Metacognitive beliefs, mood symptoms, and fatigue four years after stroke: An explorative study.

OBJECTIVE: This cross-sectional study investigated the relationship between metacognition and mood symptoms four years post-stroke and examined fatigue as a potential moderator for this relationship. METHODS: A number of 143 participants completed a survey that included the Hospital Anxiety and Depression Scale (HADS), the Metacognition Questionnaire-30 (MCQ-30), the Fatigue Severity Scale (FSS), and the modified Rankin Scale (mRS) (functional status) four years after stroke. Multiple regression analyses adjusting for demographic and stroke-specific covariates were performed with anxiety and depression as dependent variables and fatigue as a moderator. RESULTS: The proportions of participants satisfying the caseness criteria for anxiety and depression were 20% and 19%, respectively, and 35% reported severe fatigue. Analysed separately, all MCQ-30 subscales contributed significantly to anxiety, whereas only three MCQ-30 subscales contributed significantly to depression. In the adjusted analyses, the MCQ-30 subscales 'positive beliefs' (p < 0.05) and 'uncontrollability and danger' (p < 0.001), as well as fatigue (p < 0.001) and functional status at four years (p < 0.05) were significantly associated with anxiety symptoms. Similarly, the MCQ-30 subscales 'cognitive confidence' (p < 0.05) and 'self-consciousness' (p < 0.05), as well as fatigue (p < 0.001), stroke severity at baseline (p < 0.01), and functional status at four years (p < 0.01) were significantly associated with depression symptoms. Fatigue did not significantly moderate the relationship between any MCQ-30 subscale and HADS scores. CONCLUSION: Maladaptive metacognitions were associated with the mood symptoms of anxiety and depression, independent of fatigue, even after controlling for demographic and stroke-specific factors. Future studies should implement longitudinal designs to determine whether metacognitions precede anxiety or depression after a stroke, and more strongly indicate the potential of metacognitive therapy for improving the mental health of individuals after a stroke.

Applicability and Psychometric Properties of General Mental Health Assessment Tools in Autistic People: A Systematic Review.

In recent years, there has been a proliferation of instruments for assessing mental health (MH) among autistic people. This study aimed to review the psychometric properties of broadband instruments used to assess MH problems among autistic people. In accordance with the PRISMA guidelines (PROSPERO: CRD42022316571) we searched the APA PsycINFO via Ovid, Ovid MEDLINE, Ovid Embase and the Web of Science via Clarivate databases from 1980 to March 2022, with an updated search in January 2024, to identify very recent empirical studies. Independent reviewers evaluated the titles and abstracts of the retrieved records (n = 11,577) and full-text articles (n = 1000). Data were extracted from eligible studies, and the quality of the included papers was appraised. In all, 164empirical articles reporting on 35 instruments were included. The review showed variable evidence of reliability and validity of the various instruments. Among the instruments reported in more than one study, the Aberrant Behavior Checklist had consistently good or excellent psychometric evidence. The reliability and validity of other instruments, including: the Developmental Behavior Checklist, Emotion Dysregulation Inventory, Eyberg Child Behavior Inventory, Autism Spectrum Disorder-Comorbid for Children Scale, and Psychopathology in Autism Checklist, were less documented. There is a need for a greater evidence-base for MH assessment tools for autistic people.

Change characteristics of health-related quality of life and its association with post-stroke fatigue at four-year follow-up.

OBJECTIVE: To explore trajectories that describe change in post-stroke health-related quality of life with fatigue as outcome. DESIGN: Observational and prospective study. SUBJECTS: Stroke survivors (N = 144) with predominantly mild or moderate strokes. METHODS: The multidimensional Stroke-Specific Quality of Life scale was used at 1 and 4 years, and the Fatigue Severity Scale at 4 years post-stroke. Latent class growth analyses were used as person-oriented analyses to identify meaningful trajectories. Socio-demographic and stroke-related covariables provided customary adjustment of the outcome, as well as prediction of class membership. RESULTS: The latent class growth analysis models were estimated for "physical health", "visual-language", and "cognitive-social-mental" components of the Stroke-Specific Quality of Life scale, which extracted trajectories describing a variation in stable, deteriorating and improving functional patterns. The stable, well-functioning trajectory was most frequent across all components. More pronounced fatigue was associated with trajectories describing worse functioning, which was more prominent among females compared with males. Living alone implied more fatigue in the "cognitive-social-mental" component. Within the "visual-language" components' trajectories, younger and older participants reported more fatigue compared with middle-aged participants. CONCLUSION: Most participants belonged to the stable, well-functioning trajectories, which showed a consistently lower level of fatigue compared with the other trajectories.

