A novel questionnaire for evaluating digital tool use (DTUQ-D) among individuals with type 2 diabetes: exploring the digital landscape.

Introduction: Effective healthcare currently incorporates a patient-centric system and accessible technology for patient self-management. This study aimed to develop and validate a novel questionnaire titled the Digital Tool Use Questionnaire for Diabetes (DTUQ-D) - a screening tool identifying the type, number, and frequency of digital tools used by Type 2 Diabetes Mellitus (T2DM) patients with within HMOs, online, and via applications. Methods: The questionnaire was administered to two ethnic groups and both genders. A mixed-methods approach was used. In the qualitative phase, the questionnaire was developed through phone surveys of 29 T2DM patients, two endocrinologists and two technology experts. In the quantitative phase, involving 367 participants, convergent validity, construct validity, and reliability were examined. Results: Findings indicated that the DTUQ-D is valid and reliable, successfully identifying digital tools utilized by T2DM patients, notwithstanding variations in factor structures between ethnic groups. This questionnaire provides a foundation for future research, offering a standardized approach to evaluating digital tool usage. Discussion: The study enhances understanding of the role of digital tools in healthcare, especially for T2DM self-management. It also can be easily adapted to assess digital tool use for other illnesses by adjusting instructions and the wording of certain items.

Exploring the personality and relationship factors that mediate the connection between differentiation of self and phubbing.

One of the family patterns crucial for mental and physical well-being is differentiation of self. In this study, our aim was to investigate its impact on the phenomenon of phubbing-where individuals prioritize smartphones over in-person interactions. The prevalence of phubbing behavior has risen substantially in tandem with the increased adoption of smartphones. The study investigated familial, interpersonal, and personal factors that could potentially contribute to the escalation of phubbing behaviors. It was hypothesized that differentiation of self would be associated with phubbing through the mediation of fear of missing out, romantic relationship satisfaction, and loneliness in intimate relationships. We also expected gender differences in the study variables. A sample of 431 young adults, with an average age of 29 (M = 29.05, SD = 9.14), completed the DSI-R, Phubbing, FoMO, ENRICH, and LIRS questionnaires online. Results indicated that fear of missing out mediated the relationship between three dimensions of differentiation of self-emotional reactivity, emotional cutoff, and fusion with others-and phubbing behavior. However, the expected mediation by romantic relationship satisfaction and loneliness in intimate relationships did not reach significance, although these variables were found to be associated with differentiation of self. Women reported higher levels of phubbing behavior, emotional reactivity, and fusion with others, whereas men reported higher levels of I-position. We conclude that fear of missing out may serve as a catalyst, triggering anxiety in individuals, which in turn drives them to adopt phubbing as a coping mechanism. Moreover, individuals with lower levels of differentiation of self appear to be at increased risk of engaging in phubbing behaviors through the mediation of fear of missing out.

How is the loss of a parent in youth related to attachment and adult separation anxiety among women?

This study aimed to examine attachment and adult separation anxiety (ASA) among women who lost a parent in their youth. We hypothesized that insecure attachment and increased ASA from a romantic partner would be found among women who have lost a parent in youth, compared to women whose parents were both alive. Sixty women who lost one or both parents in their youth and 60 who had living parents participated in the study (mean age: 32.3, range: 18-62 years). Participants filled out the ASA and Short Attachment questionnaires. Women who lost a parent reported higher levels of anxious attachment and ASA from partner; the two groups did not differ, however, in terms of avoidant attachment. Additionally, similar effects on ASA and attachment were found among adult women who lost a father or a mother in their youth. In conclusion, the loss of a parent early in life may be associated with an insecure attachment style and increased ASA.

The experience of children and adolescents in the school setting a few years after losing a parent.

