Negative feedback-seeking in depression: The moderating roles of rumination and interpersonal life stress.

OBJECTIVES: Swann's self-verification theory proposes that negative feedback seeking (NFS)-the solicitation of negative feedback from others that confirms one's self-views-works in a negative cycle to maintain and exacerbate depression in the face of interpersonal stress. We propose a cognitive-interpersonal integration account of NFS such that this maladaptive behavior prospectively predicts depression only among those with a trait tendency to ruminate on the causes and consequences of depressed mood and stress. METHOD: Participants included 91 young adults who were over-sampled for a lifetime history of a unipolar depressive disorder (age 17-33; 69% women; 67% lifetime depressive disorder). At baseline, participants completed a structured diagnostic interview and self-report measures of NFS, rumination, and depression symptoms. In addition, participants engaged in an interpersonal rejection task (the Yale Interpersonal Stressor) followed by a behavioral measure of NFS. At a 3-month follow-up, depression symptoms were again assessed by self-report and exposure to stressful interpersonal life events in the intervening period were assessed with a rigorous contextual interview and independent rating system. RESULTS: Controlling for baseline depression severity, greater self-reported, and behaviorally assessed NFS predicted greater follow-up depression severity, but only among those with higher trait tendency to ruminate. For self-reported NFS, this association was further moderated by level of interpersonal, but not noninterpersonal, life events experienced over follow-up. CONCLUSION: These findings suggest that rumination may represent a modifiable intervention target that could break the vicious interpersonal cycle of depression and, thus, mitigate the depressogenic effects of NFS.

Connecting Attitude Position and Function: The Role of Self-Esteem.

Attitude position and function often are discussed as though they are distinct aspects of attitudes, but scholars have become increasingly interested in how they may interface. We extend existing work showing that people view their positive attitudes as more self-defining than their negative attitudes (i.e., the positivity effect). All datasets support that the positivity effect emerged most strongly among high self-esteem individuals and was attenuated, eliminated, or even reversed among low self-esteem individuals. Furthermore, Study 4 uses a broad array of individual difference measures to triangulate that the higher self-enhancement motivation associated with high self-esteem, rather than merely the positive self-worth of high self-esteem people, is responsible for moderating the positivity effect. In sum, the present work establishes boundary conditions for an important phenomenon in the attitudes literature, develops understanding of the far-ranging implications of trait self-esteem, and illuminates the psychological motivations that connect attitude position and function.

Visuospatial and Executive Dysfunction in Patients With Acute Kidney Injury, Chronic Kidney Disease, and Kidney Failure: A Multilevel Modeling Analysis.

Background: Neurocognitive impairment is a common finding across the spectrum of kidney disease and carries important consequences for quality of life. We previously demonstrated that robotic technology can identify neurocognitive impairments not readily detectable by traditional testing in patients with acute kidney injury (AKI) and chronic kidney disease (CKD). Objective: The present study aimed to assess whether these quantifiable deficits in neurocognition differ based on a diagnosis of AKI, CKD, or kidney failure. Design: This was a cross-sectional analysis of participants previously enrolled in an observational study. Setting: Patients were enrolled at a tertiary academic hospital, Kingston Health Sciences Centre, Kingston, ON, Canada. Patients: Adults with AKI, CKD, or kidney failure. Measurements: Each participant underwent robotic neurocognitive assessment using the Kinarm: an interactive robotic device that uses a series of behavioral tasks involving movement of the upper limbs to precisely quantify neurocognitive impairment across a variety of neurocognitive domains. Methods: Multilevel modeling was used to determine the effect of Kinarm task type, kidney diagnostic group (AKI vs CKD vs kidney failure), and the interaction between the two, on neurocognitive performance. Results: A total of 104 participants within 1 year of an AKI event or with CKD category G3-5 were enrolled. We found that across all of the kidney diagnostic groups, participants performed worst on the Kinarm tasks of Reverse Visually Guided Reaching (b = 0.64 [95% confidence interval = 0.42, 0.85]), Visually Guided Reaching (b = 0.28 [0.07, 0.49]), and Trail Making (b = 0.50 [0.28, 0.72]), relative to all other tasks. There were no significant differences in average performance across tasks based on kidney diagnostic group. However, diagnostic group and neurocognitive task type interacted to determine performance, such that patients with AKI performed worse than those with either CKD or kidney failure on the Reverse Visually Guided Reaching task. Limitations: Kinarm assessment was performed at a single time point, and the sample size itself was small, which may lead to the risk of a false-positive association despite the use of multilevel modeling. Our sample size also did not permit inclusion of the underlying etiology of kidney impairment as a covariate in our analyses, which may have also influenced neurocognitive function. Conclusions: In this study that utilized the Kinarm to assess neurocognitive function, patients with AKI demonstrated significantly worse neurocognitive functioning than patients with CKD or kidney failure on a task measuring executive function and visuomotor control.

