Results of a brief online group application of the unified protocol for the prevention of emotional disorders in university students: a pilot study with multiple baseline experimental design / Resultados de una aplicación grupal breve en línea del protocolo unificado para la prevención de trastornos emocionales en estudiantes universitarios: un estudio piloto con diseño experimental de línea base múltiple

Los trastornos emocionales (TEs) son los trastornos más comunes entre la población joven. El desarrollo de programas preventivos de los TEs es fundamental para evitar su posible aparición. Los programas de prevención transdiagnósticos podrían presentar una ventaja sobre los existentes para mejorar las estrategias de regulación emocional. Así, el objetivo de este estudio ha sido determinar la viabilidad y eficacia preliminar de un programa breve basado en el Protocolo Unificado (PU). El proyecto consistió en un estudio piloto utilizando un diseño experimental de línea base múltiple. Nueve estudiantes universitarios recibieron un programa de 5 sesiones basado en el PU en formato grupal online. Se encontraron diferencias significativas después de la intervención en la regulación de las emociones, el apoyo social percibido y la evitación, con tamaños del efecto moderados-grandes (r de Cohen = .49 - .59). Estas mejoras mostraron aumentos en los seguimientos al mes y a los 3 meses. Esos resultados están en línea con los que muestran que los programas preventivos transdiagnósticos breves podrían ser útiles para la prevención de los TEs en población universitaria.(AU)

Emotional disorders (EDs) are the most common disorders among the young population. The development of preventive programs for EDs is essential to avoid their possible appearance. Transdiagnostic prevention programs could present an advantage over existing ones to im-prove emotional regulation strategies. Thus, the objective of this study has been to determine the preliminary feasibility and effectiveness of a brief program based on the Unified Protocol (UP). The project consisted of a pilot study using a multiple baseline experimental design. Nine university students received a 5-session program based on the UP in online-group format. Significant differences were found after the intervention for emo-tion regulation, perceived social support and avoidance, with moderate-large effect sizes (Cohen's r= .49-.59). These improvements showed in-creases at 1-month and 3-month follow-ups. Those results are in line with those showing that brief transdiagnostic preventive programs could be use-ful for the prevention of EDs in the university population.(AU)

The emotion of gratitude as a mediator between subjective happiness, positive and negative affect and satisfaction with life in Spanish adults / La emoción de gratitud como mediadora entre la felicidad subjetiva, el afecto positivo y negativo y la satisfacción con la vida en adultos españoles

El presente estudio investigó si la satisfacción con la vida se predice a partir de la felicidad subjetiva, afectos positivos y negativos, alteración psicológica y emociones de gratitud y si la emoción de gratitud está mediando la relación con la felicidad subjetiva, los afectos y la satisfacción con la vida. Se hicieron correlación de Pearson, pruebas de regresión lineal múltiple y modelos de mediación en una muestra de 1537 adultos españoles, 73.6% mujeres y 26.4% hombres, edad 18-88 años (M = 42.56 años; DT = 16.29). Se halló que las emociones de gratitud median la relación entre felicidad subjetiva y satisfacción con la vida y entre los afectos positivos y la satisfacción con la vida. Los afectos positivos son los que más se relacionan con la satisfacción con la vida, seguidos por la felicidad subjetiva y las emociones de gratitud. Los hombres están más satisfechos con la vida cuando sienten menos afecto negativo. Además, las emociones de gratitud median la relación entre felicidad subjetiva y satisfacción con la vida y entre los afectos positivos y la satisfacción con la vida. La diferencia principal radica en que las emociones de gratitud son más fuertes en las mujeres que en los hombres.(AU)

This study aims to examine the predictability of satisfaction with life on the basis of subjective happiness, positive and negative affect, psy-chological disturbance and emotion of gratitude. It also seeks to assess whether the emotion of gratitude is a mediating variable withsubjective happiness, affect, and satisfaction with life. Statistical analyses of Pearson'scorrelation, multiple linear regression tests, and mediation models were conducted on asample of 1537 Spanish adults, 73.6% were females, 26.4% males, age between 18-88 yearsold (M = 42.56; SD = 16.29). The emo-tions of gratitude were found to mediate therelationship between subjec-tive happiness and satisfaction with life and between positiveaffect and satisfaction with life. Of the variables studied, positive affect is the most related tosatisfaction with life, followed by subjective happiness and emo-tions of gratitude. Maleparticipants are more satisfied with life when they feel the less negative affect. Regardingmediation models, emotions of grat-itude mediate the relationship between subjectivehappiness and satisfac-tion with life and between positive affect and satisfaction with life. Themaindifferenceis thatemotions of gratitudearestronger infemalesthan in males.(AU)

Identifying Under- And Overutilization Patterns For Idaho Youth With Serious Emotional Disturbance.

