A critical review of risk‐sensitive foraging Houston, Alasdair I.; Rosenström, Tom H.
Biological reviews of the Cambridge Philosophical Society,
April 2024, 2024-Apr, 2024-04-00, 20240401, Letnik:
99, Številka:
2
Journal Article
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ABSTRACT
Foraging is risk sensitive if choices depend on the variability of returns from the options as well as their mean return. Risk‐sensitive foraging is important in behavioural ecology, ...psychology and neurophysiology. It has been explained both in terms of mechanisms and in terms of evolutionary advantage. We provide a critical review, evaluating both mechanistic and evolutionary accounts. Some derivations of risk sensitivity from mechanistic models based on psychophysics are not convincing because they depend on an inappropriate use of Jensen's inequality. Attempts have been made to link risk sensitivity to the ecology of a species, but again these are not convincing. The field of risk‐sensitive foraging has provided a focus for theoretical and empirical work and has yielded important insights, but we lack a simple and empirically defendable general account of it in either mechanistic or evolutionary terms. However, empirical analysis of choice sequences under theoretically motivated experimental designs and environmental settings appears a promising avenue for mapping the scope and relative merits of existing theories. Simply put, the devil is in the sequence.
According to the self-medication and biopsychosocial models, individuals with social anxiety disorder (SAD) are at increased risk of developing an alcohol use disorder (AUD) as alcohol represents a ...maladaptive coping mechanism for some sufferers of SAD. The SAD-to-AUD causation was earlier supported in Norwegian longitudinal twin data and later questioned using longitudinal data from the USA.
We re-analyzed partly the same USA-based data (National Comorbidity Surveys, n = 5001), conducting theoretical and simulation analyses on different formulations of temporality and using real-data Logistic regression analysis to investigate whether baseline SAD was associated with AUD at the follow-up.
Upon proper analysis of temporality, SAD preceded AUD. Specifically, SAD was the only one of the seven anxiety disorders that predicted 10-year later AUD after adjusting for all other anxiety disorders and AUD at the baseline (odds ratio was 1.70% and 95% confidence interval 1.12–2.57). SAD was also associated with incident AUD (OR = 1.64, 95% CI = 1.14–2.37). We provide formal, simulation-based, and data-based arguments on how certain flawed models of incidence attenuate the temporal association.
We demonstrated temporality and specificity in SAD-to-AUD association, which are considered signs of causation. We further identified and discussed problems in previous statistical analyses with different conclusions. Our findings add support for models positing causal effects of SAD on AUD, such as the self-medication and biopsychosocial models. The available evidence suggests that treating SAD should incur better chances of preventing AUD compared to treating other anxiety disorders, which lack comparable evidence on causation.
•Social anxiety predisposes to alcohol use disorder, whereas other anxiety does not.•People self-medicate social anxiety with alcohol, not all psychological suffering.•Our transparent analysis corrects the contrary claims based on partly the same data.
Psychological pain (PP) is a potentially important risk factor for suicide. However, its temporal stability and association with suicidal ideation (SI) remain obscure. Whether PP represents a risk ...factor for SI independently of depression, anxiety, and hopelessness or is more prominent and temporally unstable in patients with depression and borderline personality disorder (BPD) is also unclear.
From November 2020 to December 2022, psychiatric inpatients with depression without (N = 37) and with (N = 30) BPD were recruited to an ecological momentary assessment (EMA) study, wherein their PP, severity of depression, SI, and hopelessness were assessed 3 times daily using visual analog scales. Multilevel regression models were estimated.
Altogether, 4,320 EMA observations were collected. PP correlated with hopelessness (
= 0.417), depression (
= 0.339), and anxiety (
= 0.496), but the between-patient variance of PP remained at 1.26 (95% CI, 1.025-1.533) after controlling for these variables. The within-patient variance of PP was associated with SI (β = 0.17 95% CI, 0.12-0.22) with a magnitude comparable to hopelessness (β = 0.1 95% CI, 0.05-0.15) and depression (β = 0.12 95% CI, 0.08-0.17). Patients with depression and BPD reported higher daily PP and SI (
< .001) and a more prominent within-patient variation in PP.
In psychiatric inpatients with depression, besides depression and hopelessness, PP represents an independent risk factor for SI, varying within a timescale of days. Depressive patients with BPD may experience more prominent and temporally unstable PP, likely underlying their higher vulnerability to SI.
