Prevalence of occupational moral injury and post-traumatic embitterment disorder: a systematic review and meta-analysis.

OBJECTIVES: Occupational moral injury and post-traumatic embitterment disorder (PTED) describe the psychological distress caused by exposure to injustice at work. This meta-analysis aims to determine the prevalence of occupational moral injury and PTED and establish whether prevalence estimates differ depending on occupation. DESIGN: A systematic review and meta-analysis. DATA SOURCES: Google Scholar, PubMed, APA PsycINFO, Web of Science Core Collection, Scopus, ScienceDirect and Sage Journals Online were searched in June 2020 and updated in November 2022. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Observational studies that measured prevalence or average scores of moral injury, or PTED in any occupational group and any geographical location. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers screened and coded eligible studies. Study design, participant demographics, sampling method, location, measurement tool and prevalence or average scores were extracted. Risk of bias was assessed using the Quality Assessment Checklist for Prevalence Studies tool. Meta-analysis was conducted using random effects models. Results that could not be combined were summarised qualitatively in a narrative synthesis using the Guidance for Systematic Reviews. RESULTS: In total, 88 studies across armed forces and veterans, healthcare, first responders, educators, journalists, child protection service employees, the unemployed, public-sector employees and mixed occupations were included. Studies included in each separate meta-analysis based on the measure used ranged from 2 to 30. The pooled prevalence of clinically relevant moral injury in healthcare professionals was 45%, and exposure to any potentially morally injurious event (PMIE) across occupations was 67%. Exposure to transgressions by others and betrayal was significantly lower in the armed forces than civilian occupations. Pooled prevalence of PTED across occupations was 26%. CONCLUSION: Exposure to PMIEs, moral injury symptoms and PTED are prevalent at work and exposure to transgressions by others and betrayal are more likely in civilian occupations than the armed forces. PROSPERO REGISTRATION NUMBER: CRD42020191766.

Morally injurious events and post-traumatic embitterment disorder in UK health and social care professionals during COVID-19: a cross-sectional web survey.

OBJECTIVE: To estimate the prevalence and predictors of morally injurious events (MIEs) and post-traumatic embitterment disorder (PTED) in UK health and social care professionals during the COVID-19 pandemic. DESIGN: Cross-sectional study. SETTING: September-October 2020 in the UK. Online survey hosted on Qualtrics, and recruited through Prolific. PARTICIPANTS: 400 health and social care workers, aged 18 or above and living and working in the UK during the pandemic. MAIN OUTCOME MEASURES: MIEs were assessed using the Moral Injury Events Scale and PTED was assessed using the PTED self-rating scale. Potential predictors were measured using surveys of exposure to occupational stressors, optimism, self-esteem, resilient coping style, consideration of future consequences and personal belief in a just world. RESULTS: 19% of participants displayed clinical levels of PTED, and 73% experienced at least one COVID-related MIE. Exposure to occupational stressors increased the risk of experiencing PTED and MIEs, whereas personal belief in a procedurally just world, which is the belief that they experienced fair processes, was a protective mechanism. CONCLUSIONS: MIEs and PTED are being experienced by UK health and social care professionals, particularly in those exposed to work-related stressors.

Searching for Something Positive in Future Negative: The Adolescent and Adult Time Inventory-Time Attitudes Scale.

