BEATVIC, a body-oriented resilience therapy for individuals with psychosis: Short term results of a multi-center RCT.

BACKGROUND: Individuals with a psychotic disorder are at an increased risk of victimization, but evidenced-based interventions are lacking. AIMS: A body-oriented resilience therapy ('BEATVIC') aimed at preventing victimization was developed and its effectiveness was assessed in a multicenter randomized controlled trial. METHODS: 105 people with a psychotic disorder were recruited from six mental health centers. Participants were randomly allocated to 20 BEATVIC group sessions (n = 53) or befriending group sessions (n = 52). Short term effects on risk factors for victimization (e.g. social cognitive deficits, inadequate interpersonal behavior, low self-esteem, internalized stigma, aggression regulation problems), physical fitness and secondary outcomes were expected. At six-month follow-up, the effect on victimization (either a 50% reduction or an absence of victimization incidents) was examined. RESULTS: Intervention-dropout was 28.30% for BEATVIC and 39.62% for befriending. In both conditions the majority of participants (60.5% BEATVIC vs 62.9% befriending) showed a reduction or absence of victimization incidents at six months follow-up, which was not significantly different according to condition. Multilevel analyses revealed no main effect of time and no significant time x group interaction on other outcome measures. Per protocol analyses (participants attending ≥ 75% of the sessions) did not change these results. CONCLUSIONS: Although a reduction or absence of victimization was found at short term follow-up for the majority of participants, BEATVIC was not more effective than the active control condition. No short-term additional effects on risk factors of victimization were found. Analysis of the data at 2-year follow-up is warranted to investigate possible effects in the long-term. TRIAL REGISTRATION NUMBER: Current Controlled Trials: ISRCTN21423535.

Shifting the Focus: A Pilot Study on the Effects of Positive Body Exposure on Body Satisfaction, Body Attitude, Eating Pathology and Depressive Symptoms in Female Patients with Eating Disorders.

One of the most commonly used techniques for the treatment of body image problems in eating disorders (ED) is body exposure (BE). However, evidence of its effectiveness in clinical populations is scarce. In the Positive Body Experience (PBE) protocol, the focus of positive BE is on aesthetic, functional and tactile aspects of the body. The current study evaluates the outcomes of positive BE with regard to changes in attitudinal body image and eating pathology, as well as the factors that influence these changes, in a sample of 84 adult female patients with different EDs who did not receive any other treatment for their EDs during the period in which BE treatment occurred. The results show significant positive changes in attitudinal body image, ED behaviors and depressive symptoms, with depressive symptoms at baseline mediating the changes in attitudinal body image. This study indicates that the PBE protocol is a suitable intervention for reducing negative attitudinal body image in anorexia and bulimia nervosa patients, as well as those with binge eating disorder. Furthermore, the results suggest that positive non-weight-related and functional body satisfaction are strong catalysts for change and that depressive symptoms play an important role in the ability to change. Additional RCTs are needed to gain more insight into the effects of PBE.

Picturing disturbed body experience: A comparison of body drawings in persons with somatoform disorder and a general population sample.

People with somatic symptom disorder or somatoform disorder are considered to have a troubled relationship to their body that is hard to assess with self-report questionnaires alone. To examine the potential value of own-body drawings as an assessment tool, objective features of drawings from 179 patients referred to treatment for somatoform disorder, were compared to those of 173 age-and-sex matched persons from the general population. While two factors had been found in the somatoform disorder sample, in the general population only the factor that reflected 'details' in own-body drawings was replicated. The two samples did not score differently on this factor. The general population sample showed a less strong association between objective body drawings scores on this 'details' factor and self-reported scores of body experience than the somatoform disorder sample. Moreover, the phenomenological contents of the drawings were more oriented towards health or appearance than the mostly mixed or unclear orientation of persons with somatoform disorder. Because the objective scoring of body drawings did not differ between groups while the contents of body drawings appeared to differ, the results suggest that this objective scoring of body drawings is not appropriate to distinguish people with and without somatoform disorder.

Cost Effectiveness and Budget Impact of the Boston University Approach to Psychiatric Rehabilitation for Increasing the Social Participation of Individuals With Severe Mental Illnesses.

