Do emotion regulation difficulties in depression extend to social context? Everyday interpersonal emotion regulation in current and remitted major depressive disorder.

Individuals with major depressive disorder (MDD) have difficulties regulating emotion on their own. As people also use social resources to regulate emotion (i.e., interpersonal emotion regulation [IER]), we examined whether these difficulties extend to IER in current and remitted MDD compared to those with no psychiatric disorders (i.e., controls). Adults with current MDD (n = 48), remitted MDD (n = 80), and controls (n = 87) assessed via diagnostic interviewing completed 2-week experience sampling, reporting on how frequently (IER frequency), from whom (sharing partners), and why (IER goals) they sought IER; how the sharing partners responded (sharing partner's extrinsic IER strategies and warmth); and how their feelings about the problem and the sharing partner changed following IER (IER outcomes). Using multilevel modeling, the current-MDD group did not differ from controls in IER frequency and sharing partners, but the current-MDD group demonstrated a more mixed (albeit generally adaptive) profile of received IER strategies and benefited similarly or more from certain IER strategies than the other two groups, suggesting that IER may be a promising avenue for effective emotion regulation in current MDD. The remitted-MDD group sought IER most frequently and demonstrated the most adaptive profile of received IER strategies, and they and the current-MDD group reported seeking more types of IER goals than controls. People with remitted MDD seem highly motivated to pursue IER support and their pursuit takes place in particularly supportive social contexts. Research is needed to examine mechanisms driving these group differences and how IER predicts the course of MDD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Do bipolar disorder symptom profiles matter for suicide risk? A latent class approach to investigating differences in suicidal desire and acquired capability.

INTRODUCTION: Depressive and mixed symptoms in bipolar disorder (BD) have been linked to higher suicide risk. Based on Klonsky and May's three-step theory and Joiner's Interpersonal Psychological Theory of Suicide, we hypothesized that patients diagnosed with BD who reported severe levels of depressive symptoms and mixed depressive and manic symptoms would also report higher levels of suicidal desire and acquired capability of suicide, as well as suicidal thoughts and behaviors. METHODS: The sample included 177 outpatients diagnosed with BD. Latent class analysis was conducted to replicate the identified groups of a previously conducted study using a smaller but overlapping dataset. Between-class and pairwise analyses with measures of suicidal desire and acquired capability were conducted. RESULTS: As expected, the classes characterized by severe depressive symptoms and mixed symptoms reported higher levels of suicidal desire. However, the results regarding acquired capability were less consistent. CONCLUSION: Given the overall elevated suicide risk of BD and the consistent relationship between depressive symptoms and other strong correlates of suicide, clinicians who work with patients diagnosed with BD should closely monitor changes in their depressive symptoms.

Everyday emotion regulation goals, motives, and strategies in current and remitted major depressive disorder: An experience sampling study.

People with major depressive disorder (MDD) report difficulties with emotion regulation (ER), particularly in habitual strategy use. We examined ER strategy use and other aspects of ER-desired emotional states (emotion goals) and reasons for ER (ER motives)-in current and remitted MDD. In a 2-week experience sampling study, adults with current MDD (n = 48), remitted MDD (n = 80), and healthy controls (n = 87) reported their negative affect (NA) and positive affect (PA), emotion goals (frequency, direction), ER motives (hedonic, instrumental), and ER strategy use (social sharing, acceptance, savoring, reappraisal, suppression, distraction). Multilevel modeling and Bayes factors were used to assess differences and similarities across groups. Compared to the remitted MDD and control groups, the current MDD group regulated emotion more frequently in general but showed weakened associations between initiating regulation and momentary affect and reported different emotion goal directions. Although all groups mostly reported emotion goals to regulate prohedonically (decrease NA, increase or maintain PA), the current MDD group was the most likely to try to amplify NA and PA simultaneously. Current MDD and remitted MDD groups endorsed hedonic motives more than controls, but the three groups did not differ in instrumental motives. The only group difference in ER strategy use was that the current MDD group used distraction more than controls. Most group differences in ER were between the current MDD group and controls, with the remitted MDD group and controls being quite similar. ER in current MDD is characterized by frequent regulation, weakened association between initiating regulation and momentary affect, increased hedonic-focused ER motives, and a greater use of distraction. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Turnover Intention and Its Associated Factors Among Psychiatrists in 41 Tertiary Hospitals in China During the COVID-19 Pandemic.

