Childhood methylphenidate adherence as a predictor of antidepressants use during adolescence.

Methylphenidate (MPH) is a common and effective treatment for attention deficit hyperactivity disorder (ADHD), but little is known about the relationship between early childhood intake of MPH and onset of antidepressant treatment during adolescence. The study aimed to examine whether adherence to MPH during early childhood predicts the initiation of antidepressants during adolescence. This is a 12-year historical prospective nationwide cohort study of children enrolled in an integrated care system who were first prescribed MPH between the ages of 6 and 8 years (N = 6830). We tested for an association between their adherence to MPH during early childhood (as indicated by medication possession ratio from MPH onset through the age of twelve) and the likelihood of being prescribed any antidepressant during adolescence (age 13-18). As all country citizens are covered by mandatory health insurance, and full services are provided by one of the four integrated care systems, data regarding patients' diagnoses, prescriptions, and medical purchases are well documented. Logistic regression analysis indicated that those with higher adherence to MPH had a 50% higher risk (95% CI 1.16-1.93) of receiving antidepressants during adolescence when controlling for other comorbid psychiatric conditions and parental use of antidepressants. In this large-scale longitudinal study, MPH adherence during early childhood emerged as a predictor for antidepressant treatment during adolescence, which may reflect increased emotional and behavioral dysregulation in this group. The highly adherent patients are at higher risk and should be clinically monitored more closely, particularly into adolescence.

Mastery avoidance: An overlooked aspect of medical students' motivation.

Background: Previous research on medical students' motivation mostly overlooked an important concept, namely, mastery-avoidance goals. The mastery-avoidance goal is defined as engaging in a task to avoid losing knowledge or skills that have already been acquired. We aimed to explore the role of mastery-avoidance goals in changes occurring in low frustration tolerance (LFT) levels over a span of one academic year. This approach enables us to understand which type of motivational orientation is expected to explain most adaptive educational outcomes. Methods: First year medical students (n = 241) participating in a physician-patient communication course completed the surveys of motivational orientations and LFT at the beginning and at the end of the academic year. A confirmatory factor analysis supported the construct validity of the motivational orientations structure. Results: Cross-lagged analysis using structural equation modelling revealed that the mastery-approach goal was negatively related to the progression of LFT while mastery-avoidance goal was positively related. Conclusions: The findings suggest that what matters is not merely the level of motivation, but rather the type of motivational orientations that students pursue. Encouraging students to improve their current skills, while discouraging competitiveness and reducing fear of losing competence, may enhance the effectiveness of medical training programmes.

Predictors of developing mathematics anxiety among middle-school students: A 2-year prospective study.

While there is an abundance of research pertaining to the development of anxiety disorders, there is still a dearth of knowledge regarding the development of anxiety in the general population. The objective of this study was to longitudinally explore the development of mathematics anxiety among normative middle-school students, and to identify the moderating role of gender, school transition and scholastic achievements on these trajectories. Subjects included 413 sixth grade students (53.3% females, mean age 11.27 ± 0.38 years). Participants were evaluated for their level of anxiety in the context of mathematics, using the Value of Education scale, in four time-points with a 6-month gap between each time-point. Data regarding subjects' grades and school transition were also collected. A growth curve analysis using hierarchical linear modelling revealed that girls, students who transitioned between schools and high achievers (each independently) reported a significant increase in mathematics related anxiety towards the end of sixth grade, which later decreased during seventh grade. The findings of this prospective study on factors affecting the development of mathematics anxiety among normative adolescents may be important in planning focused primary prevention school-based strategies.

Communication skills training in medical students: do motivational orientations predict changes over time in psychosocial attributes?

Perceived psychosocial abilities (i.e., competence in addressing the psychosocial aspects of patient care) and low frustration tolerance (LFT) (i.e., intolerance of physical or emotional discomfort) have been established as significant attributes of experienced medical professionals. We aimed to expand our understanding of the role motivation plays within communication skills training by investigating whether motivation precedes or, conversely, follows psychosocial attributes. According to goal orientations theory, motivation denotes the goals students pursue when engaging in learning tasks. We hypothesized that goal orientations would predict development of psychosocial attributes. More specifically, an adaptive goal orientation (i.e., mastery goal orientation) was expected to predict perceived psychosocial abilities, whereas the maladaptive goal orientations (i.e., performance-approach and avoidance goal orientations) were hypothesized to predict LFT (frustration intolerance). The study spanned two sequential years, in which two cohorts of first-year medical students (N = 151) completed questionnaires at the beginning and end of an annual physician-patient communication course. The questionnaires assessed goal orientations, perceived psychosocial abilities, and LFT. Cross-lagged analyses using Structural Equation Modeling indicated that goal orientations significantly predicted perceived psychosocial abilities, as hypothesized; however, LFT predicted maladaptive goal orientation, rather than the other way around. These findings provided further support for the contribution of goal orientations theory within medical education contexts. Medical schools are advised to consider motivational aspects when planning and implementing training programs.

