A randomized controlled trial of cognitive control training (CCT) as an add-on treatment for late-life depression: a study protocol.

BACKGROUND: Already a major health concern, late-life depression (LLD) is expected to form an increasing problem in the aging population. Moreover, despite current treatments, LLD is associated with a poor long-term prognosis and high rate of chronicity. Treatment provision and treatment accordingly warrant improvement, where add-on treatments might contribute to the efficacy of conventional therapies. Although it is known that impaired cognitive control contributes to LDD, it is not targeted sufficiently by current interventions. Research on cognitive control training (CCT) shows promising results on depressive symptoms, cognitive performance, and overall functioning. However, further research is needed to determine the long-term effects of CCT on LLD, its cost-effectiveness, and mechanisms of change. METHODS: In the current multicenter randomized controlled trial (RCT) with a between-subjects design participants aged 60 years and over with a current LLD receiving treatment as usual (TAU) are randomized to add-on CCT or placebo training. Randomization is stratified by depression severity. Participants will receive eight online CCT or placebo sessions spread across four consecutive weeks. They will complete a post-training assessment after 1 month and three follow-up assessments scheduled three, six and 12 months after completing the training. We expect CCT and TAU to be more (cost-)effective in reducing depressive symptoms than placebo training and TAU. Additionally, we will be looking at secondary clinical, cognitive and global functioning outcomes and likely mechanisms of change (e.g., improved cognitive functioning, reduced rumination, and improved inhibition of negative stimuli). DISCUSSION: The proposed RCT aims to contribute to the clinical and scientific knowledge on the long-term effects of CCT as an add-on treatment for LLD. Cost-effectiveness is particularly relevant considering the expected volume of the target demographic. The study will be a pragmatic trial with few inclusion restrictions, providing information on feasibility of web-based trainings in clinical settings. The outcomes are potentially generalizable to guidelines for treatment of LLD. TRIAL REGISTRATION: This trial is registered in the Netherlands Trial Register (code: NL7639 ). Registered 3 april 2019.

Attitudes Toward Asylum Policy in a Divided Europe: Diverging Contexts, Diverging Attitudes?

The large inflow of asylum-seekers in recent years has heralded a diversification in adopted asylum policies across European societies. Although a growing body of research has addressed these versatile approaches and their implications for the European integration project, insight into the social basis of these restrictive or open asylum policies remains underdeveloped. Hence, the current study provides detailed insight into public preferences for asylum policies and offers a new understanding of how these attitudes are affected by diverging socio-economic realities across Europe. In addition, this paper considers the role of individual factors that coincide with publicly adopted frames in contemporary asylum debates. In particular, to explain how contextual differences reflect on opinion climates, the impacts of the policy, economic, and migratory context are studied. On the individual-level, we focus on threat perception and human values, which represent humanitarian, economic, and cultural frames. To explore these relations, data on 20 countries from the European Social Survey Round 8 (2016) are analyzed through a multilevel structural equation modeling approach. Results indicate that, on the contextual-level, only unemployment rates have a significant impact and, rather surprisingly, lower unemployment rates provoke a more negative opinion climate. Yet, this relationship seems to be largely driven by some specific countries that are characterized by large unemployment rates and relatively positive opinion climates simultaneously. The migratory and policy context, on the other hand, do not influence attitudes toward asylum policy. This indicates that it is not necessarily the countries facing the largest inflow of asylum-seekers or issuing the most positive decisions on asylum applications that have the most restrictive opinion climates. As shown by the important roles of human values and threat perceptions, which represent widely adopted frames, public discourses seem much more important in explaining attitudes toward asylum policy across Europe.

Welfare deservingness opinions from heuristic to measurable concept: The CARIN deservingness principles scale.

A steadily growing number of studies investigate how popular support for social policies targeting particular groups is rooted in citizens' deservingness opinions. According to theory, people fall back on five criteria - Control, Attitude, Reciprocity, Identity and Need (CARIN) - to distinguish the deserving from the undeserving. Deservingness opinions are assumed to be important predictors of support for particular welfare arrangements. A striking feature of this emerging research, however, is that there is no agreed-upon strategy to measure deservingness. Most previous studies rely on proxy-variables rather than measuring the actual deservingness criteria. Deservingness functions as a heuristic rather than as a measured concept, which leads to conceptual confusion. To remedy this shortcoming, this contribution proposes and validates a new instrument -the CARIN deservingness principles scale- that captures the five basic deservingness principles. We analyse data from the Belgian National Election Study by means of structural equation modelling (SEM) to (1) test the dimensionality, validity and reliability of the scale, and (2) verify to what extent the five deservingness principles predict specific policy preferences (as a test of construct validity). Our analyses confirm that the five deservingness principles are distinct dimensions that are differently related to social structural variables and have divergent consequences for policy preferences. The finding of theoretically meaningful patterns of differentiated effects illustrates that the CARIN criteria represent distinct logics of social justice, and corroborates that our measurement instrument is capable of tapping into the essence of these criteria.