A parent's death shakes the child's world and unbalances the family structure. School can be a source of support, yet there is scarce research on the experience of bereaved children in school a few years after the loss and from their own perspective. In this qualitative-phenomenological study we set out to identify the subjective experience of parentally bereaved children and adolescents in school, at least one year after the death. Twenty parentally bereaved children and adolescents were interviewed. Findings indicated that most felt they were regarded differently by staff at school. For some, this felt right, while others were uncomfortable. Most needed consideration and flexibility and wished the staff would discuss their needs with them. We conclude that it is important to directly inquire about and address each student's needs. School personnel should be better informed about how to deal with students' loss to help them in the long term.

Differences in the Factor Structure of the Eating Attitude Test-26 (EAT-26) among Clinical vs. Non-Clinical Adolescent Israeli Females.

In recent years, the diagnostic definitions of eating disorders (EDs) have undergone dramatic changes. The Eating Attitudes Test-26 (EAT-26), which is considered an accepted instrument for community ED studies, has shown in its factorial structure to be inconsistent in different cultures and populations. The aim of the present study was to compare the factor structure of the EAT-26 among clinical and non-clinical populations. The clinical group included 207 female adolescents who were hospitalized with an ED (mean age 16.1). The non-clinical group included 155 female adolescents (mean age 16.1). Both groups completed the EAT-26. A series of factorial invariance models was conducted on the EAT-26. The results indicate that significant differences were found between the two groups regarding the original EAT-26 dimensions: dieting, bulimia and food preoccupation, and oral control. Additionally, the factorial structure of the EAT-26 was found to be significantly different in both groups compared to the original version. In the clinical group, the factorial structure of the EAT-26 consisted of four factors, whereas in the non-clinical sample, five factors were identified. Additionally, a 19-item version of the EAT-26 was found to be considerably more stable and well suited to capture ED symptoms in both groups, and a cutoff point of 22 (not 20) better differentiated clinical samples from non-clinical samples. The proposed shortening of the EAT from 40 to 26 and now to 19 items should be examined in future studies. That said, the shortened scale seems more suited for use among both clinical and non-clinical populations. These results reflect changes that have taken place in ED psychopathology over recent decades.

Personality and Family Risk Factors for Poor Mental Well-Being.

There is evidence that differentiation of self (DoS) contributes to the regulation of emotions at a young age, resulting in reduced anxiety and improved mental well-being. However, there is little evidence of the relationships between these four dimensions (DoS, self-regulation, anxiety, and mental well-being), or of the potential mediating role of self-regulation and anxiety. Our primary goal was therefore to consider the links between DoS, self-regulation, anxiety, and mental well-being. It was hypothesized that DoS (emotional reactivity, I-position, emotional cutoff, fusion with others) will be positively associated with mental well-being through the mediation of self-regulation (promotion-focused, prevention-focused) and anxiety. The study included 460 participants with a mean age of 41.18 (SD = 14.97, range = 19-60). Of them, 224 (48.7%) were women. Participants filled out four questionnaires: the Differentiation of Self Inventory-Revised, General Regulatory Focus Measure, the anxiety scale from DASS-21, and the Warwick-Edinburgh Mental Well-being Scale. The findings showed that emotional cutoff positively predicted prevention and anxiety, but did not predict promotion. In addition, promotion positively predicted mental well-being. Finally, promotion mediated the relationship between I-position and mental well-being. The results indicate that well-differentiated individuals function optimally and enjoy good quality of life.

Adolescents at risk of eating disorders: The mediating role of emotional distress in the relationship between differentiation of self and eating disorders.