Is burnout associated with referral rates among primary care physicians in community clinics?

BACKGROUND: There is little empirical research examining the effects of burnout on objective measures of primary care physicians' behaviour in the medical encounter. OBJECTIVES: We studied possible associations between primary care physicians' burnout and the rates of referrals. We conceptualized referral rate as a negative outcome of burnout because high and unnecessary referral rates incur extra costs to health care systems. METHODS: In this cross-sectional study, 136 primary care physicians in one district of one Israeli health maintenance organization (HMO) completed the Maslach Burnout Inventory in the presence of an interviewer. Data on each physician's objective workload and number of referrals for high- and low-cost imaging tests, specialist clinics and treatments by nurses were collected from the HMO's databases. RESULTS: Due to high correlations between referral rate indicators, a Confirmatory Factor Analysis revealed one factor: 'referrals for diagnostic tests and specialist clinics'. Path Analysis using Structural Equation Modelling explained a total of 18.1% of referral rate variance, with board-certified specialist mostly associated (ß = 0.31, P < 0.01), followed by burnout (ß = 0.20, P < 0.05) and objective workload (ß = 0.18, P < 0.05). CONCLUSIONS: In this preliminary investigation, we found that referral rates for diagnostic tests and specialist clinics increased independently for board-certified specialists (compared with GPs), for those with higher burnout levels and when objective workload increases. These findings support the conceptualization of referrals rates as objectively measured negative outcomes of burnout. Further replications with other objective outcomes, additional HMOs and bigger samples are warranted.

Can achievement goal theory provide a useful motivational perspective for explaining psychosocial attributes of medical students?

BACKGROUND: Psychosocial competence and frustration tolerance are important characteristics of skilled medical professionals. In the present study we explored the usefulness of applying a comprehensive motivational theory (Goal orientations), for this purpose. According to goal orientation theory, learning motivation is defined as the general goals students pursue during learning (either mastery goals - gaining new knowledge; or performance goals - gaining a positive evaluation of competence or avoiding negative evaluation). Perceived psychosocial abilities are a desirable outcome, and low frustration tolerance (LFT), is a negative feature of student behavior. The hypothesis was that the mastery goal would be positively associated with psychosocial abilities while performance goals would be positively associated with LFT. METHODS: 143 first-year medical students completed at the end of an annual doctor-patient communication course a structured questionnaire that included measures of learning goal orientations (assessed by Pattern of Adaptive Learning Scale - PALS), psychosocial abilities (assessed by Psychological Medicine Inventory- student version -PMI-S) and Low Frustration Tolerance (LFT). RESULTS: All study variables were found reliable (Cronbach's α ranged from .66 to .90) and normally distributed. Hierarchical multiple regression analysis revealed significant associations supporting the hypotheses. The mastery goal orientation was positively associated with perceived psychosocial abilities (PMI-S) (ß = .16, p < .05) and negatively associated with low frustration tolerance (ß = -.22, p < .05) while performance goal orientation was significantly associated with low frustration tolerance (ß = .36, p < .001). CONCLUSIONS: The results suggest that the goal orientations theory may be a useful theoretical framework for understanding and facilitating learning motivation among medical students. Limitations and suggestions for practice within medical education context are discussed.

COVID-19 pandemic: Impacts on mothers' and infants' mental health during pregnancy and shortly thereafter.

The COVID-19 pandemic brought about a global crisis, with profound implications on public mental health. The current review focuses on the impact of the pandemic on the mental health of mothers and their infants during pregnancy and shortly after delivery. Literature shows that in similar disaster situations, mothers' stress reaction and mental health have a critical impact on infant development. Research data on perinatal mental health during the current COVID-19 pandemic is reviewed in conjunction with studies on the relationship between maternal stress, infant development, and psychopathology. Recommendations for perinatal mental health enhancement are discussed and topics for future research suggested.

A Nationwide Study Comparing Mental Health Professionals' Willingness to Try Hallucinogenic Drugs in Basic Research or Clinical Practice.