The Adolescent and Adult Time Inventory-Time Attitudes Scale (AATI-TA) measures emotional engagement with the past, present, and future, and scores have been shown to relate meaningfully to health outcomes. For past, present, and future, five items are used to assess both positive and negative attitudes. Although evidence for the hypothesized six-factor solution has been widely reported, some studies have indicated problems with the Future Negative items. Given that a large and growing literature has emerged on the six-factor AATI-TA, and that AATI-TA scores have shown much better and more consistent fit than other temporal psychology measures, we sought to investigate the future negative factor in detail. Secondary analyses were performed on two datasets. The first was a University convenience sample (N = 410) and the second was an adolescent sample (N = 1,612). Confirmatory factor analyses revealed that the fit for the five Future Negative items was poor. Modification indices suggested that a correlated error term between Items 4 and 10 would result in good fit, and this was indeed the case. Models without Item 4 or Item 10 also yielded acceptable fit. Analyses using all four operationalizations of Future Negative (original scale, without Item 4 or Item 10, or with the correlated error between Items 4 and 10) to predict symptoms of anxiety and depression, and emotional self-efficacy revealed minor differences in the predictive validity coefficients. Potential ways forward, including a correlated error term or the dropping or replacement of Item 10, are discussed.

Intervention impact on alcohol use, alcohol harms, and a combination of both: A latent class, secondary analysis of results from a randomized controlled trial.

BACKGROUND: Alcohol use and alcohol-related harm (ARH) among adolescents places a substantial burden on health, and public services more generally. To date, attempts to intervene at a universal level have yielded results varying from iatrogenic to null, although some skill-enhancing universal interventions have successfully impacted drinking behaviors. One such intervention is SHAHRP. The present study is a secondary analysis of data from the STAMPP Trial, providing new, and more nuanced findings. METHODS: A total of 13,914 adolescents (41.7% female) participated in this cRCT where schools were randomly assigned to a control or intervention group. Growth mixture modelling was used to identify trajectory classes from baseline through third follow-up (+33 months) of adolescents on heavy episodic drinking (HED) and ARH. Extracted classes were related to school intervention participation using multinomial logistic regression. RESULTS: Five trajectory classes of the HED and ARH composite were identified: Low (62%), Late Onset (16%), Early Onset (13%), Delayed Onset (7%), and Unstable (3%). The intervention was most strongly related to Late Onset (OR = 0.50, 95%CI [0.25, 1.01]) and Delayed Onset (OR = 0.55, 95%CI [0.26, 1.16]), although not statistically significant. With classes constructed with ARH only, the Delayed Onset class was significantly related to the intervention (OR = 0.60, 95%CI [0.43, 0.84]). CONCLUSIONS: These results support those previously reported on the STAMPP Trial and provide a more nuanced insight into the effects of the intervention.

One rule for one, and a different rule for another: The case of the Parental Rules about Alcohol Questionnaire.

BACKGROUND: The parental rules about alcohol questionnaire (Van der Vorst et al., 2005, 2006) uses 10 items to assess how strictly adolescents believe the rules set by their parents about drinking are. An increasing body of literature has attested to the importance of rule setting in the prevention of problematic alcohol use among adolescents. A recent study proposed a two-factor solution in place of the hypothesized unidimensional one, with factors assessing non-normative, and normative rules. METHODS: The present study used five waves of data to examine the structure of the scale, and how well it relates to a measure of heavy episodic drinking (HED). Participants in Waves one to four {10,954-9,383} were substantively more numerous than those at wave five (N = 2,332). RESULTS: Confirmatory Factor Analyses did not support either the ten-item hypothesized model, nor the proposed two-factor solution. Results of exploratory factor analyses all pointed to a one factor solution. Using Modification Indices, we obtained a good-fitting, five-item unidimensional model in Waves one to four. At wave five, a good fitting unidimensional model was obtained with the dropping of a further item. Scores on this shortened scale were internally consistent, correlated highly with scores on the original ten-item version, and correlated to a similar degree as the original 10-item measure, with scores on a HED measure. CONCLUSION: Further work is required in assessing the properties of this scale across cultures and samples before definitively determining that two factors best represent parental rules.

An Examination of the Longer-Term Impact of a Combined Classroom and Parental Intervention on Alcohol-Related Harms and Heavy Episodic Drinking.

