Sources of Social Support and Trauma Recovery: Evidence for Bidirectional Associations from a Recently Trauma-Exposed Community Sample.

Although the association between post-traumatic stress disorder (PTSD) and social support is well documented, few studies have tested the causal pathways explaining this association at several points in the acute post-trauma recovery period or examined whether the association varies for different sources of social support. To address these gaps, 151 community individuals (mean age = 37.20 years, 69.5% women) exposed to trauma within the previous 6 months were recruited to complete measures of PTSD and social support from intimate partners, friends, and relatives four times in 1 year. In line with recent recommendations for research on social support and PTSD symptoms, random intercept cross-lagged panel modeling (RI-CLPM) was used to examine dynamic changes between PTSD severity and social support over time. The pattern of RI-CLPM cross-lagged coefficients indicated that positive deviations from one's expected stable level of total social support (across all sources) sped up the recovery of PTSD symptoms at the end of the post-trauma year, and more severe PTSD symptoms than expected based on one's expected stable level of PTSD started eroding social support midway through the assessment year. When specific sources of social support were analyzed separately, the association between within-person increases in social support from friends at any given time point accelerated the recovery from PTSD across the entire year. Among participants with intimate partners (n = 53), intimate partner support did not predict PTSD symptoms, but more severe PTSD symptoms at any given time point predicted less support at the following time point. Results from this longitudinal study provide additional support for the bidirectional relationship between PTSD and social support over time and suggest that perceived social support from friends may be especially helpful during trauma recovery.

Identifying Social Network Characteristics Associated With Youth Physical Activity Skill Competency at a Summer Care Program.

While literature suggests that youth physical activity (PA) behaviors are affected by network influences, less is known about network influences on perceived skill competency, a component of physical literacy and self-efficacy. This study aims to provide an understanding of potential network characteristics which are associated with youth PA skill competency. Youth (n = 158) between the ages of 8 and 12 years recruited from two summer care programs (i.e., Boys & Girls Clubs) participated in researcher-administered surveys. Youth self-reported their age, sex, involvement in team sports, weekly PA, and skill competency assessed using a version of the PLAYself measure. Youth were also asked to report up to five people in the summer program and five out of the program with whom they interacted the most. Linear regression was used to evaluate associations between skill competency and demographics, PA, and social network characteristics. Skill competency was significantly associated (R2 = .17) with age (ß = -.06, p = .01), sex (ß = -.06, p = .01), sports team involvement (ß = .16, p < .001), and weekly PA (ß = -.20, p < .001). Skill competency was also significantly associated with the number of connections with whom the youth played frequently (ß = .09, p < .001), the number of connections that helped the youth to be active (ß = .18, p < .001), and the heterogeneity of the type of relationships within the youth's network (ß = .11, p < .001). Skill competency scores were significantly associated with both individual variables and social network composition. In addition, youth with networks comprising several types of relationships (heterogeneity) reported a significantly high skill competency. PA interventions can be most effective when considering the reinforcing aspects of networks and skill competency.

The social contexts of behaviors and relationships: The relation of classroom and cyber victimization to number of classroom and cyber friends.

Behaviors and relationships exist within a variety of social contexts. More specifically for the current research, victimization and friendships occur in classrooms and, increasingly, in online virtual contexts. The current research examined how the number of classroom friends and number of cyber friends related to the extent of classroom victimization and extent of cyber victimization. Research has demonstrated the importance of face-to-face friendships in relation to being a victim; much less is known about the role of cyber friends in relation to being a cyber victim or how these relationships may play a role in cross-context victimization. Participants were 350 children from Grades 3 through 5 (188 girls and 162 boys). Children indicated classroom friends on a classroom roster, reported the number of their cyber friends, and indicated the extent of their cyber victimization. Peers nominated classmates for classroom victimization behaviors. A path analysis revealed that number of classroom friends was negatively associated with both extent of classroom victimization and extent of cyber victimization. Number of cyber friends was positively associated with extent of cyber victimization and was negatively related to extent of classroom victimization. Discussion of results includes the construction, use, and adaptation of social skills within and between social contexts.

Imported malaria: A 20-year retrospective study from a tertiary public hospital in Brussels, Belgium.