This study explored whether personal attitudes toward drug users are associated with professional approaches and whether the association between personal and professional attitudes varies across different mental health professions. Participants (N = 347) included medical (psychiatrists and psychiatric nurses) and other (clinical psychologists and social workers) mental health professions from all 13 mental health centers in Israel. They completed questionnaires aimed to assess familiarity with medical usage of hallucinogenic drugs, personal attitudes toward recreational drug users and willingness to use five hallucinogens in research of clinical practice. Hypotheses were tested using multiple-group structural equation modeling (SEM). Psychiatrists reported the highest levels of familiarity with and willingness to use all types of hallucinogenic drugs, as compared to other mental health professionals. Psychiatrists held the strongest belief in the potential utility of hallucinogenic drugs; yet, their personal attitudes toward drug users affected negatively their willingness to try hallucinogenic drugs in clinical practice. This was the only significant association that was found. Future research and treatment programs should address the topic of hallucinogenic drug therapy, and specifically the need to separate between individual beliefs and professional clinical decision-making.

Depression Symptoms as Mediator Between Adolescents' Sense of Loneliness at School and Nonsuicidal Self-Injury Behaviors.

Background: Previous studies indicated that perception of school experiences (i.e., teachers' psychological support and perceived peer climate) is associated with nonsuicidal self-injury (NSSI) behaviors among adolescents. Aims: The purpose of the current study was to explore whether depression symptoms mediate the relationship between sense of loneliness in school and NSSI behaviors among adolescents. Method: The sample included high-school students (N = 306; 51.6% girls) who completed surveys assessing their subjective sense of loneliness (feeling lonely, spending their time alone in school, and reporting a small number of friends), depression symptoms, and NSSI behaviors. Results: Multiple-group structural equation modeling, stratified by gender, supported the hypothesized model. Sense of loneliness was associated with depression symptoms, which in turn were associated with NSSI. Positive school attitudes were associated with depression symptoms only for girls. Results were robust when controlling for the relationships with parents. Limitations: The study is based on cross-sectional data, which limits the ability to make causal conclusions, and the instruments are based on self-report scales. Conclusion: Mental health professional are advised to note the significant role of subjective sense of loneliness in school as a possible risk factor for depression symptoms, which may be associated with NSSI behaviors.

Prenatal childbearing motivations, parenting styles, and child adjustment: A longitudinal study.

To have a child is among individuals' most important and meaningful decisions, with far-reaching implications. Despite evidence linking this decision to a wide variety of consequences, little is known about what motivates people to have children, and even less so about the long-term effects of different childbearing motivations on parenting and child adjustment. This study took a self-determination theory (SDT) perspective, examining how prenatal maternal autonomous and controlled childbearing motivations are related to child behavior problems through parenting styles. The rationale was that prenatal autonomous (sense of volition and self-fulfillment) and controlled (feeling pressured) childbearing motivations would shape later parental styles (autonomy-supportive vs. controlling, respectively) and, consequently, child adjustment. Over a period of 2 years beginning at pregnancy, 326 Israeli mothers reported their prenatal childbearing motivations, as well as parental styles and child behavior problems 20 months postpartum. Results of a path analysis revealed that prenatal autonomous childbearing motivation predicted autonomy-supportive parenting, yet the latter was not associated with children's behavior problems. Prenatal controlled motivation predicted controlling parenting, which, in turn, predicted children's internalizing and externalizing problems. No direct effects of childbearing motivation on children's behavior problems are observed, suggesting that childbearing motivation is a distal antecedent operating through more proximal factors such as parenting style. Findings were robust to children's temperamental tendencies and sociodemographic risk factors such as maternal age, high-risk pregnancy, and preterm birth. These findings have theoretical and practical implications for the discourse on motivations underlying the childbearing decision and their effects on parenting and child adjustment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Contrasting effects of music on reading comprehension in preadolescents with and without ADHD.

Children and adolescents with attention-deficit/hyperactivity disorder (ADHD) are advised to study in quiet settings; yet, many professionals assert that environments devoid of external stimulus, are often unnecessary to facilitate optimal learning conditions. Empirical controlled trials examining this assertion are scarce. This study explored whether music improves reading performance of preadolescents with ADHD compared with typically developed (TD) peers, and its correlation with changes in heart rate variability (HRV), an autonomic nervous system indicator. After a pilot phase (N = 20; age = 12.05), additional independent sample of ADHD (n = 25; age = 10.28) and TD (n = 25; age = 10.44) preadolescents completed reading tasks under four conditions: without background music, with calm music without lyrics, calm music with lyrics, and rhythmic music with lyrics. Reading comprehension and mean-levels of HRV changes (before and during each task) were assessed using validated instruments. Reading comprehension significantly improved under the music conditions in ADHD group and deteriorated among TD. Differences in HRV changes were significant between groups, and explained reading performance. These findings suggest that music may improve attentive skills of preadolescents with ADHD, but not TD, and urge the need to identify an optimal fit between individual and contextual characteristics.

