Psychological strengths and well-being: Strengths use predicts quality of life, well-being and mental health in autism.

LAY ABSTRACT: It is often suggested that supporting autistic people to identify and use their strengths will lead to positive outcomes. However, little research has explored if this is true. To date, no research has explored whether autistic people already have knowledge of and use their strengths, nor whether increased strengths knowledge and use is linked to good outcomes, such as a better quality of life, well-being and improved mental health. Comparing large samples of autistic and non-autistic people, this study tested these unanswered questions. We found that autistic and non-autistic people reported similar strengths, but autistic people reported less knowledge and use of their strengths compared to non-autistic people. Importantly however, autistic people who reported using their strengths often had better quality of life, well-being and mental health than autistic people who reported using their strengths less frequently. We, therefore, propose that supporting autistic people to use their strengths more often may be a valuable way to boost well-being in this population.

Understanding the Contributions of Trait Autism and Anxiety to Extreme Demand Avoidance in the Adult General Population.

Autism and anxiety are thought to be related to extreme demand avoidance (EDA), which is characterised by intense avoidance of everyday demands. However, the relative importance of autism and anxiety to EDA has yet to be investigated, and little is known about EDA in adulthood. We conducted two online survey studies (Ns = 267 and 549) with adults in the general population to establish the relative importance of autistic traits and anxiety as predictors of demand avoidance, using dominance analysis. Both autistic traits and anxiety were unique and equally important predictors of demand avoidance. These findings suggest EDA is linked to autism and are consistent with the theory that demand avoidance behaviours are potentially anxiety-driven in adults.

Rethinking fast and slow processing in autism.

Following the popularity of dual process models in social and cognitive psychology, there is major interest in the possibility that autism is associated with impaired "fast" intuitive thinking but enhanced "slow" or "rational" deliberative thinking. If correct, this has great potential to help understand various strengths and difficulties characteristic of autism. Previous empirical investigations of this phenomenon, however, are marred by concerns about the measurement of intuitive and deliberative processing, as well as broader problems in clinical psychological science (e.g., small underpowered studies, lack of replication). Making a step change, we conducted four large-scale studies to examine dual processing in autism, including a preregistered comparison of 200 autistic and nonautistic adults. Participants completed contemporary cognitive and self-report measures of intuitive and deliberative processing, as well as a psychometrically robust measure of general cognitive ability. Except for lower self-reported intuitive thinking, we found no unique contributions of autism to intuitive or deliberative thinking across all four studies, as evidenced by frequentist and Bayesian analyses. Overall, these studies indicate that intuitive and deliberative thinking is neither enhanced nor particularly impaired in relation to autism. We deliberate on the implications of these findings for theories of autism and future investigation of strengths and difficulties in autistic people. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Increasing aggression during the COVID-19 lockdowns.

BACKGROUND: To combat the spread of COVID-19, many communities implemented restrictions on personal movement, often referred to as "lockdowns." We hypothesized that continued lockdowns might be associated with increased feelings of aggression. METHODS: Over the first six months of the COVID-19 pandemic, the Buss-Perry Aggression Questionnaire (BPAQ) was administered to a total of 5,928 adults distributed proportionally from across the United States during independent online cross-sectional surveys collected each month. Data across the 6-month period were compared between those under lockdown versus those not under such restrictions. RESULTS: BPAQ Total Aggression scores showed a significant main effect for both month and lockdown status as well as a significant interaction effect, with increasing scores evident for those reporting that they were under lockdown relative to those reporting no restrictions. This same pattern was evident for all four subscales of the BPAQ, including Physical Aggression, Verbal Aggression, Anger, and Hostility. LIMITATIONS: Random sampling of the entire population was not possible, so generalization of the results should be made with caution. Additionally, data were collected cross-sectionally and cannot be considered to reflect longitudinal change within individuals. Finally, the cross-sectional survey design means that it is impossible to infer that the lockdowns caused the increase in aggression. CONCLUSIONS: Lockdowns were associated with elevated levels of aggression that were higher in later months of the national pandemic response.

Mental Health During the First Weeks of the COVID-19 Pandemic in the United States.

