Eating disorder symptom dimensions and protective factors: A structural network analysis study.

Eating Disorders (EDs) and related symptoms pose a substantial public health concern due to their widespread prevalence among both genders and associated negative outcomes, underscoring the need for effective preventive interventions. In this context, deepening our understanding of the interplay between ED symptoms and related protective factors appears crucial. Therefore, this study employed a structural network analysis approach considering both ED symptom dimensions (i.e., drive for thinness, bulimic symptoms, and body dissatisfaction) and related protective factors (i.e., body and functionality appreciation, intuitive eating, and self-esteem) to shed light on how these factors are interrelated. A community sample of 1391 individuals (34.4% men; Mage = 26.4 years) completed a socio-demographic schedule and self-report questionnaires. The network showed that the nodes with the highest positive expected influence were body and functionality appreciation, while those with the highest negative expected influence were eating for physical rather than emotional reasons and unconditional permission to eat (i.e., two components of intuitive eating). Crucially, the most relevant bridges between the conceptual communities "ED symptom dimensions" and "Protective factors" were the negative relations between (a) eating for physical rather than emotional reasons and bulimic symptoms, (b) unconditional permission to eat and drive for thinness, and (c) body appreciation and body dissatisfaction. Finally, age, gender, and body mass index did not moderate any edge in the network. The practical implications of these findings are discussed, especially in terms of preventive interventions for ED symptoms.

Substance addictions and suicidal thoughts and behaviors: Evidence from a multi-wave epidemiological study.

Substance addiction (SA) is a risk factor of suicidal thoughts and behaviors (STB), although it is still unclear which SAs are reliably associated with increased risk for suicidal ideation, planning, and attempt. The current study aimed to meet this goal using data from the National Survey on Drug Use and Health (NSDUH) referring to years from 2008 to 2020. The information extracted included sociodemographic and contextual information, eleven SAs (e.g., nicotine, alcohol, marijuana, cocaine, pain relievers, heroin, inhalants, hallucinogens, sedatives, stimulants, and tranquillizers), and STB. The analysis revealed that SAs for alcohol, pain relievers, marijuana, and cocaine were stable and reliable predictors for STB (e.g., suicidal ideation, planning, and attempt), while cocaine was not a stable predictor for suicide attempt. The selected SAs model showed a greater predictive accuracy than only sociodemographic and contextual factors as well as not selected SAs. Moreover, selected SAs showed comparable predictive accuracy to the full model. Furthermore, SA to alcohol showed to be an extremely effective predictor of STB, having a comparable predictive accuracy to all the other ten SAs together. In conclusion, SAs to pain relievers, alcohol, marijuana, and cocaine can be considered as important risk factors for concurrent STB.

Comorbidity among depression, anxiety and stress symptoms in naturalistic clinical samples: A cross-cultural network analysis.

Comorbidity between depression and anxiety is well-established across various settings and cultures. We approached comorbidity from the network psychopathology perspective and examined the depression, anxiety/autonomic arousal and stress/tension symptoms in naturalistic clinical samples from Serbia, Italy and Croatia. This was a multisite study in which regularized partial correlation networks of the symptoms, obtained via self-reports on the Depression Anxiety and Stress Scales-21 (DASS-21) in three cross-cultural, clinical samples (total N = 874), were compared with respect to centrality, edge weights, community structure and bridge centrality. A moderate degree of similarity in a number of network indices across the three networks was observed. While negative mood emerged to be the most central node, stress/tension nodes were the most likely bridge symptoms between depressive and anxiety/autonomic arousal symptoms. We demonstrated that the network structure and features in mixed clinical samples were similar across three different languages and cultures. The symptoms such as agitation, restlessness and inability to relax functioned as bridges across the three symptom communities explored in this study. Important theoretical and clinical implications were derived.

Defense styles, well-being, and functional disability in the African context: A structured interview-based study.

