Prevalence of pain and its association with symptoms of post-traumatic stress disorder, depression, anxiety and distress in 846 cancer patients: A cross sectional study.

OBJECTIVE: Pain depicts a severe physical symptom but its relationship to mental health problems is not well studied in cancer patients. The aim of this study was to investigate the prevalence of pain and its correlation with symptoms of post-traumatic stress disorder (PTSD), depression, anxiety and psychological distress in a large sample of cancer patients. METHODS: From 2010 to 2019, cancer patients who received outpatient treatment at the Medical University of Vienna were assessed with the Post-Traumatic Symptom Scale (PTSS-10) and the Hospital Anxiety and Depression Scales. A visual analogue scale was used to assess pain perception. For statistical analysis, linear regression models were applied to log-transformed data. RESULTS: Of the 846 cancer patients included in the study, 63.5% experienced pain (mild 43.5%, moderate 13.6%, severe 6.4%). About a third (31.2%) of the total sample presented with significant PTSD symptoms. Significant symptoms of depression, anxiety and distress were present in 13.9%, 15.1% and 25.3%, respectively. Women more often reported symptoms of PTSD, anxiety and distress. Pain scores were significantly related to symptoms of PTSD, depression and psychological distress (all with p < .001), but not to anxiety. CONCLUSIONS: Results show a high prevalence of experienced pain and indicate a clear association of elevated pain levels with psychiatric symptoms in oncological patients in a large Austrian sample. In order to decrease experienced pain and to enable better treatment of mental health problems in cancer patients, diagnostic procedures and interventions based on a biopsychosocial model need to be intensified.

Onset of effects of non-pharmaceutical interventions on COVID-19 infection rates in 176 countries.

BACKGROUND: During the initial phase of the global COVID-19 outbreak, most countries responded with non-pharmaceutical interventions (NPIs). In this study we investigate the general effectiveness of these NPIs, how long different NPIs need to be in place to take effect, and how long they should be in place for their maximum effect to unfold. METHODS: We used global data and a non-parametric machine learning model to estimate the effects of NPIs in relation to how long they have been in place. We applied a random forest model and used accumulated local effect (ALE) plots to derive estimates of the effectiveness of single NPIs in relation to their implementation date. In addition, we used bootstrap samples to investigate the variability in these ALE plots. RESULTS: Our results show that closure and regulation of schools was the most important NPI, associated with a pronounced effect about 10 days after implementation. Restrictions of mass gatherings and restrictions and regulations of businesses were found to have a more gradual effect, and social distancing was associated with a delayed effect starting about 18 days after implementation. CONCLUSIONS: Our results can inform political decisions regarding the choice of NPIs and how long they need to be in place to take effect.

Lateral preferences for hand clasping and arm folding are associated with handedness in two large-sample latent variable analyses.

Hand clasping (HC) and arm folding (AF) are bilateral limb postures which are subject to lateral preferences. Previous research suggested that left HC and left AF are "canonical" among European populations, i.e., generally preferred by right-handers. However, evidence on the associations of handedness with HC and AF to date is sparse and inconsistent, with studies mostly relying on relatively small sample sizes and arbitrary classifications of handedness. Utilizing latent class analysis for handedness classification, we present data from two large and independent middle-European samples, a discovery (n = 7,658) and replication (n = 5,062) sample. Our results indicate that right HC, not left HC, is overall preferred and that right-handedness is associated with right HC/left AF, and left- and mixed-handedness with left HC/right AF. Moreover, lateral preferences increased with age, and men had a higher preference of right HC, independent of handedness. We discuss our findings with regard to the generalizability of previous results.

Investigating the Five Facet Mindfulness Questionnaire (FFMQ): construction of a short form and evidence of a two-factor higher order structure of mindfulness.

