2,505 research outputs found

    Differences in well-being:the biological and environmental causes, related phenotypes, and real-time assessment

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    Well-being is a complex, and multifaceted construct that includes feeling good and functioning well. There is a growing global recognition of well-being as an important research topic and public policy goal. Well-being is related to less behavioral and emotional problems, and is associated with many positive aspects of daily life, including longevity, higher educational achievement, happier marriage, and more productivity at work. People differ in their levels of well-being, i.e., some people are in general happier or more satisfied with their lives than others. These individual differences in well-being can arise from many different factors, including biological (genetic) influences and environmental influences. To enhance the development of future mental health prevention and intervention strategies to increase well-being, more knowledge about these determinants and factors underlying well-being is needed. In this dissertation, I aimed to increase the understanding of the etiology in a series of studies using different methods, including systematic reviews, meta-analyses, twin designs, and molecular genetic designs. In part I, we brought together all published studies on the neural and physiological factors underlying well-being. This overview allowed us to critically investigate the claims made about the biology involved in well-being. The number of studies on the neural and physiological factors underlying well-being is increasing and the results point towards potential correlates of well-being. However, samples are often still small, and studies focus mostly on a single biomarker. Therefore, more well-powered, data-driven, and integrative studies across biological categories are needed to better understand the neural and physiological pathways that play a role in well-being. In part II, we investigated the overlap between well-being and a range of other phenotypes to learn more about the etiology of well-being. We report a large overlap with phenotypes including optimism, resilience, and depressive symptoms. Furthermore, when removing the genetic overlap between well-being and depressive symptoms, we showed that well-being has unique genetic associations with a range of phenotypes, independently from depressive symptoms. These results can be helpful in designing more effective interventions to increase well-being, taking into account the overlap and possible causality with other phenotypes. In part III, we used the extreme environmental change during the COVID-19 pandemic to investigate individual differences in the effects of such environmental changes on well-being. On average, we found a negative effect of the pandemic on different aspects of well-being, especially further into the pandemic. Whereas most previous studies only looked at this average negative effect of the pandemic on well-being, we focused on the individual differences as well. We reported large individual differences in the effects of the pandemic on well-being in both chapters. This indicates that one-size-fits-all preventions or interventions to maintain or increase well-being during the pandemic or lockdowns will not be successful for the whole population. Further research is needed for the identification of protective factors and resilience mechanisms to prevent further inequality during extreme environmental situations. In part IV, we looked at the real-time assessment of well-being, investigating the feasibility and results of previous studies. The real-time assessment of well-being, related variables, and the environment can lead to new insights about well-being, i.e., results that we cannot capture with traditional survey research. The real-time assessment of well-being is therefore a promising area for future research to unravel the dynamic nature of well-being fluctuations and the interaction with the environment in daily life. Integrating all results in this dissertation confirmed that well-being is a complex human trait that is influenced by many interrelated and interacting factors. Future directions to understand individual differences in well-being will be a data-driven approach to investigate the complex interplay of neural, physiological, genetic, and environmental factors in well-being

    Talking about personal recovery in bipolar disorder: Integrating health research, natural language processing, and corpus linguistics to analyse peer online support forum posts

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    Background: Personal recovery, ‘living a satisfying, hopeful and contributing lifeeven with the limitations caused by the illness’ (Anthony, 1993) is of particular value in bipolar disorder where symptoms often persist despite treatment. So far, personal recovery has only been studied in researcher-constructed environments (interviews, focus groups). Support forum posts can serve as a complementary naturalistic data source. Objective: The overarching aim of this thesis was to study personal recovery experiences that people living with bipolar disorder have shared in online support forums through integrating health research, NLP, and corpus linguistics in a mixed methods approach within a pragmatic research paradigm, while considering ethical issues and involving people with lived experience. Methods: This mixed-methods study analysed: 1) previous qualitative evidence on personal recovery in bipolar disorder from interviews and focus groups 2) who self-reports a bipolar disorder diagnosis on the online discussion platform Reddit 3) the relationship of mood and posting in mental health-specific Reddit forums (subreddits) 4) discussions of personal recovery in bipolar disorder subreddits. Results: A systematic review of qualitative evidence resulted in the first framework for personal recovery in bipolar disorder, POETIC (Purpose & meaning, Optimism & hope, Empowerment, Tensions, Identity, Connectedness). Mainly young or middle-aged US-based adults self-report a bipolar disorder diagnosis on Reddit. Of these, those experiencing more intense emotions appear to be more likely to post in mental health support subreddits. Their personal recovery-related discussions in bipolar disorder subreddits primarily focussed on three domains: Purpose & meaning (particularly reproductive decisions, work), Connectedness (romantic relationships, social support), Empowerment (self-management, personal responsibility). Support forum data highlighted personal recovery issues that exclusively or more frequently came up online compared to previous evidence from interviews and focus groups. Conclusion: This project is the first to analyse non-reactive data on personal recovery in bipolar disorder. Indicating the key areas that people focus on in personal recovery when posting freely and the language they use provides a helpful starting point for formal and informal carers to understand the concerns of people diagnosed with bipolar disorder and to consider how best to offer support

