Depression, Cognition, and Pain: Exploring Individual, Cultural and Country-Level Effects Across Europe.

The aim of this paper was to investigate the role of economic (eg, GDP per capita), political (eg, healthcare spending), cultural (country-level aggregates norms) and individual correlates (eg, depression) of pain in a secondary analysis of a sample of 76,000 adults in 19 countries across Europe. The sample was aggregated from 2 waves of the Study of Health, Ageing and Retirement in Europe cohort, using multilevel models with cross-level interactions between individual and country-level effects. While there has been extensive focus on individual risk factors (eg, depression, cognition, BMI), the role of social, political and cultural contextual factors has been relatively underexplored. In addition to replicating well-established individual risk factors (eg, increased depression), we demonstrate that higher levels of depression, chronic pain diagnosis, and collectivism, aggregated at the country-level, are also associated with increased pain severity. There was evidence that these country-level effects moderate the effect of individual correlates of pain. These results contribute to the literature by identifying the importance of broader cultural factors alongside individual psychological indices of pain reporting. PERSPECTIVE: In this study we model how individual, political and cultural factors influence pain in a large cross-national sample. In addition to replicating established individual effects, it shows how cultural (ie, collectivism) and political (eg, GDP, healthcare spending) factors affect individual expressions of pain, and how the cultural and individual factors interact with each other.

Understanding the construction of 'behavior' in smartphone addiction: A scoping review.

It has been claimed that smartphone usage constitutes a behavioral addiction, characterised by compulsive, excessive use of one's phone and psychological withdrawal or distress when the phone is absent. However, there is uncertainty about key phenomenological and conceptual details of smartphone addiction. One of the central problems has been understanding the processes that link smartphone usage, and addiction. The question this paper aims to answer is straightforward: based on measures utilised in the literature, what does 'behavior' mean in the context of smartphone addiction? A scoping review of the smartphone addiction literature was undertaken. This identified 1305 studies collecting smartphone addiction data. Just under half (49.89%) of all published smartphone addiction papers did not report the collection of any smartphone specific behaviors. Those that did tended to focus on a small cluster of self-reported behaviors capturing volume of overall use: hours spent using a smartphone per day, number of pickups, duration of smartphone ownership, and types of app used. Approximately 10% of papers used logged behavioral data on phones. Although the theoretical literature places increasing focus on context and patterns of use, measurements of behavior tend to focus on broad, volumetric measures. The number of studies reporting behavior has decreased over time, suggesting smartphone addiction is becoming increasingly trait-like. Both major phone operating systems have proprietary apps that collected behavioral data by default, and research in the field should take advantage of these capabilities when measuring smartphone usage.

Individual differences in decision-making: evidence for the scarcity hypothesis from the English Longitudinal Study of Ageing.

We report the results of a pre-registered analysis of data from the English Longitudinal Study of Ageing that was designed to test the hypothesis that economic scarcity is associated with individual differences in decision-making. We tested this hypothesis by comparing time preferences for different socio-economic groups and in geographical areas ranging from the most deprived to the least deprived in England using the English indices of multiple deprivation. The data supported this hypothesis: people in the most deprived areas were more likely to prefer smaller-sooner rewards than people from the least deprived areas. Similarly, people in technical or routine occupations tended to prefer smaller-sooner rewards than people in professional or intermediate occupations. In addition, we found that gender, cognitive function and subjective social status also predicted time preferences. We discuss these results in the context of theoretical models of scarcity-based models of choice behaviour and decision-making.

Identifying multiple knee pain trajectories and the prediction of opioid and NSAID medication used: A latent class growth approach.