Although fewer adolescents are consuming alcohol than was the case in previous decades, those who are consuming alcohol are still exposed to alcohol-related harms. While the evidence for the effectiveness of universal, school-based interventions is limited, a recent cluster randomised controlled trial (The STAMPP Trial) reported a significant effect at 10 months post-intervention of a combined classroom/parental intervention on heavy episodic drinking (HED) in the previous 30 days, but no significant effect on the number of self-reported alcohol-related harms (ARH) experienced in the previous 6 months. This follow-up study sought to examine intervention effects 24 months after delivery of the intervention (+ 57 months from baseline, or + 34 months post-intervention). Participants were 5029 high school students in STAMPP (38% of 12,738 pupils originally randomised into the trial), from 87 schools (82.3% of schools recruited in the original STAMPP trial). Outcomes were assessed using two-level random intercepts models (logistic regression for HED and negative binomial for number of ARH). Results of the present study show that the intervention effect for HED deteriorated over the following 2 years (OR declined from 0.60 to 0.97), and there was still no difference in ARH. This was due to an increase in the prevalence of intervention students' HED rather than a reduction in prevalence in control students. Results are discussed in the context of prevention initiatives.

The relationship between balanced and negative time perspectives, and symptoms of anxiety and depression.

Previous research has demonstrated how time perspective, and in particular scores on the Zimbardo Time Perspective Inventory (ZTPI), is significantly related to measures of Anxiety and Depression. However, ZTPI scores have been operationalized in multiple ways, including as composite scores, taking simultaneous account of mean values on all five dimensions. The present study examined if two of these composite approaches, Deviation from a Negative and/or a Balanced Time Perspective (DNTP/DBTP) scores, were significantly related to self-reported symptoms of Anxiety and Depression. Data were in two independent University samples (N = 530; N = 410), including ZTPI data, and Hospital Anxiety and Depression Scale data. While path models revealed significant relationships between DBTP, DNTP and both HADS-A and HADS-D scores, these did not always survive the inclusion of direct paths between ZTPI dimensions and HADS score. In other words, some individual ZTPI dimensions, in particular past negative, appear to be more important than overall composite score. Scores were self-reported, and both samples were gathered in the same geography, making generalizability of findings difficult. On the basis of these results, further studies across different samples and age groups using DNTP and DBTP are required.

Socio-demographic predictors of well-being in United Kingdom adolescents, and the impact of well-being on a range of health-related outcomes.

The deleterious impact of low mental well-being, and higher levels psychological symptoms (collectively well-being), on concurrent and prospective health outcomes has elsewhere been demonstrated. Further, variables such as conurbation and deprivation have been found to be related to mental and physical heath. This study used data from a longitudinal study to examine which demographic predicted well-being scores, and how scores on these constructs were related to six health-related outcomes. Participants were adolescents (N = 4,956; Male = 2376[48%]), from 72 High Schools in Northern Ireland. Three waves of data were gathered on mental well-being, psychological symptoms, subjective life expectancy (living to age 35 and age 75 years), self-rated health, frequency of physical exercise, and lifetime use of cigarettes and cannabis. Results showed that both well-being scores were significantly associated with gender cross-sectionally, but demographic variables did not predict changes in well-being longitudinally. Both well-being measures were significantly associated with health outcomes cross-sectionally, with mental well-being (over time) predicting life subjective life expectancy, self-rated health, and addictive behaviors, while psychological symptoms (over time) predicted the former two, but not addictive behaviors. Overall, the relationship between mental well-being, psychological symptoms, and the health outcomes assessed, was small in terms of effect size.

A balanced time perspective: Is it an exercise in empiricism, and does it relate meaningfully to health and well-being outcomes?