Background: The purpose of this study was to investigate the cost-effectiveness and budget impact of the Boston University Approach to Psychiatric Rehabilitation (BPR) compared to an active control condition (ACC) to increase the social participation (in competitive employment, unpaid work, education, and meaningful daily activities) of individuals with severe mental illnesses (SMIs). ACC can be described as treatment as usual but with an active component, namely the explicit assignment of providing support with rehabilitation goals in the area of social participation. Method: In a randomized clinical trial with 188 individuals with SMIs, BPR (n = 98) was compared to ACC (n = 90). Costs were assessed with the Treatment Inventory of Costs in Patients with psychiatric disorders (TIC-P). Outcome measures for the cost-effectiveness analysis were incremental cost per Quality Adjusted Life Year (QALY) and incremental cost per proportional change in social participation. Budget Impact was investigated using four implementation scenarios and two costing variants. Results: Total costs per participant at 12-month follow-up were € 12,886 in BPR and € 12,012 in ACC, a non-significant difference. There were no differences with regard to social participation or QALYs. Therefore, BPR was not cost-effective compared to ACC. Types of expenditure with the highest costs were in order of magnitude: supported and sheltered housing, inpatient care, outpatient care, and organized activities. Estimated budget impact of wide BPR implementation ranged from cost savings to €190 million, depending on assumptions regarding uptake. There were no differences between the two costing variants meaning that from a health insurer perspective, there would be no additional costs if BPR was implemented on a wider scale in mental health care institutions. Conclusions: This was the first study to investigate BPR cost-effectiveness and budget impact. The results showed that BPR was not cost-effective compared to ACC. When interpreting the results, one must keep in mind that the cost-effectiveness of BPR was investigated in the area of social participation, while BPR was designed to offer support in all rehabilitation areas. Therefore, more studies are needed before definite conclusions can be drawn on the cost-effectiveness of the method as a whole.

Development of the Body-Relatedness Observation Scale: A feasibility study.

BackgroundOne characteristic of somatoform (DSM-IV) and somatic symptom disorder (DSM-5) is the troubled relation of patients to their body. To assess body-relatedness, standardized observation by a physical therapist may add valuable information to questionnaires. Purpose: This study examines the feasibility of a physiotherapeutic observation instrument: the Body-Relatedness Observation Scale (BROS). Methods: Factorial validity and inter-rater reliability of observer scores were studied in 191 patients performing two short exercises, lying face up. Fourteen indicators of body-relatedness were selected, covering execution of instructions, perception of the body, muscle tension, and behavioral adaptation to somatic symptoms. Results: Inter-rater reliability values (Kappa or Intraclass correlation [ICC] according to model 1,1) were excellent for four observation scores, substantial for two, fair for two, and poor for six. Four out of five items relating to patients' ability to perceive the body had low inter-rater reliability values (ICC < 0.40 or Kappa < 0.20). Categorical principal components analysis with the eight reliable scores indicated a 1-factor structure including seven items with Cronbach's alpha 0.69. Conclusion: This initial analysis of a structured physical therapeutic observation for people with somatic symptom disorder indicated modestly sound psychometric quality of observations of execution of instructions, muscle tension, and behavioral adaptation, but not of patients' ability to perceive the body adequately. This shows that body-related observations are feasible and indicates the viability of further development of the BROS.

Measuring body satisfaction in women with eating disorders and healthy women: appearance-related and functional components in the Body Cathexis Scale (Dutch version).

PURPOSE: Differentiating the concept of body satisfaction, especially the functional component, is important in clinical and research context. The aim of the present study is to contribute to further refinement of the concept by evaluating the psychometric properties of the Dutch version of the Body Cathexis Scale (BCS). Differences in body satisfaction between clinical and non-clinical respondents are also explored. METHOD: Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to investigate whether functional body satisfaction can be distinguished as a separate factor, using data from 238 adult female patients from a clinical sample and 1060 women from two non-clinical samples in the Netherlands. Univariate tests were used to identify differences between non-clinical and clinical samples. RESULTS: EFA identified functionality as one of three factors, which was confirmed by CFA. CFA showed the best fit for a three-factor model, where functionality, non-weight, and weight were identified as separate factors in both populations. Internal consistency was good and correlations between factors were low. Women in the non-clinical sample scored significantly higher on the BCS than women with eating disorders on all three subscales, with high effect sizes. CONCLUSIONS: The three factors of the BCS may be used as subscales, enabling researchers and practitioners to use one scale to measure different aspects of body satisfaction, including body functionality. Use of the BCS may help to achieve a more complete understanding of how people evaluate body satisfaction and contribute to further research on the effectiveness of interventions focussing on body functionality. LEVEL OF EVIDENCE: Cross-sectional descriptive study, Level V.