BACKGROUND: Knee pain is a major source of distress and disability, with pain progression highly variable between individuals. Previous studies defining pain trajectories have all used a single measure of pain, and these differ across studies. Different measures reflect diverse pain mechanisms. To ascertain the clinical utility of pain trajectories, we explored associations between opioid and non-steroidal anti-inflammatory drug (NSAID) use. METHODS: We model pain trajectories using two measures-Intermittent and Constant Osteoarthritis Pain (ICOAP) and the painDETECT, in 2141 participants, across 3 waves (the baseline, 1- and 3-year assessments) of the Knee Pain In the Community (KPIC) cohort. RESULTS: Latent class growth analysis identified six trajectories using ICOAP subscales (High-Stable, Low-Stable, Moderate Worsening, Moderate Recovering, Worsening, and Recovering) and four trajectories using painDETECT (High-stable, Low-stable, Moderate Worsening, and Moderate Recovering). There was a high degree of correspondence between people assigned to pain trajectories between ICOAP intermittent and constant subscales, but less so using painDETECT. Opioid use was associated with ICOAP trajectories only (e.g., High-Stable and Worsening intermittent ICOAP trajectories) and in women. CONCLUSION: Different measures of pain produce different patterns of pain progression and these are differentially related to medication use. Opioid use is linked to trajectories of pain based on the impact of pain on behavior and not pain symptoms. Thus, managing pain's behavioral impact is more central to understanding opioid use than managing pain symptoms. These findings support more in-depth questioning about the type of pain and its progression in clinical practice.

The dynamic relationship between pain, depression and cognitive function in a sample of newly diagnosed arthritic adults: a cross-lagged panel model.

BACKGROUND: Pain and depression are common in the population and co-morbid with each other. Both are predictive of one another and are also associated with cognitive function; people who are in greater pain and more depressed respectively perform less well on tests of cognitive function. It has been argued that pain might cause deterioration in cognitive function, whereas better cognitive function earlier in life might be a protective factor against the emergence of disease. When looking at the dynamic relationship between these in chronic diseases, studying samples that already have advanced disease progression often confounds this relationship. METHODS: Using data from waves 1 to 3 of the English Longitudinal Study of Ageing (ELSA) (n = 516), we examined the interplay between pain, cognitive function and depression in a subsample of respondents reporting a diagnosis of arthritis at wave 2 of the ELSA using cross-lagged panel models. RESULTS: The models showed that pain, cognitive function and depression at wave 1, prior to diagnosis, predict pain at wave 2, and that pain at wave 1 predicts depression at wave 2. Pain and depression at wave 2 predict cognitive function at wave 3. CONCLUSIONS: The results indicate that better cognitive function might be protective against the emergence of pain prior to an arthritis diagnosis, but cognitive function is subsequently impaired by pain and depression. Furthermore, higher depression predicts lower cognitive function, but not vice versa. This is discussed in the context of the emerging importance of inflammation in depression.

Disease activity flares and pain flares in an early rheumatoid arthritis inception cohort; characteristics, antecedents and sequelae.

BACKGROUND: RA flares are common and disabling. They are described in terms of worsening inflammation but pain and inflammation are often discordant. To inform treatment decisions, we investigated whether inflammatory and pain flares are discrete entities. METHODS: People from the Early RA Network (ERAN) cohort were assessed annually up to 11 years after presentation (n = 719, 3703 person-years of follow up). Flare events were defined in 2 different ways that were analysed in parallel; DAS28 or Pain Flares. DAS28 Flares satisfied OMERACT flare criteria of increases in DAS28 since the previous assessment (≥1.2 points if active RA or ≥ 0.6 points if inactive RA). A ≥ 4.8-point worsening of SF36-Bodily Pain score defined Pain Flares. The first documented episode of each of DAS28 and Pain Flare in each person was analysed. Subgroups within DAS28 and Pain Flares were determined using Latent Class Analysis. Clinical course was compared between flare subgroups. RESULTS: DAS28 (45%) and Pain Flares (52%) were each common but usually discordant, with 60% of participants in DAS28 Flare not concurrently in Pain Flare, and 64% of those in Pain Flare not concurrently in DAS28 Flare. Three discrete DAS28 Flare subgroups were identified. One was characterised by increases in tender/swollen joint counts (14.4%), a second by increases in symptoms (13.1%), and a third displayed lower flare severity (72.5%). Two discrete Pain Flare subgroups were identified. One occurred following low disease activity and symptoms (88.6%), and the other occurred on the background of ongoing active disease and pain (11.4%). Despite the observed differences between DAS28 and Pain Flares, each was associated with increased disability which persisted beyond the flare episode. CONCLUSION: Flares are both common and heterogeneous in people with RA. Furthermore our findings indicate that for some patients there is a discordance between inflammation and pain in flare events. This discrete flare subgroups might reflect different underlying inflammation and pain mechanisms. Treatments addressing different mechanisms might be required to reduce persistent disability after DAS28 and Pain Flares.

Trajectories of pain predict disabilities affecting daily living in arthritis.

