College students who experience stigma report problematic alcohol use. However, the stigma- health link focuses on one form of stigma, thereby excluding the intersectional oppression of experiencing ...multiple forms of stigma. The present work has two primary aims: (1) evaluating whether additive intersectional minority stress confers greater problematic alcohol use among multiple stigmatized college students one year later, and (2) whether that link can be explained by lower belongingness and greater drinking to cope motives. Students (N = 427) ranging in stigmatized identities (14.3% zero; 46.4% one; 29.5% two; 9.8% three or more), participated in an annual health survey in two subsequent fall semesters (2020 to 2021). Structural equation modeling tested the hypothesized model on relations between number of stigmatized identities, minority stressors, belongingness, and coping motive on problematic drinking (risky and problem drinking) one year later. As hypothesized, holding more stigmatized identities predicted higher minority stress, which in turn predicted less belonging. Partially consistent with expectations, lower belonging predicted more problem drinking, but less risky drinking. As expected, higher minority stress predicted higher drinking to cope motives, which in turn, predicted more problem drinking, and risky drinking. In conclusion, belongingness and drinking to cope may be potential mechanisms through which multiple stigmatized students experience future problem drinking, but that may not always confer to more risky drinking. Implications for universities include implementation of (1) campus-wide belonging interventions for students facing stigma, and (2) initiatives to teach alternative coping strategies that reduce drinking to cope as a strategy to reduce the impact of minority stressors.
Objectives: Chronic obstructive pulmonary disease (COPD) and asthma are major concerns to health-care system. Improper inhaler device used (metered dose inhaler/dry powder inhaler) is one of the ...major causes associated with inadequate control of the disease. This study was performed to evaluate the inhaler technique among patients and to investigate factors associated with improper use and whether age or gender was associated with poor inhaler technique. Materials and Methods: A cross-sectional study of all patients who visited the chest outpatient department with asthma and COPD over a 6-month-period in a tertiary care hospital in Navi Mumbai. Information was collected about demographic data and inhaler technique was assessed using a standard checklist. Results: There were 107 patients, 71 with asthma and 36 with COPD. Inhaler techniques of 95% of patients were found to be inadequate in some form or the other as per checklist. Of all the patients interviewed, only about 60% of patients recalled that demonstration was done by doctors or other health-care professionals. Twelve percent were instructed by pharmacists and remaining followed their friend′s or relative′s suggestions along with insert literature. Conclusions: The inhaler technique is inadequate among most patients. On every visit, patient′s inhaler technique should be observed and adequate suggestions should be given to correct any deficiency.
Adaptive emotion regulation (ER) holds a critical role in promoting mental and physical health; thus, understanding the psychological and physiological processes that contribute to ER is important. ...Both perceived ER, and heart rate variability (HRV), a purported psychophysiological index of ER capacity, have been shown to relate to psychopathology and well-being. Further, meta-analytic work suggests that greater HRV is associated with more adaptive ER. However, little research has examined the longitudinal relation between HRV and perceived ER. Thus, the current study tested whether 1) increases in HRV preceded and predicted improvements in perceived ER, and 2) improvements in perceived ER preceded and predicted increases in HRV. It was hypothesized that a significant bidirectional relation would be found between HRV and perceived ER across time. Participants (N = 129) consisted of mothers assessed annually for three years. Results revealed that Respiratory Sinus Arrhythmia (RSA, an index of HRV) and perceived ER were not cross-sectionally associated at any timepoint, nor did RSA or perceived ER precede and predict the other longitudinally. The present study suggests the relation between HRV and perceived ER may be less robust than previously understood. Alternatively, methodological limitations or unidentified moderators (e.g., external stressors) may have attenuated findings.
Reducing social anxiety development among incoming college students may improve college adjustment and mental health outcomes. This study tested whether cognitive bias modification for ...interpretations (CBM-I) reduces social anxiety and increases adjustment during the transition to college, and whether changes in outcomes would be mediated by changes in interpretation biases.
Participants (N = 73) were randomly assigned to a 3-session weekly CBM-I condition or symptom tracking (ST) control condition. Multilevel models were used to estimate within-person trajectories from baseline to one week post-intervention and to test whether trajectories differed by condition.
Those in the CBM-I condition (vs. ST) reported higher increases in social adjustment across time. There were not significant differences between conditions for changes in social anxiety, academic adjustment, and personal adjustment. CBM-I was indirectly linked to improvements in outcome variables via more adaptive interpretation biases.
CBM-I was administered in a laboratory setting, requiring more resources than some computerized interventions.