Background: By March 2020, the World Health Organization declared the COVID-19 crisis as a worldwide pandemic and many local governments instituted stay-at-home orders and closed non-essential businesses. Within the United States, tens of millions of workers lost their jobs and financial security during the first few weeks of the national response, in an attempt to slow the global pandemic. Because of the enormity of the pandemic and its potential impact on mental health, the objective of the present study was to document the prevalence of mental health problems and their association with pandemic-related job loss during the third week of the nationwide shutdown. Methods: Mental health was assessed via online questionnaires among a representative sample of 1,013 U.S. adults on April 9-10, 2020. Rates of clinically significant mental health outcomes were compared between participants who lost their job as a result of COVID-19 restrictions (17.4%) vs. those who did not (82.6%). Bivariate multiple logistic regression identified factors that were predictive of, and protective against, mental health problems. Results: The prevalence of clinically significant symptoms was significantly higher than prior population estimates, ranging from 27 to 32% for depression, 30 to 46% for anxiety disorders, 15 to 18% for acute/post-traumatic stress, 25% for insomnia, and 18% for suicidal ideation. Prevalence estimates were 1.5-1.7 times higher for those who reported job loss due to COVID-19 restrictions than those who did not. Mental health problems were predicted by worry over financial instability, insomnia, social isolation, and alcohol consumption, while getting outside more often, perceived social support, and older age were protective against these problems. Conclusions: During the first 3 weeks of lockdowns/stay-at-home restrictions, mental health problems, including depression, anxiety, insomnia, and acute stress reactions were notably elevated relative to prior population estimates. Job loss related to the nationwide shutdown was particularly associated with poorer mental health. These findings provide a baseline of mental health functioning during the first weeks of the national emergency and lockdown orders in response to COVID-19.

The COVID-19 Vaccine Is Here-Now Who Is Willing to Get It?

The U.S. vaccine campaign against COVID-19 began in December 2020, but many individuals seem reluctant to get vaccinated. During the first week of the vaccination campaign, we collected data from 1017 individuals with an online survey to identify factors that were associated with willingness to get the vaccine once it is available. Most participants (55.3%) were willing to get the vaccine, although 46.2% also expressed some fear of the vaccine. Political ideology was by far the most consistent predictor of both willingness to be vaccinated and fear of the vaccine, followed by participant sex, education level, income, and race/ethnicity. Our findings suggest that, for the vaccine campaign to be broadly supported and successful, it will be important for frontline healthcare workers to discuss the role of inoculation for COVID-19 in a manner consistent with each individual patient's political and sociological worldview.

Development and validation of the Four-Item Mentalising Index.

Mentalising, also known as "Theory of Mind", is the ability to understand and infer the cognitions of others, such as their perceptions, intentions, and beliefs. Although several tools have been designed to measure mentalising in adults, there exist methodological and practical limitations. Many of the existing measures conflate mentalising with similar constructs (e.g., empathy), and most are lengthy measures that are unsuitable for large population-based studies and clinical practice. These issues are currently hampering clinical and non-clinical investigations into mentalising and related social-cognitive abilities. Drawing on questionnaire measures of social cognition, we conceived a self-report mentalising scale, the Four-Item Mentalising Index (FIMI; Studies 1a and b). The FIMI was developed through a series of studies examining its factor structure and reliability (Studies 2a and b) and by testing its construct validity against a cognitive mentalising task, autistic traits, and comparing scores in autistic and non-autistic people (Studies 3a and b). Together, we demonstrate that the FIMI is a conceptually and methodologically robust tool for measuring mentalising ability in the general population, including autistic and non-autistic people. Future research directions and practical (clinical) applications of the scale are discussed, with a focus on improving understanding and management of (a)typical mentalising ability. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Autonomic dysfunction in autism: The roles of anxiety, depression, and stress.

LAY ABSTRACT: The autonomic nervous system (ANS) is responsible for the functioning of the heart, bladder, pupils and several other bodily functions. Therefore, when the ANS functions abnormally, individuals can experience a number of physical symptoms, including dizziness, abnormal sweating and digestive difficulties. Currently, it is unclear if autistic adults experience ANS dysfunction. Therefore, in this study, we investigated whether autistic adults report more ANS-related physical symptoms, indicating greater ANS dysfunction, and whether this may be related to autism, or rather anxiety, depression, or stress. The findings suggest that ANS dysfunction, where found in autism, is due to co-occurring stress and anxiety. We therefore propose that treating stress and anxiety may be an effective way to ameliorate ANS-related health problems in autistic adults.

Alcohol dependence during COVID-19 lockdowns.

To determine whether the past half-year of COVID-19-related lockdowns, stay-at-home orders, and social isolation were associated with changes in high-risk alcohol use, a total of 5,931 individuals completed the Alcohol Use Disorders Identification Test (AUDIT) at one of six time points from April through September 2020. Over the 6-month period, hazardous alcohol use and likely dependence increased month-by-month for those under lockdowns compared to those not under restrictions. This increase in harmful alcohol use and related behaviors is likely to have prolonged adverse psychosocial, interpersonal, occupational, and health impacts as the world attempts to recover from the pandemic crisis.

Loneliness during the first half-year of COVID-19 Lockdowns.