Examining the psychometric properties of the Norwegian version of the Social Aptitudes Scale in two clinical samples.

BACKGROUND: Few studies have examined the psychometric properties of the Social Aptitudes Scale (SAS). The study aims of the current paper were to examine the internal consistency and the validity of the Norwegian SAS. METHODS: Parents of children from a clinical neuropediatric sample (N = 257) and from a clinical sample from child and adolescent's mental health services (N = 804) filled in the SAS. RESULTS: Internal consistency for the SAS were good in both samples and correlations between the SAS and different scales were in the expected directions. The results from the Confirmatory Factor Analyses indicated poor model fit. CONCLUSIONS: Future validity studies should investigate whether SAS is suitable as a screening instrument for detecting autism spectrum disorder.

Visual Problems are Associated with Long-Term Fatigue after Stroke.

OBJECTIVE: Post-stroke fatigue may be associated with functioning even in patients with mild stroke. In order to guide rehabilitation, the aim of this study was to investigate the independent contribution of 12 function-related domains to severe long-term fatigue. DESIGN: Observational follow-up study. SUBJECTS: A total of 144 stroke survivors (mean age 67.3, standard deviation (SD) 10.9 years) were included. METHODS: Fatigue 3-4 years post-stroke was measured with the Fatigue Severity Scale (cut-off ≥5). Independent variables were the multidimensional Stroke-Specific Quality of Life scale with 12 domains, demographics, and baseline stroke characteristics. RESULTS: Most of the participants had mild and moderate stroke. Thirty-five percent (n = 51) reported severe fatigue 3-4 years after stroke. Those living with a significant other, and working participants reported significantly less fatigue. All domains of the Stroke-specific Quality of Life scale were significantly associated with the Fatigue Severity Scale. Adjusted for age, sex, marital status, and work status, the domains "energy", "mood", and, unexpectedly, the domain "vision", were all variables independently associated with severe long-term fatigue. CONCLUSION: Stroke survivors with prominent self-reported visual problems were more likely to experience fatigue. This finding should be verified in further studies. Visual examination and visual rehabilitation may reduce fatigue in selected stroke survivors.

General Measurement Tools for Assessing Mental Health Problems Among Children and Adolescents with an Intellectual Disability: A Systematic Review.

There is a need for more knowledge of valid and standardized measures of mental health problems among children and adolescents with intellectual disability (ID). In this study, we systematically reviewed and evaluated the psychometric properties of instruments used to assess general mental health problems in this population. Following PRISMA guidelines, we reviewed empirical research published from 1980 through February 2020 with an updated search in March 2021 in Medline, Embase, PsycINFO, Health and Psychological Instruments, CINAHL, ERIC, and Web of Science databases. Forty-nine empirical articles were included in this review. Overall, the review indicated consistently better documentation of the reliability and validity of instruments designed for the ID population compared to instruments developed for the general child population.

The Strengths and Difficulties Questionnaire self-report-, parent-, and teacher version in children with intellectual and developmental disabilities.

