Giving birth alone due to COVID-19-related hospital restrictions compared to accompanied birth: psychological distress in women with caesarean section or vaginal birth - a cross-sectional study.

OBJECTIVES: We examined the mental health of mothers after unaccompanied birth (unaccompanied group, UG) due to COVID-19-related visiting bans and compared the data with a control group with accompanied birth (AG). Additionally, a distinction was made between caesarean section (CS) and vaginal birth (VB), as existing research indicates a higher risk for mental distress after CS. METHODS: The cross-sectional study included 27 mothers in the UG and 27 matched controls (AG). Anxiety, depression, postpartum traumatic stress symptoms (PTSS), and psychological well-being were assessed. Additionally, emotions and attitudes related to the restrictions were measured by self-developed items. RESULTS: Psychological distress was high especially in the UG (anxiety: 23%, PTSS: 34.6%, low well-being: 42.3%, depression: 11.5%). Mothers in the AG had lower psychological distress than those in the UG, but still had enhanced rates of PTSS (11.1%) and diminished well-being (22.2%). In both groups, women with CS reported higher anxiety and trauma scores and lower well-being than women with VB. Unaccompanied mothers with CS perceived visitation restrictions as less appropriate and felt more helpless, angry, worried, and frustrated about the partner's absence than women with VB. CONCLUSIONS: The partner's absence during, but also after childbirth has a major impact on psychological outcomes. Particularly, higher rates of anxiety and PTSS can lead to negative consequences for mothers and their children. Therefore, it is strongly recommended to relax visitation bans and avoid unaccompanied births. Psychological treatment in obstetric units is more urgently needed than ever, especially for women with a caesarean section.

Trait anxiety and unplanned delivery mode enhance the risk for childbirth-related post-traumatic stress disorder symptoms in women with and without risk of preterm birth: A multi sample path analysis.

Childbirth-related post-traumatic stress disorder (CB-PTSD) occurs in 3-7% of all pregnancies and about 35% of women after preterm birth (PTB) meet the criteria for acute stress reaction. Known risk factors are trait anxiety and pain intensity, whereas planned delivery mode, medical support, and positive childbirth experience are protective factors. It has not yet been investigated whether the effects of anxiety and delivery mode are mediated by other factors, and whether a PTB-risk alters these relationships. 284 women were investigated antepartum and six weeks postpartum (risk-group with preterm birth (RG-PB) N = 95, risk-group with term birth (RG-TB) N = 99, and control group (CG) N = 90). CB-PTSD symptoms and anxiety were measured using standardized psychological questionnaires. Pain intensity, medical support, and childbirth experience were assessed by single items. Delivery modes were subdivided into planned vs. unplanned delivery modes. Group differences were examined using MANOVA. To examine direct and indirect effects on CB-PTSD symptoms, a multi-sample path analysis was performed. Rates of PTS were highest in the RG-PB = 11.58% (RG-TB = 7.01%, CG = 1.1%). MANOVA revealed higher values of CB-PTSD symptoms and pain intensity in RG-PB compared to RG-TB and CG. Women with planned delivery mode reported a more positive birth experience. Path modeling revealed a good model fit. Explained variance was highest in RG-PB (R2 = 44.7%). Direct enhancing effects of trait anxiety and indirect reducing effects of planned delivery mode on CB-PTSD symptoms were observed in all groups. In both risk groups, CB-PTSD symptoms were indirectly reduced via support by medical staff and positive childbirth experience, while trait anxiety indirectly enhanced CB-PTSD symptoms via pain intensity in the CG. Especially in the RG-PB, a positive birth experience serves as protective factor against CB-PTSD symptoms. Therefore, our data highlights the importance of involving patients in the decision process even under stressful birth conditions and the need for psychological support antepartum, mainly in patients with PTB-risk and anxious traits. Trial registration number: NCT01974531 (ClinicalTrials.gov identifier).

Effects of a stand-alone web-based electronic screening and brief intervention targeting alcohol use in university students of legal drinking age: A randomized controlled trial.