Children and adolescents with serious emotional disturbance represent 7-12 percent of all youth in the United States. In 2017, the State of Idaho implemented the Youth Empowerment Service program, which allows youth with serious emotional disturbance who are younger than age eighteen living in households with income up to 300 percent of the federal poverty level to qualify for Medicaid and receive intensive, community-based treatment. A uniquely detailed method was used to assess the need for services: the Child and Adolescent Needs and Strengths tool, a ninety-seven-indicator instrument administered by a clinician. We used these indicators and Idaho's 2018-22 administrative Medicaid claims data to study the association between children and adolescents' clinical needs complexity and their actual Medicaid behavioral and mental health service use. Our findings show that there was a substantial proportion of youth who were underusing Medicaid behavioral and mental health care services, and there were virtually no overusers. Our findings have implications for the appropriateness of Medicaid utilization management in behavioral health care and program efforts to maintain families with youth having serious emotional disturbance in the Youth Empowerment Service program.

Emotion Regulation Frequency and Self-Efficacy: Differential Associations with Affective Symptoms.

Successful emotion regulation is a critical component of mental health, and difficulties with emotion regulation have been associated with a wide range of disorders, including anxiety and depressive disorders. However, although much is known about commonly used forms of emotion regulation such as cognitive reappraisal and expressive suppression, the relative contribution of two important facets of emotion regulation-frequency and self-efficacy-is not yet clearly established. To address this issue, we conducted two studies. Study 1 employed a community sample (cross-sectional N = 431; 4- to 5-month longitudinal N = 182). Study 2 employed a clinical sample (cross-sectional N = 132). Both assessed emotion regulation frequency and self-efficacy, as well as affective outcomes (anxiety and depressive symptoms). Findings indicated cognitive reappraisal self-efficacy appears to be a relevant variable understanding negative affect outcomes, cross-sectionally, longitudinally and in the clinical sample. Our findings support the process model of emotion regulation in affective symptomatology. Implications for theory and treatment are discussed.

Emotional dysregulation and stimulant medication in adult ADHD.

BACKGROUND: Emotional dysregulation affects up to two-thirds of adult patients with attention-deficit/hyperactivity disorder (ADHD) and is increasingly seen as a core ADHD symptom that is clinically associated with greater functional impairment and psychiatric comorbidity. We sought to investigate emotional dysregulation in ADHD and explored its neural underpinnings. METHODS: We studied emotion induction and regulation in a clinical cohort of adult patients with ADHD before and after a stimulant challenge. We compared patients with age- and gender-matched healthy controls using behavioural, structural, and functional measures. We hypothesized that patients would demonstrate aberrant emotion processing compared with healthy controls, and sought to find whether this could be normalized by stimulant medication. RESULTS: Behaviourally, the ADHD group showed reduced emotion induction and regulation capacity. Brain imaging revealed abberant activation and deactivation patterns during emotion regulation, lower grey-matter volume in limbic and paralimbic areas, and greater grey-matter volume in visual and cerebellar areas, compared with healthy controls. The behavioural and functional deficits seen in emotion induction and regulation in the ADHD group were not normalized by stimulant medication. CONCLUSION: Patients with ADHD may have impaired emotion induction and emotion regulation capacity, but these deficits are not reversed by stimulant medication. These results have important clinical implications when assessing which aspects of emotional dysregulation are relevant for patients and if and how traditional ADHD pharmacotherapy affects emotion induction and emotion regulation.

Associations between urinary level of bisphenol A, phthalates, 8-iso-prostaglandin-F2α, and emotional and behavioral problems among Chinese adolescents.