Neural changes following a body-oriented resilience therapy with elements of kickboxing for individuals with a psychotic disorder: a randomized controlled trial.

Individuals with a psychotic disorder are at an increased risk of becoming the victim of a crime. A body-oriented resilience therapy (BEATVIC) aimed at preventing victimization by addressing putatively underlying factors was developed. One of these factors is social cognition, particularly facial affect processing. The current study investigated neural effects of BEATVIC on facial affect processing using two face processing tasks. Participants were randomized to either BEATVIC or a 'Befriending' control group. Twenty-seven patients completed an Emotional Faces task and the Wall of Faces task during fMRI, pre- and post-intervention. General linear model analyses yielded no differences between groups over time. Independent component analyses revealed increased activation of the salience network to angry and fearful faces in BEATVIC compared to Befriending. Increased activation of the salience network may suggest an increased alertness for potentially dangerous faces.

Effectiveness of the Boston University Approach to Psychiatric Rehabilitation in Improving Social Participation in People With Severe Mental Illnesses: A Randomized Controlled Trial.

BACKGROUND: People with severe mental illnesses (SMIs) have difficulty participating in society through work or other daily activities. AIMS: To establish the effectiveness with which the Boston University Approach to Psychiatric Rehabilitation (BPR) improves the level of social participation in people with SMIs, in the Netherlands. METHOD: In a randomized controlled trial involving 188 people with SMIs, we compared BPR (n = 98) with an Active Control Condition (ACC, n = 90) (Trial registration ISRCTN88987322). Multilevel modeling was used to study intervention effects over two six-month periods. The primary outcome measure was level of social participation, expressed as having participated in paid or unpaid employment over the past six months, as the total hours spent in paid or unpaid employment, and as the current level of social participation. Secondary outcome measures were clients' views on rehabilitation goal attainment, Quality of Life (QOL), personal recovery, self-efficacy, and psychosocial functioning. RESULTS: During the study, social participation, QOL, and psychosocial functioning improved in patients in both groups. However, BPR was not more effective than ACC on any of the outcomes. Better social participation was predicted by previous work experience and a lower intensity of psychiatric symptoms. CONCLUSIONS: While ACC was as effective as BPR in improving the social participation of individuals with SMIs, much higher percentages of participants in our sample found (paid) work or other meaningful activities than in observational studies without specific support for social participation. This suggests that focused rehabilitation efforts are beneficial, irrespective of the specific methodology used.

Clinical characteristics of individuals with intellectual disability who have experienced sexual abuse. An overview of the literature.

BACKGROUND: Sexual abuse in individuals with average IQ or above is associated with a wide range of behavioural, psychological and body-related characteristics. It is unknown whether individuals with intellectual disability (ID) and a history of sexual abuse suffer from similar clinical characteristics. OBJECTIVE: The aim of the review is to provide an overview of the literature on the clinical characteristics of individuals with ID who have experienced sexual abuse. METHOD: PubMed, Embase, PsycInfo, CINAHL, Cochrane Library and Web of Sciences were searched for relevant publications using terms related to concepts of "intellectual disability" and "sexual abuse". Two independent reviewers screened and selected articles for inclusion in the study, resulting in seven studies. RESULTS: The studies mostly reported behavioural and psychological characteristics such as aggression, self-injury, or posttraumatic stress, anxiety or depressive symptoms associated with sexual abuse in individuals with ID. None mentioned body-related characteristics. CONCLUSIONS: Similar to individuals with average IQ or above, sexual abuse in individuals with ID is associated with a broad range of behavioural and psychological characteristics. Conduct disorders, self-injury, inappropriate sexualised talk and poor feelings of personal safety seem to be more indicative for the ID population. Anxiety, depression and PTSD are prevalent in individuals with and without ID who both have experienced sexual abuse. Whether individuals with ID experience body-related characteristics is unclear.

