Influence of comorbid depression and diagnostic workup on diagnosis of physical illness: a randomized experiment.

OBJECTIVES: Patients with mental illness are less likely to receive the same physical healthcare as those without mental illness and are less likely to be treated in accordance with established guidelines. This study employed a randomized experiment to investigate the influence of comorbid depression on diagnostic accuracy. METHODS: Physicians were presented with an interactive vignette describing a patient with a complex presentation of pernicious anemia. They were randomized to diagnose either a patient with or without (control) comorbid depression and related behaviors. All other clinical information was identical. Physicians recorded a differential diagnosis, ordered tests, and rated patient likeability. RESULTS: Fifty-nine physicians completed the study. The patient with comorbid depression was less likeable than the control patient (p=0.03, 95 % CI [0.09, 1.53]). Diagnostic accuracy was lower in the depression compared to control condition (59.4 % vs. 40.7 %), however this difference was not statistically significant χ2(1)=2.035, p=0.15. Exploratory analyses revealed that patient condition (depression vs. control) interacted with the number of diagnostic tests ordered to predict diagnostic accuracy (OR=2.401, p=0.038). Accuracy was lower in the depression condition (vs. control) when physicians ordered fewer tests (1 SD below mean; OR=0.103, p=0.028), but there was no difference for physicians who ordered more tests (1 SD above mean; OR=2.042, p=0.396). CONCLUSIONS: Comorbid depression and related behaviors lowered diagnostic accuracy when physicians ordered fewer tests - a time when more possibilities should have been considered. These findings underscore the critical need to develop interventions to reduce diagnostic error when treating vulnerable populations such as those with depression.

Intergroup conflict self-perpetuates via meaning: Exposure to intergroup conflict increases meaning and fuels a desire for further conflict.

We investigated whether violent conflict provides individuals with a sense of meaning that they are hesitant to let go of, thus contributing to the perpetuation of intergroup conflict. Across a wide variety of contexts, we found that making intergroup conflict salient increased the meaning people found in conflict and, in turn, increased support for conflict-perpetuating beliefs, ideologies, policies, and behaviors. These effects were detected among participants exposed to reminders of intergroup conflict (the American Revolutionary War and the U.S.-led campaign against ISIS; Studies 1A and 1B), participants living through actual intergroup conflict (the 2014 Israel-Gaza war; Study 2), and participants who perceived actual intergroup conflicts to be larger versus smaller in scope (the November 2015 Paris attacks; Studies 3 and 4). We also found that directly manipulating the perceived meaning in conflict (in the context of the 2014 NYC "hatchet attack"; Study 5) led to greater perceived meaning in life in general and thereby greater support for conflict escalation. Together, these findings suggest that intergroup conflict can serve as a source of meaning that people are motivated to hold on to. We discuss our findings in the context of the meaning making and threat compensation literatures, and consider their implications for perspectives on conflict escalation and resolution. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Do emotional control beliefs lead people to approach positive or negative situations? Two competing effects of control beliefs on emotional situation selection.

Control beliefs are widely acknowledged to play a critical role in self-regulation and well-being, but their impact on decisions to approach or avoid situations that vary in emotional valence remains unclear. We propose that two contradictory, yet equally intuitive, predictions can be made about the impact of control beliefs on emotional situation selection. On the one hand, control beliefs might encourage individuals to initiate proactive emotion regulatory efforts, helping people select positive situations. On the other hand, control beliefs might promote a sense of confidence in one's ability to manage emotions once they arise, helping people select negative situations. We propose that both effects occur via different mechanisms and suppress one another: control beliefs facilitate (1) positivity engagement by enhancing awareness of opportunities to regulate emotions, and (2) negativity engagement by enhancing confidence in one's ability to handle negative situations. We found support for this framework in four studies. Consistent with our hypotheses, control beliefs (measured in Studies 1-3 and manipulated in Study 4) exerted two simultaneous and competing effects on emotional situation selection (assessed via self-report measures in Studies 1 and 2 and behaviorally in Studies 3 and 4) via the proposed mechanisms, and evidence of suppression was found. New opportunities for research on control beliefs, emotion regulation, and motivation are discussed. (PsycINFO Database Record

The Impact of Affect on Out-Group Judgments Depends on Dominant Information-Processing Styles: Evidence From Incidental and Integral Affect Paradigms.

Two studies tested the affect-as-cognitive-feedback model, in which positive and negative affective states are not uniquely associated with particular processing styles, but rather serve as feedback about currently accessible processing styles. The studies extend existing work by investigating (a) both incidental and integral affect, (b) out-group judgments, and (c) downstream consequences. We manipulated processing styles and either incidental (Study 1) or integral (Study 2) affect and measured perceptions of out-group homogeneity. Positive (relative to negative) affect increased out-group homogeneity judgments when global processing was primed, but under local priming, the effect reversed (Studies 1 and 2). A similar interactive effect emerged on attributions, which had downstream consequences for behavioral intentions (Study 2). These results demonstrate that both incidental and integral affect do not directly produce specific processing styles, but rather influence thinking by providing feedback about currently accessible processing styles.

The impact of negative emotions on self-concept abstraction depends on accessible information processing styles.

Research suggests that anger promotes global, abstract processing whereas sadness and fear promote local, concrete processing (see Schwarz & Clore, 2007 for a review). Contrary to a large and influential body of work suggesting that specific affective experiences are tethered to specific cognitive outcomes, the affect-as-cognitive-feedback account maintains that affective experiences confer positive or negative value on currently dominant processing styles, and thus can lead to either global or local processing (Huntsinger, Isbell, & Clore, 2014). The current work extends this theoretical perspective by investigating the impact of discrete negative emotions on the self-concept. By experimentally manipulating information processing styles and discrete negative emotions that vary in appraisals of certainty, we demonstrate that the impact of discrete negative emotions on the spontaneous self-concept depends on accessible processing styles. When global processing was accessible, individuals in angry (negative, high certainty) states generated more abstract statements about themselves than individuals in either sad (Experiment 1) or fearful (Experiment 2; negative, low certainty) states. When local processing was made accessible, however, the opposite pattern emerged, whereby individuals in angry states generated fewer abstract statements than individuals in sad or fearful states. Together these studies provide new insights into the mechanisms through which discrete emotions influence cognition. In contrast to theories assuming a dedicated link between emotions and processing styles, these results suggest that discrete emotions provide feedback about accessible ways of thinking, and are consistent with recent evidence suggesting that the impact of affect on cognition is highly context-dependent. (PsycINFO Database Record

The choices we make: an examination of situation selection in younger and older adults.

The current study examined the effects of age and control beliefs on the use of situation selection. Younger and older adults spent 15 min in a room containing multiple affective streams that varied in emotional valence, and were given free choice to engage with whatever they wanted. No significant main effect of age emerged on the number of choices of, or time spent with, material of each valence. However, age and beliefs interacted such that older adults with strong emotion regulation self-efficacy and general control beliefs chose fewer negative stimuli, whereas younger adults with strong beliefs chose more negative stimuli. Results are discussed from aging and individual differences perspectives.