OBJECTIVE: We investigated the defense styles in the African context by exploring their internal structure in Burkinabé individuals. Moreover, we explored how defense styles were related to sociocultural variables. Finally, we tested whether defense styles could mediate the relationship between sociocultural variables and mental well-being as well as functional disability. METHOD: The study recruited 998 individuals (66.9% male; age = 25.50 ± 7.8 years) living in Burkina Faso. Standard measures for defense mechanisms, mental well-being, and functional disability were administered as a structured interview in the local vehicular language, that is, Dyula. RESULTS: Principal component analysis identified three major defense styles-mature, neurotic, and immature. Gender, formal education, living area, and believing in traditional practices were associated with any of the three defense styles. Moreover, the immature style mediated the impact of sociocultural variables on specific outcomes, such as higher functional disability and lower mental well-being. The neurotic style was associated with lower functional disability, while the mature style was not associated with any of the outcome variables. CONCLUSION: Our study provided preliminary support to the notion that defense styles may function similarly across cultures and they are likely reactive to the sociocultural context.

The Structure of Compulsive Sexual Behavior: A Network Analysis Study.

Compulsive sexual behavior is a phenomenon characterized by a persistent failure to control intense, repetitive sexual impulses or urges, resulting in repetitive sexual behavior that causes marked distress or impairment in personal, familial, social, educational, or occupational areas of functioning. Despite its major impact on mental health and quality of life, little is known about its internal structure and whether this phenomenon differs across genders, age groups, and risk status. By considering a large online sample (n = 3186; 68.3% males), ranging from 14 to 64 years old, compulsive sexual behavior was explored by means of network analysis. State-of-the-art analytical techniques were adopted to investigate the pattern of association among the different elements of compulsive sexual behavior, identify possible communities of nodes, pinpoint the most central nodes, and detect differences between males and females, among different age groups, as well as between individuals at low and high risk of developing a full-blown disorder. The analyses revealed that the network was characterized by three communities, namely Consequence, Preoccupation, and Perceived Dyscontrol, and that the most central node was related to (perceived) impulse dyscontrol. No substantial differences were found between males and females and across age. Failing to meet one's own commitments and responsibilities was more central in individuals at high risk of developing a full-blown disorder than in those at low risk.

Cognitive Triad and Depressive Symptoms in Adolescence: Specificity and Overlap.

Adolescence is a critical period for the development of depressive symptoms and the understanding of vulnerability factors that facilitate their onset is pivotal. In this study, we focused on Beck's cognitive triad, namely its three-fold structure, comprising views of the self, world, and future. Despite its crucial role in the cognitive theory of depression, the relationship between the cognitive triad and depressive symptoms in adolescence is still unclear. In our study, we adopted a meta-analytic commonality analysis approach, in order to clarify whether the three components of the triad overlap in accounting for depressive symptoms, or they show distinct profiles of association. By relying on six independent samples of early adolescents (age range = 13-14: n = 174, 66% female, n = 347, 41% female), mid adolescents (age range = 15-17: n = 304, 61% female; n = 92, 34% female), and late adolescents (age range = 18-21: n = 217, 84% female, n = 101, 56% female), we showed that the views of the self, world, and future substantially overlap in accounting for depressive symptoms, although specific areas of distinctiveness could be detected. Moreover, the association between the cognitive triad and depressive symptoms appeared to be a function of both the developmental phase and gender. Furthermore, the cognitive triad emerged as specifically related to symptoms related to negative mood, absence of positive mood, and negative appraisal of the past. These findings advance our understanding of cognitive vulnerability for depressive symptoms in adolescence.

The Role of Perseverative Cognition for Both Mental and Somatic Disorders in a Naturalistic Psychiatric Patient Sample.

OBJECTIVE: Perseverative cognition (PC) is the repeated or long-term activation of the cognitive representation of psychological stressors and is associated with prolonged stress including somatic and mental consequences. Hence, PC might represent a cognitive process linking mental and somatic pathology, but current research on this link is limited by investigating healthy samples, markers of somatic disease, and single disorders. The present study explored the importance of PC for different mental and somatic disorders in psychiatric patients. METHODS: Data from 260 naturalistic psychiatric outpatients were used. Psychiatric diagnoses were based on structured clinical interviews. Somatic diseases were assessed using a well-validated questionnaire and were clustered into (cardio)vascular and immune/endocrine diseases. PC was operationalized using the Perseverative Thinking Questionnaire (PTQ). RESULTS: Multiple regression complemented with relative importance analyses showed that the PTQ total and subscale scores were associated with the presence of mood disorders, addiction, and anxiety. Unexpectedly, no relatively important associations were found between the PTQ and autism spectrum disorder, attention-deficit/hyperactivity disorder, or somatic disease. CONCLUSIONS: Our data complement previous work linking PC to stress-related mental disorders but question its immediate role in neurodevelopmental and somatic disorders. Targeting PC in the treatment of mood disorders and perhaps also in addiction seems promising.