OBJECTIVES: Past research of the Five Facet Mindfulness Questionnaire (FFMQ) lacks clear results regarding its factorial validity, item fitting, mindfulness in the general population, and on the higher order structure of mindfulness. We derived an alternative two-factor higher order structure for the FFMQ, delineating the attentional and experiential aspects of mindfulness. METHOD: Data of 640 persons from the Austrian community were used for primary analyses, and data of 333 Austrian students were used for cross-validation. Confirmatory analyses and exploratory structural equation modeling (ESEM) were utilized to investigate psychometric and structural properties. Associations with related variables and indicators of mental health were examined. RESULTS: Confirmatory models fitted only poorly on the full 39-item FFMQ. Fit was acceptable in an abridged 20-item version in both samples. The Nonreact scale had only weak psychometric properties. ESEM analyses suggested a good fit of two higher order factors and revealed structural differences between the samples. Beneficial effects of mindfulness appeared to be uniquely associated with the experiential aspects of mindfulness. Strategies of emotion regulation showed differential associations with the two higher order factors in the two samples. CONCLUSIONS: Our findings are relevant both with regard to conceptual issues on mindfulness and the assessment of mindfulness with the FFMQ. Replications in meditating samples and in patients are needed.

Body image and personality: associations between the Big Five Personality Factors, actual-ideal weight discrepancy, and body appreciation.

Studies have suggested associations between personality dimensions and body image constructs, but these have not been conclusively established. In two studies, we examined direct associations between the Big Five dimensions and two body image constructs, actual-ideal weight discrepancy and body appreciation. In Study 1, 950 women completed measures of both body image constructs and a brief measure of the Big Five dimensions. In Study 2,339 women completed measures of the body image constructs and a more reliable measure of the Big Five. Both studies showed that Neuroticism was significantly associated with actual-ideal weight discrepancy (positively) and body appreciation (negatively) once the effects of body mass index and social status had been accounted for. These results are consistent with the suggestion that Neuroticism is a trait of public health significance requiring attention by body image scholars.

Blame it on patriarchy: more sexist attitudes are associated with stronger consideration of cosmetic surgery for oneself and one's partner.

In the present work, we examined associations between oppressive, sexist beliefs and consideration of cosmetic surgery for oneself and also endorsement of cosmetic surgery for one's romantic partner. A total of 554 German-speaking volunteers from the community, mainly in Austria, completed measures of consideration of cosmetic surgery and three measures of sexist attitudes, while a subset of participants in romantic relationships completed a measure of endorsement of cosmetic surgery for their partners along with the measures of sexism. Preliminary analyses showed that women and single respondents were more likely to consider having cosmetic surgery than men and committed respondents, respectively. Further analyses showed that consideration of cosmetic surgery for oneself was significantly associated with sexist attitudes, particularly hostile attitudes to women. In addition, among participants in a relationship, sexist attitudes were associated with endorsement of cosmetic surgery for one's partner. These results indicate that attitudes to cosmetic surgery for oneself and one's partner are shaped by gender-ideological belief systems in patriarchal societies. Possible implications for understanding the motivations for having cosmetic surgery, among both single respondents and couples, are discussed.

Predictors of suicide and suicide attempt in subway stations: a population-based ecological study.

Suicidal behavior on the subway often involves young people and has a considerable impact on public life, but little is known about factors associated with suicides and suicide attempts in specific subway stations. Between 1979 and 2009, 185 suicides and 107 suicide attempts occurred on the subway in Vienna, Austria. Station-specific suicide and suicide attempt rates (defined as the frequency of suicidal incidents per time period) were modeled as the outcome variables in bivariate and multivariate Poisson regression models. Structural station characteristics (presence of a surveillance unit, train types used, and construction on street level versus other construction), contextual station characteristics (neighborhood to historical sites, size of the catchment area, and in operation during time period of extensive media reporting on subway suicides), and passenger-based characteristics (number of passengers getting on the trains per day, use as meeting point by drug users, and socioeconomic status of the population in the catchment area) were used as the explanatory variables. In the multivariate analyses, subway suicides increased when stations were served by the faster train type. Subway suicide attempts increased with the daily number of passengers getting on the trains and with the stations' use as meeting points by drug users. The findings indicate that there are some differences between subway suicides and suicide attempts. Completed suicides seem to vary most with train type used. Suicide attempts seem to depend mostly on passenger-based characteristics, specifically on the station's crowdedness and on its use as meeting point by drug users. Suicide-preventive interventions should concentrate on crowded stations and on stations frequented by risk groups.

