Search Results (13)

This study explores how child emotion regulation (ER) and maternal overinvolvement contribute to the maintenance of anxiety disorders (ADs) in children. Building on the tripartite model on the impact of the family on children’s emotion regulation and adjustment, it experimentally examines the impact of maternal expectations on overinvolvement and child distress. 65 children with ADs (ages 8–15) and 64 healthy controls (HCs) and their mothers participated in a tangram task, with manipulated maternal expectations. Mother–child interactions were observed for maternal involvement and child behavior (ER, distress), with children reporting their emotional reactivity. Against expectations, maternal involvement did not differ between groups and was not influenced by expectations. HC children had better ER abilities than those with ADs. Emotional reactivity moderated the relationship between overinvolvement and ER problems. Children with ADs exhibited more distress, unaffected by maternal expectations. Further research is needed to clarify the relationship between parental behavior and child behavior, particularly regarding emotional reactivity. Full article

The university period is a transitional stage during which students develop heterogeneous interpersonal styles to navigate complex social demands. While prior studies have linked interpersonal functioning to adaptability and mental health, structural differences across interpersonal style groups remain underexplored. Therefore, the current research was designed to examine whether and how adaptability is differentially related to mental health symptoms when considered within the framework of distinct interpersonal style profiles. Using K-means clustering, we identified three distinct interpersonal profiles: the withdrawn and avoidant type, the overinvolved and compliant type, and the well-adjusted interpersonal type. Based on this classification, network analyses were conducted to examine how six dimensions of adaptability related to three core mental health symptoms within each group. The results showed a consistent pattern across all profiles, with emotional adaptability negatively associated with depression, anxiety, and stress. Subsequent network comparison analyses demonstrated that the withdrawn and avoidant group differed significantly in structure from the well-adjusted interpersonal group, particularly in the connections involving emotional, interpersonal, and economic adaptability. By uncovering meaningful differences in adaptability-mental health associations across interpersonal style, this study provides a foundation for designing targeted strategies that address the unique adaptabilities and mental health problems of distinct interpersonal profiles. Full article

In the current clinical psychiatric practice in most of the world, treatment decisions are based on a person’s capacity to make these decisions. When a person lacks the capacity to understand and appreciate treatment decisions, in many jurisdictions a third-party substitute decision maker (SDM) is appointed on his or her behalf in order to promote safety and optimal clinical outcome. In Ontario, Canada, for example, family members (typically) or public guardians are appointed as SDMs, and they form an integral part of the medical–legal system in psychiatric care. Clinicians working with both patients and their SDMs in these circumstances encounter unique challenges and deliver care in specialized ways, though little research has focused on their experiences and reflections. Based on focus group data, this qualitative study uses a descriptive and interpretative phenomenological approach through thematic analysis to examine these aspects from clinicians working in both inpatient and outpatient settings of an urban teaching hospital’s psychiatric services in Toronto, Canada. Seven key themes emerged: Clinicians (1) appreciate hardships and challenges in lives of SDMs and patients—including the challenging emotions and experiences on both sides, and the risks and relational changes from being an SDM; (2) have an understanding of the patient’s situation and respect for patient autonomy and wishes—they are promoter of autonomy and mindful of patients’ prior wishes amidst patients’ fluctuating capacity, facilitating communication, keeping patients informed and promoting transitioning from SDM to self-determination; (3) have a special working relationship with family SDMs—including supporting SDMs, avoiding harm from delayed or denied treatment, and educating and collaborating with SDMs while maintaining professional boundaries; (4) at times find it difficult working with SDMs—stemming from working with over-involved or uninterested family SDMs, coping with perceived poor SDM decisions, and they sometimes ponder if SDMs are necessary; (5) delineate differences between family and Public Guardian and Trustee (PGT) SDMs—they see PGT as closely aligned with medical decision makers, while family SDMs are more intimately involved and more likely to disagree with a physician’s recommendation; (6) recognize the importance of the SDM role in various contexts—through seeing social values in having SDMs, and acknowledging that having SDMS help them to feel better about their actions as they work to protect the patients; and (7) express ideas on how to improve the current system—at public, societal, and family SDM levels. We conclude that clinicians have unique mediating roles, with privilege and responsibility in understanding the different roles and challenges patients and SDMs face, and have opportunities to improve patient and SDM experiences, clinical outcomes, carry out education, and advocate for ethically just decisions. These clinical roles also come with frustration, discomfort, moral distress and at times vicarious trauma. Clinicians’ unique understanding of this complex and nuanced intersection of patient care provides insight into the core issues of autonomy, duty to care and protect, advocacy, and emotional dynamics involved in this sector as a larger philosophical and social movement to abolish SDMs, as advocated by the Convention on the Rights of Persons with Disability (CRPD), is taking place. We briefly discuss the role of supported decision making as an alternative as. Full article