Background: Turnover intention, an employee's intention to voluntarily leave their jobs, affects workforce sustainability. However, scarce data are available about turnover intention and its associated factors among psychiatrists in China, especially during the COVID-19 pandemic. The current research was designed to address this gap. Methods: An anonymous, nationwide online survey was disseminated to psychiatrists in 41 psychiatric hospitals in China. We collected demographic data, job-related information (duration of employment, history of participation in the frontline work against COVID-19, job satisfaction), and participants' turnover intention in the next 12 months. Results: In total, 3,973 psychiatrists completed the survey. The sample was predominantly female (58.8%) and married (79.5%), and nearly three-fourths (73.5%) had children. More than one-third (35.6%) had a master's or doctoral degree in addition to their medical degree. The overall level of job satisfaction was moderate. The rate of turnover intention was 22.0% and was comparable in males and females (22.9% in males and 21.3% in females, respectively). Psychiatrists who had participated in the frontline work of COVID-19 were more likely to report an intention to leave their current job. Multiple regression analyses suggested that turnover intention was significantly associated with having insomnia, longer working hours, and more working days per week. Conclusion: During the pandemic period, approximately one-fifth of psychiatrists in China reported turnover intention. Factors associated with turnover intention included high job-related burdens, low job satisfaction, participation in the frontline work against COVID-19, and insomnia. To improve psychiatric workforce sustainability, policymakers and hospital administrators need to be aware of this potential challenge and address the concerns of psychiatrists in China.

Gender differences in the experience of burnout and its correlates among Chinese psychiatric nurses during the COVID-19 pandemic: A large-sample nationwide survey.

Psychiatric nurses often experience burnout and other mental health symptoms. However, few studies have examined these phenomena and gender-specific associated factors during the COVID-19 pandemic. We surveyed a national sample of psychiatric nurses (N = 8971) from 41 tertiary psychiatric hospitals in China as part of a large national survey conducted during the pandemic. The Maslach Burnout Inventory-Human Service Survey was used to assess burnout and the Depression, Anxiety, and Stress Scale-21 was used to assess mental health symptoms. Binary logistic regression analyses were used to explore factors associated with burnout in the entire sample and separately by gender. The overall prevalence of burnout was 27.27%, with the rate in male psychiatric nurses (32.24%) being significantly higher than that in female psychiatric nurses (25.97%). Many key demographic factors (such as the male gender and marital status), work-related variables (such as a mid-level professional title, having an administrative position, longer working hours, more monthly night shifts, and the perceived negative impact of the COVID-19 pandemic on medical work) were significantly associated with burnout in the whole sample. Moreover, burnout was associated with depression, anxiety, and stress symptoms in the whole sample. Gender-specific factors associated with burnout were also identified: burnout was associated with night shifts in male psychiatric nurses, whereas it was associated with single or married marital status, a mid-level professional title, and having an administrative position among female psychiatric nurses. The high rates of burnout and mental health symptoms in psychiatric nurses need attention from hospital administrators. While mental health symptoms, longer working hours, and the perceived impact of COVID-19 are associated with burnout in both genders, gender-specific factors also warrant special attention when developing gender-specific interventions.

Emotion Differentiation in Current and Remitted Major Depressive Disorder.