Neural correlates of victimization in psychosis: differences in brain response to angry faces.

Individuals with psychosis are at an increased risk of victimization. Processing of facial expressions has been suggested to be associated with victimization in this patient group. Especially processing of angry expressions may be relevant in the context of victimization. Therefore, differences in brain activation and connectivity between victimized and nonvictimized patients during processing of angry faces were investigated. Thirty-nine patients, of whom nineteen had experienced threats, assaults, or sexual violence in the past 5 years, underwent fMRI scanning, during which they viewed angry and neutral facial expressions. Using general linear model (GLM) analyses, generalized psychophysiological (gPPI) analysis and independent component analyses (ICA) differences in brain activation and connectivity between groups in response to angry faces were investigated. Whereas differences in regional brain activation GLM and gPPI analyses yielded no differences between groups, ICA revealed more deactivation of the sensorimotor network in victimized participants. Deactivation of the sensorimotor network in response to angry faces in victimized patients, might indicate a freeze reaction to threatening stimuli, previously observed in traumatized individuals.

"Please tell me what happened": A descriptive study on prevalence, disclosure and characteristics of victimization in people with a psychotic disorder.

INTRODUCTION: Although people with a psychotic disorder are approximately four to six times more often victimized than the general population, victimization is not routinely assessed in mental healthcare. This study investigates prevalence, context and risk factors of victimization in patients with a psychotic disorder in the Northern, relatively rural region of the Netherlands. Moreover, disclosure rates and awareness of psychiatrists are examined. METHOD: Information on personal crime (threats, assaults and sexual violence), property and other forms of crime, the context of victimization and disclosure was routinely assessed in 353 patients with a psychotic disorder who received care at a mental health facility. In addition, involved psychiatrists reported on last year's victimization incidents in their patients. RESULTS: One third of the patients reported victimization in the previous year. More than half of the crimes were committed by someone acquainted and took place in the victim's own home or a place familiar to the victim. Younger age, having a comorbid disorder, drug use and perpetration of a crime were all positively associated with victimization. Approximately half of the reported personal crimes were disclosed to a health care professional but only in 16% of the cases the involved psychiatrist report to know about the incident. CONCLUSION: This study confirms that people with a history of psychosis have an increased risk of becoming the victim of a crime. Although our results suggest that in fifty percent of cases the patients did share the information with professionals, a substantial proportion of incidents appear to go still unnoticed.

Work Motivation and Employment Outcomes in People with Severe Mental Illness.

Purpose To study associations between the level of self-reported work motivation and employment outcomes in people with severe mental illness (SMI) enrolled in a vocational rehabilitation program. Methods Data of 151 study participants, collected from a randomised controlled trial with a 30-month follow-up period, were used for a secondary data analysis. Multiple logistic regression, linear regression and cox regression analyses were performed to analyse the association between the level of work motivation at baseline and job obtainment, duration of job, and time until job obtainment during the 30-month follow-up period. Results No statistically significant associations were found between the level of work motivation and job obtainment (OR 1.83, 95% CI 0.55-6.06, p = 0.32), job duration (B = - 0.74, 95% CI - 2.37 to 0.89, p = 0.37, R-squared = 0.03), or time until job obtainment (HR = 1.53, 95% CI 0.64-3.68, p = 0.34). Conclusions The results of this study show no statistically significant associations between the level of work motivation and employment outcomes in people with SMI enrolled in a vocational rehabilitation program. These associations may be underestimated due to range restriction of the work motivation's level. Further research is recommended to increase knowledge on the associations between work motivation and employment outcomes, as it could be relevant for further understanding success in vocational rehabilitation.

Sports participation and health-related quality of life: a longitudinal observational study in children.

