Role of narcissism in parental alienation phenomenon. A narrative review.

Parental Alienation Syndrome (PAS) is a term addressed to describe negative, psychopathological feelings, thinking and behaviours, including hostility and fear, exhibited by children who have been alienated from one parent by the other parent. Despite its relevance in the clinical psychology field, theoretical and empirical contributions to understanding and deepening the many facets of this concept are still few. In particular, literature aimed at disentangling the alienating parent's psychological characteristics is scarce and fragmented. Our contribution encompasses a narrative review of scientific literature since the term PAS was coined in 1987 by Gardner, to delineate narcissistic proneness in alienating parents. Namely, considering the narcissistic drift the western society is going toward, we hypothesised that narcissism has a pivotal role in parents' alienating behaviours against the alienated ones. Firstly, the elements that emerged from our literature search confirmed our theoretical hypothesis, in terms of the likely role of narcissism/narcissistic marked traits in alienating parents. In the second section, we contextualised the phenomenon in a psychodynamic/psychoanalytic theoretical framework. Finally, based on previous findings/considerations, the developmental trajectories of children with PAS have been traced. An improved theoretical knowledge of this phenomenon, also in terms of the psychopathology associated with its genesis, means to refine the diagnostic and treatment tools to prevent it.

Perceived Chronic Social Adversity and Suicidal Ideation Among Chinese College Students: The Moderating Role of Hope.

This study aimed to investigate the relations among perceived chronic social adversity, hope and suicidal ideation among Chinese college students. 535 college students completed the Perceived Chronic Social Adversity Questionnaire (PCSAQ), the Suicidal Ideation Scale (SIS), and the Revised Adult Dispositional Hope Scale (RADHS). The results showed that perceived chronic social adversity was positively associated with suicidal ideation, and hope was negatively associated with suicidal ideation. The results also confirmed that hope negatively moderated the relationship between perceived chronic social adversity and suicidal ideation. Further study showed that there was a significant positive relation between perceived chronic social adversity and suicidal ideation under the low hope level, however, there was a non-significant relation between perceived chronic social adversity and suicidal ideation under the high hope level.

COVID-19 e isolamento social: as implicações na saúde mental de estudantes de enfermagem / COVID-19 and social isolation: implications for undergraduate nursing students' mental health / COVID-19 y aislamiento social: implicaciones para la salud mental de estudiantes de enfermería

Objetivo: avaliar as repercussões da COVID-19 e do isolamento social durante a pandemia na saúde mental de estudantes de graduação em enfermagem. Métodos:estudo descritivo transversal, realizado no Ceará, Brasil, com 347 estudantes. Os dados foram coletados por meio de questionário para obtenção de dados sociodemográficas e informações sobre aspectos relacionados à pandemia, além do Inventário de Saúde Mental-38 (MHI-38). Resultados: percentual de 51,9% dos estudantes continuaram a graduação por meio de atividades de ensino remoto e avaliações on-line e 62,3% acessavam a internet essencialmente pelo celular. Para 76,9% dos estudantes, a maior preocupação era com a morte de um membro da família/amigo. Quanto à saúde mental dos estudantes, os escores na dimensão de Bem-estar Psicológico do MHI-38 foram em média 47,9 (± 16,8) e na dimensão de Sofrimento Psicológico a média foi 52,8 (± 18,5). A média de pontuação global no MHI-38 foi 51,0 (± 16,9), com diferenças entre os sexos (p = 0,039). Conclusão: os estudantes tiveram a saúde mental afetada pela pandemia de COVID-19 e o isolamento social, com maior impacto para as mulheres. Assim, instituições de ensino precisam desenvolver estratégias para monitorar e promover a saúde mental desta população no retorno às aulas no período pós-pandemia.

