Loneliness in patients with somatic symptom disorder.

OBJECTIVES: Patients with somatoform disorders often experience loneliness. They feel misunderstood and socially rejected. Whereas loneliness is related to several medical conditions, social support can minimize loneliness. In the current study, differences in loneliness and the evaluation of social support between patients with Somatic Symptom Disorder (SSD) and healthy controls were investigated using standardized questionnaires. In addition, the relation between loneliness and somatic symptoms was investigated. METHODS: In a cross-sectional study design, a group of patients with SSD (n=75) was compared to a healthy control group (n=112). It was hypothesized that [1] patients with SSD experience more loneliness and evaluate their social support more negatively than healthy controls and [2] loneliness will correlate positively with experienced somatic symptoms. RESULTS: In comparison to healthy controls, patients with SSD experienced more loneliness and their evaluation of social support was more negative. In addition, loneliness correlated positively with the degree of experienced somatic symptoms. CONCLUSIONS: Patients with SSD experienced lower social support, more loneliness, and across the two groups loneliness was positively associated with somatic symptoms. Effect sizes were all large. Therefore, these results may have implications for the treatment of SSD.

The role of performance pressure, loneliness and sense of belonging in predicting burnout symptoms in students in higher education.

Student burnout is raising an increasing amount of concern. Burnout often leads to psychosocial problems and drop-out. In this study multiple regression analysis was used to examine the impact of performance pressure, loneliness, and sense of belonging on the underlying dimensions of burnout in 3,134 university students in the Netherlands. Results suggest that sense of belonging could be targeted as a way to enhance student wellbeing, in order to improve the ability to cope with the high demands in student life and the prevention of burnout.

Do Men and Women Have a Different Association between Fear-Avoidance and Pain Intensity in Chronic Pain? An Experience Sampling Method Cohort-Study.

BACKGROUND: Fear-avoidance is one of the factors associated with chronic pain. However, it remains unclear whether the association between fear-avoidance and pain depends on sex. The present study aimed to investigate whether the association between fear-avoidance and pain intensity differed between men and women in chronic pain patients. Additionally, the potential confounding effect of affective experiences on the association between fear-avoidance and pain intensity was analyzed. METHOD: This cohort study included hospital referred chronic pain patients (n = 45). Short momentary assessment questions according to the experience sampling method (ESM) were used to repeatedly assess patients' pain intensity, level of fear-avoidance and positive as well as negative affect during their daily life. Linear mixed-effects models were applied in the statistical analysis. Unadjusted and adjusted models were made, in which the latter corrected for statistically significant affective experiences and baseline variables, taking the Aikake Information Criterion into account to assess a better model of fit. RESULTS: The results demonstrated an association between fear-avoidance and pain intensity that differed for men and women. In men (n = 13), no association between these variables was found (-0.04 (95% CI: -0.14, 0.06) with a p-value of 0.48), whereas in women (n = 32), an increase in fear-avoidance was associated with a (slight) increase in pain intensity (0.18 (95% CI 0.06, 0.30) with a p-value of 0.003). Affect did not confound the above-mentioned findings. CONCLUSION: Our data supports previous research highlighting the importance of sex differences in pain experience. These findings may be relevant for clinicians to consider more personalized (i.e., gender specific) pain management in chronic pain patients.

Trajectories of loneliness across adolescence: An empirical comparison of longitudinal clustering methods using R.

INTRODUCTION: In this study, we compare three different longitudinal clustering methods. As a case study, the comparison of the methods is conducted for the development of loneliness from middle childhood to young adulthood. The aim is to explore how two nonparametric longitudinal cluster methods compare with a model-based latent class mixture model approach. METHODS: The trajectories of loneliness of 130 young people between 9 and 21 years of age, were analyzed to find a set clusters within these trajectories. The data for this study were obtained from the Nijmegen Longitudinal Study on Infant and Child Development (The Netherlands). Loneliness was measured at four waves at the age of 9, 13, 16, and 21 years. The nonparametric methods are in the R-packages kml and traj, and the model-based in the lcmm package. RESULTS: All methods indicated that the optimal number of clusters to describe the heterogeneity across the trajectories was three. The kml and lcmm methods showed the most similarity in shape of all clusters and fitted the data relatively well, while the traj method yielded somewhat different shapes and didn't fit the data well. CONCLUSIONS: All three methods corroborate the literature in this field by finding that the largest portion of subjects experience stable and low levels of loneliness. However, the clustering methods also reveal that there is a portion of subjects that experience changes in loneliness during adolescence. By comparing the results of nonparametric clustering methods to the latent class mixture model, this study equips researchers with an example of how to implement these models and thereby contributes to the literature on longitudinal clustering in the social sciences. Altogether the analyses show that it might be useful to investigate different algorithms to identify the most robust solution.

