression, and anxiety. Many will also have symptoms linked to previous traumatic experiences such as impulsivity, often found in comorbid personality disorders. Although various studies have looked at specific comorbid symptoms, little is known regarding how these symptoms co-exist in individuals with psychotic symptoms and their link with social functioning. The primary objective of the present study was to identify comorbidity profiles among individuals seeking emergency room services for psychotic symptoms. The secondary objective was to investigate the relationship between comorbid symptoms and social functioning deficits in this same population. Methods: Data from 546 individuals seeking psychiatric help for psychotic symptoms was collected within the Signature Project (large data bank) in a psychiatric emergency. Participants answered brief measures of symptoms of alcohol/substance misuse (AUDIT, DAST), depression (PHQ-9), anxiety (STAI-6), childhood trauma (CEVQ), impulsivity (UPPS) and social functioning deficits (WHODAS). For this study, symptom measures and social functioning at baseline were used. Results: Cluster analyses conducted using three different methods revealed a consensus of five classes of comorbid presentations. Class 1 (n = 90) grouped people who had a high score for childhood trauma, with fairly high scores for anxiety and depression. Class 2 (n = 176) included people with mostly psychotic symptoms with little comorbid presentation across other measures. Class 3 (n = 81) grouped people with the highest anxiety and depression scores as well as high drug use and impulsivity. Individuals in Class 4 (n = 87) had the highest scores on alcohol and substance abuse, as well as high impulsivity. Class 5 (n = 112) grouped people with very low anxiety and depression scores but average trauma, alcohol, and substance misuse scores. Linear regressions revealed an association between social functioning, and depression, anxiety, and childhood trauma. Conclusions: Comorbid presentations of individuals with psychosis are frequent and diverse. Depression and anxiety, in particular, worsen social functioning deficits in people with psychotic symptoms. Given their impact on functioning, psychiatric treatments should address these comorbidities during hospitalization, as well as when followed in the community.

Survey evidence of the decline in child abuse in younger Canadian cohorts.

Physical and sexual abuse in childhood is a worldwide phenomenon with potentially dramatic consequences of both a psychological and physical nature. Measures of primary prevention have been developed in some countries. In the USA, child protection services reports and research surveys indicate that child sexual abuse has been on the decline in recent decades. Results are less clear for physical and overall abuse. The aim of this study was to describe how childhood abuse has changed over the years in Canada through an analysis of the 2012 Canadian Community Health Survey: Mental Health Edition data. The sample comprised 22,775 respondents ages 20 and over who completed a child abuse questionnaire. Respondents born from 1983 to 1992 reported significantly less overall abuse, physical abuse, and sexual abuse than did older generations, with the exception of people born in 1942 or earlier. The decrease was observed among men and women and across all the regions of Canada.Conclusion: The results are encouraging in that they may have an impact on life expectancy, severity of various chronic disorders, and suicide in the population. They also support policies that have focused on improving the childhood environment in the 1990s. Results also underline the importance of using different kinds of data sources for evaluating child abuse. What is Known: • Physical and sexual abuse in childhood has been associated with lower life expectancy in connection with an array of chronic diseases, including mental disorders, and with suicide. • Measures of primary prevention have been developed in some countries, such as the USA and Canada. What is New: • Canadians born from 1983 to 1992 report significantly less overall abuse, physical abuse, and sexual abuse than older generations do. • These encouraging results support policies implemented in the 1990s focused on improving the childhood environment.

Construct Validity of the Professional Quality of Life (ProQoL) Scale in a Sample of Child Protection Workers.