Psychotherapy for depression aims to reduce symptoms and to improve psychosocial functioning. We examined whether some symptoms are more important than others in the association between depression ...and functioning over the course of psychotherapy treatment.
We studied associations between specific symptoms of depression (PHQ-9) and change in social and occupational functioning (SOFAS), both with structural equation models (considering liabilities of depression and each specific symptom) and with logistic regression models (considering the risk for individual patients). The study sample consisted of adult patients (n = 771) from the Finnish Psychotherapy Quality Registry (FPQR) who completed psychotherapy treatment between September 2018 and September 2021.
Based on our results of logistic regression analyses and SEM models, the baseline measures of depression symptoms were not associated with changes in functioning. Changes in depressed mood or hopelessness, problems with sleep, feeling tired, and feeling little interest or pleasure were associated with improved functioning during psychotherapy. The strongest evidence for symptom-specific effects was found for the symptom of depressed mood or hopelessness.
Due to our naturalistic study design containing only two measurement points, we were unable to study the causal relationship between symptoms and functioning.
Changes in certain symptoms during psychotherapy may affect functioning independently of underlying depression. Knowledge about the dynamics between symptoms and functioning could be used in treatment planning or implementation. Depressed mood or hopelessness appears to have a role in the dynamic relationship between depression and functioning.
•Specific depression symptoms may affect functioning differently.•When studying symptom effects, it is important to adjust for overall depression.•Observed symptom effects depend on method used to adjust overall depression.•Symptoms are related to functioning differently at baseline and over treatment.•Depressed mood/hopelessness was associated with functioning during psychotherapy.
Background
Suicide risk is high in patients with major depressive disorder (MDD), bipolar disorder (BD) and borderline personality disorder (BPD). Whether risk levels of and risk factors for suicidal ...ideation (SI) and suicide attempts (SA) are similar or different in these disorders remains unclear, as few directly comparative studies exist. The relationship of short‐term changes in depression severity and SI is underinvestigated, and might differ across groups, for example, between BPD and non‐BPD patients.
Methods
We followed, for 6 months, a cohort of treatment‐seeking, major depressive episode (MDE) patients in psychiatric care (original n = 124), stratified into MDE/MDD, MDE/BD and MDE/BPD subcohorts. We examined risks of suicide‐related outcomes and their risk factors prospectively. We examined the covariation of SI and depression over time with biweekly online modified Patient Health Questionnaire 9 surveys and analysed this relationship through multi‐level modelling.
Results
Risk of SA in BPD (22.2%) was higher than non‐BPD (4.23%) patients. In regression models, BPD severity was correlated with risk of SA and clinically significant SI. During follow‐up, mean depression severity and changes in depression symptoms were associated with SI risk regardless of diagnosis.
Conclusions
Concurrent BPD in depression seems predictive for high risk of SA. Severity of BPD features is relevant for assessing risk of SA and SI in MDE. Changes in depressive symptoms indicate concurrent changes in risk of SI. BPD status at intake can index risk for future SA, whereas depressive symptoms appear a useful continuously monitored risk index.
We introduced methods for solving causal direction of dependence between variables observed in pre- and post-psychotherapy assessments, showing how to apply them and investigate their properties via ...simulations. In addition, we investigated whether changes in depressive symptoms drive changes in social and occupational functioning as suggested by the phase model of psychotherapy or vice versa, or neither.
As a Gaussian (normal-distribution) model is unidentifiable here, we used an identifiable linear non-Gaussian structural vector autoregression model, conceptualizing instantaneous effects as during-psychotherapy causation and lagged effects as pre-treatment predictors of change. We tested six alternative estimators in six simulation settings that captured different real-world scenarios, and used real psychotherapy data from 1428 adult patients (Finnish Psychotherapy Quality Registry; assessments on Patient Health Questionnaire-9 and Social and Occupational Functioning Assessment Schedule).
The methodology was successful in identifying causal directions in simulated data. The real-data results provided no evidence for single direction of dependence, suggesting shared or reciprocal causation.
A powerful new tool was presented to investigate the process of psychotherapy using observational data. Application to patient data suggested that depression symptoms and functioning may reciprocate or reflect third variables instead of one predominantly driving the other during psychotherapy.