People with current major depressive disorder (MDD) experience diminished emotion differentiation. We tested the hypothesis that this emotional disturbance is chronic and also characterizes those whose MDD has remitted. As our main aim, we examined emotion differentiation in conjunction with elevated negative and diminished positive emotional intensity, which are both cardinal symptoms of MDD. As an exploratory aim, we examined the predominant theoretical conceptualization that people low in emotion differentiation use more general state terms (e.g., bad) and fewer emotion terms (e.g., anger) to describe their emotional experience. Participants (assessed via diagnostic interview) included individuals who had current MDD (current depressed; n = 48), individuals whose MDD was in full remission (remitted depressed; n = 80), and healthy controls (n = 87). Participants also completed two self-report measures of depressive symptoms and reported momentary emotion repeatedly for 14 days via experience sampling, from which we computed emotion differentiation (i.e., intraclass correlation coefficient) and emotional intensity (i.e., average of the mean emotion ratings across surveys). Finally, participants described a momentary emotional experience via an open-response format, which was coded for the use of general state and emotion terms. Compared to the healthy control group, the current and remitted depressed groups showed similarly low levels of negative and positive emotion differentiation. These findings suggest that diminished emotion differentiation may be a stable characteristic of depressive disorders and a possible target for future prevention efforts. Diminished negative emotion differentiation was significantly associated with higher depressive symptoms as assessed by only one of the depression measures, though this finding did not hold after adjusting for negative emotional intensity. Finally, participants' emotion differentiation was not associated with use of general state and emotion terms, and groups did not use general state and emotion terms in ways that were consistent with the predominant theoretical conceptualization of emotion differentiation, suggesting the need for clarification in this research domain.

Interpersonal Emotion Regulation: an Experience Sampling Study.

People often turn to others for help with regulating their emotions, a process known as interpersonal emotion regulation (IER). Emerging research has begun to document the importance of IER in well-being. However, the basic elements of IER in daily life are still not clearly understood. We aimed to better understand the characteristics of adults' everyday IER. In this 2-week experience sampling study (five surveys daily), 87 adults (mean age = 45.5 years) reported on whether, from whom (i.e., sharing partner role type and gender), and why (i.e., IER goals) they sought IER. They also indicated which IER strategies their sharing partners used, including putatively supportive (i.e., reappraisal, problem solving, affection, encouraging sharing) and unsupportive (i.e., invalidation, blaming) strategies. Results showed that most people engaged in IER. Using multilevel modeling, we found that people tended to seek IER from close versus non-close others and were more likely to seek emotion-oriented (e.g., empathy) relative to problem-oriented goals (e.g., advice). Sharing partners were more likely to provide (a) supportive than unsupportive strategies, with reappraisal, problem solving, and affection being most frequently endorsed, and (b) problem-oriented supportive strategies (e.g., problem solving) than emotion-oriented supportive strategies (e.g., affection). We also explored gender and age differences in IER. This research contributes to the broader emotion regulation literature by elucidating everyday IER behaviors in adults. Findings highlight the ubiquity of IER as well as people's tendencies when seeking and providing IER. Supplementary Information: The online version contains supplementary material available at 10.1007/s42761-021-00044-y.

How Do Education and Family Planning Accelerate Fertility Decline?

Education and family planning can both be influenced by policy and are thought to accelerate fertility decline. However, questions remain about the nature of these effects. Does the effect of education operate through increasing educational attainment of women or educational enrollment of children? At which educational level is the effect strongest? Does the effect of family planning operate through increasing contraceptive prevalence or reducing unmet need? Is education or family planning more important? We assessed the quantitative impact of education and family planning in high-fertility settings using a regression framework inspired by Granger causality. We found that women's attainment of lower secondary education is key to accelerating fertility decline and found an accelerating effect of contraceptive prevalence for modern methods. We found the impact of contraceptive prevalence to be substantially larger than that of education. These accelerating effects hold in sub-Saharan Africa, but with smaller effect sizes there than elsewhere.

Emotion differentiation moderates the effects of rumination on depression: A longitudinal study.

Elevated trait rumination is associated with and predicts onset of major depressive disorder, but not all people with elevated trait rumination develop major depressive disorder. We hypothesize that certain emotional processes weaken the rumination-depression link, protecting against increases in depression. In this prospective longitudinal study, we examined one such process, emotion differentiation-the ability to discern specific emotions. Because higher negative emotion differentiation (NED) facilitates down-regulating negative emotions and the content of rumination tends to be negative, we predicted that NED, but not positive emotion differentiation (PED), would moderate the rumination-depression association, such that rumination would only predict increases in depression when negative emotions are less, not more, differentiated. Over 1 week of experience sampling, 65 community-dwelling adults (M = 38.4 years) repeatedly reported their emotions, from which we computed NED and PED. Participants completed self-report measures of rumination and depression at baseline and a measure of depression 6 months later. Regression analyses suggested that the combination of NED and PED, but not a unique contribution of either NED or PED, interacted with rumination to predict significant changes in depression, after controlling for mean emotion. Specifically, rumination predicted significant increases in depression when emotion differentiation was lower, but not higher. Findings demonstrate longitudinal benefits of emotion differentiation in adults and suggest emotion differentiation as a promising avenue for studying major depressive disorder. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Discovering the Unclassified Suicide Cases Among Undetermined Drug Overdose Deaths Using Machine Learning Techniques.