Time perspective research assesses the degree to which thoughts and feelings about the past, present and future influence behaviour, and a balanced time perspective profile has been posited as being ideal. Although this area of research has seen a move towards person-centred analyses, using either cluster analyses or a deviation from balanced time perspective (DBTP) approach, there are a number of theoretical and methodological issues that must be addressed. Using data from diverse samples in four countries, the present study used both cluster analyses and the DBTP approach to assess how cluster membership and DBTP scores related to a range of health and well-being outcomes. As in previous studies, a balanced profile only emerged once in cluster analyses, and positive-oriented profiles were associated with optimal outcomes. The study also found evidence of a relationship between DBTP scores and scores on well-being indicators. However, results gained after manipulating the DBTP equation in two different ways again indicated that higher than expected positive past and present or past and future scores were responsible for the positive outcomes. As such, these findings raise concerns regarding the use of the DBTP construct within clinical settings.

Interplay Between Sensation Seeking and Parental Rules in the Emergence of Heavy Episodic Drinking.

This study examined the parallel mediational processes between sensation seeking and parental rules on alcohol, in the emergence of heavy episodic drinking (HED) in adolescents. Data were drawn from a U.K. clustered randomized control trial (control arm only, N ≈ 6,300, Mage at baseline = 12.5). Using parallel process latent growth curve analysis, stricter parental rules at baseline were found to be associated with greater declines in sensation seeking over time and a lower risk of HED at follow-up (+33 months). Higher initial levels of sensation seeking predicted a faster relaxation of parental rules and a greater risk of HED. By maintaining strict rules about alcohol, parents may promote a positive reduction in sensation seeking and a lower risk of HED.

Ego depletion and the use of force: Investigating the effects of ego depletion on police officers' intention to use force.

The current study aims to investigate corresponding self-control and self-control failures that are the result of ego depletion and its impact on police officers' decision to use force. For that purpose, a total of 200 German police recruits were randomly assigned to either an experimental or control group. Ego depletion was manipulated using the "e" crossing task. Participants then worked through a video-based scenario exercise, in which they encountered a provocative citizen. They were required to indicate the time that they would take to resort to using force to resolve the situation. Results showed that ego depleted officers intended to use force earlier than controls. This indicates that circumstances that produce ego depletion could lead to the inappropriate use of force by reducing self-control. This has major implications for the police use of force and how we understand police officers' decision making in response to provocation.

Using Temporal Profiles and a Deviation from Balanced Approach to Understand Alcohol and Mental Health Problems.

The present study examined how multiple operationalizations of Zimbardo Time Perspective Inventory (ZTPI) scores (raw scores; temporal profiles, based on cluster analysis; and the Deviation from a Balanced Time Perspective, or 'transformed' methodology) were related to both alcohol-related problems and symptoms of anxiety and depression. Participants were a large (N = 816) university sample in the United Kingdom. A total of four time perspective profiles were observed: Futures, Presents, Past Negative-Futures, and Fatalists. Having a Present profile was associated with the worst alcohol-related outcomes. With regard to psychopathology, individuals with a Future profile reported the least anxious and depressive symptoms, and individuals with a Fatalistic profile reported the highest levels of depression. The effect of transformed scores was less robust, though greater deviation from a balanced perspective was associated with somewhat higher symptoms of anxiety and depression. Further, models using raw ZTPI dimension scores explained a greater amount of variance than models using the transformed scores. This study suggests that operationalizing the ZTPI in different ways produces results, which differ both in magnitude and statistical significance. We recommend that future studies using the ZTPI employ these various operationalizations in order that consensus on the optimal approach can be reached.

Time attitudes profile stability and transitions: An exploratory study of adolescent health behaviours among high school students.