BACKGROUND: Emotional and behavioral problems (EBPs) of adolescents is a worldwide public health problem. Bisphenol A (BPA) and phthalate (PAEs) are prevalent and potentially toxic to human health. Therefore, this study aimed to investigate the associations between urinary level of BPA, PAEs, 8-iso-prostaglandin-F2α (8-iso-PGF2α), and EBPs. METHODS: A total of 865 Chinese adolescents were included in this study and EBPs was assessed using the Strengths and Difficulties Questionnaire (SDQ). Urinary concentrations of BPA and seven PAEs metabolites in adolescents were determined by high performance liquid chromatography-tandem mass spectrometry. Urinary 8-iso-PGF2α concentration was detected by enzyme-linked immunosorbent assay (ELISA). Spearman rank correlation analysis, multivariate logistic regression analysis, restricted cubic spline functions were used to explore the relationship between the levels of BPA, PAEs, 8-iso-PGF2α and EBPs. RESULTS: BPA and PAEs metabolites were positively associated with EBPs in Chinese adolescents. And the 8-iso-PGF2α was significantly non-linearly correlated with emotional symptoms, conduct problems, peer problems and total difficulties. Furthermore, 8-iso-PGF2α may partially mediate the association between BPA and PAEs exposure and EBPs. LIMITATIONS: This study was a cross-sectional study, the cause-effect relationship between BPA, PAEs exposure and EBPs could not be determined. A single spot urine sample for BPA and PAEs exposure characterization maybe could not represent their long-term exposure level. CONCLUSIONS: High exposure of BPA and PAEs are associated with EBPs, which may be partly mediated by oxidative stress among adolescents. The results of this study could provide certain ideas for subsequent related research.

Emotion dysregulation mediates the relationship between sleep problems and externalizing symptoms in early adolescents: A four-wave longitudinal study.

BACKGROUND: Despite the growing body of longitudinal research linking sleep problems and externalizing symptoms, regarding the direction of the effects of both variables, the results have been inconsistent. Given the mixed findings and inconsistent results in the literature, we propose that emotion dysregulation may link sleep problems and externalizing symptoms. METHODS: The participants (N = 1281, 49.65 % female; M = 12.73 years at time 1, SD = 0.68) were middle school students who completed assessments for sleep problems, externalizing symptoms, and emotion dysregulation. The interval between each wave was six months, for two consecutive years. Autoregressive mediation models using longitudinal data and cross-sectional mediation models using baseline data were evaluated and compared through structural equation modeling. RESULTS: The results revealed that severe sleep problems (at T1, T2, or T3) were associated with higher levels of externalizing symptoms later in adolescence (at T2, T3, or T4), but not vice versa. In addition, analyses of indirect effects indicated that emotion dysregulation mediated this link, such that greater sleep problems led to more emotion dysregulation, which, in turn, led to more externalizing symptoms. CONCLUSION: The findings highlight the critical role that emotional regulation plays in the link between sleep problems and externalizing symptoms and emphasize the need for students as well as middle school administration to pay close attention to both the sleep and externalizing symptoms of early adolescents.

A latent class analysis of cognitive-affective heterogeneity in current intermittent explosive disorder.

Intermittent Explosive Disorder (IED) is a common, chronic, and impairing psychological condition characterized by recurrent, affective aggressive behavior. IED is associated with a host of cognitive and affective symptoms not included in the diagnostic criteria which may be a valuable indicator of heterogeneity in IED-such information can be useful to enhance understanding and treatment of this disorder in mental health settings. A preliminary investigation conducted on cognitive-affective symptom heterogeneity in individuals with a history of IED demonstrated that level of emotional dysregulation primarily differentiated IED subgroups, however the sample size was limited, and almost half of the individuals did not have current IED (only lifetime IED). The present study addressed these limitations by conducting a latent class analysis of cognitive-affective symptoms among a large (n = 504) sample of individuals diagnosed with current IED. The latent IED classes were then externally validated on several adverse outcomes, historical precursors, and demographic variables. Statistical and clinical indicators supported a four-class model, with classes primarily distinguished by patients' severity of emotion dysregulation. The two moderate emotion-dysregulated classes both endorsed callous-unemotional traits and low empathy relative to other classes, a finding which differs from the initial investigation. An external validation of the four classes revealed that they significantly differed on severity outcomes (e.g., aggression, suicide attempts, antisocial behavior, global functioning, comorbidities) and historical precursors (e.g., aversive parental care, childhood maltreatment). These findings provide further insight into the heterogeneity within IED and the associations of such variability with important precursors and clinical outcomes.

Impact of emotional abuse on eating disorder psychopathology: A multiple mediation analysis.