The Professional Quality of Life (ProQOL) scale is one of the most widely used measures of compassion satisfaction and fatigue despite there being little publicly available evidence to support its validity. This study, conducted among a sample of 310 child protection workers, assessed the construct validity of this measure using confirmatory factor analysis (CFA) and bifactor modeling. The CFA failed to confirm the adequacy of the three-factor structure proposed by Stamm (2010). In response, a bifactor model postulating a factor structure with a general factor in addition to independent factors (compassion satisfaction, job burnout, and secondary traumatic stress) was proposed, highlighting the unidimensionality of the ProQOL while allowing for each subscale to be used separately. Moreover, this bifactor model of the ProQOL was moderately correlated with the Posttraumatic Disorder Checklist, r = -.427, p < .001, and strongly correlated with scales of well-being at work, r = .694, p < .001, and psychological distress at work, r = -.666, p < .001, thus supporting the ProQOL's convergent validity. No associations were found between the ProQOL and the Life Event Checklist, which supports the ProQOL's discriminant validity. Overall, the results indicated that compassion satisfaction and compassion fatigue represent higher and lower levels of the same construct rather than two different constructs. Researchers and clinicians could therefore compute a single score to rate professionals' individual levels of professional quality of life.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Validez de Constructo del instrumento de medición de Calidad de Vida Profesional (ProQoL) en una muestra de trabajadores de protección infantil ESCALA DE CALIDAD DE VIDA PROFESIONAL: VALIDEZ DE CONSTRUCTO La escala de Calidad de Vida Profesional (ProQoL en su sigla en inglés) es una de las medidas más ampliamente usadas de compasión satisfacción y fatiga por compasión, a pesar de que hay escasa evidencia disponible públicamente que soporte su validez. Este estudio, realizado en una muestra de 310 trabajadores de protección infantil, evaluó la validez de constructo de esta medición usando análisis confirmatorio de factores (CFA, por su sigla en inglés) y modelado bifactor. El CFA no confirmó la idoneidad de la estructura de tres factores propuesta por Stamm (2010). En respuesta, se propone un modelo bifactor que postula una estructura factorial con un factor general junto a factores independientes (compasión satisfacción, agotamiento laboral y estrés traumático secundario), destacando la unidimensionalidad de la ProQoL mientras permite el uso por separado de cada subescala. Más aún, este modelo bifactor de la ProQoL estuvo moderadamente correlacionado con la Lista de Chequeo de Trastorno Postraumático, r = -.427, p < .001, y fuertemente correlacionado con escalas de bienestar en el trabajo, r = .694, p <.001, y malestar psicológico en el trabajo, r = -.666, p <.001, apoyando por tanto la validez convergente de la ProQoL. No se encontraron asociaciones entre la ProQoL y la Lista de Chequeo de Eventos Vitales, lo cual apoya la validez discriminante de la ProQoL. En suma, los resultados indicaron que la compasión satisfacción y la fatiga por compasión representan niveles más altos y más bajos del mismo constructo más que dos constructos diferentes. Los investigadores y los clínicos podrían por lo tanto calcular un único puntaje para calificar los niveles individuales de calidad de vida profesional de los profesionales.

Impact of a Program for the Management of Aggressive Behaviors on Seclusion and Restraint Use in Two High-Risk Units of a Mental Health Institute.

The Omega Program for the Management of Aggressive Behaviors aims to reduce patients' dangerous behaviors, towards themselves or others, and to reduce the use of seclusion and restraint (S/R). A previous study in a Mental Health Institute (Montreal, Canada) showed that implementing this program allowed employees of the intensive care and emergency units to gain confidence in coping with patients' aggressions and to reduce their psychological distress. The present study, conducted in the same high-risk units, assesses the effect of the program on S/R use. We hypothesize that the incidence and duration of S/R should diminish significantly following the implementation of the program in both units. This naturalistic, prospective study covered archival data between April 2010 and July 2014. Pre-training data (April 2010-December 2011) were compared to data during training (January 2012-October 2012) and to post-training data (November 2012-July 2014) for both units. In the intensive care unit, we confirmed an increase of both mean daily number and duration of S/R by admissions in pre-training, followed by a decrease during the training and post-training. In the emergency unit, a decreasing trend is seen during the entire period thus suggesting that the decrease in S/R may be independent of the training. These findings suggest that Omega is a promising intervention program to use in an intensive care unit. However, a more global approach, including institutional changes in culture and attitude, can be important factors to develop to increase the positive outcomes.

The company you keep: The neglected role of affiliating with delinquent friends in the development of the cannabis-violence link.