PURPOSE: To examine the interplay between pain and disability in arthritis when adjusting for patient heterogeneity in pain progression. There is consistent evidence to suggest that people experience osteoarthritis heterogeneously, with subgroups of people having different trajectories of pain. However, at present it is unclear how these pain trajectories are related to functional disability. We ask the question: Do levels of disability track changes in pain across different pain trajectories? METHODS: Secondary analysis of a subset (n = 889) from a cohort of older English adults, representative of the general population (the English Longitudinal Study of Ageing). The relationship between pain and functional disability was compared in three domains of disability: mobility, activities of daily living (ADL) and instrumental ADL. These represent increasingly complex forms of self-care required for independent living. Data analysis compared the heterogeneous analysis of pain (different trajectories) and disability compared to treating pain as a simpler homogenous construct. RESULTS: On a population level, pain was significantly positively correlated with increased disability in all three domains, and the relationship remained stable over time. However, when heterogeneity was examined respondents whose pain improved did not show a corresponding improvement in disability in two domains (ADL and mobility). CONCLUSIONS: These findings highlight how, for some people, alleviating pain, the main symptom of arthritis, might not prevent the persistence or progression of disability. Even when pain improves, further interventions that improve disability are likely to be required. Statement of contribution What is already known on this subject? Pain and functional limitation in daily living are common symptoms of arthritis. Arthritis pain is heterogeneous - there are trajectories of people whose pain gets better or worse. However, to date no study has looked at the relationship between trajectories of arthritis pain and functional disability outside of the minority of people with rheumatoid arthritis. What does this study add? Treating pain as heterogeneous explained disability better than treating pain as a single entity. Respondents in a trajectory of worsening pain reported functional disability in two domains (mobility and activities of daily living) also got worse over time. People in a trajectory of decreasing pain over time did not experience a reduction in disability, despite pain being the most common reason for why people limit their daily functioning. This suggests further intervention is required for people with arthritis, even when the most visible symptoms have been alleviated.

Gambling on Smartphones: A Study of a Potentially Addictive Behaviour in a Naturalistic Setting.

Smartphone users engage extensively with their devices, on an intermittent basis for short periods of time. These patterns of behaviour have the potential to make mobile gambling especially perseverative. This paper reports the first empirical study of mobile gambling in which a simulated gambling app was used to measure gambling behaviour in phases of acquisition and extinction. We found that participants showed considerable perseverance in the face of continued losses that were linearly related to their prior engagement with the app. Latencies between gambles were associated with the magnitude of reinforcement; more positive outcomes were associated with longer breaks between play and a greater propensity to end a gambling session. Greater latencies were associated with measurements of problem gambling, and perseverance with gambling-related cognitions and sensation-seeking behaviour.

General and disease-specific pain trajectories as predictors of social and political outcomes in arthritis and cancer.

BACKGROUND: While the heterogeniety of pain progression has been studied in chronic diseases, the extent to which patterns of pain progression among people in general as well as across different diseases affect social, civic and political engagement is unclear. We explore these issues for the first time. METHODS: Using data from the English Longitudinal Study of Ageing, latent class growth models were used to estimate trajectories of self-reported pain in the entire cohort, and within subsamples reporting diagnoses of arthritis and cancer. These were compared at baseline on physical health (e.g. body mass index, smoking) and over time on social, civic and political engagement. RESULTS: Very similar four-trajectory models fit the whole sample and arthritis subsamples, whereas a three-trajectory model fit the cancer subsample. All samples had a modal group experiencing minimal chronic pain and a group with high chronic pain that showed slight regression (more pronounced in cancer). Biometric indices were more predictive of the most painful trajectory in arthritis than cancer. In both samples the group experiencing the most pain at baseline reported impairments in social, civic and political engagement. CONCLUSIONS: The impact of pain differs between individuals and between diseases. Indicators of physical and psychological health differently predicted membership of the trajectories most affected by pain. These trajectories were associated with differences in engagement with social and civic life, which in turn were associated with poorer health and well-being.

The relationship between gaming disorder and addiction requires a behavioral analysis.

In their position paper, Aarseth et al. (2016) bring to light several timely issues concerning the categorization of gaming disorder as a form of addiction and as a discrete mental disorder. In our commentary, we welcome their caution toward this move and their discussion of the equivocal scientific data in its support and the potential negative consequences for gamers. We suggest that a more heterogeneous approach is required for understanding any behavioral addiction, as concepts from gambling appear to be more relevant for aspects of mobile gaming than for video games more generally. In addition to a greater need for clinical research, we argue that studying gaming at a different level of analysis than the epidemiological study is required to gain a meaningful understanding of the harm video games may or may not entail.