Symptom centrality and infrequency of endorsement identify adolescent depression symptoms more strongly associated with life satisfaction.

Although depression symptoms are often treated as interchangeable, some symptoms may relate to adolescent life satisfaction more strongly than others. To assess this premise, we first conducted a network analysis on the Mood and Feelings Questionnaire (MFQ) in a large (N = 1,059), cross-sectional sample of community adolescents (age M = 14.72 ± 1.79). The most central symptoms of adolescent depression, as indexed by strength, were self-hatred, loneliness, sadness, and worthlessness while the least frequently endorsed symptoms were self-hatred, anhedonia, feeling like a bad person, and feeling unloved. Moreover, the more central a depression symptom was in the network (i.e., higher strength), the more variance it shared with life satisfaction (r = 0.59, 95% CI: 0.27, 0.76). How frequently a symptom was endorsed was negatively associated with the variance symptoms shared with life satisfaction (r = -0.48, 95% CI: -0.63, -0.21). Cross-validated, prediction focused models found central symptoms were expected to predict more out of fold variance in life satisfaction than peripheral symptoms and frequently endorsed symptoms, but not the least frequently endorsed symptoms. These findings show certain depression symptoms may be more strongly associated with life satisfaction in adolescence and these symptoms can be identified by multiple symptom-level metrics. Limitations include use of cross-sectional data and utilizing a community sample. Better understanding which symptoms of depression share more variance with important outcomes like life satisfaction could help us develop a more fine-grained understanding of adolescent depression.

The Architecture of Cognitive Vulnerability to Depressive Symptoms in Adolescence: A Longitudinal Network Analysis Study.

Rates of subclinical symptoms and full-blown depression significantly increase during adolescence. Hence, understanding how multiple cognitive risk factors are related to depression in adolescence is of major importance. For this purpose, we simultaneously considered multiple cognitive vulnerabilities, as proposed by three major cognitive theories for depression, namely Beck's cognitive theory, hopelessness theory, and response style theory. In this four-wave study, we investigated the architecture, interplay, and stability of cognitive vulnerability mechanisms, depressive symptoms, and stressors in a large group of adolescents over a period of one year (n = 469; mean age = 15 years; 64% female). Network analysis was used to shed light on the structure of cognitive vulnerabilities in a data-driven fashion. Analyses revealed that different cognitive vulnerabilities were intertwined and automatic thoughts played the role of hub node in the network. Moreover, the interplay among cognitive vulnerabilities and depressive symptoms was already markedly stable in adolescence and did not change over a 12-month period. Finally, no evidence was found that cognitive vulnerabilities interacted with stressors, as proposed by diathesis-stress models. These findings advance our understanding of multiple cognitive risk factors for depression in adolescence.

What is the internal structure of intolerance of uncertainty? A network analysis approach.

Intolerance of uncertainty (IU) is a transdiagnostic vulnerability factor spanning psychological disorders. Although IU has been extensively studied, its internal structure is still not fully understood. In the current study, we applied network analysis to investigate IU - as measured by the Intolerance of Uncertainty Scale-Revised (IUS-R) - in two large non-clinical samples, consisting of undergraduates (N = 1172) and community individuals (N = 1759). Network analysis revealed that feeling a general internal uncertainty aversion and the belief that things have to be planned in advance are the most central nodes in both samples. Moreover, the community analysis revealed that, in both samples, the network of IU consists of three communities referring to negative beliefs about uncertainty, behavioral reactions to uncertainty, and emotional reactions to uncertainty. Lastly, the network was highly similar in undergraduates and community individuals in terms of network similarity, global connectivity, and structure and items mean levels; only minimal-to-negligible differences were found. The way current findings expand our knowledge of the internal structure of IU, along with theoretical and clinical implications, are discussed.