PURPOSE: In this study, longitudinal associations between sports participation and health-related quality of life (HRQoL) were explored. Sports participation was operationalized as membership of a sports club, frequency of sports participation, performing individual versus team sports and performing indoor versus outdoor sports. The concept of HRQoL referred to the self-perceived enjoyment and satisfaction with one's personal health situation. METHODS: Data from 618 fourth-grade primary school children were included at baseline; 10-13 months later, 417 children (response rate 67.5%) were retained. At both time points, children reported on sports participation (Move and Sports Monitor Questionnaire-youth aged 8-12 years) and health-related quality of life (KIDSCREEN-52). Because of the clustering of children in schools, data were analysed using linear mixed models. Analyses were adjusted for sex, age, BMI, household composition, SES and frequency of sports participation. RESULTS: The questionnaires were fully completed by 417 children. High sports-active children showed better scores on almost all dimensions of HRQoL than moderate [difference (B) = - 1.82 (p = 0.05) to - 1.51 (p = 0.05)] or low ports-active children [difference (B) = - 3.67 (p < 0.001) to - 1.95 (p = 0.03)] and non-sports club members [difference (B) = - 5.58 (p < 0.001) to - 2.65 (p = 0.02)]. Unlike frequency, the other examined characteristics of sports participation were only to a limited extent longitudinal associated with HRQoL. CONCLUSION: As frequency is more relevant than the form of sports participation, children should be encouraged to perform any kind of sports activity on a very regular base.

Sports participation and health-related quality of life in children: results of a cross-sectional study.

BACKGROUND: In children physical activity has been shown to be associated with health-related quality of life (HRQoL). This study further explores this association for specific characteristics of sports participation, namely membership of a sports club, frequency of sports participation, performing individual versus team sports, performing indoor versus outdoor sports, while differentiating between specific dimensions in the physical, psychological and social domain of HRQoL. METHODS: Cross-sectional data were collected from Dutch primary school children aged 10 to 12 years. They completed the Movement and Sports Monitor Questionnaire Youth aged 8 to 12 years (MSMQ) and the KIDSCREEN-52, an HRQoL questionnaire for children and adolescents. The data were examined using linear multilevel analyses because of the clustering of children in schools. RESULTS: The questionnaires were completed by 1876 children (response rate 81.3%). Membership of a sports club, moderate or high frequency of sports participation, and performing outdoor sports were all significantly associated with better HRQoL. These associations were largely found in the physical domain of HRQoL, to a lesser degree in the social domain, and to a limited extent in the psychological domain. CONCLUSION: The association between sports participation and HRQoL in children depends on both characteristics of sports participation and the domain of life that is concerned. These differences offer starting points for developing tailor-made sports programs for children.

Cultural Identity Confusion and Psychopathology: A Mixed-Methods Study Among Refugees and Asylum Seekers in the Netherlands.

Although there is ample empirical evidence that traumatic events, postmigration stress, and acculturation problems have a great impact on the mental health of refugees, so far no studies have included cultural identity after migration in the equation. This mixed-methods study conducted among Afghan and Iraqi refugee and asylum-seeker psychiatric patients aims to fill this gap. Associations between postmigration stress, symptoms of anxiety and depression disorders, and symptoms of posttraumatic stress disorder were significant. When differentiated for the two groups, associations with postmigration stress were no longer significant for Afghan patients, who were predominantly younger and more often single, lower educated, and without resident status compared with Iraqi patients. Qualitative results indicate that, in addition to psychopathology and postmigration stress, acculturation problems contribute to confusion of cultural identity. The findings suggest that reduction of postmigration stress and acculturation problems may clarify cultural identity and as such may contribute to posttraumatic recovery.

Prevalence Rate and Risk Factors of Victimization in Adult Patients With a Psychotic Disorder: A Systematic Review and Meta-analysis.