Data tentatively support CBM-I for first-year students to increase social adjustment. Further, mediation findings provide support for targeting interpretation biases to improve social anxiety and adjustment outcomes. Yet, CBM-I did not outperform ST in improving social anxiety symptoms or other areas of college adjustment, and effect sizes were small, suggesting that more work is needed to amplify the potential of CBM-I as a therapeutic tool.
•Cognitive bias modification may help college first-years improve social adjustment.•Cognitive bias modification did not improve social anxiety or personal adjustment.•Cognitive bias modification may affect outcomes by affecting interpretation biases.
•Social anxiety disorder is associated with heightened psychophysiological reactivity to stressors.•Panic disorder and generalized anxiety disorder may be associated with attenuated reactivity to ...stressors.•Anxiety disorders are associated with reduced reactivity of high frequency heart rate variability.•Anxiety disorders may be associated with slower autonomic recovery after the removal of a stressor.•Generally, psychophysiological reactivity and recovery were not associated with treatment outcome.
The present study aimed to examine changes in psychophysiological arousal from baseline to a stressor phase (reactivity) and from the stressor phase to a second resting phase (recovery) in patients with anxiety disorders. Fifty adult patients with DSM-5 anxiety disorders (panic disorder, generalized anxiety disorder, or social anxiety disorder) and 28 healthy control (HC) participants underwent psychophysiological monitoring including electrocardiogram, respiration rate, electrodermal activity, gastrocnemius electromyograph, and end-tidal CO2 for a 3-min resting phase, a 6-min mild stressor phase, and a 3-min recovery phase. Anxious patients then went on to receive naturalistic cognitive-behavioral therapy (CBT) in a specialty outpatient clinic. Results for the reactivity phase indicated that compared to HCs, patients with social anxiety disorder exhibited heightened psychophysiological reactivity while patients with panic disorder and generalized anxiety disorder exhibited attenuated reactivity. Results for physiological recovery (return to baseline after the stressor was withdrawn) were mixed, but provided some support for slower autonomic recovery in patients with generalized anxiety disorder and panic disorder compared to HCs. Participants with all anxiety disorders exhibited diminished change in high frequency heart rate variability compared to HCs. Generally, psychophysiological reactivity and recovery were not associated with CBT outcome, though exploratory analyses indicated that greater respiration rate reactivity and stronger respiration rate recovery were associated with better CBT outcomes in patients with panic disorder.
Bronchiectasis is a common but neglected chronic lung disease. Most epidemiological data are limited to cohorts from Europe and the USA, with few data from low-income and middle-income countries. We ...therefore aimed to describe the characteristics, severity of disease, microbiology, and treatment of patients with bronchiectasis in India.
The Indian bronchiectasis registry is a multicentre, prospective, observational cohort study. Adult patients (≥18 years) with CT-confirmed bronchiectasis were enrolled from 31 centres across India. Patients with bronchiectasis due to cystic fibrosis or traction bronchiectasis associated with another respiratory disorder were excluded. Data were collected at baseline (recruitment) with follow-up visits taking place once per year. Comprehensive clinical data were collected through the European Multicentre Bronchiectasis Audit and Research Collaboration registry platform. Underlying aetiology of bronchiectasis, as well as treatment and risk factors for bronchiectasis were analysed in the Indian bronchiectasis registry. Comparisons of demographics were made with published European and US registries, and quality of care was benchmarked against the 2017 European Respiratory Society guidelines.
From June 1, 2015, to Sept 1, 2017, 2195 patients were enrolled. Marked differences were observed between India, Europe, and the USA. Patients in India were younger (median age 56 years IQR 41–66 vs the European and US registries; p<0·0001) and more likely to be men (1249 56·9% of 2195). Previous tuberculosis (780 35·5% of 2195) was the most frequent underlying cause of bronchiectasis and Pseudomonas aeruginosa was the most common organism in sputum culture (301 13·7%) in India. Risk factors for exacerbations included being of the male sex (adjusted incidence rate ratio 1·17, 95% CI 1·03–1·32; p=0·015), P aeruginosa infection (1·29, 1·10–1·50; p=0·001), a history of pulmonary tuberculosis (1·20, 1·07–1·34; p=0·002), modified Medical Research Council Dyspnoea score (1·32, 1·25–1·39; p<0·0001), daily sputum production (1·16, 1·03–1·30; p=0·013), and radiological severity of disease (1·03, 1·01–1·04; p<0·0001). Low adherence to guideline-recommended care was observed; only 388 patients were tested for allergic bronchopulmonary aspergillosis and 82 patients had been tested for immunoglobulins.