Introduction: Adolescents may feel dissatisfied with their bodies, which may lead to a risk of eating disorders (EDs) due to several factors, with emotional distress being one of the most important. Evidence suggests that family might be one of the most significant factors that may increase or decrease emotional distress. An important family pattern found to contribute to mental and physical health is the differentiation of self (DoS). The primary purpose of the current study was to map the complex relationships between DoS, emotional distress, and EDs among adolescents. We hypothesized that emotional distress would mediate the relationship between DoS and the risk of EDs among adolescents. Moreover, based on findings indicating a higher risk of EDs among females, we expected sex differences in the research indices and the mediation model. Methods: The sample included 194 non-clinical adolescents (mean age 15.15; mean BMI 21.66). Preliminary analyses examined differences between males and females using t-tests. In addition, Pearson correlations were run to assess the association between background variables and the study metrics among males and females. To examine the mediation effect, we ran SEM. Results: Due to a sex moderation effect, two mediation models were run (SEM), one for females and one for males. Results indicated that emotional distress partially mediated the relationships between DoS and the risk of EDs. In addition, sex differences were found in the mediated indices, showing that among female adolescents, perfectionism is the only dimension of EDs that was associated with DoS through the mediation of emotional distress. While the relationship between emotional distress and the risk of EDs is well documented. Conclusions: It is concluded that high DoS may reduce emotional distress, which may, in turn, decrease the risk of EDs. In addition, the results enable an in-depth understanding of specific risk factors of EDs that characterize each sex.

Differences in the Factor Structure of the Eating Attitude Test-26 (EAT-26) in Different Cultures in Israel: Jews, Muslims, and Christians.

BACKGROUND: In recent years, there has been a shift in the clinical presentation and, hence, diagnostic definitions of eating disorders (EDs), reflected in a dramatic change in the diagnostic criteria of EDs in the DSM-5. The Eating Attitudes Test-26 (EAT-26) is currently considered an accepted instrument for community studies of EDs, although it features an inconsistent factorial structure in different cultures. Therefore, it is essential to investigate whether the EAT-26 can still be considered an adequate instrument for identifying the risk of developing EDs in different cultures. The aim of the present study was to examine the construct validity and internal consistency of the EAT-26. METHOD: The study used exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) among different cultural populations in Israel. RESULTS: Findings indicated different factors in different ethnic groups, most of which do not correspond with the original EAT-26 three-factor structure. RESULTS: The analysis yielded two main factors among Israeli Jews, four main factors among Israeli Muslim Arabs, and three main factors among Israeli Christian Arabs. CONCLUSION: These findings shed light on cultural factors affecting perceptions of the EAT-26 items. This calls for a reconsideration of the generalization of the original three-factor structure of the questionnaire in different cultures.

Depression and social anxiety mediate the relationship between parenting styles and risk of eating disorders: A study among Arab adolescents.

In multicultural Israel, the prevalence of eating disorders (EDs), a common chronic disorder among Western adolescents (especially females), has risen for Arab adolescents, who belong to an Eastern collectivist society. The study examines family and psychological factors that may increase the risk of EDs among Muslim Arab adolescents. We expected social anxiety and depressive symptoms to mediate the association between parenting styles and risk of EDs, with possible gender differences in the mediation model. Participants were 613 Muslim adolescents (394 females and 219 males); mean age = 15.4 ± 1.6; range = 12-19. The analyses revealed that the severity of depressive symptoms and especially social anxiety mediate the relationship between authoritarian parenting style and risk of EDs. Females reported higher levels of risk of EDs, social anxiety, depression and authoritative parenting style than males; no differences appeared for authoritarian or permissive parenting styles. The research sheds new light on risk factors for EDs and the likelihood of authoritarian parenting style and social anxiety being involved in the aetiology of EDs among Arab adolescents. The outcomes meaningfully add to understanding of specific psychological processes that may be associated with the risk of EDs in this population.

The Relationship between Type 2 Diabetes, Differentiation of Self, and Emotional Distress: Jews and Arabs in Israel.