Contexte: La déficience neurocognitive est fréquemment observée dans le spectre des maladies rénales et elle entraîne des conséquences importantes sur la qualité de vie. Nous avons précédemment démontré que la technologie robotique peut identifier les troubles neurocognitifs qui ne sont pas facilement détectables par les tests traditionnels chez les patients atteints d'insuffisance rénale aiguë (IRA) et d'insuffisance rénale chronique (IRC). Objectif: La présente étude visait à déterminer si ces déficits quantifiables dans les fonctions neurocognitives diffèrent selon un diagnostic d'IRA, d'IRC ou d'insuffisance rénale terminale (IRT). Type d'étude: Analyse transversale des participants précédemment inscrits à une étude observationnelle. Cadre: Les patients avaient été recrutés dans un hôpital universitaire tertiaire, le Kingston Health Sciences Centre, de Kingston (Ontario) au Canada. Sujets: Des adultes atteints d'IRA, d'IRC ou d'IRT. Mesures: Chaque participant a subi une évaluation neurocognitive robotique à l'aide du Kinarm: un dispositif robotique interactif qui utilise une série de tâches comportementales impliquant des mouvements des membres supérieurs pour quantifier avec précision les troubles neurocognitifs dans divers domaines neurocognitifs. Méthodologie: On a utilisé une modélisation à plusieurs niveaux pour déterminer l'effet du type de tâche Kinarm, du groupe de diagnostic rénal (IRA c. IRC c. IRT), et l'interaction entre les deux, sur la performance neurocognitive. Résultats: L'étude porte sur les 104 patients atteints d'IRC de stade G3-5 ou ayant vécu un épisode d'IRA dans l'année. Nous avons constaté que, dans tous les groupes de diagnostic, les participants ont obtenu les pires résultats pour les tâches Kinarm de l'atteinte guidée visuellement inversée (b = 0,64 [intervalle de confiance à 95 %: 0,42-0,85)), de l'atteinte guidée visuellement (b = 0,28 [0,07-0,49]) de création de parcours (b = 0,50 [0,28-0,72]), par rapport à toutes les autres tâches. Aucune différence significative n'a été observée dans le rendement moyen entre les tâches selon le diagnostic rénal. Cependant, le groupe de diagnostic et le type de tâche neurocognitive ont interagi pour déterminer les performances, de sorte que les patients atteints d'IRA ont obtenu de moins bons résultats que les patients atteints d'IRC ou d'IRT pour la tâche d'atteinte visuelle inversée guidée. Limites: L'évaluation Kinarm n'a été effectuée qu'une seule fois, sur un échantillon plutôt faible, ce qui pourrait entraîner un risque d'association faussement positive malgré l'utilisation d'une modélisation à plusieurs niveaux. La taille de notre échantillon n'a pas permis d'inclure l'étiologie sous-jacente de l'atteinte rénale comme covariable dans nos analyses, ce qui aurait pu également influencer la fonction neurocognitive. Conclusion: Dans cette étude où le Kinarm a été utilisé pour évaluer la fonction neurocognitive, les patients atteints d'IRA ont montré des fonctions neurocognitives significativement inférieures à celles des patients atteints d'IRC ou d'IRT lors de tâches mesurant la fonction exécutive et le contrôle visuomoteur.

Facilitating Scientific Communication Between Strangers: A Preregistered Lost E-Mail Experiment.