OBJECTIVE: The Centers for Disease Control and Prevention (CDC) monitor accidental and intentional deaths to answer questions that are critical for the development of effective prevention and resource allocation. CDC's National Violent Death Reporting System (NVDRS) is a major innovation in surveillance linking individual-level data from multiple sources. However, suicide underreporting is common, particularly from drug overdose deaths. This study sought to assess machine learning (ML) techniques in quantifying drug overdose suicide underreporting rates. METHODS: Clinical, sociodemographic, toxicological, and proximal stressor data on overdose decedents (n = 2,665) were extracted from Utah's NVDRS from 2012 to 2015. The existing well-determined cases were used to train and test our ML models. We assessed and compared multiple machine learning methods including Logistic Regression, Random Forest Classifier, Support Vector Machines, and Artificial Neural Networks. We applied a majority voting methodology to classify undetermined drug overdose deaths. RESULTS: Overdose suicide rates were estimated to be underreported by 33% across all years, increasing yearly from 29% in 2012 to 37% in 2015. The overall test accuracies for all models ranged from 92.3% to 94.6%. CONCLUSIONS: This research identifies a cost-effective, replicable, and expandable ML-based methodology to estimate the true rates of suicide which may be partially masked during the opioid epidemic.

Selection and implementation of emotion regulation strategies in major depressive disorder: An integrative review.

Emotion regulation (ER), broadly defined, has been implicated in mental health, including major depressive disorder (MDD). We review empirical studies examining selection and implementation of ER strategies in adults with current or past MDD. We focus on eight strategies (rumination, distraction, cognitive reappraisal, suppression, acceptance, savoring, positive rumination, dampening), organizing the review by research design: (1) self-reported habitual use (i.e., trait) of ER strategies, (2) spontaneous use of ER strategies in laboratory settings, (3) experimentally instructed ER strategies, and (4) use of ER strategies in naturalistic settings. Reviewed findings suggest that MDD is associated with unskillful selection of ER strategies-indexed by self-reported habitual use of ER strategies-but not impaired abilities to implement them; in fact, those with current MDD and MDD in remission show intact abilities to implement many ER strategies when instructed to do so. Additionally, the vast majority of research examines trait ER, while there is a dearth of laboratory and naturalistic studies using MDD samples. There are also discrepant findings on habitual use of ER strategies assessed by self-reports and spontaneous use of ER strategies in the lab. We discuss implications of reviewed findings and five areas for future research in emotion dysregulation in MDD.

Cleansing, moisturizing, and sun-protection regimens for normal skin, self-perceived sensitive skin, and dermatologist-assessed sensitive skin.

Acquiring or maintaining healthy skin requires a multifunctional approach: mild cleansing, moisturizing, and sun protection. The clinical benefits of a daily, healthy facial skin-care regimen comprising a mild cleanser and moisturizer were evaluated on normal skin, self-perceived sensitive skin, and dermatologist-assessed sensitive skin for a period of up to 4 weeks. Subjects with normal, healthy skin were photographed with a calibrated, high-resolution digital camera, and the average improvement in overall health was calculated using image morphing and facial averaging techniques, following a 2-week period of product application. In a second study that included subjects with self-assessed sensitive facial skin, changes in skin hydration, skin dryness, and skin sensitivity (determined by means of a lactic acid sting test and subject self-assessment) were monitored during a 3-week regimen of mild cleansing and moisturizing with products designed for sensitive skin. The third study involved dermatologist-assessed highly sensitive skin patients (mostly rosacea with an atopic background in some cases). These patients underwent a 4-week skin-care regimen involving mild cleansing and moisturizing. In all three studies, significant improvements in skin health/quality were observed by means of expert assessments, instrumental evaluations, and subjective self-assessment.