Objective:to assess the repercussions of COVID-19 and social isolation during the pandemic on undergraduate nursing students' mental health. Methods:a descriptive cross-sectional study, carried out in Ceará, Brazil, with 347 students. Data were collected through a questionnaire to obtain sociodemographic data and information on aspects related to the pandemic, in addition to the Mental Health Inventory-38 (MHI-38). Results:the amount of 51.9% of students continued studying through remote learning activities and online assessments, and 62.3% accessed the internet essentially via cell phones. For 76.9% of students, the greatest concern was the death of a family member/friend. As for students' mental health, the MHI-38 scores in the Psychological Well-Being dimension were on average 47.9 (± 16.8), and in the Psychological Distress dimension, 52.8 (± 18.5). The mean MHI-38's overall score was 51.0 (± 16.9), with differences between sexes (p = 0.039). Conclusion: students had their mental health affected by the COVID-19 pandemic and social isolation, with a greater impact on women. Thus, educational institutions need to develop strategies to monitor and promote this population's mental health when returning to school in the post-pandemic period.

Objetivo: evaluar las repercusiones del COVID-19 y el aislamiento social durante la pandemia en la salud mental de estudiantes de pregrado en enfermería. Métodos: estudio transversal descriptivo, realizado en Ceará, Brasil, con 347 estudiantes. Los datos fueron recolectados a través de un cuestionario para obtener datos sociodemográficos e información sobre aspectos relacionados con la pandemia, además del Inventario de Salud Mental-38 (MHI-38). Resultados: el 51,9% de los estudiantes continuó su graduación a través de actividades de aprendizaje a distancia y evaluaciones en línea y el 62,3% accedió a internet esencialmente a través de sus teléfonos celulares. Para el 76,9% de los estudiantes, la mayor preocupación fue la muerte de un familiar/amigo. En cuanto a la salud mental de los estudiantes, los puntajes en la dimensión del Bienestar Psicológico del MHI-38 fueron en promedio 47,9 (± 16,8) y en la dimensión del Sufrimiento Psicológico el promedio fue 52,8 (± 18,5). La puntuación global media en el MHI 38 fue de 51,0 (± 16,9), con diferencias entre sexos (p = 0,039). Conclusión: los estudiantes tuvieron su salud mental afectada por la pandemia de COVID-19 y el aislamiento social, con mayor impacto en las mujeres. Por lo tanto, las instituciones educativas necesitan desarrollar estrategias para monitorear y promover la salud mental de esta población al regresar a la escuela en el período posterior a la pandemia.

Phubbing, alienation, digital game addiction, independent self-construal, and interdependent self- construal among high school students: a path analysis / Ningufoneo, alienación, adicción a los juegos digitales, autoconstrucción independiente y autoconstrucción interdependiente entre estudiantes de secundaria: un análisis de trayectoria

In this study, the aim is to analyze the relationships between phubbing, alienation, digital game addiction, independent self-construal, and interdependent self-construal among high school students. The sample of the study consists of 1,932 students studying in different high schools in Turkey who were selected by the stratified random sampling method, considering the grade levels and gender variables. The students completed surveys regarding self-construal, digital game addiction, alienation, and phubbing. The data obtained were analyzed by path analysis, one of the structural equation modeling methods. In the research, nine hypotheses were developed for the proposed model based on theoretical knowledge. As a result of the analysis, eight hypotheses were supported, and one was unsupported. According to the findings, digital game addiction had a significant impact on alienation and phubbing; also, alienation had a considerable impact on phubbing. The model explained 16% of the variance (R2= .16) of phubbing, directly and indirectly. This means that the exogenous variables have a moderate level of influence on the endogenous variable. Moreover, alienation had a maximum degree of effect on phubbing.