BACKGROUND: Malaria continues to cause a significant number of infections in non-endemic regions. In this paper, we describe the epidemiological trend and morbidity of imported malaria diagnosed in a tertiary hospital in Brussels. METHODS: We conducted a retrospective study describing a cohort of malaria episodes (in- and outpatients) at Centre Hospitalier Universitaire Saint-Pierre from 1998 to 2017. Epidemiological and clinical data were collected by reviewing medical files. RESULTS: A total of 1011 malaria episodes were analyzed. Median age at diagnosis was 35 years, and 66 % of patients were men (672/1011). Malaria cases significantly increased over the two decades (from 17 in 1998 to 79 in 2017). Plasmodium falciparum malaria was most often diagnosed (846/935, 89 %), primarily from Central (530/935, 57 %) and West Africa (324/935, 35 %). Many cases (383/764, 50 %) were diagnosed in patients "visiting friends and relatives". HIV-infected and other immunocompromised patients were significantly more likely to present with severe malaria (at least one severity criteria as defined by the WHO) compared to other patients (24/57, 42 % vs 138/732, 19 %, p < 0.01 and 15/21, 71 % vs 147/767, 19 %, p < 0.001). Severe malaria was diagnosed in 16.9 % and the mortality rate was low (5/1011, 0.5 %). CONCLUSION: Imported malaria increased over the years with a large, albeit stable number of cases diagnosed in patients visiting friends and relatives. These findings, along with the high rate of severe malaria in HIV and immunocompromised patients, underscore an urgent need for strengthened malaria surveillance and targeted preventive interventions.

The association between neighborhood-level social fragmentation and distressing psychotic-like experiences in early adolescence: the moderating role of close friends.

BACKGROUND: Early exposure to neighborhood social fragmentation has been shown to be associated with schizophrenia. The impact of social fragmentation and friendships on distressing psychotic-like experiences (PLE) remains unknown. We investigate the relationships between neighborhood social fragmentation, number of friends, and distressing PLE among early adolescents. METHODS: Data were collected from the Adolescent Brain Cognitive Development Study. Generalized linear mixed models tested associations between social fragmentation and distressing PLE, as well as the moderating role of the number of total and close friends. RESULTS: Participants included 11 133 adolescents aged 9 to 10, with 52.3% being males. Greater neighborhood social fragmentation was associated with higher levels of distressing PLE (adjusted ß = 0.05; 95% CI: 0.01-0.09). The number of close but not total friends significantly interacted with social fragmentation to predict distressing PLE (adjusted ß = -0.02; 95% CI: -0.04 to <-0.01). Among those with fewer close friends, the association between neighborhood social fragmentation and distressing PLE was significant (adjusted ß = 0.07; 95% CI: 0.03-0.11). However, among those with more close friends, the association was non-significant (adjusted ß = 0.03; 95% CI: -0.01 to 0.07). CONCLUSIONS: Greater neighborhood social fragmentation is associated with higher levels of distressing PLE, particularly among those with fewer close friends. Further research is needed to disentangle aspects of the interaction between neighborhood characteristics and the quality of social interactions that may contribute to psychosis, which would have implications for developing effective interventions at the individual and community levels.

Soil exposure modulates the immune response to an influenza challenge in a mouse model.

There is increasing evidence that early life microbial exposure aids in immune system maturation, more recently known as the "old friends" hypothesis. To test this hypothesis, 4-week-old mice were exposed to soils of increasing microbial diversity for four weeks followed by an intranasal challenge with either live or heat inactivated influenza A virus and monitored for 7 additional days. Perturbations of the gut and lung microbiomes were explored through 16S rRNA amplicon sequencing. RNA-sequencing was used to examine the host response in the lung tissue through differential gene expression. We determined that compared to the gut microbiome, the lung microbiome is more susceptible to changes in beta diversity following soil exposure with Lachnospiraceae ASVs accounting for most of the differences between groups. While several immune system genes were found to be significantly differentially expressed in lung tissue due to soil exposures, there were no differences in viral load or weight loss. This study shows that exposure to diverse microbial communities through soil exposure alters the gut and lung microbiomes resulting in differential expression of specific immune system related genes within the lung following an influenza challenge.

Study protocol for the Screen-Free Time with Friends Feasibility Trial.