A growing body of research suggests a potential role of cannabis use on aggressive behaviors. In literature on adolescents, the lack of consideration of important confounders, such as adolescent's affiliation with delinquent peers, limits the possibility to determine whether there might be a direct or indirect link between cannabis use and aggression. Therefore, we sought to examine the effect of delinquent peers on the association between cannabis use and violence. We re-analyzed data from 850 ninth graders who were followed from mid-adolescence to early adulthood. Generalized Estimations Equations (GEE) were conducted to examine whether affiliation with delinquent peers may mediate the relationship between cannabis use and violence. Cross-Lagged Panel Models were also conducted to estimate the directionality of these relationships over time. We additionally tested whether similar relationships may be identifiable when examining rule-breaking behaviors and/or alcohol use. GEE models revealed that both cannabis use and affiliation with delinquent peers were statistically associated with aggressive behaviors. Cannabis use, alcohol use and delinquent peers also predicted rule-breaking behaviors. More precisely, cross-lagged models showed that affiliation with delinquent peers played a partially mediating role in the cannabis-aggression link, and that similar cross-lagged estimates were observed when examining rule-breaking behaviors instead of aggression. Our results indicate that cannabis use may be associated with aggression as well as rule-breaking behaviors, suggesting a broader effect on conduct problems. More importantly, our study highlights the non-negligible role of affiliating with delinquent peers during adolescence.

Hair cortisol stability after 5-year storage: Insights from a sample of 17-year-old adolescents.

Background: Hair has become an increasingly valuable medium to investigate the association between chronic stress, stable differences in systemic cortisol secretion and later health. Assessing cortisol in hair has many advantages, notably its non-invasive and retrospective nature, the need for a single biospecimen and convenient storage until analysis. However, few studies offered empirical evidence documenting the long-term temporal stability of hair cortisol concentration (HCC) prior to analysis, especially in humans. Yet, knowing how long hair samples can be stored without compromising the accuracy of cortisol measurement is of crucial importance when planning data collection and analysis. This study examined the stability of HCC in hair samples assayed twice, five years apart. Methods: We randomly selected from a larger distribution of HCC measured in 17-year-old participants 39 hair samples to be reanalyzed five years later, under the same general conditions. Samples were assayed in duplicate using a luminescence immunoassay and compared with the original HCC using the Lin's concordance correlation coefficient (CCC), Bland-Altman plot analysis and Wilcoxon rank test. Results: Findings indicated a good concordance and temporal stability between the two samples assayed five years apart (CCC [95% confidence interval] = 0.84 [0.72-0.91]), although a small decrease in HCC was noted 5 years later (8.4% reduction, p = 0.001). Conclusion: Our study confirms that hair samples, when stored at room temperature and away from sunlight, can be assayed for at least five years without risking a loss of precision in HCC measurement.

Is There a Dose-Response Relationship Between Cannabis Use and Violence? A Longitudinal Study in Individuals with Severe Mental Disorders.

Introduction: Recent longitudinal studies point toward the existence of a positive relationship between cannabis use and violence in people with severe mental disorders (SMD). However, the existence of a dose-response relationship between the frequency/severity of cannabis use and violence has seldom been investigated. Therefore, this study aims to determine if such a relationship exists in a psychiatric population. Methods: To do so, a total of 98 outpatients (81 males and 17 females, all over 18 years of age) with SMD were recruited at the Institut universitaire de santé mentale de Montréal (Montréal, Canada) and included in the analyses. Clinical evaluations were conducted every 3 months for a year. Substance use, violent behaviors, and potential covariables were assessed through self-reported assessments, urinary testing, as well as clinical, criminal, and police records. Using generalized estimating equations, the association between cannabis use frequency (nonusers, occasional, regular, and frequent users) and violence was investigated, as well as the association between the severity of cannabis use and violent behaviors. Results: It was found that cannabis use frequency and severity were significant predictors of violent behaviors. After adjustment for time, age, sex, ethnicity, diagnoses, impulsivity, and use of alcohol and stimulants, odds ratios were of 1.91 (p<0.001) between each frequency profile and 1.040 (p<0.001) for each increase of one point of the severity of cannabis use score (ranging from 0 to 79). Conclusions: Despite the high attrition rate, these findings may have important implications for clinicians as cannabis use may have serious consequences in psychiatric populations. Nevertheless, the mechanisms underlying this association remain unclear.