Psychotic disorders often have been linked with violence. However, studies have shown that people with a psychotic disorder are more often victim than perpetrator of violence. The objective of this meta-analysis was to review prevalence rates for different types of victimization and to identify risk factors associated with victimization. Based on a search in MEDLINE, PsycINFO, and Web of Science, 27 studies were found with samples consisting of adults with a psychotic disorder and possible victimization occurring during adulthood and data on "violent victimization," "sexual victimization," "non-violent victimization," and/or "victimization not otherwise specified." The median prevalence rate for violent victimization was 20%, for sexual victimization 20%, nonviolent victimization 19%, and for victimization not otherwise specified 19%. Victimization rates were approximately 4-6 times higher than in the general community. Meta-analyses showed the following significant risk factors: delusion (OR = 1.69), hallucinations (OR = 1.70), manic symptoms (OR = 1.66), drugs (OR = 1.90) or alcohol abuse (OR = 2.05), perpetration of a crime (OR = 4.33), unemployment (OR = 1.31), and homelessness (OR = 2.49). Other risk factors like previous victimization, impaired social functioning, personality disorder, and living in a disadvantaged neighborhood were found only in 1 or 2 studies. Based on the results, we conclude that, depending on the examined time period, 1 in 5 (assessment period ≤3 y) or 1 in 3 (assessment period entire adulthood) people with a psychotic disorder was victim of a crime. Clinical, behavioral, and sociodemographic factors were significantly associated with victimization, as well as previous victimization. Prospective research into risk factors is needed to capture causal trajectories of victimization.

Characteristics of sports participation and psychosocial health in children: Results of a cross-sectional study.

Several studies suggest that sports participation is beneficial for psychosocial health. There is, however, only a limited number of studies about the relationship of specific characteristics of sports participation with psychosocial health. The present study investigated associations between characteristics of sports participation and three aspects of psychosocial health, i.e. internalising problems, externalising problems and prosocial behaviour. The examined characteristics of sports participation pertained to individual versus team sports, indoor versus outdoor sports, involvement in competition or not, and contact sports versus non-contact sports. Cross-sectional data were collected from 1768 Dutch children aged 10-12 years who were member of a sports club. These children completed the Movement and Sports Monitor Questionnaire Youth aged 8-12 years (MSMQ) and the Strength and Difficulties Questionnaire (SDQ). Linear multilevel analyses and logistic generalised estimating equation were conducted. Children participating in team sports, outdoor sports, or competition showed fewer internalising problems than children engaged in individual sports, indoor sports, or only training. The associations with internalising problems were stronger for boys than for girls. Children participating in non-contact sports showed fewer externalising problems than children performing non-contact sports as well as contact sports. Children practising indoor sports or non-contact sports showed better prosocial behaviour than children doing outdoor or contact sports. In conclusion, the form of sports participation seemed to matter highly with respect to internalising problems, especially for boys, and, to a lesser extent, with respect to externalising problems and prosocial behaviour. This offers starting points for developing tailor-made sports programmes for children.

BEATVIC, a body-oriented resilience therapy using kickboxing exercises for people with a psychotic disorder: a feasibility study.

BACKGROUND: People with a psychotic disorder have an increased risk of becoming the victim of a crime. To prevent victimization a body-oriented resilience therapy using kickboxing exercises was developed. This study aims to explore the feasibility of the therapy, to improve the therapy protocol and to explore suitable outcomes for a RCT. METHODS: Twenty-four adults with a psychotic disorder received 20 weekly group sessions in which potential risk factors for victimization and strategies for dealing with them were addressed. Sessions were evaluated weekly. During pre and post assessment participants completed questionnaires on, among other, victimization, aggression regulation and social functioning. RESULTS: The short recruitment period indicates the interest in such an intervention and the willingness of clients to participate. Mean attendance was 85.3 and 88% of the participants completed fifteen or more sessions. The therapy protocol was assessed as adequate and exercises as relevant with some small improvements to be made. The victimization and aggression regulation questionnaires were found to be suitable outcome measurements for a subsequent RCT. CONCLUSION: The results support the feasibility of the BEATVIC therapy. Participants subjectively evaluated the intervention as helpful in their attempt to gain more self-esteem and assertiveness. With some minor changes in the protocol the effects of BEATVIC can be tested in a RCT. TRIAL REGISTRATION: The trial registration number (TRN) is 35949 (date submitted 09/11/2018). Retrospectively registered.

Force production parameters as behavioural measures for anger expression and control: The Method of Stamp Strike Shout.