Loneliness and Mental Health: The Mediating Effect of Perceived Social Support.

Social connectedness is a fundamental human need. The Evolutionary Theory of Loneliness (ETL) predicts that a lack of social connectedness has long-term mental and physical health consequences. Social support is a potential mechanism through which loneliness influences health. The present cross-sectional study examined the relationship between loneliness and mental health, and the mediating effects of social support in a Dutch adult sample (N = 187, age 20 to 70). The health variables included in the study are anxiety, depression, somatic symptoms as measured by the SCL-90, and the DSM-5 diagnosis somatic symptom disorder. The results indicated that social support partially mediated the relationship between loneliness and anxiety, depression, and somatic symptoms. These results indicate that social support partially explains the relationship between loneliness and physical and mental health issues. The relationship between loneliness and being diagnosed with somatic symptom disorder was not mediated by social support. This suggests that the mechanisms through which loneliness relates to either somatic symptoms or somatic symptom disorder are different.

Trajectories of Loneliness and Psychosocial Functioning.

The present study examined the relationship between developmental patterns of loneliness and psychosocial functioning among adolescents (9-21 years; N = 110, 52% male). Four-wave longitudinal data were obtained from the Nijmegen Longitudinal Study (NLS) on Infant and Child Development. Loneliness was measured at 9, 13, 16, and 21 years of age and anxiety, depression and self-esteem at 9 and 21 years of age. Using k-means cluster analysis, three trajectories of loneliness were identified as "stable low" (56% of the subjects), "high decreasing" (22% of the subjects), and "low increasing" (22% of the subjects). Importantly, trajectories of loneliness across adolescence significantly predicted psychosocial functioning in young adulthood. Both the "high-decreasing" and "low-increasing" loneliness clusters were associated with higher risk of depression and lower self-esteem compared to the "stable low" loneliness cluster. The "low-increasing" loneliness cluster was associated with higher risk of anxiety compared to the "stable low" loneliness cluster. These results indicate that loneliness in adolescence is a vulnerability that manifests itself in higher levels of anxiety and depression and lower self-esteem in young adulthood.

Aiding medical professionals in fitness-to-drive screenings for elderly drivers: development of an office-based screening tool.

ABSTRACTBackground:Elderly drivers are an increasing group in society. Previous research has found that functional and cognitive abilities are more important for driving abilities than biological age. In an attempt to conserve independent mobility for elderly drivers, many researchers have focused on elderly drivers diagnosed with cognitive decline (mild cognitive impairment or mild Dementia). This study is the first to focus on elderly drivers with cognitive complaints or suspected of diminished fitness to drive by an (in)formal caregiver as an at-risk group. METHODS: The main objective of this study was to develop a fitness to drive screening tool for elderly drivers to be used in a doctor's office. Furthermore, this study investigated the additional value of driving simulator tests in the assessment of fitness to drive. Both screenings (functional abilities and driving simulator test) were benchmarked against the official Belgian fitness to drive licensing procedure. RESULTS: One-hundred thirty-six elderly drivers participated in a functional abilities screening, a driving simulator assessment and an on-road driving test. Sixty-five percent of the sample was considered fit to drive. Visual acuity, physical flexibility, and knowledge of road signs were found to be the best predictive set of tests for the on-road fitness to drive outcome. A performance based driving simulator assessment increased predictive accuracy significantly. CONCLUSION: The proposed screening procedure saves part of the at-risk elderly driver population from stressful and costly on-road driving evaluations. This procedure provides more information of an individual driver's specific driving parameters. This opens doors for personalized older driver training to maintain independent mobility in later life.