The need for a behavioural analysis of behavioural addictions.

This review discusses research on behavioural addictions (i.e. associative learning, conditioning), with reference to contemporary models of substance addiction and ongoing controversies in the behavioural addictions literature. The role of behaviour has been well explored in substance addictions and gambling but this focus is often absent in other candidate behavioural addictions. In contrast, the standard approach to behavioural addictions has been to look at individual differences, psychopathologies and biases, often translating from pathological gambling indicators. An associative model presently captures the core elements of behavioural addiction included in the DSM (gambling) and identified for further consideration (internet gaming). Importantly, gambling has a schedule of reinforcement that shows similarities and differences from other addictions. While this is more likely than not applicable to internet gaming, it is less clear whether it is so for a number of candidate behavioural addictions. Adopting an associative perspective, this paper translates from gambling to video gaming, in light of the existing debates on this matter and the nature of the distinction between these behaviours. Finally, a framework for applying an associative model to behavioural addictions is outlined, and it's application toward treatment.

Understanding the psychology of mobile gambling: A behavioural synthesis.

This manuscript reviews the extant literature on key issues related to mobile gambling and considers whether the potential risks of harm emerging from this platform are driven by pre-existing comorbidities or by psychological processes unique to mobile gambling. We propose an account based on associative learning that suggests this form of gambling is likely to show distinctive features compared with other gambling technologies. Smartphones are a rapidly growing platform on which individuals can gamble using specifically designed applications, adapted websites or text messaging. This review considers how mobile phone use interacts with psychological processes relevant to gambling, the games users are likely to play on smartphones, and the interactions afforded by smartphones. Our interpretation of the evidence is that the schedules of reinforcement found in gambling interact with the ways in which people tend to use smartphones that may expedite the acquisition of maladaptive learned behaviours such as problem gambling. This account is consistent with existing theories and frameworks of problem gambling and has relevance to other forms of mobile phone use.

The Latent Structure of Autistic Traits: A Taxometric, Latent Class and Latent Profile Analysis of the Adult Autism Spectrum Quotient.

Autistic traits are widely thought to operate along a continuum. A taxometric analysis of Adult Autism Spectrum Quotient data was conducted to test this assumption, finding little support but identifying a high severity taxon. To understand this further, latent class and latent profile models were estimated that indicated the presence of six distinct subtypes: one with little probability of endorsing any autistic traits, one engaging in 'systemising' behaviours, three groups endorsing multiple components of Wing and Gould's autistic triad, and a group similar in size and profile to the taxon previously identified. These analyses suggest the AQ (and potentially by extension autistic traits) have a categorical structure. These findings have important implications for the analysis and interpretation of AQ data.

Why are Some Games More Addictive than Others: The Effects of Timing and Payoff on Perseverance in a Slot Machine Game.

Manipulating different behavioral characteristics of gambling games can potentially affect the extent to which individuals persevere at gambling, and their transition to problematic behaviors. This has potential impact for mobile gambling technologies and responsible gambling interventions. Two laboratory models pertinent to this are the partial reinforcement extinction effect (PREE) and the trial spacing effect. Both of these might speed up or delay the acquisition and extinction of conditioned behavior. We report an experiment that manipulated the rate of reinforcement and inter trial interval (ITI) on a simulated slot machine where participants were given the choice between gambling and skipping on each trial, before perseverative gambling was measured in extinction, followed by measurements of the illusion of control, depression and impulsivity. We hypothesized that longer ITI's in conjunction with the low rates of reinforcement observed in gambling would lead to greater perseverance. We further hypothesized, given that timing is known to be important in displaying illusory control and potentially in persevering in gambling, that prior exposure to longer intervals might affect illusions of control. An interaction between ITI and rate of reinforcement was observed, as low reinforced gamblers with a long ITI gambled for longer. Respondents also displayed extinction and a PREE. Gamblers exposed to a higher rate of reinforcement gambled for longer in acquisition. Impulsivity was associated with extended perseverance in extinction, and more depressed gamblers in the high reinforcement short ITI group persevered for longer. Performance in the contingency judgment failed to support the second hypothesis: the only significant contrast observed was that participants became better calibrated as the task progressed.