Assessment of treatment response in psychotherapies can be undermined by lack of longitudinal measurement invariance (LMI) in symptom self-report inventories, by measurement error, and/or by wrong ...model assumptions. To understand and compare these threats to validity of outcome assessment in psychotherapy research, we studied LMI, sum scores, and Davidian Curve Item Response Theory models in a naturalistic guided internet psychotherapy treatment register of 2,218 generalized anxiety disorder (GAD) patients and 3,922 depressive disorder (DD) patients (aged ≥16 years). Symptoms were repeatedly assessed by Generalized Anxiety Disorder Assessment-7 (GAD-7) or Beck Depression Inventory. The symptom self-reports adhered to LMI under equivalence testing, suggesting sum scores are reasonable proxies for disorder status. However, the standard LMI assumption of normally distributed latent factors did not hold and inflated treatment response estimates by 0.2 to 0.3 standard deviation units compared with sum scores. Further methodological research on non-normally distributed latent constructs holds promise in advancing LMI and mental health assessment.
Objective: While the CORE-10 inventory for Clinical Outcome Routine Evaluation has shown good psychometric properties in cross-sectional assessment, the feasibility of generic, short, and easy-to-use ...longitudinal assessment of a broadband construct such as the targeted "general psychological distress" remains to be psychometrically demonstrated. Therefore, we investigated longitudinal measurement invariance (LMI) of CORE-10. For comprehensiveness, we also analyzed its parent inventory, CORE-OM. Method: We investigated the LMI of pre- and post-therapy CORE-10 and -OM assessments in a naturalistic treatment register of 1715 patients' short psychotherapies, testing whether the construct of "psychological distress" remained the same across the treatments. Results: We observed good psychometric properties and no violations of LMI for CORE-10 in chi-squared equivalence tests, nor in effect-size-based evaluations. Only the highly sensitive chi-squared difference tests detected LMI violations but these had little practical influence. The CORE-OM data did not fit well with factorial models but this was cross-sectional rather than a genuinely longitudinal (LMI-related) issue. Conclusions: CORE-10 appeared a structurally valid measure of general psychological distress and suitable for longitudinal assessment, whereas the CORE-OM had a less clear factorial structure. Regarding psychometrics, these findings support the use of CORE-10 in longitudinal assessment during psychotherapy and do not support CORE-OM.
The COVID-19 pandemic has caused an unequally distributed extra workload to hospital personnel and first reports have indicated that especially front-line health care personnel are psychologically ...challenged. A majority of the Finnish COVID-19 patients are cared for in the Helsinki University Hospital district. The psychological distress of the Helsinki University Hospital personnel has been followed via an electronic survey monthly since June 2020. We report six-month follow-up results of a prospective 18-month cohort study. Individual variation explained much more of the total variance in psychological distress (68.5%, 95% CI 65.2-71.9%) and negative changes in sleep (75.6%, 95% CI 72.2-79.2%) than the study survey wave (1.6%, CI 0.5-5.5%; and 0.3%, CI 0.1-1.2%). Regional COVID-19 incidence rates correlated with the personnel's psychological distress. In adjusted multilevel generalized linear multiple regression models, potentially traumatic COVID-19 pandemic-related events (OR 6.54, 95% CI 5.00-8.56) and front-line COVID-19 work (OR 1.81, 95% CI 1.37-2.39) was associated with personnel psychological distress but age and gender was not. While vaccinations have been initiated, creating hope, continuous follow-up and psychosocial support is still needed for all hospital personnel.
Objectives
Smoking rates have declined with a slower pace among those with psychological distress compared to those without. We examined whether other health behaviors (heavy alcohol consumption, ...physical inactivity, short sleep duration) showed similar trends associated with psychological distress. We also examined differences by age and birth cohort.
Methods
Data were from the annually repeated cross-sectional U.S. National Health Interview Surveys (NHIS) of 1997–2016 (total
n
= 603,518). Psychological distress was assessed with the 6-item Kessler Psychological Distress Scale (K6).
Results
Psychological distress became more strongly associated with smoking (OR 1.09 per 10 years; 95% CI 1.07, 1.12), physical inactivity (OR 1.08; 1.05, 1.11), and short sleep (OR 1.12; 1.06, 1.18), but less strongly associated with heavy alcohol consumption (OR 0.93; 0.89, 0.98). The associations of smoking and alcohol consumption attenuated with age, whereas the association with physical inactivity strengthened with age. Compared to older birth cohorts, smoking became more strongly associated with psychological distress among younger birth cohorts up to those born in the 1980s.
Conclusions
The strength of associations between psychological distress and health behaviors may vary by time period, age, and birth cohort.
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