    30th European Congress on Obesity (ECO 2023)

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    This is the abstract book of 30th European Congress on Obesity (ECO 2023

    Community-based models of care facilitating the recovery of people living with persistent and complex mental health needs: a systematic review and narrative synthesis

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    ObjectiveThis study aims to assess the effectiveness of community-based models of care (MoCs) supporting the recovery of individuals who experience persistent and complex mental health needs.MethodWe conducted a systematic review and narrative synthesis of MoC studies reporting clinical, functional, or personal recovery from October 2016 to October 2021. Sources were Medline, EMBASE, PsycInfo, CINAHL, and Cochrane databases. Studies were grouped according to MoC features. The narrative synthesis was led by our researchers with lived experience.ResultsBeneficial MoCs ranged from well-established to novel and updated models and those explicitly addressing recovery goals and incorporating peer support: goal-focused; integrated community treatment; intensive case management; partners in recovery care coordination; rehabilitation and recovery-focused; social and community connection-focused; supported accommodation; and vocational support. None of our diverse group of MoCs supporting recovery warranted a rating of best practice. Established MoCs, such as intensive case management, are promising practices regarding clinical and functional recovery, with potential for enhancements to support personal recovery. Emerging practice models that support personal and functional recovery are those where consumer goals and priorities are central.ConclusionEvidence for established models of care shows that there is a need for inevitable evolution and adaptation. Considering the high importance of effective MoCs for people experiencing persistent and complex mental health needs, further attention to service innovation and research is required. Greater emphasis on the inclusion of lived and living experience in the design, delivery, implementation, and research of MoCs is needed, to enhance MOCs' relevance for achieving individual consumer recovery outcomes

    Measuring abortion stigma in Australia and Aotearoa New Zealand: the development, adaptation, and validation of multiple individual-level instruments

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    The stigmatisation of abortion is a pervasive influence on the prohibiting, threatening, and undermining of quality abortion care. In Australia and Aotearoa New Zealand (ANZ) abortion stigma impacts abortion care quality, including the experiences of accessing, providing, and supporting abortion. Although there are qualitative reports of how abortion stigma is experienced in ANZ, quantitative details are scant. This thesis aimed to address gaps in quantifying abortion stigma in ANZ. To understand how to best measure abortion stigma in ANZ, we conducted a systematic review of approaches quantifying abortion stigma globally. No instrument measuring abortion stigma in ANZ was found. The Individual Level Abortion Stigma scale (ILAS) and Abortion Providers Stigma Scale – Revised (APSS-R) have the most robust psychometric properties according to rigorous guidelines for evaluating measurement properties. The ILAS and APSS-R measure individual level abortion stigma. Through qualitative inquiry, the ILAS and APSS-R were reviewed for use in ANZ and their appropriateness for measuring stigmatisation of people, groups, and organisations supporting abortion care in ANZ. Four instruments measuring individual-level abortion stigma in ANZ were generated for: A) people who have had an abortion; B) people who provide abortion related care; C) people who publicly support abortion; and, D) groups/organisations supporting and/or providing abortion care. The four ANZ instruments were revised by representatives of the relevant end-user groups. Through an online survey, the instruments have been psychometrically tested for Australia demonstrating validity and reliability. These instruments can improve our understanding of abortion stigma and the evaluation of interventions addressing abortion stigma. Future co-designed research should explore the role of research in stigmatising abortion, revise the instruments for specific subgroups, and explore short form versions of the instruments