Further investigation of the validity and reliability of the photographic figure rating scale for body image assessment.

Previous studies have not fully investigated the psychometric properties of the Photographic Figure Rating Scale (PFRS). In 2 studies, we report on the test-retest reliability and convergent validity of ratings derived from the PFRS. In Study 1, 322 female university students in Britain provided self-ratings on the PFRS and objectively measured body mass index (BMI); a subsample of 132 women also completed the task after 5 weeks. In Study 2, 243 women from the community in Austria completed the PFRS along with a battery of other body image scales. Results of Study 1 showed that ratings on the PFRS had good test-retest reliability (all rs > .87) and good convergent validity in relation to BMI. Results of Study 2 showed that PFRS-derived body dissatisfaction scores were significantly correlated with a range of body image variables. These results provide evidence for the convergent validity and good test-retest reliability of the PFRS.

Internalizing and externalizing behaviour problems in childhood contribute to the development of anorexia and bulimia nervosa-a study comparing sister pairs.

OBJECTIVE: We wanted to clarify whether there is any clinically relevant behavioural psychopathology in patients before onset of an eating disorder (ED) compared with their healthy sisters and if there are differences in behavioural problems between the ED subtypes anorexia nervosa-restricting type (AN-R) and EDs with bulimic behaviour. METHOD: Behavioural psychopathology was examined by parental report using the Child Behaviour Checklist retrospectively in 83 sister pairs discordant for an ED (37 with AN-R and 46 with bulimic EDs) by means of conditional logistic regression. RESULTS: Participants who later developed an ED had significantly higher internalizing and externalizing behavioural abnormality scores before onset of the ED than their unaffected sisters. Conditional logistic regression revealed significantly higher internalizing behaviour scores in AN-R and significantly higher internalizing and externalizing scores in the bulimic disorders. DISCUSSION: Internalizing problems (anxiety, depression and somatization) preceded the development of AN, whereas both internalizing and externalizing behaviour problems (aggressive and delinquent behaviour) preceded bulimic disorders.

Academic workload, research productivity, and end of life: a single-case historiometric study.

Fourteen years of biographical time-series data were analyzed quantitatively retrospectively using the historiometric approach. The data were descriptions of self-recorded daily working hours for one academic researcher's career and life. The researcher's unexpected death was preceded by a notable decline in daily working hours and conference travels commencing two years before. Well-known calendar effects (week and academic year) as well as effects of increased academic rank and duties on working hours were all discernible in these unobtrusive data. However, effort (total working hours) did not predict concurrent or near-future research output, even when teaching load was controlled for.

Personality differences between tattooed and non-tattooed individuals.

This study examined differences between tattooed and non-tattooed individuals on a range of personality and individual difference measures. A community sample of 540 individuals from the southern German-speaking area of central Europe completed a survey consisting of measures of the Big Five personality factors, Need for Uniqueness, Self-esteem, sensation seeking, Religious and Spiritual Beliefs, Attitudes Toward Tattoos, tattoo possession, and demographics. Preliminary analyses showed that 22% of the total sample possessed at least one tattoo. Further analyses showed that, compared with non-tattooed (n = 420) individuals, tattooed participants (n = 120) had significantly higher scores on Extraversion, Experience Seeking, Need for Uniqueness, and held more positive Attitudes Toward Tattoos, although effect sizes of these group differences were generally small- to medium-sized. These results are considered in relation to the contemporary prevalence of tattoos in socioeconomically developed societies.

Latent structure and measurement invariance of the Hospital Anxiety and Depression Scale in cancer outpatients.