Communication scholars are increasingly concerned about biases that shape people's interactions with science. Past study has focused on echo chambers (cultivating social networks that reinforce existing worldviews). People's facilitation of scientific discourse between strangers also may be shaped by their attitudes. To study the latter, we employed a recent adaptation of Milgram's lost letter technique called the lost e-mail technique (LET). We conducted a preregistered field study using a large undergraduate university sample (N = 1,508) to examine how the LET might elucidate people's treatment of scientific information. We distributed four ostensibly misaddressed scientific messages and monitored the likelihood of these e-mails being facilitated by participants. Participants' beliefs about self-esteem's importance, assessed months earlier, were associated with increased facilitation of scientific claims congruent with (vs. incongruent with) these beliefs. Thus, people shape the spread of online information in a manner matching their beliefs, even for people outside their social networks.

Mind-Body Practices and Self-Enhancement: Direct Replications of Gebauer et al.'s (2018) Experiments 1 and 2.

Mind-body practices such as yoga and meditation are often believed to instill a "quiet ego," entailing less self-enhancement. In two experiments, however, Gebauer et al. (2018) demonstrated that mind-body practices may actually increase self-enhancement, particularly because such practices become self-central bases for self-esteem. We conducted preregistered replications of both of Gebauer et al.'s experiments. Experiment 1 was a field study of Canadian yoga students (N = 97), and Experiment 2 was a multiwave meditation intervention among Canadian university students (N = 300). Our results supported Gebauer et al.'s original conclusions that mind-body practices increase self-enhancement. Although the self-centrality effects were not clearly replicated in either experiment, we found evidence that measurement and sampling differences may explain this discrepancy. Moreover, an integrative data analysis of the original and the replication data strongly supported all of Gebauer et al.'s conclusions. In short, we provide new evidence against the ego-quieting perspective and in support of the self-centrality interpretation of mind-body practices.

Principal Components Analysis Using Data Collected From Healthy Individuals on Two Robotic Assessment Platforms Yields Similar Behavioral Patterns.

BACKGROUND: Kinarm Standard Tests (KSTs) is a suite of upper limb tasks to assess sensory, motor, and cognitive functions, which produces granular performance data that reflect spatial and temporal aspects of behavior (>100 variables per individual). We have previously used principal component analysis (PCA) to reduce the dimensionality of multivariate data using the Kinarm End-Point Lab (EP). Here, we performed PCA using data from the Kinarm Exoskeleton Lab (EXO), and determined agreement of PCA results across EP and EXO platforms in healthy participants. We additionally examined whether further dimensionality reduction was possible by using PCA across behavioral tasks. METHODS: Healthy participants were assessed using the Kinarm EXO (N = 469) and EP (N = 170-200). Four behavioral tasks (six assessments in total) were performed that quantified arm sensory and motor function, including position sense [Arm Position Matching (APM)] and three motor tasks [Visually Guided Reaching (VGR), Object Hit (OH), and Object Hit and Avoid (OHA)]. The number of components to include per task was determined from scree plots and parallel analysis, and rotation type (orthogonal vs. oblique) was decided on a per-task basis. To assess agreement, we compared principal components (PCs) across platforms using distance correlation. We additionally considered inter-task interactions in EXO data by performing PCA across all six behavioral assessments. RESULTS: By applying PCA on a per task basis to data collected using the EXO, the number of behavioral parameters were substantially reduced by 58-75% while accounting for 76-87% of the variance. These results compared well to the EP analysis, and we found good-to-excellent agreement values (0.75-0.99) between PCs from the EXO and those from the EP. Finally, we were able to reduce the dimensionality of the EXO data across tasks down to 16 components out of a total of 76 behavioral parameters, which represents a reduction of 79% while accounting for 73% of the total variance. CONCLUSION: PCA of Kinarm robotic assessment appears to capture similar relationships between kinematic features in healthy individuals and is agnostic to the robotic platform used for collection. Further work is needed to investigate the use of PCA-based data reduction for the characterization of neurological deficits in clinical populations.

Modelling symptoms to suicide risk in individuals with inflammatory bowel disease.