INTRODUCTION: Childhood maltreatment, particularly emotional abuse (EA), has been identified as a significant risk factor for the development of eating disorders (EDs). This study investigated the association between EA and ED symptoms while considering multiple potential mediators. METHODS: Participants included 151 individuals with Anorexia Nervosa (AN), 115 with Bulimia Nervosa (BN), and 108 healthy controls. The Childhood trauma questionnaire, the Toronto Alexithymia scale, the Behavioral inhibition System, and the Eating Disorder Inventory 2 scale were completed before treatment. A mediator path model was conducted in each group: EA was set as independent variable, eating symptoms as dependent variables and ineffectiveness, sensitivity to punishment, alexithymia, and impulsivity as mediators. RESULTS: In individuals with AN, impulsivity emerged as a significant mediator between EA and desire for thinness and bulimic behaviors. Conversely, in individuals with BN, sensitivity to punishment was found to mediate the association between EA and dissatisfaction with one's body. Ineffectiveness and difficulty identifying emotions were identified as transdiagnostic mediators in both clinical groups. No mediation effect was found in healthy individuals. DISCUSSION: The simultaneous assessment of multiple mediators in a unique model outlines the complex interplay between childhood EA and ED psychopathology. Improving ineffectiveness, emotion identification, sensitivity to punishment and impulsivity and exploring their relations with early emotional abuse may represent treatment targets in individuals with EDs and childhood trauma.

The Role of Cultural Capital in Self-Reported Alexithymia and Empathy.

BACKGROUND: Sociocultural factors play an essential role in the way we process and express emotions. In this study, we asked whether Cultural Capital (CC)-the set of knowledge, cultural codes, and skills embodied by people-explains individual differences in two constructs measuring the capacity to understand our own emotions (alexithymia) or others' emotions (empathy). METHOD: A pre-registered survey was conducted with an Italian sample (N = 475). Alexithymia and empathy were assessed respectively via the Toronto Alexithymia Scale and the Interpersonal Reactivity Index. RESULTS: Regression analyses confirmed a significant, although limited, role of CC in predicting alexithymia and empathy. People with higher CC showed lower Externally Oriented Thinking, higher Perspective Taking, and higher Fantasy. Self-reported alexithymia and empathy were also impacted by scores on a social desirability scale. CONCLUSIONS: These results suggest that i) Cultural Capital influences the ability to analyse one's own feelings and understand others' perspectives, and ii) social desirability threatens the validity of self-report measures of emotional abilities. Overall, this research underlines the importance of studying affective processes by considering an individual's cultural context.

Social-emotional problems in 3-to 5-year-old children: a cross-sectional study of highly educated migrants in a Chinese urban area.

Background: Previous research has primarily examined the mental well-being of children from labor migrant families, yet there is a lack of understanding regarding the mental well-being of children from highly educated migrant backgrounds. This study investigated the social-emotional problems of 3-5-year-olds from highly educated migrant families residing in an urban area of China, as well as explored potential differences in demographic variables. Methods: A cross-sectional study was conducted in Qiantang District, Hangzhou, China, with 1,494 (53.3% boys) children selected via a convenient sampling method. The Ages & Stages Questionnaires: social-Emotional, Second Edition (ASQ:SE-2) was used to measure social-emotional problems. Results: The results showed that 23.6% of the children were at risk for social-emotional problems. More boys (26.7%) than girls (20.1%) had scores above the cut-off. Additionally, more children in the low socioeconomic status (29.9%) had scores above the cut-off than those in the high socioeconomic status (18.9%). There were three common issues among all age groups: "being more active than others," "excessive attachment to parents," and "being overly friendly with strangers. Conclusion: The social-emotional development of children from highly educated migrant families is a significant aspect that deserves recognition, contributing valuable insights to the existing literature on this topic.

The relationship between childhood maltreatment and self-harm: the mediating roles of alexithymia, dissociation, internalizing and posttraumatic symptoms.

Background: Although childhood maltreatment is associated with later self-harm, the mechanism through which it might lead to self-harm is not completely understood. The purpose of this study was to examine the roles of alexithymia, dissociation, internalizing and posttraumatic symptoms in the association between exposure to childhood maltreatment and subsequent self-harm.Methods: A total of 360 adolescents were asked to complete the Childhood Trauma Questionnaire, the Toronto Alexithymia Scale, the Dissociative Experience Scale, the Somatoform Dissociation Questionnaire-20, the Posttraumatic Stress Checklist for DSM-5, and the Deliberate Self-Harm Inventory.Results: Results of structural equation modelling analysis revealed the significant mediation effects of alexithymia and dissociative symptoms in the relationship between childhood maltreatment and self-harm, while internalizing and posttraumatic symptoms did not significantly mediate.Conclusion: The findings indicate that alexithymia and dissociative symptoms may be proximal mechanisms linking maltreatment exposure and adolescence self-harm.