BACKGROUND: Many intervention efforts targeting student drinking were developed to address US college students, which usually involves underage drinking. It remains unclear, if research evidence from these interventions is generalizable to university and college students of legal drinking age, e.g., in Europe. OBJECTIVE: To evaluate the effectiveness of a translated and adapted version of the eCHECKUP TO GO, applied as stand-alone web-based electronic screening and brief intervention (e-SBI), in German university students at risk for hazardous drinking. METHODS: A fully automated web-based two-arm parallel-group randomized controlled trial was conducted. Participants were randomized to an e-SBI or assessment-only (AO) condition. The current paper analyzed students with baseline AUDIT-C scores ≥3 for women and ≥4 for men (sample at baseline: e-SBI [n=514], AO [n=467]; 3-month follow-up: e-SBI [n=194], AO [n=231]; 6-month follow-up: e-SBI [n=146], AO [n=200]). The primary outcome was prior four weeks' alcohol consumption. Secondary outcomes were frequency of heavy drinking occasions, peak blood alcohol concentration, and number of alcohol-related problems. RESULTS: Mixed linear model analyses revealed significant interaction effects between groups and time points on the primary outcome after 3 and 6months. Compared to students in the AO condition, students in the e-SBI condition reported consuming 4.11 fewer standard drinks during the previous four weeks after 3months, and 4.78 fewer standard drinks after 6months. Mixed results were found on secondary outcomes. CONCLUSIONS: The results indicate that evidence on and knowledge of web-based e-SBIs based on US college student samples is transferable to German university students of legal drinking age. However, knowledge of what motivates students to complete programs under voluntary conditions, although rare, is needed.

Disentangling the Common Variance of Perfectionistic Strivings and Perfectionistic Concerns: A Bifactor Model of Perfectionism.

Perfectionism nowadays is frequently understood as a multidimensional personality trait with two higher-order dimensions of perfectionistic strivings and perfectionistic concerns. While perfectionistic concerns are robustly found to correlate with negative outcomes and psychological malfunctioning, findings concerning the outcomes of perfectionistic strivings are inconsistent. There is evidence that perfectionistic strivings relate to psychological maladjustment on the one hand but to positive outcomes on the other hand as well. Moreover, perfectionistic strivings and perfectionistic concerns frequently showed substantial overlap. These inconsistencies of differential relations and the substantial overlap of perfectionistic strivings and perfectionistic concerns raise questions concerning the factorial structure of perfectionism and the meaning of its dimensions. In this study, several bifactor models were applied to disentangle the common variance of perfectionistic strivings and perfectionistic concerns at the item level using Hill et al.'s (2004) Perfectionism Inventory (PI). The PI measures a broad range of perfectionism dimensions by four perfectionistic strivings and four perfectionistic concerns subscales. The bifactor-(S - 1) model with one general factor defined by concern over mistakes as the reference facet, four specific perfectionistic strivings factors, and three specific perfectionistic concerns factors showed acceptable fit. The results revealed a clear separation between perfectionistic strivings and perfectionistic concerns, as the general factor represented concern over mistakes, while the perfectionistic strivings factors each explained a substantial amount of reliable variance independent of the general factor. As a result, factor scores of the specific perfectionistic strivings factors and the general factor had differential relationships with achievement motivation, neuroticism, conscientiousness, and self-efficacy that met with theoretical expectations, while results for manifest subscale scores were ambiguous. Our results question the existence of reliable sub-constructs of perfectionistic concerns independent of the general factor when defined by concern over mistakes.

A template model of embodiment while dreaming: Proposal of a mini-me.

Dreams are usually centered around a dream self capable of tasks generally impossible in waking, e.g. flying or walking through walls. Moreover, the bodily dream self appears relatively stable and insensitive to changes of the embodied wake self, raising the question of whether and to what extent the dream self is embodied. To further explore its determinants, we tested whether the dream self would be affected by either pre-sleep focused attention to a body part or by its experimental alteration during the day. Choosing a repeated-measures design, we analyzed how often key words reflecting the experimental manipulations appeared in the dream reports. Results suggest that the dream self is not affected by these manipulations, strengthening the hypothesis that, in the majority of dreams, the dream self is only weakly embodied, utilizing a standard template of embodiment akin to a prototype of self operating independently from the physical waking self.