Power Distance and Physician-Nurse Collegial Relations Across 14 European Countries: National Culture is Not Merely a Nuisance Factor in International Comparative Research.

PURPOSE: This study illustrates the huge untapped potential of quantifying the impact of culture in making meaningful comparisons across groups. Our focus is on cross-national differences in nurses' reports of their relations with physicians, and how the measurement of this complex construct and the evaluation of true differences are related to dimensions of national culture. DESIGN: We examine across 14 European countries the association between indices of national culture from the seminal work of Hofstede and 39,435 nurses' ratings of their relations with physicians. Multilevel confirmatory factor analysis was used to evaluate strong factorial invariance across countries and to examine the influence of power distance and masculinity. FINDINGS: There was wide variation across countries in nurses' reports of their relations with physicians. Strong factorial invariance was shown for a one-factor model, which confirmed that across countries the seven survey items measure a common factor of physician-nurse relations. This model showed no country bias for any of the seven survey items, which suggests that differences across countries reflect true differences. These true differences were significantly associated with variation in country values of power distance, which showed a significant negative correlation with physician-nurse relations. CONCLUSIONS: Continuously pursuing a better understanding of characteristics that impact the studied indicators, such as national culture, is elementary to better understand the construct under study. In this application, country values of power distance negatively impacted nurse-reported relations with physicians, which strongly varied across countries. CLINICAL RELEVANCE: Better nurse-reported relations between nurses and physicians link to higher nurse job satisfaction, lower emotional exhaustion, better nurse-perceived quality of care, and lower patient mortality. The Practice Environment Scale of the Nursing Work Index is an excellent instrument to characterize variation in working relations between nurses and physicians as well as physicians' professional posture towards nurses.

Examining macroeconomic determinants of trust in parliament: A dynamic multilevel framework.

The extensive literature on political trust has long suggested a link between macroeconomic conditions and public trust in political institutions. However, empirical evidence regarding this relationship remains ambiguous. Conflicting results appear to be related to differences in research design: while cross-sectional studies tend not to find evidence of a link between macroeconomic variables and trust in political institutions, most longitudinal studies do. In this paper, using recent advances in multilevel methodology, we examine both cross-sectional and longitudinal effects of macroeconomic variables on trust in national parliament within a single dynamic multilevel framework. By analyzing all seven waves of the European Social Survey (2002-2014), we demonstrate that declining macroeconomic performance has a negative within-country effect on trust in national parliament. At the same time, we find limited evidence in support of this association at the between-country level. This discrepancy suggests the presence of confounding factors that are unaccounted for in cross-sectional designs. We therefore argue for the importance of examining within-country effects as they provide a more stringent test of causality.

Walloons as General or Specific Others? A Comparison of anti-Walloon and anti-immigrant Attitudes in Flanders.

This study attempts to shed light on the structure, the prevalence and the determinants of anti-Walloon attitudes in Flanders. For this purpose, we contrast anti-Walloon prejudice with prejudice against a relatively well-understood and archetypical out-group, namely immigrants. Our theoretical approach draws on insights from two paradigms of intergroup relations: the Group-Focused Enmity approach stressing that specific prejudices have a strong common denominator, and the Differentiated Threat model arguing that specific prejudices are contingent on the context of intergroup relations as well as the involved types of threat. To assess the (dis)similarities in anti-Walloon and anti-immigrant prejudice, we use the Flemish dataset of the Belgian National Election Study (BNES) 2010. Comparable measurement instruments for both forms of prejudice are analyzed by means of structural equation modeling. Our results reveal a nuanced picture regarding the similarities and differences between anti-Walloon and anti-immigrant attitudes in Flanders. One the one hand, anti-Walloon and anti-immigration attitudes are strongly correlated and rooted in economic threat perceptions. On the other hand, anti-Walloon attitudes are less outspoken in the Flemish population than anti-immigrant attitudes, are less founded on cultural threat perceptions and are more closely linked to feelings of identification with the Flemish in-group.

Bayesian Multilevel MIMIC Modeling for Studying Measurement Invariance in Cross-group Comparisons.