El objetivo de este estudio es analizar las relaciones entre ningufoneo, alienación, adicción a los juegos digitales, autoconstrucción independiente y autoconstrucción interdependiente entre estudiantes de secundaria. La muestra consta de 1.932 estudiantes de diferentes escuelas secundarias de Turquía, que fueron seleccionados por el método de muestreo aleatorio estratificado considerando los niveles de grado y el sexo. Los estudiantes completaron encuestas sobre autoconstrucción, adicción a los juegos digitales, alienación y ningufoneo. Los datos obtenidos se analizaron mediante análisis de trayectoria, uno de los métodos de modelado de ecuaciones estructurales. En la investigación se desarrollaron nueve hipótesis para el modelo propuesto a partir de conocimientos teóricos. Como resultado del análisis se confirmaron ocho hipótesis y una no se confirmó. Según los hallazgos, la adicción a los juegos digitales tuvo un impacto significativo en la alienación y el ningufoneo; además, la alienación tuvo un impacto considerable en el ningufoneo. El modelo explicó el 16% de la varianza (R2= 0,16) de ningufoneo, directa e indirectamente. Esto significa que las variables exógenas tienen un nivel moderado de influencia sobre la variable endógena. Además, la alienación tuvo un grado máximo de efecto sobre el ningufoneo.

Perspectivas y tendencias actuales del concepto de alienación parental: una revisión sistemática de la literatura / Current perspectives and trends of the concept of parental alienation: a systematic review of the literature

Resumen: Antecedentes: Son diversos las/os investigadoras/es que se han interesado por el fenómeno de la alienación parental. No obstante, esta compleja dinámica relacional no ha estado exenta de controversias. Objetivo: Realizar una revisión sistemática de las perspectivas y tendencias actuales del concepto de alienación parental, sus características y efectos en la población que experimentan estas circunstancias. Método: Se utilizó la metodología PRISMA-P para llevar a cabo una búsqueda bibliográfica exhaustiva de artículos publicados entre el año 2016 y junio de 2020 en revistas indexadas Scopus y/o WOS. Se contemplaron 95 estudios, de los cuales 11 fueron considerados para la revisión, de acuerdo con los criterios de inclusión y exclusión preestablecidos. Se identificó un amplio campo investigativo en el cual se circunscribe la alienación parental, como dinámica relacional. Resultados: Los 11 estudios seleccionados establecían relaciones entre la experiencia de alienación parental e indicadores de salud mental, tanto en niños, niñas, adolescentes, como adultos que experimentan o experimentaron estas dinámicas. Así también, se relacionó con maltrato psicológico. Conclusiones: La alienación parental es un fenómeno con una importante prevalencia en la población y se ha vinculado con un deterioro en la salud mental de las personas que la experimentan o la han experimentado.

Abstract: Background: Several researchers have been interested in the phenomenon of parental alienation. However, this complex relational dynamic has not been without controversy. Objective: To conduct a systematic review of current perspectives and trends on the concept of parental alienation, its characteristics and effects on the population experiencing these circumstances. Method: PRISMA-P methodology was used to conduct an exhaustive literature search of articles published between 2016 and June 2020 in Scopus and/or WOS indexed journals. Ninety-five studies were contemplated, of which 11 were considered for the review, according to the pre-established inclusion and exclusion criteria. A broad field of research was identified in which parental alienation is circumscribed as a relational dynamic. Results: The 11 selected studies established relationships between the experience of parental alienation and mental health indicators, both in children, adolescents and adults who experience or have experienced these dynamics. Thus, it was also related to psychological maltreatment. Conclusions: Parental alienation is a phenomenon with a significant prevalence in the population and has been linked to a deterioration in the mental health of people who experience or have experienced it.

Cultural alienation: A concept analysis.

AIM: To analyze the concept of cultural alienation BACKGROUND: Culturally diverse populations are increasing nationwide. However, many culturally diverse clients have experienced cultural alienation. DESIGN: Rodgerian's method of concept analysis DATA SOURCE: Literature in CINAHL, PubMed, PsycINFO, JSTOR, Scopus, LGBT Life, and Oxford Bibliographic databases were searched. Inclusion criteria were full text, peer-reviewed, English language, and published within 5 years. REVIEW METHODS: Articles were read in their entirety and reread to determine more contextual data. Antecedents, attributes, and consequences were extracted. RESULTS: Fifteen studies were included. Antecedents included: identification with racial, ethnic, sexual minority, disability, chronic illness, and threat to way of life. Attributes were traditional, different, negotiator, preserving, and sustaining. Consequences resulted in sociocultural deprivation, resistance, mistrust, distrust, loss of identity, and racism. CONCLUSIONS: Nurses, health care providers, and communities can better support and engage their clients by working together to create an inclusive environment, in which exists a safe space to work, play, and heal. Findings highlight the need to examine one's own assumptions, inquire about the client's cultural care needs, tailor communication at the client's level, acknowledge individual strengths, provide empathetic support, and promote autonomy.