Shaping our personal past: Assessing the phenomenology of autobiographical memory and its association with object and spatial imagery.

A new instrument has been developed that allows a comprehensive assessment of the relevant dimensions of the phenomenology of autobiographical memories (Assessment of the Phenomenology of Autobiographical Memory, APAM), and their association with visual object and spatial imagery has been examined. An initial version of APAM consisting of 30 items (the first 28 measured on a seven-point Likert-type scale) was developed and administered to a sample of 138 undergraduates. To test whether each item consistently measured the same dimension across different memories, all questions were rated for 12 cues. Results showed that 25 Likert-type items possessed adequate levels of internal consistency and unidimensionality across cues. We also found that higher levels of visual object imagery were associated with more sensory details and recollective qualities of memory, and with stronger experience of sensory and emotional reliving. The theoretical and practical usefulness of APAM as well as the relevance of visual object imagery in the phenomenology of autobiographical memory are discussed.

Outcomes of a novel bariatric stent in the management of sleeve gastrectomy leaks: a multicenter study.

BACKGROUND: The management of laparoscopic sleeve gastrectomy leaks remains a challenge. This can be treated with placement of self-expandable metal stents, which are most effective in the acute and early settings. However, migration is a frequent adverse event (AE). Novel, fully covered stents with a larger proximal flare to limit migration designed specifically to treat postsleeve leaks were recently introduced. OBJECTIVES: The aim of this study was to evaluate the safety and efficacy of a novel stent specifically designed for postsleeve leaks treatment. SETTING: Multicenter retrospective study. METHODS: This is a multicenter study, including patients with acute and early post laparoscopic sleeve gastrectomy leaks, treated with a large bariatric stent. The outcomes include technical success, clinical success, and safety profile. A multivariable regression was performed to assess predictors of success. RESULTS: Thirty-seven patients were included (10 acute and 27 early leaks), with 30 stents in the postpyloric (POST) and 7 in the prepyloric position. Technical success was 100%. Mean stent dwell time was 29.08 days. Clinical success was achieved in 78.37%. Leak duration, leak size, and stent dwell time did not correlate with clinical success. During follow-up, 8 patients had stent migration (21.62%) and all were in a POST position. AE poststent removal were also evaluated (prepyloric: 57.14% vs POST: 33.3%, P = .45). There was no difference between prepyloric and POST position in the severe AE analysis. CONCLUSIONS: This novel, large-caliber, fully covered stent specifically designed for sleeve leaks appears to be effective at treating acute and early leaks. However, the large flanges and long stent length do not appear to reduce migration rate and may be associated with higher overall severe AE rates. Avoiding placement in the POST position may help mitigate migration risk; however, owing to the risk profile this stent should be used with caution.

Measuring cognitive vulnerability to depression: Further evidence on the factorial and predictive validity of negative cognitive style.

BACKGROUND AND OBJECTIVES: Previous research has provided insufficient evidence on the factorial validity of the negative cognitive style questionnaires, which is a problem for the validity of the total score's computation. In Study 1, we focused on the relationship between internality and the other dimensions of negative cognitive style. In Study 2, we explored the predictive validity of negative cognitive style for negative interpretation bias. METHODS: In Study 1, 770 participants completed the Cognitive Style Questionnaire - Short Form (CSQ-SF). In Study 2, from a prescreening data collection (N = 300) we selected participants with low (N = 40) and high (N = 32) cognitive vulnerability to depression who were primed with negative mood induction and who completed a generative interpretation task. RESULTS: In Study 1, a confirmatory factor analysis (CFA) indicated that the best fitting model for the CSQ-SF was a bifactor model without the internality dimension. In Study 2, a CFA replicated the factorial structure of Study 1 and individuals with a high negative cognitive style exhibited a negative interpretation bias after controlling for depressive symptoms. LIMITATIONS: The university-age sample limited the generalizability of our results to different populations, and the lack of longitudinal data prevented us from discussing further implications on the relationship between the negative interpretation bias and negative cognitive style in predicting depression. CONCLUSIONS: Together, the results of our two studies support the construct validity of the CSQ-SF and recommend the use of a composite score of negative cognitive style without internality.