Given that suicidal behaviour is a pressing concern in inflammatory bowel disease populations, this study sought to model the sequence of variables that lead to its development. Participants (n = 282) completed online self-report questionnaires regarding predictors of suicidal behaviour. A cross-sectional model of the progression from symptoms to suicide risk revealed that biomedical variables were significantly associated with psychosocial predictors of suicidal behaviour, which were significantly related to theory-driven predictors of suicidal behaviour, which were ultimately associated with suicide risk. Evidently, interventions need to target distal predictors of suicidal behaviour to mitigate harmful downstream effects.

Naïve beliefs shape emotional reactions to evaluative feedback.

People are motivated to acquire self-evaluative information that favours themselves (self-enhancement) or information that confirms their present self-views (self-consistency). We proposed that participants' naïve theories characterising self-esteem as important may moderate their self-enhancement motivations. Across three samples, we demonstrated that increasing self-esteem importance causes prevention-based emotional reactions to become increasingly dependent on the favorability of feedback. We thus infer that self-enhancement motivation increases when people hold favourable beliefs about the importance of maximising self-esteem. We also replicated past findings in which people regard positive (versus negative) self-relevant information as more valid when they have high (versus low) self-esteem, revealing self-consistency. Individual differences in self-esteem importance and trait self-esteem thus play distinct roles in shaping people's enhancement and consistency motivations.

Assessing the relationship between near-infrared spectroscopy-derived regional cerebral oxygenation and neurological dysfunction in critically ill adults: a prospective observational multicentre protocol, on behalf of the Canadian Critical Care Trials Group.

INTRODUCTION: Survivors of critical illness frequently exhibit acute and chronic neurological complications. The underlying aetiology of this dysfunction remains unknown but may be associated with cerebral ischaemia. This study will use near-infrared spectroscopy to non-invasively quantify regional cerebral oxygenation (rSO2) to assess the association between poor rSO2 during the first 72 hours of critical illness with delirium severity, as well as long-term sensorimotor and cognitive impairment among intensive care unit (ICU) survivors. Further, the physiological determinants of rSO2 will be examined. METHODS AND ANALYSIS: This multicentre prospective observational study will consider adult patients (≥18 years old) eligible for enrolment if within 24 hours of ICU admission, they require mechanical ventilation and/or vasopressor support. For 72 hours, rSO2 will be continuously recorded, while vital signs (eg, heart rate) and peripheral oxygenation saturation will be concurrently captured with data monitoring software. Arterial and central venous gases will be sampled every 12 hours for the 72 hours recording period and will include: pH, PaO2, PaCO2, and haemoglobin concentration. Participants will be screened daily for delirium with the confusion assessment method (CAM)-ICU, whereas the brief-CAM will be used on the ward. At 3 and 12 months post-ICU discharge, neurological function will be assessed with the Repeatable Battery for the Assessment of Neuropsychological Status and KINARM sensorimotor and cognitive robot-based behavioural tasks. ETHICS AND DISSEMINATION: The study protocol has been approved in Ontario by a central research ethics board (Clinical Trials Ontario); non-Ontario sites will obtain local ethics approval. The study will be conducted under the guidance of the Canadian Critical Care Trials Group (CCCTG) and the results of this study will be presented at national meetings of the CCCTG for internal peer review. Results will also be presented at national/international scientific conferences. On completion, the study findings will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT03141619.

The physiological determinants of near-infrared spectroscopy-derived regional cerebral oxygenation in critically ill adults.