During the first 6-months of the COVID-19 pandemic, the primary weapons against the spread of the virus have included local government orders for restriction of movement and broad implementation of face masks and social distancing policies. While some early reports suggested increases in loneliness during the pandemic restrictions, others reported no changes. Here, we provide an update on self-reported loneliness over the first 6-months of community lockdown restrictions from a nationwide sample of 6,186 U.S. adults who completed the UCLA Loneliness Scale-3 and Public Health Questionnaire-9 during the pandemic. Loneliness scores increased significantly from April through September 2020 and were significantly higher for those reporting they were under stay-at-home, shelter-in-place, or lockdown orders compared to those reporting no restrictions. Greater loneliness was positively correlated with depression and suicidal ideation. Loneliness has increased over the first half-year of the pandemic, particularly for those under lockdown restrictions, and remains a significant mental health concern.

Trends in suicidal ideation over the first three months of COVID-19 lockdowns.

To reduce viral spread during the first months of the COVID-19 pandemic, most communities across the U.S. engaged in some form of stay-at-home restrictions or lockdowns that limited social interaction and movement outside the home. To determine the effect of these restrictions on suicidal ideation, a total of 3,120 individuals completed the Patient Health Questionnaire (PHQ-9) at one of three time points from April through June 2020. The percentage of respondents endorsing suicidal ideation was greater with each passing month for those under lockdown or shelter-in-place restrictions due to the novel coronavirus, but remained relatively stable and unchanged for those who reported no such restrictions. Public health policy and routine clinical care need to address the potential for increased suicidal thinking among those experiencing prolonged restrictions of normal social contact.

Three months of loneliness during the COVID-19 lockdown.

The majority of the U.S. population has been under stay-at-home restrictions to reduce the spread of COVID-19 since March 2020. Over the first three months of restrictions, 3,121 U.S. adults completed the UCLA Loneliness Scale-3 and Patient Health Questionnaire-9 (PHQ-9). Despite relaxation of lockdowns and shelter-in-place orders over that time, loneliness scores increased significantly, particularly from April to May 2020, and appear to have plateaued by June. Loneliness was correlated with depression and suicidal ideation at all time points and was most prevalent among individuals who reported that they were still under community restrictions to socially isolate due to the novel coronavirus. Loneliness remains elevated despite the reopening of many communities.

Suicidal ideation during the COVID-19 pandemic: The role of insomnia.

There is growing concern over the potential for increased suicide risk in vulnerable populations as the COVID-19 pandemic unfolds. To contextualize this risk during the first weeks of the nationwide lockdown efforts, we had 1,013 U.S. adults complete questionnaires assessing worries over COVID-19, insomnia severity, and suicidal ideation. Anxiety about COVID-19 correlated positively with insomnia severity and suicidal ideation. Analysis revealed that the statistical association between pandemic fears and suicidal thinking was fully accounted for by insomnia severity, suggesting that interventions aimed at improving sleep may be useful in reducing suicide risk during the current pandemic.

Psychological resilience during the COVID-19 lockdown.

Some individuals are more psychologically resilient to adversity than others, an issue of great importance during the emerging mental health issues associated with the COVID-19 pandemic. To identify factors that may contribute to greater psychological resilience during the first weeks of the nation-wide lockdown efforts, we asked 1,004 U.S. adults to complete assessments of resilience, mental health, and daily behaviors and relationships. Average resilience was lower than published norms, but was greater among those who tended to get outside more often, exercise more, perceive more social support from family, friends, and significant others, sleep better, and pray more often. Psychological resilience in the face of the pandemic is related to modifiable factors.

Loneliness: A signature mental health concern in the era of COVID-19.

In response to the COVID-19 pandemic, most communities in the United States imposed stay-at-home orders to mitigate the spread of the novel coronavirus, potentially leading to chronic social isolation. During the third week of shelter-in-place guidelines, 1,013 U.S. adults completed the UCLA Loneliness Scale-3 and Public Health Questionnaire (PHQ-9). Loneliness was elevated, with 43% of respondents scoring above published cutoffs, and was strongly associated with greater depression and suicidal ideation. Loneliness is a critical public health concern that must be considered during the social isolation efforts to combat the pandemic.

Implementing the ten steps to successful breastfeeding in multiple hospitals serving low-wealth patients in the US: innovative research design and baseline findings.