BACKGROUND: The Strengths and Difficulties Questionnaire (SDQ) is a frequently used behavioral screening instrument. However, its psychometric properties have been rarely examined among children with intellectual and developmental disabilities (IDD). AIMS: The main aims of this study were to examine the internal consistency (i.e., McDonald's Omega), the convergent validity (by correlating the Total difficulties score with the Aberrant Behavior Checklist [ABC]), the divergent validity (by correlating the Total difficulties score with the Vineland Adaptive Behavior Composite; VABS-II Total) and the factorial validity (by the means of confirmatory factor analyses [CFA]) of the SDQ self-report-, parent-, and teacher version in a sample of children with IDD. METHOD: Participants were 365 children and adolescents (males n = 238; 65 %) aged 4-18 years (M = 10.11, SD = 3.82) referred for a developmental/neurological assessment to the neuropediatric outpatient clinics in the specialist health services. The SDQ was filled inn by 115 children, 337 parents, and 248 teachers. RESULTS: McDonald's Omega was overall lowest for the self-report version. Correlations of the SDQ Total difficulties score and the ABC subscales were strongest for the parent version. The results of the CFA indicated best model fit for the six-factor model that included a method factor for all three versions of the SDQ, however, model fit was overall not good. CONCLUSIONS: Further research that examines the psychometric properties of the SDQ among multiple informants in large samples of children with IDD is needed.

Factors associated with non-completion of and scores on physical capability tests in health surveys: The North Health in Intellectual Disability Study.

BACKGROUND: This study investigated the completion rates, scores and factors associated with non-completion and low scores on physical capability tests in a health survey administered to adults with intellectual disabilities. METHOD: Assessment comprised body mass index (BMI), the Short Physical Performance Battery (SPPB), the timed up-and-go (TUG) test, the one-legged stance (OLS) test; and gross motor, communication and behavioural functioning tests. RESULTS: The completion rates among 93 participants (aged 17-78) were 46% for the SPPB, 42% for the TUG, and 31% for the OLS. More severe intellectual disability (OR = 3.12, p < .001) and lower BMI (OR = 0.859, p = .001) were related to test non-completion. The SPPB scores were below the reference values from the general population. Lower scores were associated with older age, motor disabilities and intellectual disability severity. CONCLUSIONS: Including physical capability tests in health surveys among adults with intellectual disabilities is important to monitor functional status and guide prevention strategies.

Determinants of caregiver satisfaction with child neurodevelopmental assessment in neuropaediatric clinics.

BACKGROUND: In addition to patient evaluations, caregiver evaluations and experiences are important indicators of the quality of health services. The aim of this study was to examine determinants of caregiver satisfaction with and perceived benefit of child neurodevelopmental assessment in neuropaediatric clinics. METHODS: The study was conducted among caregivers of children and adolescents aged 4-18 years (N = 330) referred for neurodevelopmental assessment in two neuropaediatric clinics in the specialised health service in Northern Norway. The Generic Short Patient Experiences Questionnaire (GS-PEQ) for child psychiatric outpatient patients was distributed to caregivers immediately following the assessment, and two of its items were used as measurements of caregiver satisfaction with and perceived benefit of the assessment. RESULTS: Caregiver satisfaction with the assessment was correlated with a better general level of function in the child, higher socioeconomic status, Norwegian mother tongue, referral from a specialist, and the respondent being a woman. Higher perceived benefit of the assessment was correlated with higher socioeconomic status, Norwegian mother tongue, and younger age of the child. Regression analysis revealed that caregivers' perception that the assessment was suited to their child's situation and that there was good cooperation with other public services (e.g., primary care and social/educational services) seemed more fundamental to caregiver satisfaction with neuropaediatric clinics' services than any background variable. Younger age of the child, in addition to caregivers' perception that the assessment was suited to their child and receiving sufficient information about the child's diagnosis/afflictions, were essential to the perceived benefit of the assessment. CONCLUSIONS: Caregiver satisfaction with child neurodevelopmental assessment in neuropaediatric clinics partly depends on variables not related to the assessment experience per se. An assessment that was suited to the child, good cooperation with other public services such as primary health care and social/educational services, and giving sufficient information about the child's diagnosis are essential to an overall positive caregiver evaluation of neurodevelopmental assessments.

Parental mental health screening in a neuropaediatric sample: Psychometric properties of the Everyday Feeling Questionnaire and variables associated with parental mental health.