Expressed emotion (EE) toward patients with schizophrenia is typically reported to be lower in psychiatric halfway houses than in families. This is the first study directly comparing EE between these settings and investigating the pathways mediating EE differences. We included 40 inpatients in halfway houses and 40 outpatients living with their families and recorded 22 psychiatric nurses’ and 56 parents’ EE, respectively, through Five Minutes Speech Samples. Each inpatient was rated by 2–5 nurses and each outpatient by 1–2 parents. As EE ratings had a multilevel structure, generalized linear mixed models were fitted, adjusting for patient-related confounders and caregiver demographics. Mediatory effects were investigated in multilevel structural equation models. Outpatients were younger, less chronic, and better educated, with higher negative symptoms and perceived criticism than inpatients. Nurses were younger and better educated than parents. Before adjustment, EE rates were equally high across settings. After adjusting for patient-related confounders, emotional overinvolvement was significantly higher in parents. However, after also adjusting for caregiver demographics, only criticism was significantly higher in nurses. Patients’ age, negative symptoms, and perceived criticism and caregivers’ age and sex significantly mediated EE group differences. Our findings highlight pathways underlying EE differences between halfway houses and families and underscore the importance of staff and family psychoeducation. Full article

Objective: In this study, we investigated the effects of a mindfulness-based family psychoeducation (MBFPE) program on the mental-health outcomes of both caregivers and young adults with first-episode psychosis with an onset in the past three years through a multi-site randomized controlled trial. We also studied the outcomes of three potential mediating effects of interpersonal mindfulness, expressed emotions, and non-attachment on the program. Method: We randomly assigned 65 caregivers of young adults with psychosis to MBFPE (n = 33) or an ordinary family psychoeducation (FPE) program (n = 32); among them, 18 young adults in recovery also participated in the evaluation of outcomes. Results: Intent-to-treat analyses were conducted. No significant time × group interaction effects of MBFPE and FPE programs were found in any of the caregivers’ outcomes. However, the young adults with psychosis reported higher levels of recovery after the MBFPE program than after the ordinary FPE program (F = 8.268, p = 0.012, d = 1.484). They also reported a larger reduction in over-involvement of their caregivers (F = 4.846, p = 0.044, d = 1.136), showing that MBFPE had a superior effect to FPE in promoting recovery and reducing over-involvement. Conclusions: A brief psychoeducation program may not reduce the burden on or improve the mental-health outcome of caregivers of individuals with recent-onset psychosis. However, integrating mindfulness into a conventional family psychoeducation program may reduce the expressed emotions of caregivers, especially over-involvement. Further studies should explore how psychoeducation programs can reduce the impact of psychosis on family through sustainable effects in terms of reducing their burden and expressed emotions, using a rigorous study and adequate sample size. Full article

Expressed emotion (EE) is an established prognostic factor for relapse in schizophrenia. Through critical comments (CC), hostility (H) and emotional overinvolvement (EOI), a relative can be rated as high or low EE, but the role of warmth should also be evaluated in order to consider the influence of a positive affect within the family context. In this study, EE was assessed in a sample of 48 relatives of patients with schizophrenia using the Camberwell Family Interview (CFI). Questionnaires assessing coping (brief-COPE), their wellbeing (World Health Organization Well-Being Index WHO-5) and the socio-demographic variables were also administered. Relatives who expressed a higher level of warmth were found to make fewer CC (5.2 ± 4.6 vs. 8.4 ± 4.6, p = 0.009) and have, on average, higher EOI scores (3.2 ± 1.0 vs. 1.9 ± 1.1, p = 0.002) than those who expressed no or very little warmth. High EE was found to be associated with having fewer family members (p = 0.035), while relatives with a higher level of education expressed less warmth (p = 0.007). Relatives with a low level of warmth had higher maladaptive coping scores and tended to score worse for their overall wellbeing in comparison to relatives who showed a higher level of warmth (28.4 ± 5.0 vs. 24.1 ± 5.2, p = 0.006 and 39.1 ± 20.4 vs. 51.3 ± 22.0, p = 0.073, respectively). Since the role of warmth is important, it should be taken into account when designing family interventions, independently from lowering EE. Customized interventions to promote warmth and the routine screening of relatives are recommended. Full article