BACKGROUND: Children are spending less leisure time with their friends in person and an increasing amount of time with digital screens. These changes may negatively affect children's physical and mental health. The Screen-Free Time with Friends Feasibility Trial will test the feasibility, including acceptability and compliance, of an intervention designed to reduce screen media usage and encourage physical interaction with friends during leisure time in 9-11-year-old children. METHODS: A non-randomized single-group feasibility trial will be conducted from March to October 2023 including approximately 75 children (aged 9-11 years) and 75 parents (at least 1 per child) from 3 different schools recruited from 3 different municipalities in Denmark. The Screen-Free Time with Friends intervention is a multicomponent intervention targeting families, afterschool clubs, and local communities. It has been developed using a systematic process guided by the Medical Research Council UK's framework for developing and evaluating complex interventions. With a systems perspective in mind, the intervention and implementation approach has been designed to facilitate adaptation to the specific needs of diverse local communities while maintaining the core components of the intervention. Feasibility and acceptability of the intervention will be assessed during the intervention using process evaluation inspired by the RE-AIM framework including questionnaires and interviews with the municipality project managers, research team members, local ambassadors and stakeholders, parents and school, and afterschool club personnel. In addition, participation, recruitment, retention rate, and compliance to the outcome measurements will be investigated and presented. DISCUSSION: The trial will investigate the feasibility and acceptability of the Screen-Free Time with Friends intervention, the recruitment strategy, and the planned outcome measurements. This feasibility study will investigate necessary refinements before the implementation of the intervention program in a larger cluster randomized controlled trial to evaluate its impact. CLINICALTRIALS: gov, ID: NCT05480085. Registered 29 July 2022. https://clinicaltrials.gov/ct2/show/NCT05480085?cond=Screen+free+time+with+friends&draw=2&rank=1.

How Do Social Relationships Affect Later Life Planning?

Relatively little is known about how social relationships affect later life planning. Our study focuses on an underexamined aspect of social relationships, frequency of contact - not only with family members but also with friends. Using data from a survey of Floridians aged 50 and older conducted between December 2020 and April 2021 (n = 3,832), we examine the association between frequency of contact and five planning types: finances, health care, living arrangements, driving retirement, and end-of-life. We found that more frequent contact was associated with greater likelihood of planning, and this result was largely consistent across types of relationships and types of planning. Our findings suggest that contact with family members and friends may encourage more planning, which could reduce the stress that can accompany later life transitions. Our study offers further evidence of social relationships' centrality to later life well-being and points to the many benefits of enhancing them.

Longitudinal Associations Between Support and Prosocial Behavior Across Adolescence: The Roles of Fathers, Mothers, Siblings, and Friends.

Family members and friends can play an important role in adolescents' prosocial behavior. To better understand the relation between support and prosocial behavior in adolescence, it's important to conduct longitudinal studies that distinguish between within-dyad variance and between-dyad variance. The current study investigated longitudinal associations between adolescents' prosocial behavior, autonomy support, and emotional support from family and friends across adolescence. Across six annual years, 497 Dutch adolescents (284 boys; mean age T1 = 13.03 years, SDage = 0.46), fathers, mothers, siblings, and friends reported on their prosocial behavior. Adolescents also reported on perceived autonomy and emotional support. Between-dyads almost all associations of support and prosocial behavior of family members and friends with adolescents' prosocial behavior were significant, with higher levels of adolescents' prosocial behavior being associated with higher levels of prosocial behavior and support from fathers, mothers and friends. Within-dyads, several concurrent associations were significant, but within-dyads links between prosocial behavior and autonomy support are particularly driven by adolescent-mother or adolescent-sibling effects. This study highlights processes that occurred either at the between-dyad level or at the within-dyad level, but that varied per relationship type and that adolescents are the main catalysts in within-dyads changes in prosocial behavior and support. Preregistration: This study was preregistered on 20 January 2020 at https://osf.io/vxkm3/?view_only=dca87fd1585c444ba5cd5a00c22280ae .

Resistance to peer influence, smoking friends, cigarette and betel nut use, and gender among Pacific Islander youth.