Self-harm can be used as a maladaptive coping strategy in response to both hyper- and hypo-arousal symptoms.Alexithymia and dissociative symptoms may be proximal mechanisms linking maltreatment exposure and adolescent self-harm.Posttraumatic symptoms did not mediate the relationship between a history of childhood maltreatment and self-harm.

Impact of COVID-19 on emotional and behavioral problems among preschool children: a meta-analysis.

The impact of the Coronavirus Disease 2019 (COVID-19) on society is continuous, resulting in negative psychological consequences. Given the vulnerability and sensitivity to the environment among preschool children, their emotional and behavioral problems deserve more attention. The current study aimed to explore the impact of the epidemic on preschool children's mental health by determining the pooled prevalence of emotional and behavioral problems amidst the Coronavirus Disease 2019 pandemic and to reveal potential reasons for variations between studies. Published studies were searched in Embase, PubMed, ProQuest, PsycINFO, Web of Science, CNKI, and Wanfang. Based on the inclusion criteria outlined in this study, a total of 10 studies encompassing 38,059 participants were incorporated. Employing a random-effect model for estimating the prevalence of emotional and behavioral problems, the results revealed a pooled prevalence rate of 24.3% (95% CI, 0.15-0.38; I²=99.9%) among preschool children. This rate surpasses the pre-outbreak prevalence observed in different countries, signifying a detrimental influence of the epidemic on the mental well-being of preschoolers. Therefore, mental health care and recovery are essential for the vulnerable group during and after the public health crisis. Specific emotional and behavioral problems among preschool children are expected to be researched in the future to provide more targeted guidance for intervention.

The association among negative life events, alexithymia, and depressive symptoms in a psychosomatic outpatient sample.

BACKGROUND: Depression is a life-threatening mental health problem. Various factors have been demonstrated to be associated with depressive symptoms, including negative life events (NLEs) and alexithymia. A retrospective study was conducted to investigate the relationship among negative life events, alexithymia, and depression symptoms in a psychosomatic outpatient sample in China. METHODS: A total of 2747 outpatients (aged 18 - 65) were included in this investigation. The Life Events Scale (LES), Toronto alexithymia scale (TAS-26), and 9-item Patient Health Questionnaire (PHQ-9) were used to assess NLEs, alexithymia, and depressive symptoms, respectively. A stepwise regression analysis model was established to investigate the relationship among alexithymia, NLEs, and depressive symptoms. RESULTS: Overall, 67.0% of the patient sample had a PHQ-9 score of 10 or higher. The stepwise regression analysis model showed a well-fitted model, in which NLEs and alexithymia explain a total of 34.2% of the variance of depressive symptoms in these participants. NLEs (ß = 0.256, p < 0.001) and dimensions of alexithymia (difficult describing feelings (ß = 0.192, p < 0.001) and identifying feelings (ß = 0.308, p < 0.001)) were positively correlated with symptoms of depression. CONCLUSIONS: Previous studies have confirmed the correlation between NLEs and depression, alexithymia and depression, respectively. In our study, we used a stepwise regression model to explain the relationship among those variables simultaneously, and found that NLEs and alexithymia could function as predictors of depressive symptoms. Based on this discovery, alexithymia-focused treatment strategies could be alternative in depressive patients with alexithymia, but this remains to be verified in the future.

The intersection between alexithymia, testosterone reactivity, and coparenting in fathers predicts child's prosocial behavior.

