The role of self-referential and social processing in the relationship between pubertal status and difficulties in mental health and emotion regulation in adolescent girls in the UK.

Adolescence is marked by the onset of puberty, which is associated with an increase in mental health difficulties, particularly in girls. Social and self-referential processes also develop during this period: adolescents become more aware of others' perspectives, and judgements about themselves become less favourable. In the current study, data from 119 girls (from London, UK) aged 9-16 years were collected at two-time points (between 2019 and 2021) to investigate the relationship between puberty and difficulties in mental health and emotion regulation, as well as the role of self-referential and social processing in this relationship. Structural equation modelling showed that advanced pubertal status predicted greater mental health and emotion regulation difficulties, including depression and anxiety, rumination and overall difficulties in emotion regulation, and in mental health and behaviour. Advanced pubertal status also predicted greater perspective-taking abilities and negative self-schemas. Exploratory analyses showed that negative self-schemas mediated the relationships between puberty and rumination, overall emotion regulation difficulties, and depression (although these effects were small and would not survive correction for multiple comparisons). The results suggest that advanced pubertal status is associated with higher mental health and emotion regulation problems during adolescence and that negative self-schemas may play a role in this association. RESEARCH HIGHLIGHTS: This study investigates the relationship between puberty, mental health, emotion regulation difficulties, and social and self-referential processing in girls aged 9-16 years. Advanced pubertal status was associated with worse mental health and greater emotion regulation difficulties, better perspective-taking abilities and negative self-schemas. Negative self-schemas may play a role in the relationships between advanced pubertal status and depression, and advanced pubertal status and emotion regulation difficulties, including rumination.

Exploration heuristics decrease during youth.

Deciding between exploring new avenues and exploiting known choices is central to learning, and this exploration-exploitation trade-off changes during development. Exploration is not a unitary concept, and humans deploy multiple distinct mechanisms, but little is known about their specific emergence during development. Using a previously validated task in adults, changes in exploration mechanisms were investigated between childhood (8-9 y/o, N = 26; 16 females), early (12-13 y/o, N = 38; 21 females), and late adolescence (16-17 y/o, N = 33; 19 females) in ethnically and socially diverse schools from disadvantaged areas. We find an increased usage of a computationally light exploration heuristic in younger groups, effectively accommodating their limited neurocognitive resources. Moreover, this heuristic was associated with self-reported, attention-deficit/hyperactivity disorder symptoms in this population-based sample. This study enriches our mechanistic understanding about how exploration strategies mature during development.

I know better! Emerging metacognition allows adolescents to ignore false advice.

Adolescents aspire for independence. Successful independence means knowing when to rely on one's own knowledge and when to listen to others. A critical prerequisite thus is a well-developed metacognitive ability to accurately assess the quality of one's own knowledge. Little is known about whether the strive to become an independent decision maker in adolescence is underpinned by the necessary metacognitive skills. Here, we demonstrate that metacognition matures from childhood to adolescence (N = 107) and that this process coincides with greater independent decision-making. We show that adolescents, in contrast to children, take on others' advice less often, but only when the advice is misleading. Finally, we demonstrate that adolescents' reduced reliance on others' advice is explained by their increased metacognitive skills, suggesting that a developing ability to introspect may support independent decision-making in adolescence.

Children are full of optimism, but those rose-tinted glasses are fading-Reduced learning from negative outcomes drives hyperoptimism in children.

Believing that good things will happen in life is essential to maintain motivation and achieve highly ambitious goals. This optimism bias, the overestimation of positive outcomes, may be particularly important during childhood when motivation must be maintained in the face of negative outcomes. In a learning task, we have thus studied the mechanisms underlying the development of optimism bias. Investigating children (8 to 9 year-olds), early (12 to 13 year-olds), and late adolescents (16 to 17 year-olds), we find a consistent optimism bias across age groups. However, children were particularly hyperoptimistic, with the optimism bias decreasing with age. Using computational modeling, we show that this was driven by a reduced learning from worse-than-expected outcomes, and this reduced learning explains why children are hyperoptimistic. Our findings thus show that insensitivity to bad outcomes in childhood helps to prevent taking on an overly realistic perspective and maintain motivation. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Children perform extensive information gathering when it is not costly.

Humans often face decisions where little is known about the choice options. Gathering information prior to making a choice is an important strategy to improve decision making under uncertainty. This is of particular importance during childhood and adolescence, when knowledge about the world is still limited. To examine how much information youths gather, we asked 107 children (8-9 years, N = 30), early (12-13 years, N = 41) and late adolescents (16-17 years, N = 36) to perform an information sampling task. We find that children gather significantly more information before making a decision compared to adolescents, but only if it does not come with explicit costs. Using computational modelling, we find that this is because children have reduced subjective costs for gathering information. Our findings thus demonstrate how children overcome their limited knowledge and neurocognitive constraints by deploying excessive information gathering, a developmental feature that could inform aberrant information gathering in psychiatric disorders.

Postdecision Evidence Integration and Depressive Symptoms.