Loss of Control as a Discriminating Factor Between Different Latent Classes of Disordered Gambling Severity.

Analyses of disordered gambling assessment data have indicated that commonly used screens appear to measure latent categories. This stands in contrast to the oft-held assumption that problem gambling is at the extreme of a continuum. To explore this further, we report a series of latent class analyses of a number of prevalent problem gambling assessments (PGSI, SOGS, DSM-IV Pathological Gambling based assessments) in nationally representative British surveys between 1999 and 2012, analysing data from nearly fifty thousand individuals. The analyses converged on a three class model in which the classes differed by problem gambling severity. This identified an initial class of gamblers showing minimal problems, a additional class predominantly endorsing indicators of preoccupation and loss chasing, and a third endorsing a range of disordered gambling criteria. However, there was considerable evidence to suggest that classes of intermediate and high severity disordered gamblers differed systematically in their responses to items related to loss of control, and not simply on the most 'difficult' items. It appeared that these differences were similar between assessments. An important exception to this was one set of DSM-IV criteria based analyses using a specific cutoff, which was also used in an analysis that identified an increase in UK problem gambling prevalence between 2007 and 2010. The results suggest that disordered gambling has a mixed latent structure, and that present assessments of problem gambling appear to converge on a broadly similar construct.

Sociodemographic predictors of latent class membership of problematic and disordered gamblers.

This paper reports a series of analyses examining the predictors of gambling subtypes identified from a latent class analysis of problem gambling assessment data, pooled from four health and gambling surveys conducted in Britain between 2007 and 2012. Previous analyses have indicated that gambling assessments have a consistent three class structure showing quantitative and potentially qualitative differences. Bringing this data together is useful for studying more severe problem gamblers, where the small number of respondents has been a chronic limitation of gambling prevalence research. Predictors were drawn from sociodemographic indicators and engagement with other legal addictive behaviours, namely smoking and alcohol consumption. The pooled data was entered into a multinomial logistic regression model in which class membership was regressed along a series of demographic variables and survey year, based on previous analyses of gambling prevalence data. The results identified multiple demographic differences (age, general health, SES, being single, membership of ethnic minority groups) between the non-problem and two classes endorsing some problem gambling indicators. Although these two groups tended to share a sociodemographic profile, the odds of being male, British Asian and a smoker increased between the three groups in line with problem gambling severity. Being widowed was also found to be associated with the most severe gambling class. A number of associations were also observed with other addictive behaviours. However these should be taken as indicative as these were limited subsamples of a single dataset. These findings identify specific groups in which gambling problems are more prevalent, and highlight the importance of the interaction between acute and determinant aspects of impulsivity, suggesting that a more complex account of impulsivity should be considered than is currently present in the gambling literature.

On the latent structure of problem gambling: a taxometric analysis.

AIMS: To test whether problem gambling is a categorical or dimensional disorder on the basis of two problem gambling assessments. This distinction discriminates between two different conceptualizations of problem gambling: one that problem gambling is defined by its addictive properties, the other that it is a continuum of harm. METHOD: Using The British Gambling Prevalence Survey 2010, a nationally representative sample of the United Kingdom conducted by the National Centre for Social Research, five different taxometric analyses were carried out on cases from two problem gambling screens: the Problem Gambling Severity Index (PGSI) and a measure derived from the DSM-IV Pathological Gambling criteria. Two further analyses were conducted on the total scores for these measures. RESULTS: There was strong evidence that both scales were measuring a categorical construct. Fit indices consistently supported a categorical interpretation [comparison curve fit index (CCFI) > 0.6]. The PGSI analysis indicated the presence of a taxon (CCFIs = 0.633, 0.756). The analysis conducted on the adapted DSM-IV criteria indicated stronger quantitative support for a taxon (CCFIs = 0.717, 0.811 and 0.756) but items probing a loss of control were inconsistent. The taxometric analyses of both scales support a categorical interpretation (CCFIs = 0.628, 0.567), but extreme caution should be used due to high nuisance covariance. CONCLUSIONS: Two problem gambling screens (the Problem Gambling Severity Index and a measure derived from the DSM-IV Pathological Gambling criteria) appear to measure a categorical construct that taps into a categorical, loss of control model of problem gambling. There is some evidence that the two screens measure different aspects of an addiction construct.