The present study examined the relationships between resistance to peer influence and cigarette and betel nut use, as well as the potential mediating role of friends who use cigarettes and betel nut, among boys and girls in Guam. This study included 673 ethnically diverse students (49% female; M age = 12.7, SD = 0.89) from eight public middle schools. The mediation analysis demonstrated that higher resistance to peer influence for both cigarette and betel nut use was associated with lower cigarette and betel nut use directly and that this association was mediated by friends who used cigarette and betel nut products. That is, low resistance to peer influence for both cigarette and betel nut use was associated with a greater number of friends who smoke and use betel nut, which was linked with more cigarette and betel nut use. The moderated mediation analysis revealed no gender difference in the indirect effect (i.e., the mediation of friends who used cigarettes and betel nut). These findings can be used to inform the design and implementation of intervention and prevention programs for at-risk youth, regardless of gender, who are vulnerable to substance use in the Pacific.

When intergroup contact correlates with gender-prejudice beliefs of emerging adults.

This study examined whether the contact emerging adults have with same-gender and other-gender friends, and other-gender romantic partners is associated with their sexist and gender-inequality beliefs, and whether these associations are moderated by their gender or gender contentedness (feeling content with one's gender). Dutch emerging adults (N = 381, 18-25 years old, 51% female) completed an online survey. Hierarchical multiple regression analyses revealed that more other-gender contact was associated with less gender-inequality beliefs and with less hostile sexism in people who felt less content with their gender, but with more hostile sexism in people who feel highly content with their gender. More same-gender contact was associated with more benevolent sexism and gender-inequality beliefs, as well as with men's hostile sexism. Contact with romantic partners was not associated with gender-prejudice beliefs. Thus, same-gender contact and other-gender contact with friends each are associated with gender prejudice, depending on gender and gender contentedness.

Peer Influences on (Dis)Engagement in Early Adolescence: the Role of Friendship, Social Status, and Academic Status.

Academic engagement in adolescence is shaped by influences from the peer environment, yet the types of peers impacting engagement remain unclear. This study explores the roles of friends, popular students, and intelligent students in shaping peers' behavioral and emotional (dis)engagement. Data were analyzed from 3409 Flemish eighth-grade students (Mage = 13.48 years, SD = 0.46, 50.09% female), utilizing self-reports and peer nominations to measure (dis)engagement and map friendship, popularity, and intelligence networks in the fall and spring. Longitudinal network analysis revealed that, while accounting for selection and network structure, friends influenced all dimensions of engagement. Popular students influenced emotional disengagement, and intelligent students impacted emotional engagement. These findings underscore the intricate nature of peer dynamics, highlighting the need for a multidimensional approach to studying peer influences on engagement.

Perceiving the outlier in the crowd: The influence of facial identity.

The accurate perception of groups with outliers can help us identify potential risks. However, it is unclear how outliers affect the perception of group emotion. To address this question, we conducted a study on group emotion perception in the context of facial identity. We presented 74 participants with pictures of crowds, and asked them to evaluate the valence ratios and intensity of the crowd by means of the Emotional Aperture Measure. The results revealed that outlier emotions were often overestimated within crowds. Moreover, we found that the emotional expression of a close friend modulated the perception of outliers. Specifically, when a close friend expressed the group emotion, participants overestimated the outlier less than when a close friend expressed the outlier emotion. These results suggest that people can detect outliers within groups, and that their perception of group emotion is influenced by close friends. Thus, we provide evidence that facial identity affects group emotion perception.

Coming Out to Family and Friends in the Trans and Gender Diverse Context.

Despite the risks of rejection and discrimination, "coming out" can be an important psychological milestone for transgender (trans) and gender diverse people (TGD). We evaluated the dimensions of identity that predict coming out to family and friends, and the role of social support in explaining the psychosocial benefits associated with coming out. An online survey was completed by 951 TGD adults, 516 (54.3%) who identify as gender binary (164 transwomen and 352 transmen) and 435 (45.7%) who identify as nonbinary. Overall, gender binary TGD people were more likely than nonbinary people to disclose their identity to family and friends. Hierarchical binary logistic regressions further revealed that appearance congruence and strength of TGD identity are associated with disclosure to family, whereas positive TGD identity is associated with disclosure to friends. Path analyses confirmed that coming out is associated with improved resilience, psychological adjustment, and wellbeing, and that social support is a partial mediator of these associations. The results highlight the importance of coming out in the TGD context and suggest that greater access to social support may account for some of these benefits.

A commentary on children's books about autism: What messages do they send about neurodiversity?