BACKGROUND: Many previous studies have highlighted distress in parents of children with neurodevelopmental disorders. Further knowledge about the relationship between parental mental health and children's characteristics could help neuropaediatric services improve treatment. The current study examined the applicability of the Everyday Feeling Questionnaire (EFQ) as a screening tool for parental mental health in a neuropaediatric sample. METHODS: Children and adolescents (N = 299) referred to neurodevelopmental/neurological assessment at neuropaediatric outpatient clinics in Northern Norway were assessed for concurrent mental health problems; one of their parents completed the EFQ. RESULTS: The EFQ items loaded highly on a general mental health factor. Parental mental health was more strongly associated with child functional impairment than child emotional/conduct difficulties; it was not associated with child neurodevelopmental disorders. CONCLUSIONS: The EFQ is a suitable screening tool for parental mental health in a neuropaediatric population. Child functional impairment seems an important predictor of parental mental health.

Cortisol levels and cognitive profile in major depression: A comparison of currently and previously depressed patients.

The association between depressive symptoms and elevated cortisol levels, and depression and cognitive functioning, has been less robust in outpatients with symptoms in the mild to moderate range. Furthermore, the association between elevated cortisol levels and cognitive functioning is unclear. In the present study, currently depressed (n = 37), previously depressed (n = 81) and never depressed controls (n = 50) were assessed on a range of neuropsychological measures. Salivary cortisol was measured in the morning and evening. Participants with current depression were non-hospitalized and had symptoms predominately in the mild to moderate range. Elevated salivary evening cortisol, but not morning cortisol, was significantly related to depressive symptoms. The difference in cortisol levels between the previously depressed group and the never depressed controls was not significant. The groups had significantly different cognitive profiles, with the currently depressed performing poorer on tasks related to working memory compared to the never depressed controls. Both the currently and previously depressed performed worse on attentional tasks. The findings indicate that outpatients with mild to moderate depression have elevated cortisol levels and limited mild cognitive impairments. Furthermore, mild impairments in attention may persist after remission, indicating that this could be a trait-marker in depression. The present study did not find support for a significant relationship between cortisol and cognitive functioning.

Confirmatory factor analysis of the behavior rating inventory of executive function in a neuro-pediatric sample and its application to mental disorders.

The construct validity of the 9-scale version of the Behavior Rating Inventory of Executive Function (BRIEF) parent form was examined in a clinical sample of children and adolescents with neurological and neurodevelopmental disorders (N = 281). Confirmatory factor analysis supported a three-factor model separating the inhibitory behavioral control dimension from the emotional control and metacognitive problem-solving dimensions. The Metacognitive factor was also related to a diagnosis of attention deficit/hyperactivity disorder (ADHD) after controlling for age, gender, IQ, adaptive functioning, and a conventional behavioral rating scale, which included inattention-hyperactivity symptoms. The Emotional Regulation factor was related to a diagnosis of oppositional defiant disorder. Correlational analyses indicated that child comorbid emotional and behavioral problems may exacerbate parental BRIEF reporting. Accordingly, when assessing executive function among children with neurological and neurodevelopmental disorders, the BRIEF should be complemented with assessments of mental health problems.

Neurodevelopmental correlates of behavioural and emotional problems in a neuropaediatric sample.

Most research does not address the overlap between neurodevelopmental disorders when investigating concomitant mental health problems. The purpose of the present study was to examine the association of intellectual disability (ID), autism spectrum disorder (ASD), and attention-deficit/hyperactivity disorder (ADHD) with the presence of behavioural and emotional problems after controlling for other well-known correlates and risk factors. The sample included 4- to 18-year-old children who attended neuropaediatric clinics (N = 331). After controlling for adversity, age, gender, other developmental/neurological disorders, parental emotional problems, and parenting strategies, the presence of ADHD but not ASD or ID was uniquely associated with behaviour problems. Neither ADHD nor ASD nor ID was significantly associated with emotional problems after controlling for other risk factors. However, ADHD, ASD and behavioural/emotional disorders but not ID were significantly associated with functional impairment in everyday activities after controlling for other risk factors. Because children with neurodevelopmental disorders have complex needs, a holistic approach to diagnosis and interventions is highly warranted, including the assessment and treatment of behavioural and emotional disorders.

Coping, thought suppression, and perceived stress in currently depressed, previously depressed, and never depressed individuals.