Risk and protective factors for antepartum and postpartum depression: a prospective study.

INTRODUCTION: Antepartum risk and protective factors for postpartum depression (PPD; the most common mental disorder after childbirth besides postpartum anxiety), have been frequently investigated in cross-sectional studies, but less often longitudinally. This study examined linear and moderator effects of risk and protective factors for peripartum depression. First, we investigated the predictive power of risk factors (physical problems during pregnancy, pregnancy-related anxiety, stressful life events, dysfunctional self-consciousness (DSC)) and protective factors (resilience, social support) for antepartum depression (APD) and PPD. Second, as DSC plays an important role in major depression, we examined whether the protective factors moderate the association between the risk factors DSC and APD as well as PPD. METHODS: We conducted a prospective study with three measurement time points: six weeks antepartum (N = 297), as well as six weeks (N = 278) and twelve weeks (N = 266) postpartum. Direct and moderator effects on APD were analyzed using hierarchical regression analysis. Moderated mediation effects were investigated to explore whether the indirect, long-term effect of DSC on PPD six weeks after birth (PPD-6) and PPD twelve weeks after birth (PPD-12) is moderated by resilience. RESULTS: Predictors for APD were high DSC, high concerns about one's appearance, low resilience and low social support. Resilience buffered (weakened) the impact of DSC on APD and affected PPD-6 and PPD-12 indirectly through APD. DISCUSSION: The results suggest that PPD-12 is influenced directly and indirectly through PPD-6 by APD, but that this effect depends upon risk and protective factors, especially on the combined effects of resilience and DSC. The key finding of our study is the moderating (i.e. weakening) effect of resilience on the relationship between DSC and depression. Resilience and DSC may be an important issue for depression prevention and treatment programs in the peripartum period.

Longitudinal effects of dysfunctional perfectionism and avoidant personality style on postpartum mental disorders: Pathways through antepartum depression and anxiety.

BACKGROUND: There is first evidence that some personality characteristics raise the risk of postpartum depression (PPD). The present longitudinal study investigates whether dysfunctional perfectionism and avoidant personality style predict PPD, postpartum anxiety (PPA) and bonding impairment (BI) directly or indirectly through antepartum anxiety (APA) and antepartum depression (APD). METHODS: Pregnant women were recruited in two obstetric departments in Germany. The assessment occurred at two measurement time points: In the third trimester of pregnancy (N=297) and twelve weeks postpartum (N=266). Six questionnaires were administered during pregnancy: perfectionism, personality styles, anxiety, and depression. Postpartum, data on PPA, PPD and BI were collected. We conducted two path analyses in order to examine direct and indirect effects of the two personality characteristics on postpartum disorders. RESULTS: Testing for direct effects of dysfunctional perfectionism and avoidant personality style on PPD, PPA, and BI did not yield significant results. Instead, significant indirect effects were found: PPD, PPA, and BI were influenced indirectly by dysfunctional perfectionism and avoidant personality style via APD and APA. This model explained high portions of the variance of PPD, PPA, and impaired bonding. Each of the two personality characteristics explained a unique part of the outcome measures. The influence on BI was mediated by PPD. APD affected PPD and PPA more strongly than APA. LIMITATION: Path models with manifest (observed) variables may lead to measurement errors. Self-rating questionnaires may raise the problem of social desirability. CONCLUSION: Dysfunctional perfectionism and avoidant personality style are significant risk factors for PPD, PPA, and BI. Screenings of both variables, as well as of APA and APD, which mediated the effect of personality traits on postpartum syndromes, are necessary.

Evaluation of model fit in nonlinear multilevel structural equation modeling.