    Outcome Measurement in Functional Neurological Symptom Disorder

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    Outcome measurement in Functional Neurological Symptom Disorders (FNSDs) is particularly complex. Pressing questions include what kind of measure is more accurate or meaningful, or how to achieve standardisation in a clinically heterogenous group where subjective and objective observations of the same construct may deviate. This project aimed to build on the limited knowledge of measuring outcomes in FNSDs and attempts to address one of its inherent complexities; where clinical aspects of the disorder confound the usual prioritisation of "objective" over "subjective" (or patient-rated) measures. This PhD comprised a literature review and three research studies, each using different measures to assess the current status and (potential) outcomes in FNSD patients. A narrative description of systematically identified literature on stress, distress, and arousal measures in FNSD presents an overarching profile of the relationships between subjective and objective study measures. Eighteen studies (12 functional seizures, six other FNSD) capturing 396 FNSD patients were included. Eleven reported no correlation between subjective and objective measures. Only four studies reported significant correlations (r's=-0.74-0.59, p's <0.05). The small number of studies and diverse methodologies limit the conclusions of this review. However, the review's findings underscore the importance of validating outcome measures in patients with FNSD, carefully selecting the most appropriate measures for the research objectives, and possibly combining different measures optimally to triangulate a patient's current state, level of functioning or disability. Study One used factor analysis and Rasch modelling to investigate the psychometric properties of a novel FNSD-specific resource-based measure developed as an outcome measure for psychological therapies (The sElf-efficacy, assertiveness, Social support, self-awareness and helpful thinking (EASE) questionnaire). A 4-factor model identified self-efficacy (SE), self-awareness/assertiveness (SA), social support (SS) and interpersonal illness burden (IIB) as relevant domains. Each latent scale fits the Rasch model after refinement of the category responses and removing two items. With further improvement, the EASE-F has the potential to reliably measure self-reported SE, SA, SS, and IIB constructs which were found to be meaningful to patients with FNSD. This can identify patients with strengths and deficits in these constructs, allowing therapists to individualise interventions. Recommendations for refinement of future instrument versions, using the measure in clinical practice, and research in FNSDs are discussed. Study Two sought to understand the urgent and emergency care (UEC) service usage patterns among FNSD patients. Retrospective FNSD patient data from 2013 to 2016 UEC records (including NHS 111 calls, ambulance services, A&E visits, and acute admissions) were used to compare FNSD UEC usage rates with those of the general population and to model rates before and after psychotherapy. FNSD patients displayed 23 to 60 times higher UEC usage than the general population. Emergency service usage rates showed a significant reduction in level (rate level change = -0.90--0.70, p's <0.05) immediately after psychotherapy. While this study was uncontrolled, and a causal relationship between psychotherapy and reduced UEC service use cannot be proven by its design, the decrease in pre-treatment service usage among FNSD patients mirrors treatment-related improvements in health status and functioning previously documented using self-reported outcome measures. Further research is warranted to elucidate features of emergency care service use by patients with FNSD, assess interventions' cost-effectiveness, and help to optimise limited health care resource allocation. Study Three utilised a delay discounting and emotional bias task to assess if these measures could indicate the health state of FNSD patients and to compare findings in patients with those in healthy controls. This online-based study collected data on cognitive-affective functioning, decision-making and, indirectly, emotion regulation, alongside self-reported health data and indicators of mood while completing the tasks. Delay discounting (DD) was steeper in patients with FNSD, indicating a preference for less subjectively valuable immediate rewards. Patients displayed priming and interference effects for angry and happy facial expressions, which differed from the interference effects observed in healthy controls [F(1,76) = 3.5, p = 0.037, η2p = 0.084]. Modest associations (r's =0.26-0.33, p's <0.05) were found between the DD estimates and self-reported generalised anxiety, but not current feelings of anxiety in FNSD. There were no correlations with indices for negative affective priming or interference. These measures did not show predictive ability for self-reported difficulty regulating emotions, anxiety, depression or coping in FNSD. However, the fact that the DD task and self-reported constructs failed to correlate does not invalidate this objective test. The findings underscore the importance of using a combined approach to outcome measurement. This project highlights the importance of a more comprehensive understanding of outcomes and measures that capture clinically valid and meaningful health information. Given that subjective and objective measures capture different aspects of health state or function, a combination of measurement approaches will likely produce the most comprehensive understanding of patients' current state or treatment outcome. Because of the attentional, emotional, and perceptual alterations implicated in FNSD and the variable external representations of these, the difference between objective and subjective measures represents an interesting observation in its own right. The size of the discrepancy between subjective and objective measures may provide additional valuable insights into the underlying pathology. Nonetheless, there is still a need for standardisation and consistency in FNSD outcome measurement and reporting. Several important factors, such as the timeframe of measures, the influence of confounding factors, and the variety of presentation of any aspect of the disorder (e.g., physiological, cognitive, social, or behavioural presentations of arousal/stress), will need to be considered when designing and interpreting measurements for research or clinical analysis of the patient group

    Brain-based versus external memory stores: influencing factors and underlying neural correlates

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    Technological advancements provide people with more opportunity to rely on external resources to support cognitive processes. These associated processes are defined as cognitive offloading (Risko & Gilbert, 2016). The current thesis aims to explore the psychological processes and neural mechanism of cognitive offloading. In Experiment 1, we developed an ‘optimal reminder’ task by calculating whether people were biased towards using reminders or their own memory, compared with an optimal strategy. If participants were biased, the second purpose of Experiment 1 was to assess whether such bias could be reduced through metacognitive advice. Results revealed people were biased towards setting reminders, and the bias was eliminated by metacognitive advice. Experiment 2 used the optimal reminder task to evaluate the effect of ageing on cognitive offloading. This showed that older people set more reminders than younger adults, but were less biased towards setting reminders when the impaired memory performance of older people was taken into account. Experiment 3 investigated the effects of three factors: delay length, metacognitive judgement, and clock revealability, on cognitive offloading in a time-based task (e.g. remembering to press a specific button after 10 seconds). We found participants’ use of reminders was based on both the characteristics of the task (i.e., delay and clock revealability) and metacognitive judgements. Experiment 4 used fMRI to evaluate whether an instruction to offload information to an external reminder triggered different brain activity to an instruction to forget or remember. Results showed that brain activity associated with an offload cue was similar, but not identical, to brain activity associated with a forget cue. We conclude by suggesting possible applications of the results to finding methods for improving intention offloading and avoiding memory failures
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