BACKGROUND: Previous research shows that depression is associated with an increase in stressful life events and perceived stress as well as dysfunctional ways of coping with stress. However, knowledge about coping in previously depressed individuals is scant. METHODS: This study compared perceived stress, coping, and thought suppression in a sample of 30 currently depressed, 63 previously depressed, and 42 never depressed individuals. RESULTS: Analysis of variance revealed that previously depressed individuals showed less wishful thinking and thought suppression than the currently depressed individuals, but scored significantly higher on these strategies than the never depressed individuals. However, the group differences became nonsignificant when controlling for perceived stress and intrusions. CONCLUSIONS: This study shows that both current depression and previous depression is related to avoidant coping (wishful thinking and thought suppression). However, these associations might be explained by the higher level of perceived stress among individuals with current or previous depression.

Psychometric properties of a Norwegian adaption of the Barratt Impulsiveness Scale-11 in a sample of Parkinson patients, headache patients, and controls.

OBJECTIVE: To assess the psychometric properties of a Norwegian translation of the Barratt Impulsiveness Scale (BIS-11) for use in populations of headache, Parkinson's disease (PD), and healthy controls. MATERIALS AND METHODS: The BIS-11 was forward and backward translated by native speakers of both Norwegian and English to give Norwegian BIS-11 (Nor-BIS-11). A convenience sample (110 subjects) of healthy controls (47), PD patients (43), and chronic headache patients (20) (the latter two recruited from a Neurology outpatient clinic), were asked to complete the scale (a subset twice for test-retest). Exploratory and confirmatory factor analyses were done for a single-factor model, the original three-factor model and a two-factor model. Test-retest results were analyzed using the Bland-Altman approach. RESULTS: The Nor-BIS-11 scale showed good utility and acceptability as well as good test-retest reliability in this sample. Cronbach's α was .68, test-retest bias was -0.73, Cohen's δ = -.134, and limits of agreement were -11.48 to 10.01. The factor structure was found to fit better with a two-factor model than with the original model with three factors. The model fit indices indicated a moderate fit. CONCLUSIONS: The Nor-BIS-11 scale is acceptable and reliable to use in Parkinson's disease patients, chronic headache patients, and healthy controls. The results should be interpreted in a two-factor model but with caution due to low construct validity. External validity needs to be further tested.

Metacognitions and Mindful Attention Awareness in Depression: A Comparison Of Currently Depressed, Previously Depressed and Never Depressed Individuals.

The primary aim of the study was to test (1) how metacognition relates to the concept of mindful attention awareness, and (2) whether metacognitions or mindful attention awareness best predicted symptoms of depression. Data was collected from three samples: currently depressed (n = 37), previously depressed (n = 81) and never depressed controls (n = 50). There was a moderate correlation between mindful attention awareness and three of five metacognitive subscales. Both mindful attention awareness and metacognition were significantly correlated with depression severity scores after controlling for anxiety. The depressed group had significantly more dysfunctional metacognitions and less mindful attention awareness than the never depressed group. Negative beliefs about worry and mindful attention awareness were also significantly different in the previously depressed group compared with the never depressed. This suggests that metacognitions and mindful attention awareness can be vulnerability factors for depression. The results also indicated that anxiety symptoms and negative beliefs about worry were the most important factors in predicting depression. In conclusion, the study shows that metacognitions and mindful attention awareness are two related but separate constructs and that metacognitions emerged as the best predictor of depression. These results provide support for the metacognitive model of emotional disorders. Copyright © 2015 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE: Metacognitions and mindful attention awareness are related but separate constructs Both mindful attention awareness and metacognition are associated with depression Anxiety and negative beliefs about worry (metacognitions) are most important in predicting depression Addressing metacognitions in therapy should be considered in treatment of depression.

Changes Over Time of Prescription and Nonprescription Analgesics for Headache With or Without Other Somatic Pain: Effects of Prescription Regulatory Changes.