Democratizing Vitreoretinal Surgery Training With a Portable and Affordable Virtual Reality Simulator in the Metaverse.

Purpose: The purpose of this study was to develop and validate RetinaVR, an affordable, portable, and fully immersive virtual reality (VR) simulator for vitreoretinal surgery training. Methods: We built RetinaVR as a standalone app on the Meta Quest 2 VR headset. It simulates core vitrectomy, peripheral shaving, membrane peeling, and endolaser application. In a validation study (n = 20 novices and experts), we measured: efficiency, safety, and module-specific performance. We first explored unadjusted performance differences through an effect size analysis. Then, a linear mixed-effects model was used to isolate the impact of age, sex, expertise, and experimental run on performance. Results: Experts were significantly safer in membrane peeling but not when controlling for other factors. Experts were significantly better in core vitrectomy, even when controlling for other factors (P = 0.014). Heatmap analysis of endolaser applications showed more consistent retinopexy among experts. Age had no impact on performance, but male subjects were faster in peripheral shaving (P = 0.036) and membrane peeling (P = 0.004). A learning curve was demonstrated with improving efficiency at each experimental run for all modules. Repetition also led to improved safety during membrane peeling (P = 0.003), and better task-specific performance during core vitrectomy (P = 0.038), peripheral shaving (P = 0.011), and endolaser application (P = 0.043). User experience was favorable to excellent in all spheres. Conclusions: RetinaVR demonstrates potential as an affordable, portable training tool for vitreoretinal surgery. Its construct validity is established, showing varying performance in a way that correlates with experimental runs, age, sex, and level of expertise. Translational Relevance: Fully immersive VR technology could revolutionize surgical training, making it more accessible, especially in developing nations.

Data-driven dynamic profiles of tonic heat pain perception in pain-free volunteers are associated with differences in anandamide levels.

Our laboratory previously developed a method for assessing experimentally induced pain perception through a 2-min constant heat pain stimulation. However, the traditional analysis relying on group means struggles to interpret the considerable inter-individual variability due to the dynamic nature of the response. Recently, trajectory analysis techniques based on extended mixed models have emerged, providing insights into distinct response profiles. Notably, these methods have never been applied to pain paradigms before. Furthermore, various socio-demographic and neurobiological factors, including endocannabinoids, may account for these inter-individual differences. This study aims to apply the novel analysis to dynamic pain responses and investigate variations in response profiles concerning socio-demographic, psychological, and blood endocannabinoid concentrations. 346 pain-free participants were enrolled in a psychophysical test involving a continuous painful heat stimulation lasting for 2 min at a moderate intensity. Pain perception was continuously recorded using a computerized visual scale. Dynamic pain response analyses were conducted using the innovative extended mixed model approach. In contrast to the traditional group-mean analysis, the extended mixed model revealed three pain response trajectories. Trajectory 1 is characterized by a delay peak pain. Trajectory 2 is equivalent to the classic approach (peak pain follow by a constant and moderate increase of pain perception). Trajectory 3 is characterized by extreme responses (steep peak pain, decrease, and increase of pain perception), Furthermore, age and blood anandamide levels exhibited significant variations among these three trajectories. Using an innovative statistical approach, we found that a large proportion of our sample had a response significantly different from the average expected response. Endocannabinoid system seems to play a role in pain response profile.

A step-by-step and data-driven guide to index gender in psychiatry.

Beyond sex as a binary or biological variable, within-sex variations related to sociocultural gender variables are of increasing interest in psychiatric research to better understand individual differences. Using a data-driven approach, we developed a composite gender score based on sociodemographic and psychosocial variables showing sex differences in a sample of psychiatric emergency patients upon admission (N = 1708; 39.4% birth-assigned females; mean age = 40 years; age standard deviation = 14). This gender score was extracted from a confirmatory factor analysis (CFI = 0.966; RMSEA = 0.044, SRMR = 0.030) and could predict a person's birth-assigned sex with 67% accuracy. This score allowed the further identification of differences on impulsivity measures that were absent when looking solely at birth-assigned sex. Female birth-assigned sex was also associated with higher rates of mood and personality disorder diagnoses, while higher feminine gender scores were related to higher proportions of anxiety and mood disorder diagnoses. By contrast, male birth-assigned sex and higher masculine gender scores were associated with higher proportions of psychotic and substance use disorder diagnoses. Patients with undifferentiated gender scores (i.e., scoring between masculine and feminine threshold defined by terciles) were more represented in the psychotic disorder group. Considering both sex and gender in psychiatric research is essential and can be achieved even when using secondary data to index gender comprised of demographic and psychosocial variables.