Background/Objective: The aim of the present study was to compare competing psychometric models and analyze measurement invariance of the Hospital Anxiety and Depression Scale (HADS) in cancer outpatients. Method: The sample included 3,260 cancer outpatients. Latent structure of the HADS was analyzed using confirmatory factor analysis (CFA) with robust maximum likelihood estimation (MLR). Measurement invariance was tested for age, time of response, gender, and cancer type by comparing nested multigroup CFA models with parameter restrictions. Results: Except for the one-factor solutions, all models showed acceptable model fit and measurement invariance. The model with the best fit was the originally proposed two-factor model with exclusion of two items. The one-factor solutions showed inacceptable model fit and were not invariant for age and gender. Conclusions: The HADS has a robust two-factor structure in cancer outpatients. We recommend excluding item 7 and 10 when screening for anxiety and depression.

Sensitivity to initial values in full non-parametric maximum-likelihood estimation of the two-parameter logistic model.

Parameters of the two-parameter logistic model are generally estimated via the expectation-maximization (EM) algorithm by the maximum-likelihood (ML) method. In so doing, it is beneficial to estimate the common prior distribution of the latent ability from data. Full non-parametric ML (FNPML) estimation allows estimation of the latent distribution with maximum flexibility, as the distribution is modelled non-parametrically on a number of (freely moving) support points. It is generally assumed that EM estimation of the two-parameter logistic model is not influenced by initial values, but studies on this topic are unavailable. Therefore, the present study investigates the sensitivity to initial values in FNPML estimation. In contrast to the common assumption, initial values are found to have notable influence: for a standard convergence criterion, item discrimination and difficulty parameter estimates as well as item characteristic curve (ICC) recovery were influenced by initial values. For more stringent criteria, item parameter estimates were mainly influenced by the initial latent distribution, whilst ICC recovery was unaffected. The reason for this might be a flat surface of the log-likelihood function, which would necessitate setting a sufficiently tight convergence criterion for accurate recovery of item parameters.

Latent structure and measurement invariance of the Hospital Anxiety and Depression Scale in cancer outpatients

Background/Objective: The aim of the present study was to compare competing psychometric models and analyze measurement invariance of the Hospital Anxiety and Depression Scale (HADS) in cancer outpatients.Method: The sample included 3,260 cancer outpatients. Latent structure of the HADS was analyzed using confirmatory factor analysis (CFA) with robust maximum likelihood estimation (MLR). Measurement invariance was tested for age, time of response, gender, and cancer type by comparing nested multigroup CFA models with parameter restrictions.Results: Except for the one-factor solutions, all models showed acceptable model fit and measurement invariance. The model with the best fit was the originally proposed two-factor model with exclusion of two items. The one-factor solutions showed inacceptable model fit and were not invariant for age and gender.Conclusions: The HADS has a robust two-factor structure in cancer outpatients. We recommend excluding item 7 and 10 when screening for anxiety and depression. (AU)

Effects of Initial Values and Convergence Criterion in the Two-Parameter Logistic Model When Estimating the Latent Distribution in BILOG-MG 3.

Parameters of the two-parameter logistic model are generally estimated via the expectation-maximization algorithm, which improves initial values for all parameters iteratively until convergence is reached. Effects of initial values are rarely discussed in item response theory (IRT), but initial values were recently found to affect item parameters when estimating the latent distribution with full non-parametric maximum likelihood. However, this method is rarely used in practice. Hence, the present study investigated effects of initial values on item parameter bias and on recovery of item characteristic curves in BILOG-MG 3, a widely used IRT software package. Results showed notable effects of initial values on item parameters. For tighter convergence criteria, effects of initial values decreased, but item parameter bias increased, and the recovery of the latent distribution worsened. For practical application, it is advised to use the BILOG default convergence criterion with appropriate initial values when estimating the latent distribution from data.

Ethnicity moderates the association between 5-HTTLPR and national suicide rates.