Do daily dynamics in rumination and affect predict depressive symptoms and trait rumination? An experience sampling study.

BACKGROUND AND OBJECTIVES: Rumination has been shown to prospectively predict the onset of depression. However, it is unclear how rumination and affect in daily life influence the development of depressive symptoms. The present study examined whether the structure of dynamics in rumination and affect could prospectively predict depressive symptoms and trait rumination in an undergraduate sample (n = 63). METHODS: The main index used was entropy, which reflects the instability of a system's structure. Momentary rumination and affect were assessed eight times per day for a period of seven days. Additionally, depressive symptoms and trait rumination were measured at the beginning of the experiment and at six weeks follow-up. RESULTS: The results showed that entropy significantly predicted trait rumination at follow-up (and depressive symptoms at trend level) while taking into account baseline depressive symptoms and trait rumination. LIMITATIONS: The follow-up measurements conducted six weeks after the baseline were relatively short. Further research may test the predictive effect of the structure over a longer period and confirm its effect by using different indices that describe the structure. CONCLUSIONS: These findings indicate that examining the structure of the dynamics in momentary rumination and affect holds promise for understanding the risk for depression.

Using Network Analysis to Identify Central Symptoms of Adolescent Depression.

Experiencing depression symptoms, even at mild to moderate levels, is associated with maladaptive outcomes for adolescents. We used network analysis to evaluate which symptoms (and associations between symptoms) are most central to adolescent depression. Participants were part of a large, diverse community sample (N = 1,409) of adolescents between 13 and 19 years of age. Network analysis was used to identify the most central symptoms (nodes) and associations between symptoms (edges) assessed by the Children's Depression Inventory. We also evaluated these centrality indicators for network robustness using stability and accuracy tests, associated symptom centrality with mean levels of symptoms, and examined potential differences between the structure and connectivity of depression networks in boys and girls. The most central symptoms in the network were self-hatred, loneliness, sadness, and pessimism. The strongest associations between symptoms were sadness-crying, anhedonia-school dislike, sadness-loneliness, school work difficulty-school performance decrement, self-hatred-negative body image, sleep disturbance-fatigue, and self-deprecation-self-blame. The network was robust to stability and accuracy tests. Notably, symptom centrality and mean levels of symptoms were not associated. Boys and girls' networks did not differ in levels of connectivity, though the link between body image and self-hatred was stronger in girls than boys. Self-hatred, loneliness, sadness, and pessimism were the most central symptoms in adolescent depression networks, suggesting that these symptoms (and associations between symptoms) should be prioritized in theoretical models of adolescent depression and could also serve as important treatment targets for adolescent depression interventions.

Temperamental factors in remitted depression: The role of effortful control and attentional mechanisms.

BACKGROUND: Temperamental effortful control and attentional networks are increasingly viewed as important underlying processes in depression and anxiety. However, it is still unknown whether these factors facilitate depressive and anxiety symptoms in the general population and, more specifically, in remitted depressed individuals. METHODS: We investigated to what extent effortful control and attentional networks (i.e., Attention Network Task) explain concurrent depressive and anxious symptoms in healthy individuals (n = 270) and remitted depressed individuals (n = 90). Both samples were highly representative of the US population. RESULTS: Increased effortful control predicted a substantial decrease in symptoms of both depression and anxiety in the whole sample, whereas decreased efficiency of executive attention predicted a modest increase in depressive symptoms. Remitted depressed individuals did not show less effortful control nor less efficient attentional networks than healthy individuals. Moreover, clinical status did not moderate the relationship between temperamental factors and either depressive or anxiety symptoms. LIMITATIONS: Limitations include the cross-sectional nature of the study. CONCLUSIONS: Our study shows that temperamental effortful control represents an important transdiagnostic process for depressive and anxiety symptoms in adults.

Specificity and overlap of attention and memory biases in depression.