The Relationship between Frailty, Obesity and Social Deprivation in Non-Institutionalized Elderly People.

BACKGROUND: With the increasing prevalence of obesity and the risk of increased dependency among the elderly, it becomes important to characterize the link between obesity and frailty. The relationship between obesity and social deprivation would be bidirectional, with each influencing the other. OBJECTIVES: Main objective was to study the relationship between frailty as defined by Fried and obesity (Body Mass Index (BMI) and abdominal obesity). Secondary objective was to assess the relationship between frailty and social deprivation. MATERIALS AND METHODS: This was a cross-sectional study, with data collected between January 2014 and December 2015 using a senior periodic health prevention examination form used in the 4 sites of the health examination center, in Rhone, among non-institutionalized seniors (≥ 65 years). Frailty was defined according to Fried's criteria. Obesity was defined by a BMI ≥ 30 kg / m2 and a waist circumference > 88 cm for women and >102 cm for men. We studied the association between obesity according to BMI ≥ 30kg / m2 on the one hand and abdominal obesity on the other hand with frailty according to Fried. The analyzes were adjusted for gender, age, education level, not being in a relationship and social deprivation quantified by the assessment score of deprivation and health inequalities (EPICES score). RESULTS: 1593 senior health prevention examination forms were studied. According to BMI, senior women were almost twice as likely to be frail when obese (RR = 1.92, 95% CI [1.06 - 3.45], p = 0.018). The results were similar for abdominal obesity in women aged 65-74 years (RR = 2.12, 95% CI [1.03-4.35], p = 0.029). There was no relationship in men for both types of obesity. Seniors who were socially deprived were 2.7 times more likely to be frail than non-deprived seniors (adjusted RR = 2.76, 95% CI [1.808 - 4.203], p <0.001). CONCLUSIONS: Obesity (BMI ≥ 30kg / m2 and high waist circumference) was associated with increased frailty among older, non-institutionalized women who came for a periodic health prevention examination. Screening and prevention of obesity in the elderly appears to be a major public health issue, and remains a priority target for action.

Aspects of protection and social vulnerability of teenagers in public all-day schools.

OBJECTIVE: identify and analyze aspects related to social vulnerability of a group of teenagers of a public all-day school with regard to harmful and abusive use of psychoactive drugs. METHODS: a strategic social study, with a qualitative approach, was carried out with 49 teenagers of a public all-day secondary school. Focus groups were carried out between 2016 and 2017, and the resulting material was transcribed and analyzed by means of thematic content analysis, resulting in the following categories: The family I come from; Birds of a feather; If I'm studying, how can I work?; Drugs: a non-parallel universe. RESULTS: social vulnerability was associated with unequal income distribution, fragile social relations affected by the harmful use of drugs and vulnerability of public all-day schools. Final considerations: all-day schools did not appear as an effective tool to break away with the context of social vulnerability regarding the use of drugs.

Sense of community, pathway to, or bridge from alienation?

Psychological Sense of Community (PSOC) represents a formative conceptual offering of Community Psychology to the social sciences. Nearly five decades ago, PSOC offered a window into the influence of ecological factors to understanding the emotional and behavioral well-being of members of disenfranchised and underserved segments of the population, especially members of minority and low-income subgroups. Our discipline's founders viewed PSOC as one promising vehicle for pursuing the desired paradigmatic shift from individual to systemically focused interventions to achieve intended outcomes of the emerging community mental health movement. This Commentary reflects the authors' shared thoughts to the adoption of PSOC by conservative spokespersons to explain the resistance of some to the diversification of the population and growing voice of progressive advocates.

Exploring mentalization, trust, communication quality, and alienation in adolescents.