BACKGROUND: To maintain adequate oxygen delivery to tissue, resuscitation of critically ill patients is guided by assessing surrogate markers of perfusion. As there is no direct indicator of cerebral perfusion used in routine critical care, identifying an accurate strategy to monitor brain perfusion is paramount. Near-infrared spectroscopy (NIRS) is a non-invasive technique to quantify regional cerebral oxygenation (rSO2) that has been used for decades during cardiac surgery which has led to targeted algorithms to optimize rSO2 being developed. However, these targeted algorithms do not exist during critical care, as the physiological determinants of rSO2 during critical illness remain poorly understood. MATERIALS AND METHODS: This prospective observational study was an exploratory analysis of a nested cohort of patients within the CONFOCAL study ( NCT02344043 ) who received high-fidelity vital sign monitoring. Adult patients (≥ 18 years) admitted < 24 h to a medical/surgical intensive care unit were eligible if they had shock and/or required mechanical ventilation. Patients underwent rSO2 monitoring with the FORESIGHT oximeter for 24 h, vital signs were concurrently recorded, and clinically ordered arterial blood gas samples and hemoglobin concentration were also documented. Simultaneous multiple linear regression was performed using all available predictors, followed by model selection using the corrected Akaike information criterion (AICc). RESULTS: Our simultaneous multivariate model included age, heart rate, arterial oxygen saturation, mean arterial pressure, pH, partial pressure of oxygen, partial pressure of carbon dioxide (PaCO2), and hemoglobin concentration. This model accounted for a significant proportion of variance in rSO2 (R2 = 0.58, p < 0.01) and was significantly associated with PaCO2 (p < 0.05) and hemoglobin concentration (p < 0.01). Our selected regression model using AICc accounted for a significant proportion of variance in rSO2 (R2 = 0.54, p < 0.01) and was significantly related to age (p < 0.05), PaCO2 (p < 0.01), hemoglobin (p < 0.01), and heart rate (p < 0.05). CONCLUSIONS: Known and established physiological determinants of oxygen delivery accounted for a significant proportion of the rSO2 signal, which provides evidence that NIRS is a viable modality to assess cerebral oxygenation in critically ill adults. Further elucidation of the determinants of rSO2 has the potential to develop a NIRS-guided resuscitation algorithm during critical illness. TRIAL REGISTRATION: This trial is registered on clinicaltrials.gov (Identifier: NCT02344043 ), retrospectively registered January 8, 2015.

Using principal component analysis to reduce complex datasets produced by robotic technology in healthy participants.

BACKGROUND: The KINARM robot produces a granular dataset of participant performance metrics associated with proprioceptive, motor, visuospatial, and executive function. This comprehensive battery includes several behavioral tasks that each generate 9 to 20 metrics of performance. Therefore, the entire battery of tasks generates well over 100 metrics per participant, which can make clinical interpretation challenging. Therefore, we sought to reduce these multivariate data by applying principal component analysis (PCA) to increase interpretability while minimizing information loss. METHODS: Healthy right-hand dominant participants were assessed using a bilateral KINARM end-point robot. Subjects (Ns = 101-208) were assessed using 6 behavioral tasks and automated software generated 9 to 20 metrics related to the spatial and temporal aspects of subject performance. Data from these metrics were converted to Z-scores prior to PCA. The number of components was determined from scree plots and parallel analysis, with interpretability considered as a qualitative criterion. Rotation type (orthogonal vs oblique) was decided on a per task basis. RESULTS: The KINARM performance data, per task, was substantially reduced (range 67-79%), while still accounting for a large amount of variance (range 70-82%). The number of KINARM parameters reduced to 3 components for 5 out of 6 tasks and to 5 components for the sixth task. Many components were comprised of KINARM parameters with high loadings and only some cross loadings were observed, which demonstrates a strong separation of components. CONCLUSIONS: Complex participant data produced by the KINARM robot can be reduced into a small number of interpretable components by using PCA. Future applications of PCA may offer potential insight into specific patterns of sensorimotor impairment among patient populations.

The score distribution and factor structure of the Community Assessment of Psychic Experiences-Positive Scale (CAPE-P15) in a Canadian sample.

AIM: Psychotic-like experiences (PLEs) share several risk factors with psychotic disorders and confer greater risk of developing a psychotic disorder. Thus, individuals with PLEs not only comprise a valuable population in which to study the aetiology and premorbid changes associated with psychosis, but also represent a high-risk population that could benefit from clinical monitoring or early intervention efforts. METHOD: We examined the score distribution and factor structure of the current 15-item Community Assessment of Psychic Experiences-Positive Scale (CAPE-P15) in a Canadian sample. The CAPE-P15, which measures current PLEs in the general population, was completed by 1741 university students. RESULTS: The distribution of total scores was positively skewed, and confirmatory factor analysis indicated that a 3-factor structure produced the best fit. CONCLUSION: The CAPE-P15 has a similar score distribution and consistently measures three types of positive PLEs: persecutory ideation, bizarre experiences and perceptual abnormalities when administered in Canada vs Australia.

Self-Resemblance and Social Rejection.