BACKGROUND: Recent methodological advancements should catalyze the evaluation of measurement invariance across groups, which is required for conducting meaningful cross-group comparisons. OBJECTIVE: The aim of this study was to apply a state-of-the-art statistical method for comparing latent mean scores and evaluating measurement invariance across managers' and frontline workers' ratings of the organization of hospital care. METHODS: On the 87 nursing units in a single institution, French-speaking and Dutch-speaking nursing unit managers' and staff nurses' ratings of their work environment were measured using the multidimensional 32-item practice environment scale of the nursing work index (PES-NWI). Measurement invariance and latent mean scores were evaluated in the form of a Bayesian 2-level multiple indicators multiple causes model with covariates at the individual nurse and nursing unit level. Role (manager, staff nurse) and language (French, Dutch) are of primary interest. RESULTS: Language group membership accounted for 7 of 11 PES-NWI items showing measurement noninvariance. Cross-group comparisons also showed that covariates at both within-level and between-level had significant effects on PES-NWI latent mean scores. Most notably, nursing unit managers, when compared with staff nurses, hold more positive views of several PES-NWI dimensions. CONCLUSIONS: Using a widely used instrument for measuring nurses' work environment, this study shows that precautions for the potential threat of measurement noninvariance are necessary in all stages of a study that relies on survey data to compare groups, particularly in multilingual settings. A Bayesian multilevel multiple indicators multiple causes approach can accommodate for detecting all possible instances of noninvariance for multiple covariates of interest at the within-level and between-level jointly.

Immigrant Integration policies and perceived Group Threat: A Multilevel Study of 27 Western and Eastern European Countries.

Although immigrant integration policies have long been hypothesized to be associated with majority members' anti-immigrant sentiments, systematic empirical research exploring this relationship is largely absent. To address this gap in the literature, the present research takes a cross-national perspective. Drawing from theory and research on group conflict and intergroup norms, we conduct two studies to examine whether preexisting integration policies that are more permissive promote or impede majority group members' subsequent negative attitudes regarding immigrants. For several Western and Eastern European countries, we link country-level information on immigrant integration policies from 2006 with individual-level survey data from the Eurobarometer 71.3 collected in 2009 (Study 1) and from the fourth wave of the European Value Study collected between 2008 and 2009 (Study 2). For both studies, the results from multilevel regression models demonstrate that immigrant integration policies that are more permissive are associated with decreased perceptions of group threat from immigrants. These findings suggest that immigrant integration policies are of key importance in improving majority members' attitudes regarding immigrants, which is widely considered desirable in modern immigrant-receiving societies.

Depressive symptoms in the Belgian population: disentangling age and cohort effects.

OBJECTIVE: Although the association between age and depression has been previously demonstrated, uncertainty remains because of the confounding relationship existing between age and cohort. A study by Yang (J Health Soc Behav 48(1):16, 2007) has evidenced important cohort effects and age-by-cohort interactions in depressive symptoms among US citizens. A crucial limitation, however, is that this study confines itself to elderly population. The objective of the present study is to bring further clarification to the association between age, cohort membership and depressive symptoms, by analyzing a sample with a wider age range. METHODS: The Panel Study of Belgian Households is a prospective longitudinal survey, following adults ages 25-74, annually from 1992 to 2002. Missing data were replaced using multiple imputation, allowing for a complete dataset (N = 7,000) at each wave. Respondents were classified into one of five birth cohorts: 1918-1927; 1928-1937; 1938-1947; 1948-1957; 1958-1967. Frequency of depressive symptoms was reported using a modified version of the Health and Daily Living form. Growth curve modeling was used to determine the effect of age and cohort on depression trajectory. RESULTS: All cohorts differed significantly from one another, with recent cohorts always obtaining the highest mean HDL-depression score. The intensity of depressive symptoms increases linearly with age, but significant age-by-cohorts interactions were detected, indicating that the relationship between age and depression varies across cohorts. No evidence of a WW2 effect was found. CONCLUSION: The association between age and depression has to take cohort membership into account. Cohort replacement effects explain the increase in depression in Belgium.

Changing attitudes toward immigration in Europe, 2002-2007: a dynamic group conflict theory approach.

Anti-immigration attitudes and its origins have been investigated quite extensively. Research that focuses on the evolution of attitudes toward immigration, however, is far more scarce. In this paper, we use data from the first three rounds of the European Social Survey (ESS) to study the trend of anti-immigration attitudes between 2002 and 2007 in 17 European countries. In the first part of the paper, we discuss the critical legitimacy for comparing latent variable means over countries and time. A Multiple-Group Multiple Indicator Structural Equation Modeling (MGSEM) approach is used to test the cross-country and cross-time equivalence of the variables under study. In a second step, we try to offer an explanation for the observed trends using a dynamic version of group conflict theory. The country-specific evolutions in attitudes toward immigration are shown to coincide with national context factors, such as immigration flows and changes in unemployment rates.