INTRODUCTION: A growing body of evidence has demonstrated the importance of mentalization for adolescents' psychosocial functioning; however, further research is needed to understand links between mentalization and other socio-cognitive factors. The aim of this quantitative, cross-sectional study was to investigate the relationship between a teen's capacity to mentalize and three attachment-related factors: parent-teen trust, parent-teen communication, and parent-teen alienation. METHODS: In an online survey, 82 (mainly) Australian adolescents (57 female; 23 male; 2 non-binary; mean age 17.09 years) completed: i) The Children's Eyes Test, which measured mentalization; and ii) The Inventory of Parent and Peer Attachment-45, which measured trust, communication quality, and alienation. RESULTS: In teens' relationships with both mothers and fathers, trust and communication quality were significantly positively correlated (p = .001) when controlling for age and gender. Both were significantly negatively correlated with alienation (p = .001) with control variables included. Capacity to mentalize did not correlate with trust, communication quality, or alienation in relationships with either mothers or fathers (p ≤ .05). CONCLUSIONS: Possible reasons are proposed for why no relationship was found between mentalization and trust, communication quality, or alienation. Implications for future research are discussed.

A Meta-Analytic Review of the Association Between Alienation Appraisals and Posttraumatic Stress Disorder Symptoms in Trauma-Exposed Adults.

Ehlers and Clark's (2000) cognitive model of posttraumatic stress disorder (PTSD) highlights the importance of negative appraisals in maintaining posttraumatic stress. Recent research suggests that alienation appraisals, defined as feeling disconnected from the self and others, mediate the association between traumatic experiences and subsequent PTSD symptoms. To our knowledge, no systematic review has yet explored the relation between alienation appraisals and PTSD symptoms in trauma-exposed adults, despite the important clinical implications posed by this association. A systematic search of the SCOPUS, Web of Science, PsycInfo, MEDLINE, CINAHL Plus, and PILOTS databases resulted in 470 studies, nine of which met full inclusion criteria. Studies were quality-assessed for risk of bias using the Quality Assessment Tool for Studies with Diverse Designs (QATSDD) quality assessment tool. A random-effects meta-analysis for the association between alienation appraisals and PTSD symptoms showed a large total effect size, r = .57, 95% CI [.46, .66], z = 8.41, p < .001. This large effect suggests that as alienation appraisals increase, PTSD symptoms increase. Although a strong positive association was found between alienation and PTSD symptoms, the mechanism of this association remains unclear. Limitations of the research included significant heterogeneity across studies and the fact that data were correlational. Future research to explore why alienation appraisals are significant in posttraumatic stress may further help to inform therapeutic approaches to targeting alienation appraisals in trauma survivors. Recommendations are made for the clinical assessment of alienation appraisals when exploring the impact of the traumatic experience on the survivor.

Apocalyptic themes in times of trouble: when young men are deeply alienated.

Boys and young men more frequently live out aspects of their psychic and social alienation online. This paper explores some of the risks and dangers that can arise from retreats into the two-dimensional world of cyberspace. It focuses more specifically on videogaming called MOBA, multi-player online battle arena games, in which players point and shoot at others. A case example emphasizes the clinical problems emerging from violent fantasies that seek a false form of containment in cyberspace. Themes of destructive fantasizing are further amplified through images of apocalypse, which are often prevalent in combat arena videogames. Textual sources from the Book of Revelation offer possible understanding for various elements of destructiveness as it appears in vulnerable male psyches. Therapeutic contact that combines a relational, containing approach and a broadly spiritual and soulful perspective can provide a path to healing such violent splits within the psyches of boys and young men.