Measuring working memory load effects on electrophysiological markers of attention orienting during a simulated drive.

Intersection accidents result in a significant proportion of road fatalities, and attention allocation likely plays a role. Attention allocation may depend on (limited) working memory (WM) capacity. Driving is often combined with tasks increasing WM load, consequently impairing attention orienting. This study (n = 22) investigated WM load effects on event-related potentials (ERPs) related to attention orienting. A simulated driving environment allowed continuous lane-keeping measurement. Participants were asked to orient attention covertly towards the side indicated by an arrow, and to respond only to moving cars appearing on the attended side by pressing a button. WM load was manipulated using a concurrent memory task. ERPs showed typical attentional modulation (cue: contralateral negativity, LDAP; car: N1, P1, SN and P3) under low and high load conditions. With increased WM load, lane-keeping performance improved, while dual task performance degraded (memory task: increased error rate; orienting task: increased false alarms, smaller P3). Practitioner Summary: Intersection driver-support systems aim to improve traffic safety and flow. However, in-vehicle systems induce WM load, increasing the tendency to yield. Traffic flow reduces if drivers stop at inappropriate times, reducing the effectiveness of systems. Consequently, driver-support systems could include WM load measurement during driving in the development phase.

The effect of pavement markings on driving behaviour in curves: a simulator study.

This study investigates the effect of two pavement markings (transverse rumble strips (TRS) and a backward pointing herringbone pattern (HP)) on speed and lateral control in and nearby curves. Two real-world curves with strong indications of a safety problem were replicated as realistic as possible in the simulator. Results show that both speed and lateral control differ between the curves. These behavioural differences are probably due to curve-related dissimilarities with respect to geometric alignment, cross-sectional design and speed limit. TRS and HP both influenced mean speed and mean acceleration/deceleration but not lateral control. TRS generated an earlier and more stable speed reduction than HP which induced significant speed reductions along the curve. The TRS gives drivers more time to generate the right expectations about the upcoming curve. When accidents occur primarily near the curve entry, TRS is recommended. The HP has the potential to reduce accidents at the curve end. Practitioner Summary: Two pavement markings (transversal rumble strips and HP) nearby dangerous curves were investigated in the driving simulator. TRS generated an earlier and more stable speed reduction than HP which induced speed reductions along the curve. The TRS gives drivers more time to generate right expectations about the upcoming curve.

Investigating risky, distracting, and protective peer passenger effects in a dual process framework.

Prior studies indicated higher collision rates among young novice drivers with peer passengers. This driving simulator study provided a test for a dual process theory of risky driving by examining social rewards (peer passengers) and cognitive control (inhibitory control). The analyses included age (17-18 yrs, n=30; 21-24 yrs, n=20). Risky, distracting, and protective effects were classified by underlying driver error mechanisms. In the first drive, participants drove alone. In the second, participants drove with a peer passenger. Red-light running (violation) was more prevalent in the presence of peer passengers, which provided initial support for a dual process theory of risk driving. In a subgroup with low inhibitory control, speeding (violation) was more prevalent in the presence of peer passengers. Reduced lane-keeping variability reflected distracting effects. Nevertheless, possible protective effects for amber-light running and hazard handling (cognition and decision-making) were found in the drive with peer passengers. Avenues for further research and possible implications for targets of future driver training programs are discussed.

Effect of working memory load on electrophysiological markers of visuospatial orienting in a spatial cueing task simulating a traffic situation.

Visuospatial attentional orienting has typically been studied in abstract tasks with low ecological validity. However, real-life tasks such as driving require allocation of working memory (WM) resources to several subtasks over and above orienting in a complex sensory environment. The aims of this study were twofold: firstly, to establish whether electrophysiological signatures of attentional orienting commonly observed under simplified task conditions generalize to a more naturalistic task situation with realistic-looking stimuli, and, secondly, to assess how these signatures are affected by increased WM load under such conditions. Sixteen healthy participants performed a dual task consisting of a spatial cueing paradigm and a concurrent verbal memory task that simulated aspects of an actual traffic situation. Behaviorally, we observed a load-induced detriment of sensitivity to targets. In the EEG, we replicated orienting-related alpha lateralization, the lateralized ERPs ADAN, EDAN, and LDAP, and the P1-N1 attention effect. When WM load was high (i.e., WM resources were reduced), lateralization of oscillatory activity in the lower alpha band was delayed. In the ERPs, we found that ADAN was also delayed, while EDAN was absent. Later ERP correlates were unaffected by load. Our results show that the findings in highly controlled artificial tasks can be generalized to spatial orienting in ecologically more valid tasks, and further suggest that the initiation of spatial orienting is delayed when WM demands of an unrelated secondary task are high.