Humans perceive and treat self-resembling others in ways that suggest that self-resemblance is a cue of kinship. However, we know little about how individuals respond to treatment by self-resembling others. Here we approach this problem by connecting facial self-resemblance to social rejection. Given that individuals should expect to cooperate with kin, we hypothesized that (1) social inclusion by perceived kin should elicit lesser feelings of rejection and (2) social exclusion by perceived kin should elicit greater feelings of rejection relative to inclusion or exclusion, respectively, by nonkin. To test these hypotheses, we recruited 90 participants to play two games of Cyberball, a virtual ball-tossing game, with separate pairs of ostensible partners. In one game, the ostensible partners were programed to fully include the participants in group play and, in the other game, they were programed to exclude the participants after a few rounds; the order of inclusion and exclusion was counterbalanced across participants. Partner faces were digitally manipulated to be either self- or nonself-resembling, and these conditions were also counterbalanced. Rejection feelings differed significantly as a function of self-resemblance between the inclusion and exclusion conditions, but only for participants who experienced inclusion first. Moreover, for these individuals, inclusion by self-resembling partners led to significantly lesser feelings of rejection than did inclusion by nonself-resembling partners. To explain this effect, we explore potential mechanisms of kin recognition and social rejection. Although nuanced, our results suggest that perceptions of kinship can moderate psychological responses to the actions of others.

Religion replenishes self-control.

Researchers have proposed that the emergence of religion was a cultural adaptation necessary for promoting self-control. Self-control, in turn, may serve as a psychological pillar supporting a myriad of adaptive psychological and behavioral tendencies. If this proposal is true, then subtle reminders of religious concepts should result in higher levels of self-control. In a series of four experiments, we consistently found that when religious themes were made implicitly salient, people exercised greater self-control, which, in turn, augmented their ability to make decisions in a number of behavioral domains that are theoretically relevant to both major religions and humans' evolutionary success. Furthermore, when self-control resources were minimized, making it difficult for people to exercise restraint on future unrelated self-control tasks, we found that implicit reminders of religious concepts refueled people's ability to exercise self-control. Moreover, compared with morality- or death-related concepts, religion had a unique influence on self-control.

The effects of culture and self-construal on responses to threatening health information.

OBJECTIVE: The current studies examined if cultural and self-construal differences in self-enhancement extended to defensive responses to health threats. DESIGN: Responses to fictitious medical diagnoses were compared between Asian-Americans and European-North Americans in experiment 1 and between Canadians primed with an interdependent versus an independent self-construal in experiment 3. In experiment 2, the responses of Chinese and Canadians who were either heavy or light soft drink consumers were assessed after reading an article linking soft drink consumption to insulin resistance. MAIN OUTCOME MEASURE: The primary-dependent measure reflected participants' defensiveness about threatening versus nonthreatening health information. RESULTS: In experiment 1, all participants responded more defensively to an unfavourable than a favourable diagnosis; however, Asian-Americans responded less defensively than did European-North Americans. In experiment 2, all high soft drink consumers were less convinced by the threatening information than were low soft drink consumers; however, among high consumers, Chinese changed their self-reported consumption levels less than did European-Canadians. In experiment 3, interdependence-primed participants responded less defensively to an unfavourable diagnosis than did independence-primed participants. CONCLUSION: Defensive reactions to threatening health information were found consistently; however, self-enhancement was more pronounced in individuals with Western cultural backgrounds or independent self-construals.

For love or money? What motivates people to know the minds of others?

Mood affects social cognition and "theory of mind", such that people in a persistent negative mood (i.e., dysphoria) have enhanced abilities at making subtle judgements about others' mental states. Theorists have argued that this hypersensitivity to subtle social cues may have adaptive significance in terms of solving interpersonal problems and/or minimising social risk. We tested whether increasing the social salience of a theory of mind task would preferentially increase dyspshoric individuals' performance on the task. Forty-four dysphoric and 51 non-dysphoric undergraduate women participated in a theory of mind decoding task following one of three motivational manipulations: (i) social motivation (ii) monetary motivation, or (iii) no motivation. Social motivation was associated with the greatest accuracy of mental state decoding for the dysphoric group, whereas the non-dysphoric group showed the highest accuracy in the monetary motivation condition. These results suggest that dysphoric individuals may be especially, and preferentially, motivated to understand the mental states of others.