Les garçons et les jeunes hommes vivent de manière plus fréquente par internet leur aliénation psychique et sociale. Cet article explore certains des risques et dangers qui peuvent provenir de retraites dans le monde bidimensionnel du cyberespace. Il porte plus spécifiquement sur les jeux vidéo MOBA, des jeux de combats multi-joueurs en ligne, dans lesquels les joueurs se visent et se tirent dessus. Un cas clinique souligne les problèmes cliniques qui émergent des fantasmes violents cherchant une fausse forme de contenance (containment) dans le cyberespace. Les thèmes de fantasmes destructifs sont amplifiés par des images d'apocalypse, qui sont souvent largement répandues dans les jeux vidéo de zone de combat. Des sources textuelles venant du Livre de la Révélation apportent des possibilités de compréhension de plusieurs éléments de destructivité telle qu'elle apparait dans les psychés masculines vulnérables. Le contact thérapeutique qui combine une approche relationnelle et contenante ainsi qu'une perspective spirituelle au sens large du terme peut fournir un chemin pour guérir de tels clivages à l'intérieur de la psyché de garçons et de jeunes hommes.

Niños y jóvenes, cada vez más frecuentemente, viven aspectos de su alienación psíquica y social, en el mundo virtual. El presente trabajo explora algunos de los riesgos y peligros que pueden emerger a partir del retiro al mundo bidimensional del ciber-espacio. Se focaliza más específicamente en un juego virtual llamado MOBA, batallas online de jugadores múltiples, en las cuales, los jugadores apuntan y disparan a otros. Un ejemplo clínico enfatiza los problemas clínicos que emergen a partir de las violentas fantasías que buscan una contención falsa en el ciber-espacio. Temas de fantasías destructivas son amplificadas a través de imágenes de apocalipsis, las cuales prevalecen a menudos en los combates virtuales. Fuentes textuales del Libro de las Revelaciones ofrecen una posible comprensión a los varios elementos de destructividad tal como se manifiestan en las psiques masculinas vulnerables. Un contacto terapéutico que combina un abordaje relacional contenedor y una perspectiva espiritual más amplia puede proveer un camino hacia la curación de semejantes disociaciones violentas en las psiques de niños y de jóvenes.

Saudi Children's Perception of Strabismus: A Hospital-Based Study.

PURPOSE: Children with strabismus may face difficulties interacting with their peers in elementary school. This study investigates the psychosocial effect of different types of strabismus on Saudi children's selection of a playmate. METHODS: Photographs of orthotropic children were digitally modified to simulate various magnitudes of strabismus. Orthotropic children with normal visual acuity viewed 18 sets of paired photographs and were asked to choose a playmate from each pair. Parents were asked to fill out a questionnaire on their socioeconomic background and to determine whether surgery should be indicated in strabismic patients for psychosocial reasons. Parents were also asked to rate their perception of seven personal characteristics of two images of the same child (one orthotropic and one strabismic). RESULTS: Two hundred and thirty-three children, aged 3-15 years (mean age: 9.94 [3.6] years), were studied. Children aged ≤6 years were significantly more likely not to distinguish between orthotropic children and those with strabismus (P < 0.001). Out of 233 participants, 69.6% were significantly in favor of orthotropic faces as opposed to 30.4% (P < 0.0001). Children perceived esotropia as less disturbing than exotropia and hypertropia (P < 0.001). Smaller magnitudes of strabismus were significantly preferred over larger angles (P < 0.001). Parents judged strabismic faces more negatively than orthotropic faces on all seven characteristics. Almost 88.4% of the adults thought that strabismic patients should undergo surgery for correction. CONCLUSIONS: Our findings suggest that children with apparent strabismus are perceived negatively and might be subjected to social alienation at a young age. Therefore, there is a need for strategies to address negative social bias toward children with strabismus and to enhance their peer acceptance in our society.

The presence, characteristics and correlates of pathological social withdrawal in Taiwan: An online survey.