Patients with bronchiectasis in India have more severe disease and have distinct characteristics from those reported in other countries. This study provides a benchmark to improve quality of care for patients with bronchiectasis in India.
EU/European Federation of Pharmaceutical Industries and Associations Innovative Medicines Initiative inhaled Antibiotics in Bronchiectasis and Cystic Fibrosis Consortium, European Respiratory Society, and the British Lung Foundation.
ABSTRACTIndividuals with generalized anxiety disorder (GAD) report poorer quality of life (QOL) than do nonanxious controls. Further, although positive affect (PA) and negative affect (NA) have been ...shown to predict QOL, no previous literature has tested this relationship in the context of individuals with GAD. In the present study, we evaluated the unique and interactive contributions of PA and NA on QOL within a sample of individuals diagnosed with GAD (N = 50). Specifically, a hierarchical regression was conducted to evaluate the unique contributions of PA, NA, and their interaction on QOL, over and above symptoms of depression. PA and depression symptoms were both significant predictors of QOL, whereas neither the main effect for NA nor the PA × NA interaction was statistically significant. Results suggest that, for those with GAD, PA uniquely contributes to QOL. Strategies to upregulate PA may be a useful treatment target for increasing QOL in individuals with GAD.
Behavioral impulsivity may be a mechanism of hoarding disorder (HD). A commonly used and well-validated measure of impulsivity is the delay and probability discounting task, which consists of making ...decisions about receiving monetary rewards after varying delay intervals and delivery probabilities. We compared delay and probability discounting and self-reported behavioral impulsivity in 81 patients with a primary diagnosis of HD and 45 nonclinical controls. HD participants completed the impulsivity measures before and after 16 weekly sessions of cognitive-behavioral therapy (CBT), whereas control group participants completed the measures before and after a 16-week waiting period. Despite the fact that self-reported impulsivity was greater in the HD group than the control group, delay and probability discounting did not differ between groups. Additionally, while self-reported behavioral impulsivity improved over the course of CBT in HD participants, delay and probability discounting did not change during treatment. Furthermore, higher delay discounting scores (i.e., greater preference for immediate rewards, indicating greater impulsivity) were associated with lower hoarding symptom severity. The findings suggest that self-reported impulsivity, but not objective performance on a behavioral impulsivity task, may be impaired in HD, and are discussed in terms of cognitive and affective factors in decision-making.
•Patients with hoarding disorder (HD) report a range of cognitive deficits.•Cognitive deficits in HD are not solely attributable to comorbid symptoms.•Cognitive deficits in HD are related to a desire ...to save possessions in order to avoid forgetting.
The aim of the present study was to examine subjective cognitive impairment among adult patients with hoarding disorder (HD). Eighty-three patients with HD and 46 age- and gender-matched healthy control (HC) participants received a diagnostic interview and completed measures of subjective cognitive functioning and motivations for saving behavior, as well as measures of hoarding severity, depression, anxiety, stress, and obsessive-compulsive disorder (OCD) symptoms. The HD group reported more impairment than did the HC group in domains of memory, distractibility, blunders, memory for names, and inattention. These differences generally remained significant when controlling for comorbid symptoms. In the HD group, the degree of cognitive impairment was significantly correlated with severity of saving and acquiring behaviors, although results were attenuated when controlling for comorbid symptoms (overall HD severity, but not saving behavior specifically, remained significantly correlated with cognitive impairment). Subjective cognitive impairment was further associated with a desire to save possessions in order to avoid forgetting, and these results remained significant when controlling for comorbid symptoms. These results comport with current behavioral models of HD that emphasize decision-making deficits, as well as clinician observations suggestive of impaired cognitive function, and complement a growing body of neuropsychological testing studies.
Objective
The Outcome Questionnaire‐45.2 (OQ‐45) is a self‐report measure of general psychological distress. Although intended to be transdiagnostic, the OQ‐45 may be best conceptualized as a measure ...of depression; as such, its utility in assessing other symptoms such as anxiety is unclear.
Method
We examined scores on the OQ‐45 in a sample of 329 patients with anxiety and related disorders, half of whom had co‐occurring depression.
Results
Eighty‐two percent of patients scored above the OQ‐45 cutoff, whereas 18% were incorrectly screened out. Patients with co‐occurring depression were more likely to score above the OQ‐45 cutoff than nondepressed patients. Depression severity predicted many of the OQ‐45 scales, even after controlling for anxiety severity. By contrast, most of the anxiety‐specific measures failed to predict the OQ‐45 after controlling for depression severity.
Conclusions
Findings suggest that the OQ‐45 may not adequately capture anxiety symptoms and are discussed in terms of diagnostic screening and assessment.
PDF