Type 2 diabetes mellitus (T2DM) is considered a global epidemic, and is constantly on the rise. In Israel, the percentage of diabetics in the Arab population is twice that found in the Jewish population (12% and 6.2%, respectively). Findings suggest that low differentiation of self (DoS: emotional reactivity+ fusion with others, I-position, emotional cutoff) may raise vulnerability to certain physiological pathologies by increasing susceptibility to psychological distress. The major goal of this study was to test differences in DoS and emotional distress (anxiety and depressive symptoms) between diabetic and healthy participants. The second aim was to examine cultural differences within these metrics. Another purpose was to examine the relationship between DoS and emotional distress among healthy and diabetic participants. The sample included 261 participants, of whom 154 were healthy and 107 were diabetic. Diabetics reported more severe depressive symptoms, higher levels of anxiety and emotional cutoff and lower levels of I-position than healthy individuals. The groups did not differ in their levels of emotional reactivity + fusion with others. Arabs demonstrated higher levels of emotional cutoff, anxiety and depressive symptoms and lower levels of I-position than Jews. However, Arabs and Jews did not differ in their levels of emotional reactivity + fusion with others. Emotional reactivity + fusion with others contributed the most to diabetes among Arabs, while depressive symptoms contributed the most among Jews. Finally, among Jewish participants, age was positively correlated with emotional cutoff and depressive symptoms. Emotional cutoff was positively correlated with anxiety and depressive symptoms. Emotional reactivity + fusion with others was positively correlated with anxiety. Among Arab participants, age was positively correlated with emotional cutoff, anxiety and depressive symptoms. I-position was negatively correlated with all study variables. Emotional cutoff was positively correlated, anxiety and depressive symptoms. Emotional reactivity + fusion with others was positively correlated with anxiety and depressive symptoms.

Marital interactions and experiences of women living in polygamy: An exploratory study.

The study examines interactions and experiences of Bedouin women living in polygamous households in Israel. A mixed-method approach was applied in a two-part study. The quantitative part examined differences in differentiation of self and marital satisfaction between 50 Bedouin women in polygamous marriages and 50 in monogamous marriages. It found that, in polygamous families, women's levels of marital satisfaction were positively related to their I-position and fusion with others and negatively related to emotional cutoff and number of children at home, whereas among monogamous counterparts, marital satisfaction was only negatively associated with emotional cutoff. Surprisingly, fused relationships with the family of origin predicted higher satisfaction only in women in polygamous marriages. The qualitative part, which yielded deeper understanding of the authentic voices and experiences of 18 senior wives, revealed that they had severe emotional and physiological responses to their husbands' marriage to another woman. For most, particularly those who married young, living in a polygamous family adversely affected their marital satisfaction. Interactions ranged from violent relationships, accompanied by jealousy and anger, to respectful and harmonious relations. Along with the challenges, some women, especially the educated, chose proactive ways of coping. Educated women also preferred cohabitation with the other wife.

Parenting among mothers exposed to ongoing military conflict in childhood: An exploratory study.

Mothers living in areas exposed to ongoing military conflict are at higher risk for psychological difficulties, such as posttraumatic stress disorder, than those not living in such areas. The aim of this two-part exploratory study was twofold. The first aim was to examine differences between mothers who grew up under ongoing military conflict in childhood and mothers who did not grow up in affected areas in terms of their levels of differentiation of self and parental self-efficacy (PSE). The second aim was to identify and describe the parenting experiences of mothers who were exposed to military conflict in childhood. In Part 1 of the study, the sample included 120 mothers (half of whom reported on being exposed to ongoing military conflict in childhood). Findings showed that mothers exposed to ongoing military conflict in childhood reported lower levels of differentiation of self and PSE than their counterparts. In Part 2, 10 mothers who were exposed to ongoing military conflict as children were interviewed about their experience as parents and their PSE. Results indicated that the mothers felt their childhood experiences affected their parenting and PSE negatively, resulting in anxiety, difficulty dealing with stress and sometimes posttraumatic symptoms as well as parental patterns of overprotectiveness, separation anxiety and intergenerational transmission of anxiety. The results highlight the consequences of exposure to ongoing military conflict during childhood on levels of differentiation of self and parenting practices.

Individuals With Type 2 Diabetes: An Exploratory Study of Their Experience of Family Relationships and Coping With the Illness.