OBJECTIVES: Pathological social withdrawal (PSW) has become a public health concern, especially in Asia. However, few studies have investigated the presence of PSW and its characteristics in Taiwan. In this study, we aimed to discover whether individuals in Taiwan display PSW behaviours, the demographic characteristics and psychiatric history of those meeting criteria for PSW and the associated psychological risks. METHODS: An online self-report survey collected participants' demographic characteristics, social behaviours and their psychiatric history, along with information on adherence to cultural norms and mental health. RESULTS: Among 1,046 valid respondents, 9% reported behaviours consistent with PSW for at least 6 months, commensurate with other online surveys in Asian countries. Around 20% of these also reported current or past psychiatric disorders, although this was lower than previous findings (50%-80%). Participants with PSW reported poorer mental health and lower confidence in social/academic/work skills than unaffected participants. CONCLUSION: This study identified for the first time the presence of PSW in Taiwan. Except the lower rates of psychiatric comorbidity (which could be explained by sociocultural factors and sampling methods), data were consistent with previous findings. We also extended our understanding of possible psychological risk factors associated with this pathological condition.

At the borders of the average man: Adolphe Quêtelet on mental, moral, and criminal monstrosities.

This study examines Adolphe Quêtelet's conception of deviance. It investigates how he identified social marginalities and what actions he recommended governments to undertake. To get a close understanding of his views, this paper examines three cases of "monstrosities," namely mental alienation, drunkenness, and criminality. My main thesis is that Quêtelet provided scientific authority to a conception of deviance as sickness, immorality, and cost thus encouraging legislators to use statistics for containing social marginalities. The case of alienation shows that Quêtelet viewed insanity as a pathology of civilization to be understood through phrenology. The case of drunkenness demonstrates how Quêtelet conflated the notion of statistical mean with moral decency. The case of criminality illustrates Quêtelet's major concern with the cost of criminals for the state. While advocating for the perfectibility of mankind, Quêtelet urged governments to take actions against what he considered the monstrosities of society.

Why Do Socially Withdrawn Children Tend to Become Heterosexually Active Later than Their Peers? A Mediation Model.

Socially withdrawn children are more likely to be heterosexually inactive in early adulthood. This study aimed to test a three-mediator model. We hypothesized that social withdrawal during childhood would hinder a sense of social competence in early adolescence, limiting other-gender friendships in mid-adolescence, in turn limiting involvement in romantic relationships in late adolescence, and thus favoring a later transition into sexual activity. This mediation model was tested on a sample of 332 participants assessed annually between the ages of 12 and 22. Structural equation modeling revealed a significant indirect effect of social withdrawal on late transition into heterosexual activity through the three tested mediators. The direct effect of social withdrawal on late transition into heterosexual activity was also significant, suggesting a partial mediation.

The 'Hikikomori' syndrome: worldwide prevalence and co-occurring major psychiatric disorders: a systematic review and meta-analysis protocol.

INTRODUCTION: The 'Hikikomori' syndrome (HS) consists of prolonged and severe social withdrawal. It has been studied first in Japan and recently has increasingly drawn the attention of researchers and clinicians all over the world. It is unclear whether it exists in other cultural contexts than Asia. The existing systematic reviews did not provide a quantitative synthesis on its prevalence. In addition, a summary of the co-occurring rates of psychiatric disorders is lacking. To provide a more comprehensive understanding of the clinical picture, it seems important to investigate which psychiatric disorders listed in the classification systems are most frequently associated with this psychological condition affecting young people. This paper describes a systematic review and meta-analysis protocol summarising worldwide prevalence of the HS in general population and clinical samples with psychiatric disorders. The review will also assess the co-occurrence between HS and each psychiatric disorder defined by any version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) in any clinical samples with psychiatric disorders. METHODS AND ANALYSIS: A systematic review will be conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies will be included if they use youth aged 12-35 years, recruited from general population or population with psychiatric disorders, if they use international criteria to diagnose HS. No restriction about design or language will be applied. The search will be conducted during the first week of November 2019 by two independent reviewers through the databases Scopus, PubMed, PsycINFO, Web of Science, by examining study references, by looking for conference proceedings/dissertations/theses, by contacting study corresponding authors. Random-effect meta-analysis will be performed by computing effect sizes as logit event rates. Study quality will be assessed through the Newcastle-Ottawa Scale. ETHICS AND DISSEMINATION: The current review does not require ethics approval. The results will be disseminated through conference presentations and publications in peer-reviewed journals. PROSPERO REGISTRATION NUMBER: CRD 42018098747.