The effectiveness of an online short-format Recovery College model: a co-learning model to support mental health.

BACKGROUND: Our societies are facing mental health challenges, which have been compounded by the Covid-19. This event led people to isolate themselves and to stop seeking the help they needed. In response to this situation, the Health and Recovery Learning Center, applying the Recovery College (RC) model, modified its training program to a shorter online format. This study examines the effectiveness of a single RC training course delivered in a shortened online format to a diverse population at risk of mental health deterioration in the context of Covid-19. METHODS: This quasi-experimental study used a one-group pretest-posttest design with repeated measures. Three hundred and fifteen (n = 315) learners agreed to take part in the study and completed questionnaires on wellbeing, anxiety, resilience, self-management, empowerment and stigmatizing attitudes and behaviors. RESULTS: Analyses of variance using a linear mixed models revealed that attending a RC training course had, over time, a statistically significant effect on wellbeing (p = 0.004), anxiety (p < 0.001), self-esteem/self-efficacy (p = 0.005), disclosure/help-seeking (p < 0.001) and a slight effect on resilience (p = 0.019) and optimism/control over the future (p = 0.01). CONCLUSIONS: This study is the first to measure participation in a single online short-format RC training course, with a diversity of learners and a large sample. These results support the hypothesis that an online short-format training course can reduce psychological distress and increase self-efficacy and help-seeking. TRIAL REGISTRATION: This study was previously approved by two certified ethics committees: Comité d'éthique de la recherche du CIUSSS EMTL, which acted as the committee responsible for the multicenter study, reference number MP-12-2021-2421, and Comité d'éthique avec les êtres humains de l'UQTR, reference number CER-20-270-07.01.

Learning to embrace one's stress: the selective effects of short videos on youth's stress mindsets.

BACKGROUND AND OBJECTIVES: Stress is not inherently negative. As youth will inevitably experience stress when facing the various challenges of adolescence, they can benefit from developing a stress-can-be-enhancing mindset rather than learning to fear their stress responses and avoid taking on challenges. We aimed to verify whether a rapid intervention improved stress mindsets and diminished perceived stress and anxiety sensitivity in adolescents. DESIGN AND METHODS: An online experimental design randomly exposed 233 Canadian youths aged 14-17 (83% female) to four videos of the Stress N' Go intervention (how to embrace stress) or to control condition videos (brain facts). Validated questionnaires assessing stress mindsets, perceived stress, and anxiety sensitivity were administered pre- and post-intervention, followed by open-ended questions. RESULTS: The intervention content successfully instilled a stress-can-be-enhancing mindset compared to the control condition. Although Bayes factor analyses showed no main differences in perceived stress or anxiety sensitivity between conditions, a thematic analysis revealed that the intervention helped participants to live better with their stress. CONCLUSIONS: Overall, these results suggest that our intervention can rapidly modify stress mindsets in youth. Future studies are needed to determine whether modifying stress mindsets is sufficient to alter anxiety sensitivity in certain adolescents and contexts.

Assessing the medical reasoning skills of GPT-4 in complex ophthalmology cases.