PURPOSE: Time attitudes refer to individuals' feelings about the past, present, and future, and an increasing number of cross-sectional studies have demonstrated that positive time attitudes are significantly related to better health and well-being. We investigated time attitude profile membership and associated transitions longitudinally in United Kingdom-based adolescents, and assessed the relationship between time attitude profile development on health behaviours at + 21 months after the data collection involving time attitudes. METHODS: Participants were high school students (N = 1306; 41.8% female, Mage 12.5-14.5 years [waves 1-3]). The Adolescent and Adult Time Inventory - Time Attitudes Scale was employed to identify profiles, and a mover-stayer latent transition analysis was employed to examine developmental changes. Data were also gathered on sensation seeking, and a range of health indicators were assessed: Past week frequency of physical exercise, self-rated health, subjective life expectancy, lifetime cannabis and smoking, and dental attendance. RESULTS: Staying in a positive time attitude profile was related to higher subjective life expectancy, and less frequent use of cannabis and cigarettes (1.00 ≤ d ≤ 4.00). Further, moving to a positive profile predicted healthier outcomes for most health measures used. CONCLUSIONS: Notwithstanding the limitation that health outcomes in the present study were distal, the present study bolstered a developing cross-sectional literature supporting the association between positive time attitudes and better health and well-being outcomes. Future longitudinal studies which assess measures concurrently are required.

The influence of time attitudes profile membership on mental well-being and psychosomatic symptomatology: A United Kingdom-based prospective study.

Mental well-being is of great importance for emotional, psychological and social functioning, particularly in adolescence, a period characterized by significant physical, social, and emotional changes. The extant literature examining the relationship between temporal attitudes and mental and psychosomatic health outcomes is increasing rapidly. Using Latent Transition Analysis (LTA) of Adolescent and Adult Time Inventory-Time Attitude Scale scores across three waves of data (N = 1667; 13-15 years; 42.0% female), we sought to examine the predictive power of time attitudes profile membership on mental well-being and psychosomatic symptomatology at distal wave four. Results indicated that staying in the Positive or Ambivalent profile was associated with more favorable distal outcomes at + 9 months; whereas staying in Negative or Moderately-Negative profile was strongly related to more somatic and psychological symptomatology, and lower mental well-being. Given the potential to modify time attitudes, these findings have several implications for interventions targeting adolescent mental and physical health.

Temporal focus clusters differ meaningfully in terms of anxiety and depressive symptomatology.

The present study examined the relationship between temporal focus profiles and scores on psychiatric symptomatology. Participants were recruited by undergraduate students in a university in the United Kingdom (N = 372; 46% male). Five clusters emerged from hierarchical cluster analysis and were labelled, No Focus, Multi Focus, Past Focus, Future Focus, and Current Focus. The worst outcomes in terms of psychiatric symptomatology were observed for those belonging to the Past Focus cluster. These results build on the only previous study using cluster analysis of Temporal Focus Scale scores, where being past focussed was associated with lower self-esteem in adolescents.

How Individuals Feel About the Past, Present, and Future Bears Little Relation to Alcohol-Related Problems, Anxiety, and Depression: A Person-Centered Analysis in a University Sample.

Previous studies using bivariate or correlational analyses have established a relationship between alcohol use, symptoms of anxiety and depression, and scores on a range of temporal psychology measures. Temporal psychology measures variously assess the cognitive or affective (or in some cases, both) engagement with the past, present, and future. Although developed and validated in adolescents, recent research has suggested that the Time Attitudes Scale is internally consistent and reliable in adults also. The present study is the first to apply a person-centered approach to assessing the relationship between scores on the Time Attitudes Scale and symptoms of anxiety, depression, and alcohol-related problems in adults. Participants were recruited from a University in England. Results support the validity and internal consistency of the Time Attitudes Scale. Meaningful time attitudes profiles emerged, however, taking the sample size into account, the only substantive finding showed that those with a negative time attitudes profile scored higher on depressive symptomatology than those with a positive profile. While elsewhere, Zimbardo Time Perspective Inventory scores have been shown to be meaningfully related to anxiety, depression and alcohol use, the present study questions the degree to which the affective dimension of temporal psychology is driving that relationship.

The direct and indirect effect of loneliness on the development of adolescent alcohol use in the United Kingdom.