Increased sensitivity to social exclusion during the luteal phase: Progesterone as resilience factor buffering against ostracism?

A woman's social behaviour reportedly varies across the menstrual cycle. In this study, we estimated changes in sensitivity to social exclusion across the menstrual cycle and scrutinized the related role of progesterone. Forty-nine naturally cycling women played a virtual ball-tossing game (Cyberball) to manipulate social inclusion. All participants underwent inclusion and exclusion conditions during the late follicular and the luteal phase. We assessed salivary progesterone concentrations at each cycle phase. After each Cyberball session we measured positive/negative mood using the Multidimensional Mood State Questionnaire (MDMQ). Multilevel analyses indicated that women showed worse mood following exclusion as compared to inclusion conditions (p = 0.014). Notably, this exclusion effect was more pronounced during the luteal phase than the late follicular phase (p = 0.029). As expected, progesterone concentrations were higher during the luteal phase as compared to the late follicular phase, but interestingly, progesterone concentrations were negatively associated with exclusion effects. When accounting for mediation via progesterone, direct cycle-phase related differences in social exclusion effects even increased as compared to the model without mediator. These findings suggest that progesterone may function as buffer against negative feelings that result from being socially excluded. The relevance of these findings for Premenstrual Dysphoric Disorder (PMDD) are discussed, and we conclude that social exclusion may represent an important research domain criterion (RDoC) of relevance for PMDD, with progesterone pointing to new potential pharmacological targets.

Regaining agency and autonomy: A grounded typology of concealed pregnancy.

AIM: To explore and understand the experience of concealed pregnancy and develop a framework for practitioners. BACKGROUND: Numerous cases of concealed pregnancy resulting in serious outcomes including maternal and perinatal death, newborn abandonment, and neonaticide are reported internationally. Historically concealed pregnancy is associated with oppressive religious cultures where premarital pregnancy was shunned. Concealed pregnancy has traditionally been viewed through a biomedical lens and associated with mental illness but this assertion remains unsubstantiated by robust evidence. DESIGN: A Glaserian grounded theory study was undertaken. DATA SOURCES: Thirty women were interviewed, between 2014 - 2016, on up to three occasions (46 interviews) and 22 cases of public interest were included as data. METHODS: The constant comparative method and theoretical sampling which are the analytical strategies of grounded theory were used to analyse the data and generate the typology. RESULTS: Concealed pregnancy is a fearful, life-altering, and traumatic experience. Women with a history of controlling and oppressive relationships characterized by fear respond to a crisis pregnancy by keeping it secret. Many women's relationships were characterized by emotional, mental, sexual, or physical violence. Fear for one's survival is common, may render women unable to access care or support and can be so extreme that a woman may end her own life or give birth alone. CONCLUSIONS: This typology of concealed pregnancy is intended to aid understanding the fear, trauma, and complexities associated with concealed pregnancy which is vital if practitioners are to provide sensitive, responsive and non-judgemental care.

The mediating role of work alienation in the effect of workplace loneliness on nurses' performance.

AIM: The purpose of this study was to determine the mediating role that work alienation has in the effect of loneliness at the workplace on nurses' job performance. BACKGROUND: The literature includes no research on the relationship between nurses' workplace loneliness, work alienation and job performance. The study used work alienation as a mediating variable, which adds to the originality of the study. This study was carried out to contribute to relevant field research. METHODS: The study used a cross-sectional research design and surveyed 138 nurses working in a public hospital in Turkey. The data were analysed using descriptive statistical methods, Pearson correlation analysis and the PROCESS macro Model 4 in the regression analysis. RESULTS: Workplace loneliness has a negative effect on job performance. This negative effect is magnified when work alienation is used as a mediating variable. CONCLUSION: Nurses' loneliness at the workplace and work alienation leads to a decline in their job performance. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing managers should take into consideration that nurses' feelings of workplace loneliness and alienation can reduce the nurses' job performance. When managers create formal and informal support networks, it can reduce nurses' negative feelings of loneliness and alienation. Thus, helping nurses to perform better at work.