BACKGROUND: The Ten Steps to Successful Breastfeeding are maternity practices proven to support successful achievement of exclusive breastfeeding. They also are the basis for the WHO/UNICEF Baby-Friendly Hospital Initiative (BFHI). This study explores implementation of these steps in hospitals that serve predominantly low wealth populations. METHODS: A quasi-experimental design with mixed methods for data collection and analysis was included within an intervention project. We compared the impact of a modified Ten Steps implementation approach to a control group. The intervention was carried out in hospitals where: 1) BFHI designation was not necessarily under consideration, and 2) the majority of the patient population was low wealth, i.e., eligible for Medicaid. Hospitals in the research aspect of this project were systematically assigned to one of two groups: Initial Intervention or Initial Control/Later Intervention. This paper includes analyses from the baseline data collection, which consisted of an eSurvey (i.e., Carolina B-KAP), Maternity Practices in Infant Nutrition and Care survey tool (mPINC), the BFHI Self-Appraisal, key informant interviews, breastfeeding data, and formatted feedback discussion. RESULTS: Comparability was ensured by statistical and non-parametric tests of baseline characteristics of the two groups. Additional findings of interest included: 1) a universal lack of consistent breastfeeding records and statistics for regular monitoring/review, 2) widespread misinterpretation of associated terminology, 3) health care providers' reported practices not necessarily reflective of their knowledge and attitudes, and 4) specific steps were found to be associated with hospital breastfeeding rates. A comprehensive set of facilitators and obstacles to initiation of the Ten Steps emerged, and hospital-specific practice change challenges were identified. DISCUSSION: This is one of the first studies to examine introduction of the Ten Steps in multiple hospitals with a control group and in hospitals that were not necessarily interested in BFHI designation, where the population served is predominantly low wealth, and with the use of a mixed methods approach. Limitations including numbers of hospitals and inability to adhere to all elements of the design are discussed. CONCLUSIONS: For improvements in quality of care for breastfeeding dyads, innovative and site-specific intervention modification must be considered.

Applying organisation theory to understand barriers and facilitators to the implementation of baby-friendly: A multisite qualitative study.

OBJECTIVES: (a) to apply an organisation-level, pre-implementation theory to identify and describe factors that may impact hospitals' readiness to achieve the Ten Steps and (b) to explore whether/how these factors vary across hospitals. DESIGN: a multisite, descriptive, qualitative study of eight hospitals that used semi-structured interviews of health-care professionals. Template analyses identified factors that related to organisation-level theory. Cross-site comparative analyses explored how factors varied across hospitals. SETTING: thirty-four health-care professionals from eight North Carolina hospitals serving low-wealth populations. The hospitals are participating in a quality improvement project to support the implementation of the Ten Steps. This study occurred during the pre-implementation phase. FINDINGS: several factors emerged relating to collective efficacy (i.e., the shared belief that the group, as a whole, is able to implement the Steps) and collective commitment (i.e., the shared belief that the group, as a whole, is committed to implementing the Steps) to implement the Ten Steps. Factors relating to both constructs included 'staff age/experience,' 'perceptions of forcing versus supporting mothers,' 'perceptions of mothers' culture,' and 'reliance on lactation consultants.' Factors relating to commitment included 'night versus day shift,' 'management support,' 'change champions,' 'observing mothers utilize breastfeeding support.' Factors relating to efficacy included 'staffing,' 'trainings,' and 'visitors in room.' Commitment-factors were more salient than efficacy-factors among the three large hospitals. Efficacy-factors were more salient than commitment-factors among the smaller hospitals. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: interventions focused on implementing the Ten Step may benefit from improving collective efficacy and collective commitment. Potential approaches could include skills-based, hands-on training highlighting benefits for mothers, staff, and the hospital, and addressing context-specific misconceptions about the Steps.

Implementing the Ten Steps for Successful Breastfeeding in hospitals serving low-wealth patients.

OBJECTIVES: The Ten Steps to Successful Breastfeeding is a proven approach to support breastfeeding in maternity settings; however, scant literature exists on the relative impact and interpretation of each step on breastfeeding. We assessed the Ten Steps and their relationship with in-hospital breastfeeding rates at facilities serving low-wealth populations and explored the outcomes to identify step-specific actions. METHODS: We present descriptive and nonparametric comparisons and qualitative findings to examine the relationship between the Ten Steps and breastfeeding rates from each hospital using baseline data collection. RESULTS: Some steps (1--policy, 2--training, 4--skin-to-skin, 6--no supplements, and 9--no artificial nipples, followed by 3--prenatal counseling, 7--rooming-in) reflected differences in relative baseline breastfeeding rates between settings. Key informant interviews revealed misunderstanding of some steps. CONCLUSIONS: Self-appraisal may be less valid when not all elements of the criteria for evaluating Step implementation may be fully understood. Limited exposure and understanding may lead to self-appraisal errors, resulting in scores that are not reflective of actual practices. Nonetheless, the indication that breastfeeding rates may be better mirrored by a defined subset of steps may provide some constructive insight toward prioritizing implementation activities and simplifying assessment. These issues will be further explored in the next phase of this study.