The past three decades have seen an exponential increase in the publication of children's books about autism. This increased availability of children's books is exciting because they have the power to promote understanding, acceptance, and appreciation of neurodiversity. However, growing concerns have been raised by both autistic and non-autistic people that some children's books about autism may work against neurodiversity, rather than promoting it. This Commentary discusses the strikingly different ways in which children's books about autism portray key concepts related to neurodiversity, including autistic differences, agency, abilities, and communication. We present concrete examples (including books by autistic authors); highlight the views of autistic and non-autistic parents of autistic children; and discuss how different books may leave readers with different impressions of autism and neurodiversity. Given the vastly different themes that emerge across different books, we conclude that it is important for educators, families, and other members of the autism community to make informed and individualized choices about what books they use for what purpose. We emphasize the need for systematic, high-quality research on children's books about autism, including content analyses and studies that determine what messages these books send to their intended audience: children. It is vital that autistic people continue to shape this conversation, contributing unique insights that inform research priorities and the methodological approaches used to investigate them.

Age integration in the social convoys of young and late midlife adults.

Homophily on the basis of age is a notable characteristic of social convoys across the life course. Ties to older and younger persons, therefore, are both unusual and potentially provide unique social support resources. This study examined relationships with older, younger, and same-aged non-kin ties among young and late midlife adults. Data came from the University of California Berkeley Social Networks Study (UCNets), a sample of 485 people aged 21-30 and 674 people aged 50-70. A majority of non-kin ties were to people whose age was within 5 years of the participant's own age, although the majority was much larger for young adults (81 %) than late midlife adults (52 %). Younger and older ties often came from different social settings (school, work, religious organizations, and neighborhoods) than same-aged ties, and there were also some cohort differences in the social settings that produced younger, older, and same-aged ties. Younger and older ties also provided different forms of social support than did ties to same-aged persons. Again, the functions of younger and older ties varied by cohort. Implications for life course studies are discussed.

Improving Social Isolation and Loneliness Among Adolescents With Physical Disabilities Through Group-Based Virtual Reality Gaming: Feasibility Pre-Post Trial Study.

BACKGROUND: Adolescents with disabilities experience alarmingly higher rates of depression and isolation than peers without disabilities. There is a need to identify interventions that can improve mental health and isolation among this underserved population. Innovations in virtual reality (VR) gaming "standalone" headsets allow greater access to immersive high-quality digital experiences, due to their relatively low cost. OBJECTIVE: This study had three purposes, which were to (1) examine the preliminary effects of a low-cost, home-based VR multiplayer recreation and socialization on depression, socialization, and loneliness; (2) quantify the acceptability of the program as measured by participant adherence, total play time, and exercise time; and (3) identify and describe behavioral mechanisms that affected participant engagement. METHODS: This was a single-group, pre- to postdesign trial. The intervention was conducted at home. Participants were recruited from a children's hospital. The intervention lasted 4 weeks and included 2×1-hour sessions per week of supervised peer-to-peer gaming. Participants used the Meta Quest 2 headset to meet peers and 2 coaches in a private party held digitally. Aim 1 was evaluated with the Children's Depression Inventory 2 Short Form and the University of California, Los Angeles Loneliness Scale 20 items, which are measures of social isolation and loneliness, respectively. Aim 2 was evaluated through the following metrics: participant adherence, the types of games played, friendship building and playtime, and program satisfaction and enjoyment. RESULTS: In total, 12 people enrolled (mean age 16.6, SD 1.8 years; male: n=9 and female: n=3), and 8 people completed the program. Mean attendance for the 8 participants was 77% (49 sessions of 64 total possible sessions; mean 6, SD 2 sessions). A trend was observed for improved Children's Depression Inventory 2 Short Form scores (mean preintervention score 7.25, SD 4.2; mean postintervention score 5.38, SD 4.1; P=.06; effect size=0.45, 95% CI -0.15 to 3.9), but this was not statistically significant; no difference was observed for University of California, Los Angeles Loneliness Scale 20 items scores. Most participants (7/8, 88%) stated that they became friends with a peer in class; 50% (4/8) reported that they played with other people. Participants reported high levels of enjoyment and satisfaction with how the program was implemented. Qualitative analysis resulted in 4 qualitative themes that explained behavioral mechanisms that determined engagement in the program. CONCLUSIONS: The study findings demonstrated that a brief VR group program could be valuable for potentially improving mental health among adolescents with physical disabilities. Participants built friendships with peers and other players on the web, using low-cost consumer equipment that provided easy access and strong scale-up potential. Study findings identified factors that can be addressed to enhance the program within a larger clinical trial. TRIAL REGISTRATION: ClinicalTrials.gov NCT05259462; https://clinicaltrials.gov/study/NCT05259462. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/42651.