Discrepancies in adolescent-mother dyads' reports of core depression symptoms: Association with adolescents' help-seeking in school and their somatic complaints.

OBJECTIVE: Parents of adolescents with mental problems do not always recognize the symptoms in their children, particularly regarding depression, and therefore do not seek professional help. Adolescents themselves tend to seek help from school personnel for their emotional or social difficulties. In contrast, adolescents do report somatic complaints and parents are likely to seek help for these problems. The current study explored whether the divergence between maternal and child reports of depression symptoms is associated with child's help-seeking in school and patterns of somatic complaints. METHOD: A sample of 9th grade students (N = 693; 56% girls; mean age = 15.1) and their mothers representing the Muslim and Druze populations in northern Israel were interviewed simultaneously and independently. Maternal reports were classified either as underestimating, matching, or overestimating their own child self-report of three core symptoms of depression (depressed mood, anhedonia, and irritability). Adolescents reported whether they had consulted school staff and were classified into clusters based on self-reported somatic complaints. RESULTS: Maternal misidentification of their child's depression symptoms was associated with increased help-seeking in school, particularly by boys if depressed mood or irritability were misidentified and particularly by girls if anhedonia was misidentified. Hierarchical cluster analysis indicated that the number and severity of somatic complaints was higher among adolescents whose depression symptoms were not identified, regardless of gender. CONCLUSION: Mental health professionals, educators and parents should be aware that adolescents may attempt to communicate their emotional difficulties through somatic complaints and by seeking help in school.

Exploring Particular Facets of Cognitive Emotion Regulation and Their Relationships With Nonsuicidal Self-Injury Among Adolescents.

Background: Nonsuicidal self-injury (NSSI) has been found to be associated with poor emotion regulation. Aims: The goal of this study was to examine the association of multidimensional cognitive emotion regulation strategies with NSSI among adolescents and compare the different patterns of NSSI. Method: A sample of 594 high-school students (54.4% boys; mean age = 14.96 years), from five regional schools across Israel, were assessed for five facets of cognitive emotion regulation strategies (acceptance, refocus on planning, positive refocusing, putting into perspective, and positive reappraisal) and NSSI behaviors using validated scales. Participants were allocated into three groups: repetitive NSSI (more than six occasions of NSSI; 7.1%), occasional NSSI (at least one incident but less than six; 8.3%), and no NSSI (84.6%). Results: Analysis of covariance, controlling for gender and depression symptoms, revealed that students with NSSI reported higher levels of acceptance, but lower levels of refocus on planning and putting into perspective. Limitations: The study used a cross-sectional design, which was a limitation. Conclusion: These findings demonstrate that particular cognitive emotion regulation strategies differ substantially in their relationship with NSSI. Adolescents who focus on planning and putting stressful situations into perspective may have increased resilience, whereas adolescents who are accepting of negative events that have happened may be more prone to maladaptive coping behaviors.

Social skills, executive functioning and social engagement.

The study explored hypothesized mediation of social interaction skills between executive functions and social engagement among adolescents diagnosed with schizophrenia. Participants (N = 92; 62% boys; age = 16.8) were assessed four weeks after hospitalization using previously validated scales. A regression mediation analysis followed by Structural Equation Modeling (SEM; with bootstrap analysis) supported the hypothesis. Executive functions were significantly associated with communication skills, which in turn was associated with social engagement (indirect effect = 0.29; standardized). These findings highlight the importance of understanding the heterogeneity of executive functions among adolescent patients with schizophrenia, and the subsequent association with their social skills and engagement.

Suicidal ideation and behaviors within the school context: Perceived teacher, peer and parental support.

School-related factors have been found to be associated with adolescents' suicidal ideation and behaviors, including teacher and peer support. Research has tended to ignore the nested nature of school-related data, which may be critical in this context. The current study implemented a multi-level approach on data from the 2013-14 Health Behaviors in School-aged Children (HBSC-WHO) Israeli survey among high school children (N = 4241; 56% female). Participants completed measures of teacher-, peer-, and parental-support (coded reversely from 1 = high to 5 = low), and suicidal ideation and behaviors in the last 12 months. Hierarchical Linear Modeling (HLM), controlling for gender and age, revealed that classroom-level teachers' support was significantly related to students' suicidal ideation and behaviors (OR = 1.71, 95% CI = 1.20-2.44; OR = 1.39, 95% CI = 1.04-1.86; respectively), whereas parental (OR = 1.56, 95% CI = 1.40-1.75; OR = 1.41, 95% CI = 1.30-1.55; respectively) and peer support (OR = 1.21, 95% CI = 1.12-1.31; OR = 1.11, 95% CI = 1.02-1.21; respectively) were significant at the individual-level. The school environment can play a significant role in reducing risk for suicidal ideation and behaviors. Findings can inform future research and practice in planning and implementing evidence-based intervention programs within schools.