UNLABELLED: The aim of this study was to examine the association and changes over time between headaches with or without somatic pain and the self-reported use of pain medication. The study further examined whether the law amendment in 2003 in Norway releasing the sale of nonprescription drugs to shops has changed these relationships. The study is on the basis of repeated self-report cross-sectional studies from 1998 to 2012 in Norway. A total of 27,247 adults were included. As expected, there was a strong association between headache, especially headache with comorbid somatic pain and consumption of prescription versus nonprescription analgesics, although the overall consumption decreased slightly after 2003. We conclude that the strong association between especially headache, whether complicated by somatic pain or not, and the consumption of prescription-free analgesics did not seem to be negatively affected by the prescription regulatory changes. The very high use of nonprescription medication among headache patients suggests the need for continued observation and information regarding the risk of medication-overuse headache. PERSPECTIVE: In Norway, headache was strongly associated with use of over-the-counter analgesics, for other somatic pain prescription analgesics were equally common. Between 1998 and 2012 headache and related analgesic consumption was reduced and other somatic pain increased. Making over-the-counter analgesics available outside pharmacies in 2003 did not increase the self-reported intake.

Early Maladaptive Schemas: A Comparison Between Bipolar Disorder and Major Depressive Disorder.

BACKGROUND: It is still unclear how bipolar disorder (BD) differentiates from major depressive disorder (MDD) outside major mood episodes. To further elucidate this area, the present study compared the two mood disorders in terms of early maladaptive schemas (EMSs) during remission. METHOD: The sample consisted of 49 participants with BD and 30 participants with MDD who were currently in remission. The participants completed the Young Schema Questionnaire. RESULTS: The BD group scored significantly higher than the MDD group on seven EMSs: abandonment, failure to achieve, insufficient self-control, subjugation, unrelenting standards, enmeshment and entitlement. CONCLUSION: By suggesting that EMSs are more severe in BD compared with MDD, the findings highlight potential vulnerabilities in BD, which merit further examination in terms of their underlying causes and potential treatment implications. KEY PRACTITIONER MESSAGE: Early maladaptive schemas are relevant psychological dimensions to consider in remitted phases of major mood disorders. Findings from the current study suggest that early maladaptive schemas are more prevalent in adults with bipolar disorder compared to adults with major depressive disorder when measured during remission. Interventions targeting early maladaptive schemas may be valuable in treatment of bipolar disorder.

Invisible emotional expressions influence social judgments and pupillary responses of both depressed and non-depressed individuals.

We used filtered low spatial frequency images of facial emotional expressions (angry, fearful, happy, sad, or neutral faces) that were blended with a high-frequency image of the same face but with a neutral facial expression, so as to obtain a "hybrid" face image that "masked" the subjective perception of its emotional expression. Participants were categorized in three groups of participants: healthy control participants (N = 49), recovered previously depressed (N = 79), and currently depressed individuals (N = 36), All participants were asked to rate how friendly the person in the picture looked. Simultaneously we recorded, by use of an infrared eye-tracker, their pupillary responses. We expected that depressed individuals (either currently or previously depressed) would show a negative bias and therefore rate the negative emotional faces, albeit the emotions being invisible, as more negative (i.e., less friendly) than the healthy controls would. Similarly, we expected that depressed individuals would overreact to the negative emotions and that this would result in greater dilations of the pupil's diameter than those shown by controls for the same emotions. Although we observed the expected pattern of effects of the hidden emotions on both ratings and pupillary changes, both responses did not differ significantly among the three groups of participants. The implications of this finding are discussed.

Rorschach variables and dysfunctional attitudes as measures of depressive vulnerability: a 9-year follow-up study of individuals with different histories of major depressive episodes.

Forty-six individuals with different histories of major depressive episodes (MDEs) completed the Rorschach (Exner, 2003 ) and the Dysfunctional Attitude Scale (DAS; Weissman & Beck, 1978) at 2 assessment points (T1, T2) over a 9-year follow-up. At T1, history of MDE and the Rorschach variable MOR (associated with negative self-image) emerged as significant predictors of number of MDEs over the follow-up. At T2, Rorschach markers of depressive vulnerability and scars were identified (i.e., WSum6, related to illogical thinking; X+%, related to conventional perception and social adjustment; X-%, linked to erroneous judgments; MQ-, associated with impaired social relations; and MOR). Test-retest analyses displayed significant temporal stability in Rorschach variables, with r ranging from .34 to .67 and in the DAS, r = .42. Our findings highlight MDE as a recurrent and serious disorder, number of MDEs as a risk factor for future depressions, and Rorschach variables as markers of depressive vulnerability and scars.