Does attention capacity moderate the effect of driver distraction in older drivers?

With age, a decline in attention capacity may occur and this may impact driving performance especially while distracted. Although the effect of distraction on driving performance of older drivers has been investigated, the moderating effect of attention capacity on driving performance during distraction has not been investigated yet. Therefore, the aim was to investigate whether attention capacity has a moderating effect on older drivers' driving performance during visual distraction (experiment 1) and cognitive distraction (experiment 2). In a fixed-based driving simulator, older drivers completed a driving task without and with visual distraction (experiment 1, N=17, mean age 78 years) or cognitive distraction (experiment 2, N=35, mean age 76 years). Several specific driving measures of varying complexity (i.e., speed, lane keeping, following distance, braking behavior, and crashes) were investigated. In addition to these objective driving measures, subjective measures of workload and driving performance were also included. In experiment 1, crash occurrence increased with visual distraction and was negatively related to attention capacity. In experiment 2, complete stops at stop signs decreased, initiation of braking at pedestrian crossings was later, and crash occurrence increased with cognitive distraction. Interestingly, for a measure of lane keeping (i.e., standard deviation of lateral lane position (SDLP)), effects of both types of distraction were moderated by attention capacity. Despite the decrease of driving performance with distraction, participants estimated their driving performance during distraction as good. These results imply that attention capacity is important for driving. Driver assessment and training programs might therefore focus on attention capacity. Nonetheless, it is crucial to eliminate driver distraction as much as possible given the deterioration of performance on several driving measures in those with low and high attention capacity.

Investigating the influence of working memory capacity when driving behavior is combined with cognitive load: An LCT study of young novice drivers.

Distracted driving has received increasing attention in the literature due to potential adverse safety outcomes. An often posed solution to alleviate distraction while driving is hands-free technology. Interference by distraction can occur however at the sensory input (e.g., visual) level, but also at the cognitive level where hands-free technology induces working memory (WM) load. Active maintenance of goal-directed behavior in the presence of distraction depends on WM capacity (i.e., Lavie's Load theory) which implies that people with higher WM capacity are less susceptible to distractor interference. This study investigated the interaction between verbal WM load and WM capacity on driving performance to determine whether individuals with higher WM capacity were less affected by verbal WM load, leading to a smaller deterioration of driving performance. Driving performance of 46 young novice drivers (17-25 years-old) was measured with the lane change task (LCT). Participants drove without and with verbal WM load of increasing complexity (auditory-verbal response N-back task). Both visuospatial and verbal WM capacity were investigated. Dependent measures were mean deviation in the lane change path (MDEV), lane change initiation (LCI) and percentage of correct lane changes (PCL). Driving experience was included as a covariate. Performance on each dependent measure deteriorated with increasing verbal WM load. Meanwhile, higher WM capacity related to better LCT performance. Finally, for LCI and PCL, participants with higher verbal WM capacity were influenced less by verbal WM load. These findings entail that completely eliminating distraction is necessary to minimize crash risks among young novice drivers.

A simulator study on the impact of traffic calming measures in urban areas on driving behavior and workload.