BACKGROUND: Attentional and memory biases are viewed as crucial cognitive processes underlying symptoms of depression. However, it is still unclear whether these two biases are uniquely related to depression or whether they show substantial overlap. METHODS: We investigated the degree of specificity and overlap of attentional and memory biases for depressotypic stimuli in relation to depression and anxiety by means of meta-analytic commonality analysis. By including four published studies, we considered a pool of 463 healthy and subclinically depressed individuals, different experimental paradigms, and different psychological measures. RESULTS: Memory bias is reliably and strongly related to depression and, specifically, to symptoms of negative mood, worthlessness, feelings of failure, and pessimism. Memory bias for negative information was minimally related to anxiety. Moreover, neither attentional bias nor the overlap between attentional and memory biases were significantly related to depression. LIMITATIONS: Limitations include cross-sectional nature of the study. CONCLUSIONS: Our study showed that, across different paradigms and psychological measures, memory bias (and not attentional bias) represents a primary mechanism in depression.

Manipulating cues in mind wandering: Verbal cues affect the frequency and the temporal focus of mind wandering.

Our understanding of mind wandering (MW) has dramatically increased over the past decade. A key challenge still facing research is the identification of the processes and events that directly cause and control its occurrence. In the present study we sought to shed light on this question, by investigating the effects of verbal cues on the frequency and temporal focus of MW. To this aim, we experimentally manipulated the presence of irrelevant verbal cues during a vigilance task, in two independent groups (Verbal-cues group vs. No-cues group). We found that compared to the No-cues group, the Verbal-cues group reported a higher amount of MW, mostly triggered by the irrelevant cue-words, and a higher proportion of past-oriented MW compared to the other temporal orientations. These results demonstrate that task-irrelevant verbal stimulation increases the frequency of MW and steers its temporal orientation toward the past. Implications for the research on MW are discussed.

Unveiling the Structure of Cognitive Vulnerability for Depression: Specificity and Overlap.

There is extensive literature establishing the influence of rumination, hopelessness, and dysfunctional attitudes on depressive symptoms. However, it is unclear whether these vulnerability factors are distinctly related to depressive symptoms or show substantial overlap. In two large samples of undergraduates (Study #1, n = 304; Study #2, n = 491) and two samples of clinically depressed individuals (Study #3, n = 141; Study #4, n = 109, from published studies), questionnaire data were used to examine the relationship between cognitive vulnerability factors and depressive symptoms, along with additional measures of anxiety and stress symptoms. To decompose model fit into its specific and common partitions, we relied on commonality analysis (CA). CA showed that there is substantial overlap in cognitive risk factors for depression. Moreover, we found strong evidence that hopelessness provides a unique statistical contribution to depression. This pattern of findings was stable in healthy as well as clinical samples. Symptom-levels analysis revealed that a specific subset of depressive symptoms are associated with hopelessness. In closing, we showed that CA provides a powerful tool to map unique and overlapping variance between multiple risk factors. Moreover, hopelessness emerged to be an important focus of clinical attention.

The interplay between cognitive risk and resilience factors in remitted depression: A network analysis.

BACKGROUND: Individuals in remission from depression are at increased risk for developing future depressive episodes. Several cognitive risk- and resilience factors have been suggested to account for this vulnerability. In the current study we explored how risk- and protective factors such as cognitive control, adaptive and maladaptive emotion regulation, residual symptomatology, and resilience relate to one another in a remitted depressed (RMD) sample. METHODS: We examined the relationships between these constructs in a cross-sectional dataset of 69 RMD patients using network analyses in order to obtain a comprehensive, data-driven view on the interplay between these constructs. We subsequently present an association network, a concentration network, and a relative importance network. RESULTS: In all three networks resilience formed the central hub, connecting perceived cognitive control (i.e., working memory complaints), emotion regulation, and residual symptomatology. The contribution of the behavioral measure for cognitive control in the network was negligible. Moreover, the directed relative importance network indicates bidirectional influences between these constructs, with all indicators of centrality suggesting a key role of resilience in remission from depression. LIMITATIONS: The presented findings are cross-sectional and networks are limited to a fixed set of key constructs in the literature pertaining cognitive vulnerability for depression. CONCLUSIONS: These findings indicate the importance of resilience to successfully cope with stressors following remission from depression. Further in-depth studies will be essential to identify the specific underlying resilience mechanisms that may be key to successful remission from depression.