Alcohol use among adolescents in the United Kingdom (UK) remains relatively high compared to those in other European countries. The present study sought to examine both the direct and indirect effect of loneliness on drinking behavior. Participants were school children (mean age 13.5 years at Time 1) participating in a Randomized Controlled Trial in the UK, who completed a battery of questionnaires examining alcohol-use indicators, loneliness, self-efficacy and sensation seeking at Time 1 and at +12 months. Loneliness at Time 1 had a substantive, though largely indirect (i.e., via self-efficacy and sensation seeking covariates), impact on alcohol-related harm at +12 months. Furthermore, Loneliness interacted with gender in the prediction of context of alcohol use, where being female and experiencing loneliness put an individual at a greater risk of unsupervised drinking. Females experiencing loneliness were also 2.9 times as likely to have had a drink in the past 30 days, and around 2.5 times as likely to have ever consumed a full drink, when compared to their male peers. The current results indicate that loneliness is an important but complex factor in adolescent drinking. There are important implications for the development of interventions to prevent underage drinking, not least that it is not appropriate to consider all underage drinkers as socially marginalised. However, for those that are, the self-medication hypothesis is potentially relevant through emotional self-efficacy.

The relationship between temporal profiles and alcohol-related problems in University undergraduates: Results from the United Kingdom.

Time perspective is an individual difference variable which assesses the extent to which orientation to the past, present and future affects current behaviors. The present study investigated the viability of temporal profiles and the degree (if any) to which these predict meaningful differences in alcohol-related problems. Participants were undergraduates recruited from a University in the North West of England. Full survey data were available for 455 individuals (aged 18-25; 49.7% male) on (a) time perspective, and (b) alcohol-related problems. Four profiles emerged and were labeled Future-Positive, Present, Past Negative-Future, and Ambivalent. As hypothesized, the Future-Positive profile was associated with the best alcohol-related outcomes. The Present profile was associated with the worst outcomes. This study demonstrates that temporal profiles are associated with alcohol-related problems.

MDMA and the "ecstasy paradigm".

For nearly 30 years, there has been a steady flow of research papers highlighting the dangers of MDMA and the implications for ecstasy users. After such a long time, it would be reasonable to expect that these dangers would be obvious due to the large number of ecstasy users. The available evidence does not indicate that there are millions of ecstasy users experiencing any problems linked to their ecstasy use. The "precautionary principle" suggests that, in the absence of knowing for certain, "experts" should argue that MDMA be avoided. However, this may have been taken too far, as the dire warnings do not seem to be reducing with the lack of epidemiological evidence of clinically relevant problems. The "ecstasy paradigm" is one way of articulating this situation, in that the needs of research funders and publication bias lead to a specific set of subcultural norms around what information is acceptable in the public domain. By digging a little deeper, it is easy to find problems with the evidence base that informs the public debate around MDMA. The key question is whether it is acceptable to maintain this status quo given the therapeutic potential of MDMA.

The effects of exercise and body armor on cognitive function in healthy volunteers.

Police officers routinely wear body armor to protect themselves against the threat posed by firearms and edged weapons, yet little is known of the cognitive effects of doing so. Two studies investigated the effects of exercise and body armor on working memory function in healthy volunteers. In study 1, male undergraduates were assigned to one of four groups: (i) brief exercise, (ii) brief exercise wearing body armor, (iii) extended exercise, and (iv) extended exercise wearing body armor. In study 2, university gym members were assigned to one of two groups: (i) wearing body armor and (ii) not wearing body armor. In both studies, heart rate and oral temperature were measured before, immediately after, and 5 minutes after exercise. The phonemic verbal fluency task and digits backward test were administered at the same time points. In both studies, a mixed analysis of variance revealed statistically significant changes to the cognitive functioning of participants. A change in cognitive strategy was observed, reflected by a decrease in executive function (switches) and an increase in nonexecutive function (cluster size). These data suggest that the cognitive effects of exercise and body armor may have profound implications for police officers' ability to make tactical decisions.