Qualitative studies have identified a diverse array of motivations for purchasing items within video games through chance-based mechanisms (i.e., “loot boxes”). Given that some individuals—particularly those at risk of disordered gaming and/or gambling—are prone to over-involvement with loot box purchasing, it is important to have a reliable, valid means of measuring the role of different motivations in driving purchasing behaviour. Building on prior qualitative research, this paper reports the development and validation of the “RAFFLE” scale, to measure the Reasons and Facilitators for Loot box Engagement. A 23-item, seven-factor scale was developed through cognitive interviews (n = 25) followed by two surveys of UK-based gamers who purchase loot boxes; analysed via exploratory (n = 503) and confirmatory (n = 1495) factor analysis, respectively. Subscales encompassed “enhancement’; “progression’; “social pressure’; “distraction/compulsion’; “altruism’; “fear of missing out’; and “resale”. The scale showed good criterion and construct validity (correlating well with measures of loot box engagement; the risky loot box index (r = 0.63) and monthly self-reported spend (r = 0.38)), and good internal validity (Cronbach’s alpha = 0.84). Parallels with, and divergence from, motivations for related activities of gaming and gambling, and alignment with broader theoretical models of motivation, are discussed. Full article

Driver behavior is a determining factor in more than 90% of road accidents. Previous research regarding the relationship between speeding behavior and crashes suggests that drivers who engage in frequent and extreme speeding behavior are overinvolved in crashes. Consequently, there is a significant benefit in identifying drivers who engage in unsafe driving practices to enhance road safety. The proposed method uses continuously logged driving data to collect vehicle operation information, including vehicle speed, engine revolutions per minute (RPM), throttle position, and calculated engine load via the on-board diagnostics (OBD) interface. Then the proposed method makes use of severity stratification of acceleration to create a driving behavior classification model to determine whether the current driving behavior belongs to safe driving or not. The safe driving behavior is characterized by an acceleration value that ranges from about ±2 m/s². The risk of collision starts from ±4 m/s², which represents in this study the aggressive drivers. By measuring the in-vehicle accelerations, it is possible to categorize the driving behavior into four main classes based on real-time experiments: safe drivers, normal, aggressive, and dangerous drivers. Subsequently, the driver’s characteristics derived from the driver model are embedded into the advanced driver assistance systems. When the vehicle is in a risk situation, the system based on nRF24L01 + power amplifier/low noise amplifier PA/LNA, global positioning system GPS, and OBD-II passes a signal to the driver using a dedicated liquid-crystal display LCD and light signal. Experimental results show the correctness of the proposed driving behavior analysis method can achieve an average of 90% accuracy rate in various driving scenarios. Full article

This study aims to examine the differences in family environment, psychological distress, and disordered eating symptomatology between children classified by weight status with or without loss of control (LOC) eating and to test a model of the role of emotional regulation of LOC eating based on a dysfunctional family environment. A cross-sectional study was conducted among 239 families. The assessment measured family expressed emotion, family adaptability and cohesion, child levels of depression and anxiety, body esteem, and disordered eating attitudes. The assessment was carried out in primary care centers and primary schools. Child body mass index (BMI) was associated with higher expressed emotion, psychological distress, and disordered eating symptomatology. Children with obesity and LOC presented higher BMI, poorer body esteem, and more disordered eating attitudes than children without LOC. Children with overweight/obesity, both with or without LOC, exhibited higher psychological distress and emotional overinvolvement than normal-weight children. A partial mediation of depression or anxiety and disordered eating attitudes between expressed emotion and LOC was found. Findings support that children with overweight/obesity show more family and psychological distress. Body esteem issues and disordered eating attitudes could alert the presence of LOC in children with obesity. The function of LOC might be to cope with psychological distress that may appear in a dysfunctional family environment. Full article