To lose a friend: the relationship between professional help and grief among close bereaved friends after the terror attack, 22 July 2011.

Background: Close friends are often an overlooked group of bereaved people. This study is based on a sub-project on young adults who experienced the loss of a close friend in the terrorist attack on Utøya, Norway, on 22 July 2011.Objective: The aim of this longitudinal study was to explore the relationship between complicated grief reactions, the need for help, and help received after losing a close friend to a traumatic death.Method: In total, data from 89 people (with a mean age of 21 years, 76.4% female) were collected at one or more of the four time-points: 18, 28, 40, and 102 months after the incident. Latent growth modelling was used to analyse levels of grief reactions and change over time, experienced need for help, and help received.Results: According to the results, the bereaved friends in our study were profoundly impacted by the loss and experienced level of reactions indicating complicated grief (mean scores on the Inventory of Complicated Grief varied from 36.2 to 23.7). A need for help was related to a decrease in grief symptoms, whereas a prolonged need for help was related to no reduction or an increase in grief. Received help was not related to decrease in grief symptoms.Conclusions: These findings underscore the need for continuous professional help, and demonstrate that the present help measures used after traumatic events may not adequately meet the needs of close bereaved friends. This emphasizes the importance of acknowledging friends as bereaved and that follow-up measures should also include this group. Finally, the study highlights the need to learn more about how professional can help bereaved friends.

Young adults who experience the traumatic loss of a close friend may experience levels of grief reactions indicating complicated grief.The need for help reported after experiencing the loss of a close friend is high; this is also the case when some time has passed since the loss.Bereaved friends need more acknowledgement, and help measures after traumatic events often do not meet their need for help and follow-up after the loss.

Barriers and Facilitators to Resolving Older Adult Homelessness through Stays with Family: Qualitative findings from the HOPE HOME Study.

Living with family and friends is a common strategy used to prevent or exit homelessness, but little is known about structural barriers that impede family and friends' ability to provide temporary or permanent housing for older homeless adults. We conducted semi-structured interviews with 46 homeless participants from the HOPE HOME study, a cohort of 350 community-recruited homeless adults age 50 or older in Oakland, CA, who reported having stayed with housed family/friends for 1 or more nights in the prior 6 months. We conducted semi-structured interviews with 19 hosts of homeless participants and 11 stakeholders in housing and homelessness. We found that homeless older adults and hosts perceived staying with family or friends as a form of temporary housing rather than as a permanent exit to homelessness. Structural barriers to family and friends providing housing for temporary stays or permanent exits from homelessness included housing regulations restricting visitors and changing rent obligations; decreased eligibility and priority for shelter and permanent housing; geographic and transportation challenges; and environments inconducive to older adults. We suggest four areas for policy reform: providing subsidies to hosts and homeless individuals, removing disincentives for homeless older adults to stay with family, changing lease regulations, and expanding the supply of affordable housing.

Effects of the need fulfillment given by opposite-sex friends on breakup considerations: A moderated mediation model.

The purpose of this study was to investigate the impact of need fulfillment given by opposite-sex friends (NFOF) on breakup considerations, the mediating role of love commitment in this relationship, and the moderating role of need fulfillment given by romantic partners (NFRP). A total of 334 unmarried individuals in romantic relationships from Northwest China were invited to participate in the study. The findings revealed the following: (1) NFOF significantly and positively predicted breakup considerations. (2) This relationship is mediated by love commitment (3) The association between NFOF and breakup considerations was moderated by NFRP (in terms of the first mediation path). Specifically, those who hold higher levels of NFRP are appreciably buffered against the negative impact of NFOF on love commitment. These findings emphasize the crucial role of NFOF and NFRP in shaping love commitment and breakup considerations. Moreover, our research has important realistic implications: NFOF, as a trigger, has a negative effects the quality of romantic relationships and leads to breakup considerations. And, the key to maintaining a romantic relationship is to focus on their partners' need fulfillment as much as possible and increasing the level of their love commitment.