The development of prosocial skills in children is a key predictor of long-term social, cognitive, and emotional functioning. However, the role of fathers' psychological characteristics in fostering prosocial development, including during the prenatal period, and the mechanisms underlying their influence, remain relatively unexplored. This study aimed to examine whether a higher tendency of alexithymia, a difficulty to identify and verbalize emotions, in expectant fathers predicts prosocial behavior of two-year-old toddlers through the quality of coparenting and whether greater testosterone increase during a stressful parenting task moderates this indirect effect. A sample of 105 couples and their children was tracked longitudinally starting from the third trimester of pregnancy (T1), at three months (T2), and at two years postnatally (T3). Using self-report questionnaires, fathers reported on alexithymia (T1) and mothers and fathers reported on coparenting quality (T2). Additionally, fathers provided saliva samples before and after engaging in a stressful parenting task (the Inconsolable Doll Task) to measure testosterone reactivity (T1). Children's prosocial behavior was observed during an out-of-reach task (T3). A moderated mediation analysis using structural equation modeling showed that higher levels of alexithymia pre-birth predicted lower coparenting quality three months after birth, which in turn predicted lower prosocial behavior of two-year-old children, but only among fathers with mean or high testosterone increases. This study illuminates a potential mechanism by which fathers' alexithymia and testosterone reactivity forecast their toddlers' prosocial behavior.

Relationships among alexithymia, psychological distress, and disordered eating behaviors in adolescents.

This cross-sectional study aimed to evaluate the relations between psychological distress, alexithymia, disordered eating behaviors (DEBs), and body mass index (BMI) and to assess if psychological stress would mediate the influence of alexithymia on DEBs in adolescents. A total of 1609 high school students (58.9% females) aged 14-18 years were included in the study. Data were collected using a self-administered questionnaire. DEBs including emotional eating, cognitive restraint, and uncontrolled eating were assessed with the Three-Factor Eating Questionnaire, psychological distress was assessed with the Depression Anxiety Stress Scale and alexithymia was assessed with the Toronto Alexithymia Scale. Anthropometric measurements were performed. Psychological distress was found to be positively associated with alexithymia, emotional eating, uncontrolled eating, and cognitive restraint (p < 0.01). Both direct and indirect effects of alexithymia on emotional eating and uncontrolled eating were significant. Psychological distress partially mediated the relationship between alexithymia and uncontrolled eating (ß = 0.05) and emotional eating (ß = 0.04), while it fully mediated the relationship between alexithymia and cognitive restraint (ß = 0.05). BMI z score was not correlated with alexithymia and psychological distress. Emotional eating (ß = 0.16) and cognitive restraint (ß = 0.34), but not uncontrolled eating, significantly were associated with BMI z score. This study demonstrated that alexithymia and psychological distress are positively associated with DEBs in adolescents. It also showed that psychological distress plays a mediating role between alexithymia and DEBs. Moreover, it showed that emotional eating and cognitive restraint are positively associated with the BMI z score. These results suggest that interventions aimed at improving adolescents' psychological well-being and their ability to identify and describe their emotions may reduce DEBs in adolescents, thereby preventing obesity in adolescents.

Cluster analysis based on gambling variables and mental health in a clinical population of gamblers.

BACKGROUND: Interest in characterizing individuals involved in addictive behaviors has been growing, which allows tailoring prevention and intervention strategies to the gambler's needs. The study aimed to 1) identify clusters of gamblers according to gambling-related characteristics and mental health; and 2) analyze differences in psychological variables between the clusters. METHODS: A total of 83 participants undergoing treatment for gambling disorder (Mage = 45.52, 51.8 % female) completed a set of questionnaires. Hierarchical cluster analysis was performed to classify gambling based on gambling variables (i.e., gambling severity and gambling motives) and mental health (i.e., depression, anxiety, and hostility). Several ANOVAs were conducted to illustrate the distinguishing features of each cluster, encompassing both the variables included in the cluster analysis and other relevant psychological variables. RESULTS: Findings suggest that gamblers can be classified into three clusters based on these variables: 1) "high gambling severity and good mental health," 2) "high gambling severity and poor mental health," and 3) "low gambling severity and good mental health." These clusters were differentiated as a function of psychological variables, such as emotional dependence, alexithymia, and stressful life events. CONCLUSIONS: Classifying gamblers according to their profile provides a better understanding of their needs and problems, allowing for a more tailored approach in terms of prevention and intervention strategies.

A national survey of pandemic fear and cyberchondria after ending zero-COVID policy: The chain mediating role of alexithymia and psychological distress.