Evaluating model fit in nonlinear multilevel structural equation models (MSEM) presents a challenge as no adequate test statistic is available. Nevertheless, using a product indicator approach a likelihood ratio test for linear models is provided which may also be useful for nonlinear MSEM. The main problem with nonlinear models is that product variables are non-normally distributed. Although robust test statistics have been developed for linear SEM to ensure valid results under the condition of non-normality, they have not yet been investigated for nonlinear MSEM. In a Monte Carlo study, the performance of the robust likelihood ratio test was investigated for models with single-level latent interaction effects using the unconstrained product indicator approach. As overall model fit evaluation has a potential limitation in detecting the lack of fit at a single level even for linear models, level-specific model fit evaluation was also investigated using partially saturated models. Four population models were considered: a model with interaction effects at both levels, an interaction effect at the within-group level, an interaction effect at the between-group level, and a model with no interaction effects at both levels. For these models the number of groups, predictor correlation, and model misspecification was varied. The results indicate that the robust test statistic performed sufficiently well. Advantages of level-specific model fit evaluation for the detection of model misfit are demonstrated.

Consistent Partial Least Squares for nonlinear structural equation models.

Partial Least Squares as applied to models with latent variables, measured indirectly by indicators, is well-known to be inconsistent. The linear compounds of indicators that PLS substitutes for the latent variables do not obey the equations that the latter satisfy. We propose simple, non-iterative corrections leading to consistent and asymptotically normal (CAN)-estimators for the loadings and for the correlations between the latent variables. Moreover, we show how to obtain CAN-estimators for the parameters of structural recursive systems of equations, containing linear and interaction terms, without the need to specify a particular joint distribution. If quadratic and higher order terms are included, the approach will produce CAN-estimators as well when predictor variables and error terms are jointly normal. We compare the adjusted PLS, denoted by PLSc, with Latent Moderated Structural Equations (LMS), using Monte Carlo studies and an empirical application.

Relapses in recurrent depression 1 year after maintenance cognitive-behavioral therapy: the role of therapist adherence, competence, and the therapeutic alliance.

The prevention of relapse in recurrent depression is considered a central aim in cognitive-behavioral therapy, given the high risk of relapse. In this study, patients with recurrent major depressive disorder (currently remitted) received 16 sessions of Maintenance Cognitive-Behavioral Therapy (M-CBT) over a period of 8 months, in order to prevent relapse. Therapist adherence and competence, as well as the therapeutic alliance, were investigated as predictors for reducing the risk of recurrence in depression. Videotapes of 80 participants were analyzed in order to evaluate therapist adherence and competence. Additionally, the therapeutic alliance was assessed by questionnaire. No associations were found between therapist adherence or competence, and the risk of relapse 1 year after treatment. By contrast, the therapeutic alliance was a significant predictor of the time to relapse. Moreover, we found that the number of previous depressive episodes (≥ 5 vs. ≤ 4) was a significant moderator variable. This indicates that the alliance-outcome relationship was particularly important when patients with five or more previous depressive episodes were taken into account, in comparison to patients with four or fewer episodes. For the psychotherapeutic treatment of recurrent depression and the prevention of relapse, sufficient attention should be paid to the therapeutic alliance.

Super-leadership and work enjoyment: direct and moderated influences.

Super-leadership is part of an approach called 'empowering leadership.' Within this approach, super-leadership is assumed to enable subordinates to lead themselves. The current study examined correlates of super-leadership. A questionnaire measuring two dimensions of super-leadership was used to analyze relationships between super-leadership and subordinates' work enjoyment, i.e., job satisfaction, subjective well-being, and emotional organizational commitment. In addition, moderating effects of the organizational context, i.e., organizational decentralization, on the relationships between super-leadership and work enjoyment were explored. 198 German employees from different occupations participated in the study. Latent moderator structural equation analysis revealed that the two factors of super-leadership, "coaching and communicative support" and "facilitation of personal autonomy and responsibility," had direct positive effects on subordinates' work enjoyment. Organizational decentralization moderated the effect of "coaching and communicative support" on work enjoyment but not the relations involving "facilitation of personal autonomy and responsibility." Conclusions for further research and practical applications were discussed.

Measuring consciousness in dreams: the lucidity and consciousness in dreams scale.