Context changes choices: a prospective study of the effects of hospitalization on life-sustaining treatment preferences.

OBJECTIVE: Policy and law encouraging individuals to document their wishes for life-sustaining medical treatment in advance of serious illness assumes that these wishes are unaffected by changes in health condition. To test this assumption, the authors examine the life-sustaining treatment preferences of a sample of elderly adults prior to, soon after, and several months after a hospitalization experience. SUBJECTS AND METHODS: As part of the Advance Directives, Values Assessment, and Communication Enhancement (ADVANCE) project, 401 individuals older than age 65 participated in 3 annual interviews. A subsample of 88 individuals who were hospitalized for greater than 48 hours during the course of the study participated in an additional "recovery" interview conducted soon after their release from the hospital (M = 14 days postdischarge). At each interview, subjects indicated their desire to receive 4 life-sustaining medical treatments in 4 serious illness scenarios. RESULTS: Treatment preferences showed a significant "hospitalization dip," with subjects reporting less desire to receive life-sustaining treatment at the recovery interview than they did at the annual interview conducted prior to hospitalization, but with desire returning to near prehospitalization levels at the annual interview conducted several months after hospitalization. This dip was more pronounced in preferences for cardiopulmonary resuscitation and artificial nutrition and hydration than in preferences for less invasive treatments. CONCLUSIONS: Preferences for life-sustaining treatment are dependent on the context in which they are made, and thus individuals may express different treatment preferences when they are healthy than when they are ill. These results challenge a key psychological assumption underlying the use of instructional advance directives in end-of-life decision making.

Mental state decoding abilities in clinical depression.

BACKGROUND: Depression is associated with profound impairments in social functioning. Past research and theory suggests that these impairments may be related to a difficulty in the ability of depressed individuals to identify and decode others' social cues. However, the nature of this difficulty is equivocal. This investigation is the first to adopt a theory-of-mind framework to examine unipolar depressed individuals' ability to identify complex mental states from eye expressions. METHODS: Women with unipolar clinical depression (N=52) and nondepressed controls (N=30) completed the "Reading the Mind in the Eyes Task" (). All participants also completed self-report measures assessing depressive and anxious symptoms. RESULTS: Depressed women were significantly impaired in their ability to identify mental states in the Eyes task compared to nondepressed participants. This difference remained after controlling for anxiety and was stronger for the affective than the somatic symptoms of depression. LIMITATIONS: The present study was limited by its sample size, resulting in low power for some comparisons. In addition, the study is limited by its use of a heterogeneous depressed sample, including outpatients and volunteers from the community, as well as its use of only female participants. CONCLUSIONS: Our results demonstrate that severely depressed individuals are significantly impaired in their ability to decode others' mental states. We suggest that strategies based on improving basic theory-of-mind reasoning could be incorporated into current therapeutic interventions for depressed individuals to ameliorate their understanding and interpretation of social information.

Stability of older adults' preferences for life-sustaining medical treatment.

The use of instructional advance directives assumes that preferences for life-sustaining medical treatment remain stable over time and across changes in life condition. A sample of 332 older adults recorded their preferences for 4 life-sustaining treatments in 9 illness scenarios. These preferences were elicited again 1 and 2 years after the original interview. Overall, preferences for life-sustaining treatment were moderately stable over time, but stability varied significantly across judgments. Preferences were most stable for illness scenarios that were most and least serious and for decisions to refuse treatment. Age, gender, education, and prior completion of an advance directive were all related to preference stability, and evidence indicated that declines in physical or psychological functioning resulted in decreased interest in life-sustaining treatment.

Confirmatory factor analysis of the Family Emotional Involvement and Criticism Scale: evidence of the dimensionality of expressed emotion.

Using a convenience sample of 152 married couples, the present study tested models that alternately considered family members' perceptions of Expressed Emotion to be a one-, two-, three-, or four-factor construct as measured by the Family Emotional Involvement and Criticism Scale. Results of confirmatory factor analysis procedures indicated that perceptions of Expressed Emotion were best represented by a four-factor model that consisted of involvement, criticism, upset feelings, and approval. The methodological implications of these findings are discussed.