Workaholism and overcommitment are often used as interchangeable constructs describing an individual’s over-involvement toward their own job. Employees with high levels in both constructs are characterized by an excessive effort and attachment to their job, with the incapability to detach from it and negative consequences in terms of poor health and job burnout. However, few studies have simultaneously measured both constructs, and their relationships are still not clear. In this study, we try to disentangle workaholism and overcommitment by comparing them with theoretically related contextual and personal antecedents, as well as their health consequences. We conducted a nonprobability mixed mode research design on 133 employees from different organizations in Italy using both self- and other-reported measures. To test our hypothesis that workaholism and overcommitment are related yet different constructs, we used partial correlations and regression analyses. The results confirm that these two constructs are related to each other, but also outline that overcommitment (and not workaholism) is uniquely related to job burnout, so that overcommitment rather than workaholism could represent the true negative aspect of work drive. Additionally, workaholism is more related to conscientiousness than overcommitment, while overcommitment shows a stronger relationship with neuroticism than workaholism. The theoretical implications are discussed. Full article

Conflict between religion and state politics is a persistent phenomenon in human history. Hence it is not surprising that the propagation of Christianity often faces the challenge of “political theology”. When the Church of the East monk Aluoben reached China in 635 during the reign of Emperor Tang Taizong, he received the favorable invitation of the emperor to translate Christian sacred texts for the collections of Tang Imperial Library. This marks the beginning of Jingjiao (景教) mission in China. In historiographical sense, China has always been a political domineering society where the role of religion is subservient and secondary. A school of scholarship in Jingjiao studies holds that the fall of Jingjiao in China is the obvious result of its over-involvement in local politics. The flaw of such an assumption is the overlooking of the fact that in the Tang context, it is impossible for any religious establishments to avoid getting in touch with the Tang government. In the light of this notion, this article attempts to approach this issue from the perspective of “political theology” and argues that instead of over-involvement, it is rather the clashing of “ideologies” between the Jingjiao establishment and the ever-changing Tang court’s policies towards foreigners and religious bodies that caused the downfall of Jingjiao Christianity in China. This article will posit its argument based on the analysis of the Chinese Jingjiao canonical texts, especially the Xian Stele, and takes this as a point of departure to observe the political dynamics between Jingjiao and Tang court. The finding of this paper does show that the intellectual history of Chinese Christianity is in a sense a comprehensive history of “political theology”. Full article

The interpersonal relationship among the coach, athlete, and parent (C-A-P) in youth sports is a complex and dynamic phenomenon. The evaluation of such interpersonal relationship becomes an important factor in trying to understand the overall youth sports environment. The purpose of this study was to begin the development of a questionnaire to assess the coach-athlete–parent interpersonal relationships in youth sports. To achieve our purpose, two qualitative studies were conducted. In the first qualitative study, 136 research participants completed an online questionnaire asking for statements concerning the C-A-P based on an extensive literature review. In the second phase, a follow up phenomenological study design was conducted. For the phenomenological study, 30 participants (10 coaches, 10 athletes, and 10 youth sports parents) completed in-depth interviews. Based on both qualitative study results, the following three themes emerged: group processes, motivation, and over-involvement. The two qualitative investigations revealed themes and 48 potential questions to be used in developing a C-A-P questionnaire in quantifying the C-A-P results. Full article

Injuries (unintentional and intentional) are the main cause of death and disability worldwide, including Jordan. The main purpose of this hospital-based retrospective study was to identify characteristics, causes, and risk factors of unintentional injuries and violence among all adult patients who approached the Accidents and Emergency department because of injury in Northern Jordan. Data were collected retrospectively from four major hospitals from January 2008 to January 2013. A total of 2425 Jordanian individuals who accessed and were treated by the four hospitals were included in this study. The findings show that the majority of patients who approached the Accidents and Emergency departments in the four hospitals were males (n = 2044, 87.16%) versus females (n = 301, 12.8%). Violence was the most common reason of injury (70.66%), followed by road traffic crashes (23.21%). The most common anatomical locations of reported injuries were the head (38.74%), followed by abdomen/pelvis and lower back, among males and females (9.93%). Violence had a high significant effect on the site of injuries. Patients who had been injured to the head because of a stab wound or fighting were substantially over-involved in head injuries, with injury rates 3.88 and 7.51 times higher than those who had been injured to the head due to gunshot, respectively. Even patients who had been injured to the head because of assault show much higher involvement in injury risk than non-assault patients (Odds Ratio = 8.46). These findings highlight the need for a large national study to confirm the findings. It also draws attention to the importance of public awareness and to special injury prevention programs that not only focus on saving lives and lessening the number of injuries, illnesses, and fatalities, but also to limit the social and economic burden of injury among adults in Northern Jordan. Full article