In this article, we present results from an interdisciplinary research project aimed at assessing consciousness in dreams. For this purpose, we compared lucid dreams with normal non-lucid dreams from REM sleep. Both lucid and non-lucid dreams are an important contrast condition for theories of waking consciousness, giving valuable insights into the structure of conscious experience and its neural correlates during sleep. However, the precise differences between lucid and non-lucid dreams remain poorly understood. The construction of the Lucidity and Consciousness in Dreams scale (LuCiD) was based on theoretical considerations and empirical observations. Exploratory factor analysis of the data from the first survey identified eight factors that were validated in a second survey using confirmatory factor analysis: INSIGHT, CONTROL, THOUGHT, REALISM, MEMORY, DISSOCIATION, NEGATIVE EMOTION, and POSITIVE EMOTION. While all factors are involved in dream consciousness, realism and negative emotion do not differentiate between lucid and non-lucid dreams, suggesting that lucid insight is separable from both bizarreness in dreams and a change in the subjectively experienced realism of the dream.

Reliability of adherence and competence assessment in cognitive behavioral therapy: influence of clinical experience.

The use of highly experienced expert judges was suggested for the assessment of therapists' adherence and competence. However, such an approach implies high costs. It can be questioned whether only experts are able to evaluate therapists' adherence and competence reliably. To test this, 4 judges evaluated therapist adherence and competence in 30 randomly selected videotapes of cognitive therapy sessions for depression. In that, 2 judges exhibited high clinical experience (experts), whereas 2 judges did not (novices). We could demonstrate that novices evaluated an aggregated adherence and competence measure with high reliability. However, several adherence and competence aspects were not assessed with satisfactory reliability by novices. Although adherence ratings of experts and novices showed high concordance, the concordance of competence ratings was only moderate. Results revealed that therapists' adherence could be evaluated satisfactorily by trained novices with some restrictions, but not their competence.

The factor structure of the Social Interaction Anxiety Scale and the Social Phobia Scale.

The Social Interaction Anxiety Scale (SIAS) and the Social Phobia Scale (SPS) are two compendium measures that have become some of the most popular self-report scales of social anxiety. Despite their popularity, it remains unclear whether it is necessary to maintain two separate scales of social anxiety. The primary objective of the present study was to examine the factor analytic structure of both measures to determine the factorial validity of each scale. For this purpose, we administered both scales to 577 patients at the beginning of outpatient treatment. Analyzing both scales simultaneously, a CFA with two correlated factors showed a better fit to the data than a single factor model. An additional EFA with an oblique rotation on all 40 items using the WLSMV estimator further supported the two factor solution. These results suggest that the SIAS and SPS measure similar, but not identical facets of social anxiety. Thus, our findings provide support to retain the SIAS and SPS as two separate scales.

Waking and dreaming: related but structurally independent. Dream reports of congenitally paraplegic and deaf-mute persons.

Models of dream analysis either assume a continuum of waking and dreaming or the existence of two dissociated realities. Both approaches rely on different methodology. Whereas continuity models are based on content analysis, discontinuity models use a structural approach. In our study, we applied both methods to test specific hypotheses about continuity or discontinuity. We contrasted dream reports of congenitally deaf-mute and congenitally paraplegic individuals with those of non-handicapped controls. Continuity theory would predict that either the deficit itself or compensatory experiences would surface in the dream narrative. We found that dream form and content of sensorially limited persons was indifferent from those of non-handicapped controls. Surprisingly, perceptual representations, even of modalities not experienced during waking, were quite common in the dream reports of our handicapped subjects. Results are discussed with respect to feedforward mechanisms and protoconsciousness theory of dreaming.

The moderator effect that wasn't there: statistical problems in ambivalence research.

Ambivalence researchers often collapse separate measures of positivity and negativity into a single numerical index of ambivalence and refer to it as objective, operative, or potential ambivalence. The authors argue that this univariate approach to ambivalence models undermines the validity of subsequent statistical analyses because it confounds the effects of the index and its components. To remedy this situation, they demonstrate how the assumptions underlying the indices derived from the conflicting reactions model and similarity-intensity model can be tested using a multivariate approach to ambivalence models. On the basis of computer simulations and reanalyses of published moderator effects, the authors show that the frequently reported moderating influence of ambivalence on attitude effects may be a statistical artifact resulting from unmodeled correlations of positivity and negativity with attitude and the dependent variable. On the basis of extensive power analyses, they conclude that it may be extremely difficult to detect moderator effects of ambivalence in observational data. Therefore, they encourage ambivalence researchers to take an experimental approach to study design and a multivariate approach to data analysis.