PURPOSE: The purpose of this qualitative study is to explore familial patterns that may be related to type 2 diabetes (T2DM) and to patients' ways of coping with the illness. METHODS: A purposive sample of 32 Israeli Jewish (n = 12) and Arab (n = 20) individuals with T2DM were recruited from a community population and interviewed about their familial experiences and their illness. Interview data were analyzed using Colaizzi's phenomenological method. RESULTS: Many participants, particularly from the Arab society, reported familial patterns that suggest fused relationships and emotional cutoff. They described highly close and positive family relationships, on one hand, but demonstrated unwillingness to share their difficulties with their family members, on the other hand. Precipitating stressful or traumatic events and day-to-day stress appeared as leading perceived causes of the illness. Maintaining an appropriate lifestyle, stress reduction, and family support were the main coping strategies with the illness. CONCLUSIONS: The findings suggest a possible avenue in which fusion with family members and inability to attenuate emotional distress by sharing difficulties with others may contribute to the development of T2DM. Assessment of such family dynamics and ways of coping with stress could lead to more appropriately nuanced treatment for individuals with T2DM and prediabetes.

Depressive symptoms mediate the relationship between sleep disturbances and type 2 diabetes mellitus.

BACKGROUND: The current study aimed at examining whether individuals diagnosed with type 2 diabetes mellitus (T2DM) have more severe sleep disturbances compared to individuals who are healthy or have prediabetes and whether depressive symptoms mediate the relationship between sleep disturbances and having T2DM. METHODS: T2DM patients (n = 107) were compared to individuals with prediabetes (n = 48) and healthy individuals (n = 154) regarding the severity of depressive symptoms, measured via the Beck Depression Inventory-II (BDI-II), and sleep disturbances, measured via the Mini Sleep Questionnaire (MSQ). Mediation analysis examined whether depressive symptoms mediated the relationship between sleep disturbances and T2DM. RESULTS: Compared to healthy individuals and individuals with prediabetes, T2DM patients had more depressive symptoms and higher levels of insomnia, hypersomnia, and overall more sleep disturbances. The prediabetes group did not differ from the healthy control group on these measures, and these groups were thus combined for further analysis. Sleep disturbances were correlated with severity of depressive symptoms (r =0.43). After controlling for age, gender, and ethnic background, both severity of sleep disturbances (odds ratio [OR]: 1.04; 95% CI: 1.01-1.07, P <.001) and severity of depressive symptoms (OR: 8.54, 95% CI: 3.37-21.69, P <.001) predicted T2DM. Depression symptoms mediated the relationship between sleep disturbances and T2DM, whereas the direct relationship between sleep disturbances and T2DM was nonsignificant. CONCLUSIONS: The findings imply that sleep disturbances may contribute to the development and progression of T2DM by promoting depressive symptoms. Thus, treatments for the emotional distress associated with sleep disturbances may help reduce the risk for T2DM and the progression of the disease.

Depressive Symptoms Mediate the Relationship between Emotional Cutoff and Type 2 Diabetes Mellitus.

BACKGROUND: Differentiation of self is a family systems construct defined as the ability to balance intimacy and autonomy and to separate instinctually driven emotional reactions and thoughtfully considered goal-directed functioning. In theory, low differentiation of self is reflected by four components: a low tendency to take an I-position in relationships (i.e., to own one's thoughts and feelings); emotional cutoff from others; a greater tendency to fuse with others; and a tendency towards emotional reactivity. Low differentiation of self is associated with anxiety and depression, which are risk factors for type 2 diabetes mellitus. The current study examines the relationship between differentiation of self and type 2 diabetes mellitus. METHOD: Individuals with type 2 diabetes mellitus (N = 107) and healthy individuals (N = 145) completed the Differentiation of Self Inventory-Revised (DSI-R), the State-Trait Anxiety Inventory (STAI), and the Beck Depression Inventory (BDI-II). RESULTS: Compared with healthy individuals, participants with type 2 diabetes had more severe depressive symptoms, higher levels of emotional cutoff, and a lower tendency to take an I-position, but had similar levels of trait anxiety, emotional reactivity, and fusion with others (factor analysis revealed these factors were not separable in the current sample and thus were merged into a single construct). Importantly, the severity of depressive symptoms mediated the relationship between emotional cutoff and being in the type 2 diabetes study group rather than the healthy group. CONCLUSION: These findings suggest a new perspective on the role of psychological patterns in type 2 diabetes mellitus development and progression.