Background: Metacognition, or the ability to reflect on one's own thoughts, may be important in the development of depressive symptoms. Recent work has reported that depressive symptoms were associated with lower metacognitive bias (overall confidence) during perceptual decision making and a trend toward a positive association with metacognitive sensitivity (the ability to discriminate correct and incorrect decisions). Here, we extended this work, investigating whether confidence judgments are more malleable in individuals experiencing depressive symptoms. We hypothesized that depressive symptoms would be associated with greater adjustment of confidence in light of new evidence presented after a perceptual decision had been made. Methods: Participants (N = 416) were recruited via Amazon Mechanical Turk. Metacognitive confidence was assessed through two perceptual decision-making tasks. In both tasks, participants made a decision about which of two squares contained more dots. In the first task, participants rated their confidence immediately following the decision, whereas in the second task, participants observed new evidence (always in the same direction as initial evidence) before rating their confidence. Participants also completed questionnaires measuring depressive symptoms and self-esteem. Analysis: Metacognitive bias was calculated as overall mean confidence, whereas metacognitive sensitivity was calculated using meta-d' (a response-bias free measure of how closely confidence tracks task performance) in the first task. Postdecision evidence integration (PDEI) was defined as the change in confidence following postdecision evidence on the second task. Results: Participants with more depressive symptoms made greater confidence adjustments (i.e., greater PDEI) in light of new evidence (ß = 0.119, p = 0.045), confirming our main hypothesis. We also observed that lower overall confidence was associated with greater depressive symptoms, although this narrowly missed statistical significance (ß = -0.099, p = 0.056), and we did not find an association between metacognitive sensitivity (meta-d') and depressive symptoms. Notably, self-esteem was robustly associated with overall confidence (ß = 0.203, p < 0.001), which remained significant when controlling for depressive symptoms. Conclusions: We found that individuals with depressive symptoms were more influenced by postdecisional evidence, adjusting their confidence more in light of new evidence. Individuals with low self-esteem were less confident about their initial decisions. This study should be replicated in a clinically depressed sample.

Chemotherapy in patients with unresected pancreatic cancer in Australia: A population-based study of uptake and survival.

AIM: Palliative chemotherapy improves symptom control and prolongs survival in patients with unresectable pancreatic cancer, but there is a paucity of data describing its use and effectiveness in everyday practice. We explored patterns of chemotherapy use in patients with unresected pancreatic cancer in Australia and the impact of use on survival. METHODS: We reviewed the medical records of residents of New South Wales or Queensland, Australia, diagnosed with unresectable pancreatic adenocarcinoma between July 2009 and June 2011. Associations between receipt of chemotherapy and sociodemographic, clinical and health service factors were evaluated using logistic regression. We used Cox proportional hazards models to analyze associations between chemotherapy use and survival. RESULTS: Data were collected for 1173 eligible patients. Chemotherapy was received by 44% (n = 184/414) of patients with localized pancreatic cancer and 53% (n = 406/759) of patients with metastases. Chemotherapy receipt depended on clinical factors, such as performance status and comorbidity burden, and nonclinical factors, such as age, place of residence, multidisciplinary team review and the type of specialist first encountered. Consultation with an oncologist mitigated most of the sociodemographic and service-related disparities in chemotherapy use. The receipt of chemotherapy was associated with prolonged survival in patients with inoperable pancreatic cancer, including after adjusting for common prognostic factors. CONCLUSIONS: These findings highlight the need to establish referral pathways to ensure that all patients have the opportunity to discuss treatment options with a medical oncologist. This is particularly relevant for health care systems covering areas with a geographically dispersed population.

Determinants of Outcomes Following Resection for Pancreatic Cancer-a Population-Based Study.

BACKGROUND: Patient and health system determinants of outcomes following pancreatic cancer resection, particularly the relative importance of hospital and surgeon volume, are unclear. Our objective was to identify patient, tumour and health service factors related to mortality and survival amongst a cohort of patients who underwent completed resection for pancreatic cancer. METHODS: Eligible patients were diagnosed with pancreatic adenocarcinoma between July 2009 and June 2011 and had a completed resection performed in Queensland or New South Wales, Australia, with either tumour-free (R0) or microscopically involved margins (R1) (n = 270). Associations were examined using logistic regression (for binary outcomes) and Cox proportional hazards or stratified Cox models (for time-to-event outcomes). RESULTS: Patients treated by surgeons who performed <4 resections/year were more likely to die from a surgical complication (versus ≥4 resections/year, P = 0.04), had higher 1-year mortality (P = 0.03), and worse overall survival up to 1.5 years after surgery (adjusted hazard ratio 1.58, 95 % confidence interval 1.07-2.34). Amongst patients who had ≥1 complication within 30 days of surgery, those aged ≥70 years had higher 1-year mortality compared to patients aged <60 years. Adjuvant chemotherapy treatment improved recurrence-free survival (P = 0.01). There were no significant associations between hospital volume and mortality or survival. CONCLUSIONS: Systems should be implemented to ensure that surgeons are completing a sufficient number of resections to optimize patient outcomes. These findings may be particularly relevant for countries with a relatively small and geographically dispersed population.

Describing Patterns of Care in Pancreatic Cancer: A Population-Based Study.

OBJECTIVES: Despite pancreatic cancer being the fifth highest cause of cancer death in developed regions, there is a paucity of population-based management details for patients with pancreatic cancer. The objective of this study was to reflect on current practice and outcomes to facilitate future improvement. METHODS: A comprehensive population-based patterns-of-care study in 2 Australian states was conducted. Patients diagnosed with pancreatic adenocarcinoma between July 2009 and June 2011 were identified by cancer registries, and detailed clinical data were collected from medical records. RESULTS: Data were collected for 1863 patients, 96% of those eligible. The majority resided in major cities; their median age was 72 years, and 54% were men. Over half of the cases (58%) had metastatic disease at diagnosis. Resection was attempted for 20% of patients but only completed in 15%. The uptake of adjuvant chemotherapy (76%) and the proportion alive at 1-year (22%) were higher than reported in previous population-based reports. Of those with no complete surgical resection, 43% received palliative chemotherapy. CONCLUSIONS: This population-based overview of the management of patients with pancreatic cancer suggests that, despite evidence that the proportion surviving and the use of adjuvant chemotherapy has increased, there may still be underutilization of cancer-directed therapies.