Pain regulation and health-related quality of life after thoracolumbar fractures of the spine.

Fractures of the thoracolumbar spine rank among the severest injuries of the human skeleton. Especially in younger patients they often result from high-energy accidents. Recently, a shift in paradigm towards more aggressive treatment strategies including anterior procedures could be observed. However, so far only few data exist reflecting the quality of life (QoL) after such injuries. The aim of this study was to evaluate medium-term QoL and further to identify factors that influence the clinical outcome in patients with fractures of the thoracolumbar spine. Data of 906 patients who were treated during a 10-year period in our institution were evaluated retrospectively. Only patients with single-level traumatic injuries aged between 18 and 65 years without neurological deficits, concomitant injuries of other locations and internal comorbidities were included into the investigation (n = 204). Three different treatment groups (i.e. non-operative, dorsal and dorsoventral stabilisation) were compared to healthy controls as well as different pain populations. The QoL was assessed using established questionnaires (SF-36, HFAQ, VAS-Spinescore, PRQ, and PTSD). Sixty-five percent of the included patients (n = 133) were studied at an average follow-up of 5.3 +/- 1.7 years after injury. All treatment groups revealed an identical gender and age distribution. More severe and unstable injuries were found in the surgical groups associated with higher treatment costs and a longer inability to work. Compared to healthy controls, QoL was compromised to the same extent in all groups. Furthermore, all patients treated in this study did significantly better than low back pain individuals with regard to QoL and pain regulation parameters. In our study, patients with thoracolumbar spine fractures showed a reduced QoL compared to healthy controls. Thus, patients do not seem to regain their former QoL. However, the level of discomfort was comparably low in all groups, even in patients with more severe injuries requiring extensive surgery. Overall, outcome and QoL after traumatic fractures of the thoracolumbar spine rather seem to be determined by the severity of injury than by pain regulation or other psychosocial factors which is likely the case in low back pain disorders.

Intrapersonal conflict in goals and values of patients with unipolar depression.

BACKGROUND: Although increased conflicts between attitudes and beliefs about certain goals or values are often discussed as important factors in depression, there are only few empirical studies investigating these relations among patients with depressive disorders. METHODS: In the present study, we used the Intrapersonal Conflict Test to assess cognitive inconsistencies in goals or values. A total of 53 inpatients with unipolar depression and 24 nondepressed controls (inpatients of an internal and a surgery ward) participated in the study. In addition to the Intrapersonal Conflict Test, patients completed the Beck Depression Inventory, the Dysfunctional Attitude Scale, the Inventory of Interpersonal Problems as well as the Problem Solving Inventory. RESULTS: Compared with controls, patients with depressive disorders showed significantly higher scores for global inconsistencies, inconsistencies within different goals/values, as well as between goals/values and their perceived realization. Significant correlations were found between conflict measures and the Inventory of Interpersonal Problems, as well as the Problem Solving Inventory. Path analyses show that group differences in intrapersonal conflicts were partially mediated by interpersonal problems but not by depressive symptoms or cognitive vulnerability factors. CONCLUSIONS: Given the cross-sectional design of the study, the findings of this exploratory study do not allow for conclusions regarding the role of intrapersonal conflicts in the development and course of depression. Nevertheless, the high levels of intrapersonal conflicts observed in the study suggest that inconsistencies in goals or values should be considered in the psychological treatment of depression.

Decomposing person and occasion-specific effects: an extension of latent state-trait (LSI) theory to hierarchical LST models.

An extension of latent state-trait (LST) theory to hierarchical LST models is presented. In hierarchical LST models, the covariances between 2 or more latent traits are explained by a general 3rd-order factor, and the covariances between latent state residuals pertaining to different traits measured on the same measurement occasion are explained by 2nd-order latent occasion-specific factors. Analogous to recent developments in multitrait-multimethod methodology, all factors are interpreted in relation to factors taken as comparison standards. An empirical example from test anxiety research illustrates how estimates of additive variance components due to general trait, specific trait, occasion, state residual, method, and measurement error can be obtained using confirmatory factor analysis. Advantages and limitations of these models are discussed.