Repetitive vs. occasional non-suicidal self-injury and school-related factors among Israeli high school students.

The current study explored the relationship between non-suicidal self-injuries (NSSI) and students' perceptions of school among adolescents. A sample of 594 high-school students (54.4% male; mean age 14.96) completed validated self-reported measures. Students were divided into three groups: repetitive-NSSI (more than 6 occasions), occasional-NSSI (at least once but less than 6), and no-NSSI. Multi-nominal regression, controlling for gender, age, and depression symptoms, indicated that teachers' psychological support, a sense of school belongingness, and negative perceptions of peer climate were significantly different between repetitive-NSSI and non-NSSI groups. These school-related factors should be considered as risk factors for NSSI behaviors.

Perceived school climate across the transition from elementary to middle school.

The implications of the transition from elementary to middle school are of major concern for educators and researchers worldwide. Previous studies have yielded ambiguous findings; some have indicated negative outcomes of school transition, whereas others have demonstrated null or even positive effects. The aim of the current research was to explore the impact of school transition on students' perceived educational climate while distinguishing between transition effects and age-related effects by comparing students who transitioned to middle schools at the end of the sixth grade versus those who did not. The research included 2 complementary studies. Study 1 was based on a large-scale national survey in Israel (N = 71,739) that compared students from fifth to eighth grades using a cross-sectional design, in which the students completed a survey once in the middle of the school year. Study 2 followed a sample of 415 students across 2 years including 4 waves of survey completion, at the beginning and the end of 2 consecutive school years, during which 55% of the students experienced a transition and 45% remained in elementary school. In both studies, the students completed self-report surveys assessing the perceived school climate. Both multilevel and nonlinear growth-curve analyses consistently indicated that the students who transitioned reported positive perceptions of the school climate before the transition that declined more quickly and become equal to or lower than those of the nontransitioning students. Teachers should apply practices that enhance students' sense of support, specifically following school transitions. (PsycINFO Database Record

Parental support and adolescent motivation for dieting: the Self-Determination Theory perspective.

This article focuses on parents' role in overweight adolescents' motivation to diet and successful weight loss. The study employed Self-Determination Theory (SDT) as the theoretical framework (Deci & Ryan, 2000, 2011). Ninety-nine participants (ages 20-30) who had been overweight during adolescence according to their Body Mass Index (BMI mean = 25, SD = 1.6), completed retrospective questionnaires about their motivation to diet and their parents' behavior in the context of dieting. Findings from a structural equation modeling analysis suggested that participants who viewed their parents' as more need-supportive demonstrated more autonomous motivation to diet, which, in turn, contributed to their successful weight loss. The findings highlight the importance of parental support of adolescents' psychological needs in the quality of their motivation to diet. This is an important insight for parents and professionals who aim to encourage more constructive parent involvement in adolescents' dieting and well-being.

The role of goal structures and peer climate in trajectories of social achievement goals during high school.

Students' social goals--reasons for engaging in interpersonal relationships with peers--are consequential for students' interactions with their peers at school and for their well-being. Despite the salience of peer relationships during adolescence, research on social goals is generally lacking compared with academic goals, and it is unknown how these social goals develop over time, especially among high school students. The aim of the study was to assess trajectories of students' social goals and to determine how relevant individual and contextual variables predicted initial levels and trajectories of students' social goals. Participants were 9th through 12th grade students (N = 526) attending a U.S. high school. Students filled out surveys of their social goals (social development, social demonstration-approach, and social demonstration-avoidance) 6 times across 2 school years. Nonlinear growth curve analyses and piecewise growth curve analyses were used to assess trajectories of social goals across time. Students' initial levels of social goals differed based on their gender, grade level, prior achievement, and perceptions of classroom goals structures and peer climate. Furthermore, despite substantial stability over time, the shapes of these goal trajectories were predicted by students' gender, grade level, and perceptions of classroom goal structures and peer climate. In particular, students who perceived an increase in performance-avoidance classroom goals maintained higher demonstration social goals and decreased in developmental social goals over time, and students who perceived an increase in positive peer climate decreased in demonstration-avoidance social goals. Implications and directions for future research on social goals are discussed.