Differentiation of self and trait anxiety: A cross-cultural perspective.

Cultural differences are likely to affect the ability to deal with anxiety. We investigated this issue among four cultural groups-Germans and Italians (Europeans living in South Tyrol, Italy), Jews and Arabs (Israelis)-in terms of their levels of differentiation of self, trait anxiety and somatic symptoms. We also examined the relationship of differentiation of self to trait anxiety and somatic symptoms. The sample consisted of 824 students: 387 Israelis (mean age 23.6) and 437 Europeans (mean age 22.3). Israeli participants reported lower levels of trait anxiety than European students. Jewish students reported lower trait anxiety than Arab students (mean difference = -.14, p < .009), while there was no difference between German and Italian students (mean difference = .03, p > .99). Jews reported a significantly lower level of emotional cutoff than Arabs (mean difference = -.45, p < .001), and Germans reported a significantly lower level of emotional reactivity than Italians (mean difference = .29, p < .001). Emotional reactivity and I-position predicted all participants' trait anxiety. On the whole, results point to the importance of examining differentiation of self when trying to reduce trait anxiety, as well as some important cultural differences.

The relationships between stressful life events during childhood and differentiation of self and intergenerational triangulation in adulthood.

This study examined the relationships between stressful life events in childhood and differentiation of self and intergenerational triangulation in adulthood. The sample included 217 students (173 females and 44 males) from a college in northern Israel. Participants completed the Hebrew versions of Life Events Checklist (LEC), Differentiation of Self Inventory-Revised (DSI-R) and intergenerational triangulation (INTRI). The main findings were that levels of stressful life events during childhood and adolescence among both genders were positively correlated with the levels of fusion with others and intergenerational triangulation. The levels of positive life events were negatively related to levels of emotional reactivity, emotional cut-off and intergenerational triangulation. Levels of stressful life events in females were positively correlated with emotional reactivity. Intergenerational triangulation was correlated with emotional reactivity, emotional cut-off, fusion with others and I-position. Findings suggest that families that experience higher levels of stressful life events may be at risk for higher levels of intergenerational triangulation and lower levels of differentiation of self.

Worry about terror among young adults living in ongoing security uncertainty.

The aim of the current study was to investigate worry about terror as a mediating variable, with the exogenous variables being media viewing, differentiation of self, and trait anxiety, and the endogenous variables being somatic symptoms and perceptions of security-related stress. Participants were divided into two groups by age/academic level: 248 high school students and 191 university students. A pathway correlation model was used to investigate worry about terror as a mediating variable. The central finding was that worry about terror was a significant mediating variable in the relationship between the extent of media viewing following terror events and the level of perception of security-related stress. That is, young people who said they worried a lot reported a high level of stress relating to the terror events they saw covered in the media. In addition, trait anxiety was found to have an effect on stress perception only via the level of worry about terror. This means that high levels of stress are not experienced by all highly trait-anxious people, but only by those who suffer from higher levels of worry about terror.

Doomed to read in a second language: implications for learning.

The aim of the study was to elucidate whether and how reliance on a second language impacts the learning of new information under very basic learning conditions. The paradigm used to investigate this issue required individuals to learn a series of associations between numerals and particular letter strings. Participants were two groups of university students: (1) individuals for whom spoken Hebrew was the mother tongue and written Hebrew a primary orthography (L1 group), and (2) individuals for whom Hebrew, both spoken and written, was a second language (L2 group). Data were collected under two conditions. In the language-dependent condition (LDC), the paradigm required learning associations between eight numerals and the letter strings of eight familiar Hebrew words. In the language-independent condition (LIC), it required learning associations between eight numerals and eight random letter strings in Hebrew. Results suggest that learners may be significantly disadvantaged when compelled to learn new information mediated in a second language. This disadvantage appears to manifest itself at a very basic learning level and in instances where new information is mediated by language that is fairly overlearned by the L2 learner.