BACKGROUND: More than half the domestic population in China were infected with COVID-19 in two months after ending "zero-infection policy", which severely overwhelmed frontline healthcare providers with stress and fear. However, there is no study to date investigating the associations between nurses' fear of pandemic and cyberchondria. This study aimed to 1) investigate the correlations between fear pandemic and cyberchondria among frontline nurses, and 2) discover its potential mechanism. METHODS: A cross-sectional sample of frontline nurses (N = 8161) was recruited from 98 hospitals across China in February 2023. Participants were invited to complete an online, self-rated standardized questionnaire focused on pandemic fear, alexithymia, psychological distress, and cyberchondria. Environmental, clinical and socioeconomic information were collected for adjustment while conducting chain mediation analysis. RESULTS: When other covariates were controlled, it was found that fear of the pandemic significantly contributed to cyberchondria (b = 0.58, 95%CI [0.56, 0.60], p < .001). The chain mediation model suggested that both alexithymia and psychological distress were mediating factors between pandemic fear and cyberchondria. CONCLUSIONS: The higher the perceived fear, the greater the cyberchondria, which suggests that reducing fear about the pandemic and providing adequate support could reduce the incidence of cyberchondria. As alexithymia and psychological distress may be transdiagnostic mechanisms between fear and cyberchondria, targeted interventions focused on expression dysregulation and emotional identification could be useful.

A comparison of patients with epileptic seizures (ES) versus those with psychogenic non-epileptic seizures (PNES) on measures of alexithymia, mood, and anxiety.

OBJECTIVE: To compare persons with epilepsy (PWE) to those with psychogenic non-epileptic seizures (PNES) on measures of depression, anxiety, and alexithymia subscales (i.e., difficulty identifying emotions, difficulty describing emotions, and external-oriented thinking). MATERIAL AND METHODS: In this retrospective study, 235 epilepsy patients and 90 patients with PNES were evaluated between 2012 and 2020 at the Northeast Regional Epilepsy Group. These patients had completed the Toronto Alexithymia Scale (TAS-20), The Center for Epidemiologic Studies - Depression Scale (CES-D) and The State-Trait Anxiety Inventory (STAI). Background information was collected regarding work/student/disability status at the time of the evaluation history of psychiatric diagnosis; psychological trauma; and involvement in psychotherapy either at the time of the evaluation or prior. RESULTS: Significant differences between PWEs and those with PNES were found not only in historical data (e.g., Psychiatric History, History of Trauma, and History of Therapy) (p < .001) but also on measures of Depression (p = .002) and Anxiety (p < .001). ANOVA analysis also revealed significant differences in the distribution of the TAS-Total score, TAS-Describing emotions, and TAS-Identifying emotions. Using logistic regression (stepwise model) the optimal set of predictors for a differential diagnosis of epilepsy and PNES was combination of TAS-Identifying emotions score, history of psychological trauma, and history of therapy. The accuracy of the prediction was determined to be 80.2 %. CONCLUSIONS: Although higher alexithymia rates are present in PNES and PWEs, clinicians may find a combination of TAS-Identifying Emotion score, history of trauma, and history of psychotherapy useful in supporting a differential diagnosis. Also, a subgroup may exist among those with PNES with high levels of alexithymia, depression, and anxiety that may require a different treatment approach focused on addressing difficulties in identifying and describing their emotions and their other symptomatology.

The contribution of alexithymia, childhood maltreatment, impulsivity, C-reactive protein, lipid profile, and thyroid hormones to aggression and psychological distress (depression and anxiety) in schizophrenia.

There are individual effects of alexithymia, childhood maltreatment, impulsivity, and some biological markers on aggression and psychological distress in schizophrenia. However, the combined effects of these psychological and biological markers have not yet been fully studied. This study therefore aimed to investigate the influence of these psychological and biological markers on aggression and psychological distress (e.g., depression and anxiety) in inpatients with schizophrenia (n = 355). Participants completed self-report and clinician-rated scales, and blood samples were collected. There were no significant differences between patients with and without alexithymia regarding biological markers. Patients with childhood maltreatment exhibited higher levels of free triiodothyronine (FT3) and C-reactive protein (CRP), as well as lower total cholesterol (TC) levels, compared to non-traumatized individuals. Aggression was positively predicted by psychological distress, alexithymia, childhood maltreatment, impulsivity, CRP, and FT3, and negatively by TC and low-density lipoprotein cholesterol. Negative symptoms, childhood maltreatment, alexithymia, aggression, and CRP positively, and high-density lipoprotein cholesterol negatively emerged as predictors of psychological distress. The study highlights the connections between childhood maltreatment, alexithymia, impulsivity, and potentially related biological dysregulation in explaining aggression and negative mood states as a bio-psychological model of aggression and mood in schizophrenia.