BACKGROUND/AIMS: This study assesses the proficiency of Generative Pre-trained Transformer (GPT)-4 in answering questions about complex clinical ophthalmology cases. METHODS: We tested GPT-4 on 422 Journal of the American Medical Association Ophthalmology Clinical Challenges, and prompted the model to determine the diagnosis (open-ended question) and identify the next-step (multiple-choice question). We generated responses using two zero-shot prompting strategies, including zero-shot plan-and-solve+ (PS+), to improve the reasoning of the model. We compared the best-performing model to human graders in a benchmarking effort. RESULTS: Using PS+ prompting, GPT-4 achieved mean accuracies of 48.0% (95% CI (43.1% to 52.9%)) and 63.0% (95% CI (58.2% to 67.6%)) in diagnosis and next step, respectively. Next-step accuracy did not significantly differ by subspecialty (p=0.44). However, diagnostic accuracy in pathology and tumours was significantly higher than in uveitis (p=0.027). When the diagnosis was accurate, 75.2% (95% CI (68.6% to 80.9%)) of the next steps were correct. Conversely, when the diagnosis was incorrect, 50.2% (95% CI (43.8% to 56.6%)) of the next steps were accurate. The next step was three times more likely to be accurate when the initial diagnosis was correct (p<0.001). No significant differences were observed in diagnostic accuracy and decision-making between board-certified ophthalmologists and GPT-4. Among trainees, senior residents outperformed GPT-4 in diagnostic accuracy (p≤0.001 and 0.049) and in accuracy of next step (p=0.002 and 0.020). CONCLUSION: Improved prompting enhances GPT-4's performance in complex clinical situations, although it does not surpass ophthalmology trainees in our context. Specialised large language models hold promise for future assistance in medical decision-making and diagnosis.

The Signature Biobank: A longitudinal biopsychosocial repository of psychiatric emergency patients.

The Signature Biobank is a longitudinal repository of biospecimen, psychological, sociodemographic, and diagnostic data that was created in 2012. The Signature Consortium represents a group of approximately one hundred Quebec-based transdisciplinary clinicians and research scientists with various expertise in the field of psychiatry. The objective of the Signature Biobank is to investigate the multi-faceted underpinnings of psychiatric disorders among patients in crisis. The Signature Consortium is expanding and includes new active members that seek to highlight the contributions made by Signature Biobank since its inception. This article details our research protocol, directions, and summarizes contributions. To date, we have collected biological samples (n = 1,986), and questionnaire data (n = 2,085) from psychiatric emergency patients of the Institut universitaire en santé mentale de Montréal (Quebec, Canada), with a large proportion from whom both data types were collected (n = 1,926). In addition to this, a subsample of patients was followed-up at hospital discharge, and two additional outpatient clinic appointments (n = 958 with at least one follow-up). In addition, a socio-demographically matched comparison group of individuals who were not hospitalized for psychiatric disorders (n = 149) was recruited from the surrounding catchment area. To summarize, a systematic review of the literature shows that the Signature Biobank has contributed to better characterizing psychiatric comorbidities, biological profiles, and psychosocial functioning across some of the most common psychiatric disorders, including psychosis, mood, anxiety, and substance use disorders. The Signature Biobank is now one of the world's largest repositories of data collected from patients receiving care at a psychiatric emergency unit.

The effects of adherence to professional identity, workplace aggression, and felt accountability on child protection workers' professional quality of life.

BACKGROUND: Child protection workers (CPWs) are exposed to physical and psychological violence initiated by clients. The consequences associated with exposure to this type of trauma and others are compounded by the anxiety generated by the feelings of being accountable and the constant scrutiny and monitoring CPWs are under. Previous research suggests that acting according to one's professional values can help protect against the effects of trauma exposure and the anxiety associated with being held accountable when situations devolve into crises. METHODS AND OBJECTIVES: Using path analysis, this study sought to investigate how this complex intersection between client aggression, felt accountability, and professional identity among 310 CPWs is related to their professional quality of life (ProQol). RESULTS: Results show that adherence to professional identity was strongly and positively associated with ProQoL scores (ß = -0.42, p < .001). Felt accountability and exposure to psychological violence (but no other forms of violence) were consistently and negatively related to ProQoL scores (ß = -0.42, p < .001/ß = -0.20, p < .001). The impact of felt accountability on ProQoL scores can be partially explained by lowered adherence to professional identity. This suggests that the current way CPWs are held accountable and evaluated comes at odds with their professional values. CONCLUSION: The article ends with a discussion on how organizational changes surrounding accountability can be anxiety-inducing for some CPWs who increasingly feel overwhelmed by the complexity of their cases. Organizations must therefore reflect on how they can better embody the values of their clinicians.