This study examined the impact of traffic calming measures (TCM) on major roads in rural and urban areas. More specifically we investigated the effect of gate constructions located at the entrance of the urban area and horizontal curves within the urban area on driving behavior and workload. Forty-six participants completed a 34km test-drive on a driving simulator with eight thoroughfare configurations, i.e., 2 (curves: present, absent)×2 (gates: present, absent)×2 (peripheral detection task (PDT): present, absent) in a within-subject design. PDT performance (mean response time (RT) and hit rate) indicated that drivers experienced the road outside the urban area as cognitively less demanding relative to the more complex road environment inside the urban area. Whereas curves induced a speed reduction that was sustained throughout the entire urban area, variability of acceleration/deceleration and lateral position were increased. In addition, PDT performance indicated higher workload when curves were present (versus absent). Gate constructions locally reduced speed (i.e., shortly before and after the entrance) and slightly increased variability of acceleration/deceleration and lateral position nearby the entrance. However, the effects on SDL-A/D and SDLP are too small to expect traffic safety problems. It can be concluded that both curves and gate constructions can improve traffic safety. Notwithstanding, the decision to implement these measures will depend on contextual factors such as whether the road serves a traffic-, rather than a residential function.

Cognitive processes and attitudes in bipolar disorder: a study into personality, dysfunctional attitudes and attention bias in patients with bipolar disorder and their relatives.

BACKGROUND: Research in cognitive processes and attitudes in bipolar disorder is scarce and has provided mixed findings, possibly due to differences in current mood state. It is unclear whether alterations in cognitive processes and attitudes are only related to the depressive mood states of bipolar patients or also represent a vulnerability marker for the development of future (depressive) episodes. This was investigated in the current study. METHODS: Both implicit (attentional bias for emotional words) and explicit (dysfunctional attitudes and personality characteristics) measures of cognitive processes and attitudes were assessed in 77 bipolar patients with varying levels of depressive symptoms (depressed=17, euthymic n=60), their healthy first-degree relatives (n=39) and a healthy control group (n=61). Analyses of variance were used to investigate differences between groups. RESULTS: Mildly depressed patients with bipolar disorder demonstrated an attentional bias away from positive emotional words and showed increased dysfunctional attitudes and higher levels of neuroticism. Euthymic patients were largely comparable to healthy controls and only differed from controls in higher levels of neuroticism. Relatives were similar to controls on all measures, although they significantly differed from bipolar patients in displaying less neuroticism and more extraversion. LIMITATIONS: No firm conclusions regarding causality can be drawn from the associations that were found between cognitive processes and attitudes and the evolution of mood symptoms in bipolar disorder. CONCLUSION: Alterations in cognitive processes and attitudes in bipolar patients appear to be mostly related to the expression of mood symptomatology rather than to the vulnerability for bipolar disorder.

Effects of concurrent working memory load on distractor and conflict processing in a name-face Stroop task.

To examine the time course of effects of working memory (WM) load on interference control, ERPs were measured in a combined WM and Stroop task. A WM load of 0, 2, or 4 letters was imposed, and during the maintenance-interval Stroop trials were presented that required participants to classify names of famous people while ignoring faces that were either congruent or incongruent with the names. Behavioral interference was not modulated by WM load, but WM load led to an overall reduction of Stroop stimulus encoding as reflected by reduced N170 and N250 amplitudes independent of congruency. Incongruent distractor faces induced interference as shown by a delayed and reduced positivity between 480-600 ms (N450) and an enhanced positivity between 760-1000 ms (P600), indicating longer stimulus evaluation, conflict detection, and conflict resolution, respectively. WM load led to an increase of the P600 at frontal and parietal sites, possibly reflecting PFC-driven top-down control of posterior sites, necessary for conflict resolution.

70 km/h speed limits on former 90 km/h roads: effects of sign repetition and distraction on speed.

OBJECTIVE: It was investigated how speed limit repetition and distraction affect drivers' speed management throughout a road section where the imposed speed limit is not in accordance (too low) with road design. BACKGROUND: It is not clear how driving speed evolves and to what degree speed limit repetition is necessary on roads where the imposed speed limit is not in accordance (too low) with road design. It is furthermore of interest how all these factors are influenced by driver distraction. METHOD: In a driving simulator, 47 volunteers completed one trip with and without distraction. Within each trip, three configurations were presented: speed limit sign repetition after every intersection, repetition only in the middle of a segment, or no repetition. RESULTS: Distraction lowered driving speed. Speed management varied depending on speed limit repetition. The speed limit was exceeded more often when speed limit signs were repeated less frequently. When drivers were not reminded of the limit, speed linearly increased throughout the segment. In all three configurations, speed increased toward the end of the segment, but this increase was largest when there had been no repetition at all of the speed limit. CONCLUSION: In low-demanding road designs that allow drivers to exceed the speed limit, limit repetition is necessary. Frequent repetition may be preferred, as speed management was most homogenous in that case. APPLICATION: The proposed analysis of speed management throughout a section increases our understanding of how speed evolves and thereby shows where repetition of the speed limit is necessary.