This study presents first test results of a new performance-based, psychomotor method to measure anger expression and control, based on voice expression and physical force production in directional movement of arms and legs, called the Method of Stamp Strike Shout (MSSS). Recorded are the standardized impact of stamping on a force plate, hitting a punching bag, and the amplitude of shouting in a microphone at various force levels. The premise is, that these body behaviours stand for the 'urge to act or shout' that belongs to anger-related emotions. The MSSS is meant to be applied in addition to potentially biased self-report questionnaires and has been designed for diagnostic as well as therapeutic purposes in clinical practice. First, this paper focusses on the instrumentation, internal structure and reliability of the MSSS. An explorative study in a student sample (n = 104) shows correlation patterns between increasing and decreasing levels of force production within each subtest (Stamp, Strike and Shout) and between the three subtests. We found excellent internal consistency of the three subtests and high test-retest reliability. The parameters of increasing and decreasing force levels form the slopes of what we call a force pyramid. To adjust for the clustering within persons, aggregated outcomes were calculated: sum scores per subtest as an indication of total force produced, two linear contrast scores to indicate the rate of increase / decrease, and two quadratic contrast scores as measures of the curvature of the slopes. On all subtests, all aggregated scores showed differences between men and women, also when controlled for weight. To test the validity of the MSSS, the second part of the paper examines the relationship between force parameters and anger coping style, measured by the Self-Expression and Control Scale (SECS). The results suggest that the Shout subtest was the most sensitive indicator for anger coping style, showing negative correlations with Anger In, for women as well as men. For women, higher amplitude was also associated with higher Anger Out and lower amplitude with higher Anger Control. The Stamp subtest showed weak positive correlations with the Anger In subscales, whereas no correlations were found on the Strike subtest. Further, a more robust comparison was made between two groups of participants who reported to have an internalizing versus an externalizing anger coping style. Results indicated that internalizing women as well as men used less force than externalizing participants on all three subtests, especially on the Shout subtest. This was confirmed by lower mean sum scores on the Shout subtest for internalizing women compared with externalizing women. No differences in linear contrast scores were shown between internalizing and externalizing participants. The quadratic contrast scores suggested differences of the curvation of the slopes between women with more or less anger control when stamping, and men with more or less anger control when striking. As this is an explorative study, findings should be interpreted with caution.

Sports participation and psychosocial health: a longitudinal observational study in children.

BACKGROUND: It is well known that sports participation is positively associated with psychosocial health in children, but details about this association over time are lacking. This study aimed to explore longitudinal associations between several characteristics of sports participation and three aspects of psychosocial health (internalizing problems, externalizing problems and prosocial behaviour) in Dutch children aged 10-12 years. METHODS: Data from 695 fourth-grade primary school children were included at baseline; 10-13 months later, 487 children (response rate 70.1%) were retained. At both time points, children reported on their sports participation (Move and Sports Monitor Questionnaire - Youth Aged 8-12 Years) and psychosocial health (Strength and Difficulties Questionnaire). Longitudinal associations between several characteristics of sports participation and the three aspects of psychosocial health were analysed using linear mixed models, both clustering the repeated measures within children and clustering the children within schools. In addition to crude analyses, analyses were performed adjusting for sex, age, BMI, household composition, SES and frequency of sports participation. RESULTS: Membership in a sports club, moderate or high frequency of sports participation, performing team sports, performing outdoor sports, performing contact sports and involvement in competition were longitudinally associated with fewer internalizing problems. The longitudinal association of higher frequency of sports participation with fewer internalizing problems was stronger as a child's BMI increased. The association of performing team sports with fewer internalizing problems was only observed for boys. Membership in a sports club and moderate or high frequency of sports participation were also longitudinally associated with better prosocial behaviour. These associations with prosocial behaviour were stronger for girls. None of the characteristics of sports participation examined were longitudinally associated with externalizing problems. CONCLUSIONS: This study shows that from a longitudinal perspective, fewer internalizing problems and better prosocial behaviour were seen in children who were active in sports. Fewer internalizing problems were also associated with the kind of sports participation; for example, with performing outdoor sports. No associations were found for externalizing problems. Future research should preferably take the form of an intervention to investigate whether the observed statistical associations are of a causal nature.