The association between ethnicity, national suicide rates, and the functional serotonin transporter gene polymorphism (5-HTTLPR), under consideration of the role of economic indicators, national alcohol intake, and national happiness scores was analyzed with an ecologic analysis. Data on allelic frequencies of the short (s) allele from 38 countries from over 100,000 healthy screened or general population individuals were analyzed with multiple regression models. Allele frequency varied widely both within and across ethnicities and an ethnicity-based interaction between national suicide rates and 5-HTTLPR allele frequency was revealed with the s allele acting as protective factor in Caucasian and as a risk factor in non-Caucasian populations. This interaction effect underlines the importance of ethnicity as a moderating factor in the genetics of suicide.

Development of a scale to assess knowledge about suicide postvention using item response theory.

Knowledge about suicide postvention (KSPV) is an important distal outcome in the evaluation of suicide prevention programs that focus on the bereaved. However, most scales are specifically tailored to the evaluation study in question and psychometric properties are often unsatisfactory. Therefore, we developed the KSPV scale. Scale properties were investigated with Rasch trees, a newly developed method in the framework of item response theory. Additionally, we provide cues for convergent validity. In summary, the scale shows satisfactory properties for assessing KSPV and could be used to evaluate suicide postvention programs more effectively.

Investigating dimensionality of Eskin's attitudes toward suicide scale with Mokken scaling and confirmatory factor analysis.

Attitudes toward suicide are often investigated by means of questionnaires, most of which are overly long or of low psychometric quality. Eskin's ( 2004 ) Attitudes Towards Suicide Scale is short and first investigations suggest good psychometric properties, but its factor structure has scarcely been explored. Hence, we examined this instrument by a data-analytic approach that combines Mokken scaling and confirmatory factor analysis (CFA). Results revealed 6 factors, of which 1 possessed only weak measurement properties. CFAs indicated only borderline fit of models found in prior research, but adequate fit for the scale structures revealed by Mokken scaling. Psychometric properties of these scales were satisfactory. Both the instrument as well as the methodological approach presented here can be recommended for further research.

Suicide seasonality: complex demodulation as a novel approach in epidemiologic analysis.

BACKGROUND: Seasonality of suicides is well-known and nearly ubiquitous, but recent evidence showed inconsistent patterns of decreasing or increasing seasonality in different countries. Furthermore, strength of seasonality was hypothesized to be associated with suicide prevalence. This study aimed at pointing out methodological difficulties in examining changes in suicide seasonality. METHODODOLOGY/PRINCIPAL FINDINGS: The present study examines the hypothesis of decreasing seasonality with a superior method that allows continuous modeling of seasonality. Suicides in Austria (1970-2008, N = 67,741) were analyzed with complex demodulation, a local (point-in-time specific) version of harmonic analysis. This avoids the need to arbitrarily split the time series, as is common practice in the field of suicide seasonality research, and facilitates incorporating the association with suicide prevalence. Regression models were used to assess time trends and association of amplitude and absolute suicide numbers. Results showed that strength of seasonality was associated with absolute suicide numbers, and that strength of seasonality was stable during the study period when this association was taken into account. CONCLUSION/SIGNIFICANCE: Continuous modeling of suicide seasonality with complex demodulation avoids spurious findings that can result when time series are segmented and analyzed piecewise or when the association with suicide prevalence is disregarded.

Chew on this: No support for facilitating effects of gum on spatial task performance.

OBJECTIVE: To determine whether chewing of gum facilitates spatial task performance in healthy participants, two behavioral experiments were performed. DESIGN: In the first experiment, spatial task performance of 349 men and women preceding and after treatment administration (saccharated chewing gum, sugar-free chewing gum, no chewing gum) was assessed using effect modeling by means of Item Response Theory. In the second experiment, another 100 participants were either administered sugar-free chewing gum or no chewing gum during spatial task performance. Effects of gum in the second study were assessed by standard means of data analysis. RESULTS: Results indicated no significant effects of either chewing gum or sugar on spatial task performance in either experiment. CONCLUSIONS: Our findings are consistent with recent studies investigating the influences of chewing gum on various memory functions, extending them by another measure of cognitive ability. Thus, further doubt is cast on enhancing effects of chewing gum on cognitive task performance.