The developmental pattern of stimulus and response interference in a color-object Stroop task: an ERP study.

BACKGROUND: Several studies have shown that Stroop interference is stronger in children than in adults. However, in a standard Stroop paradigm, stimulus interference and response interference are confounded. The purpose of the present study was to determine whether interference at the stimulus level and the response level are subject to distinct maturational patterns across childhood. Three groups of children (6-7 year-olds, 8-9 year-olds, and 10-12 year-olds) and a group of adults performed a manual Color-Object Stroop designed to disentangle stimulus interference and response interference. This was accomplished by comparing three trial types. In congruent (C) trials there was no interference. In stimulus incongruent (SI) trials there was only stimulus interference. In response incongruent (RI) trials there was stimulus interference and response interference. Stimulus interference and response interference were measured by a comparison of SI with C, and RI with SI trials, respectively. Event-related potentials (ERPs) were measured to study the temporal dynamics of these processes of interference. RESULTS: There was no behavioral evidence for stimulus interference in any of the groups, but in 6-7 year-old children ERPs in the SI condition in comparison with the C condition showed an occipital P1-reduction (80-140 ms) and a widely distributed amplitude enhancement of a negative component followed by an amplitude reduction of a positive component (400-560 ms). For response interference, all groups showed a comparable reaction time (RT) delay, but children made more errors than adults. ERPs in the RI condition in comparison with the SI condition showed an amplitude reduction of a positive component over lateral parietal (-occipital) sites in 10-12 year-olds and adults (300-540 ms), and a widely distributed amplitude enhancement of a positive component in all age groups (680-960 ms). The size of the enhancement correlated positively with the RT response interference effect. CONCLUSION: Although processes of stimulus interference control as measured with the color-object Stroop task seem to reach mature levels relatively early in childhood (6-7 years), development of response interference control appears to continue into late adolescence as 10-12 year-olds were still more susceptible to errors of response interference than adults.

Lateralized ERP components related to spatial orienting: discriminating the direction of attention from processing sensory aspects of the cue.

Two spatial cueing experiments were conducted to examine the functional significance of lateralized ERP components after cue-onset and to discriminate components related to sensory cue aspects and components related to the direction of attention. In Experiment 1, a simple detection task was presented. In Experiment 2, attentional selection was augmented. Two unimodal visual cueing tasks were presented using nonlateralized line cues and lateralized arrow cues. Lateralized cue effects and modulation after stimulus onset were stronger in Experiment 2. An early posterior component was related to the physical shape of arrows. A posterior negativity (EDAN) may be related to the encoding of direction from arrow cues. An anterior negativity (ADAN) and a posterior positivity (LDAP) were related to the direction of attention. The ADAN was delayed when it was more difficult to derive cue meaning. Finally, the data suggested an overlap of the LDAP and the EDAN.

Sequence effects in a spatial cueing task: endogenous orienting is sensitive to orienting in the preceding trial.

In a spatial cueing paradigm it was investigated whether endogenous orienting is sensitive to orienting processes in the previous trial. Specifically, the effect of the previous cue direction, the previous trial type (valid, invalid, neutral, catch) and target alternation effects were studied. Strategic effects were shown as attentional costs and benefits were larger after a valid than after an invalid trial. Following catch trials, an overall response slowing was observed, but costs and benefits were unaffected. This was interpreted as a reduction in alertness and as support for the dissociation between spatial and temporal attentional mechanisms. Repetition of target position per se had no effect, but in neutral trials responses were slower to targets appearing at the location that was cued in the previous trial, independent of validity of the preceding trial. This suggests that long-term inhibition-of-return can occur between trials when attention is controlled endogenously.