Individual differences in behavioural inhibition explain free riding in public good games when punishment is expected but not implemented

Background: The literature on social dilemmas and punishment focuses on the behaviour of the punisher. However, to fully explain the effect of punishment on cooperation, it is important to understand the psychological mechanisms influencing the behaviour of those who expect to be punished. This paper examines whether the expectation of punishment, rather than the implementation of punishment is sufficient to prevent individuals from free riding. Individual differences in the punishment sensitivity have been linked to both threat responses (flight, fight, fear system, or the FFFS) and to the response to the uncertainty of punishment (BIS-anxiety).The paper, therefore, examines if individual differences in BIS-anxiety and FFFS can explain some of the variability in free riding in the face of implemented and non-implemented punishment. Methods: Participants took part in a series of one-shot Public Goods Games (PGGs) facing two punishment conditions (implemented and non-implemented) and two standard non-punishment PGGs. The punishment was implemented as a centralized authority punishment (i.e., if one participant contributed less than their group members, they were automatically fined). Individual contribution levels and presence/absence of zero contributions indexed free riding. Individual differences in behavioural inhibition were assessed. Results: Individuals contributed more under the threat of punishment (both implemented and non-implemented). However, individuals contributed less when the punishment was not implemented compared to when it was. Those scoring high in BIS-anxiety contributed more when the punishment expectations were not implemented. This effect was not observed for FFFS. Conclusion: Supporting previous research, punishment had a powerful effect in increasing contribution levels in the PGGs. However, when expected punishment was not implemented, individual differences in punishment sensitivity, specifically in BIS-anxiety, were related to fewer contributions (increased free riding) as compared to the situation when punishment was not implemented. This has implications for our understanding of why some people cannot resist the temptation to free ride, even when facing possible punishment for their actions. Our findings suggest that the diminished functioning of mechanisms, associated with trait behavioural inhibition, can partly explain such behaviours

Altruistic and Warm-Glow Motivations: Differentiating First Time From Repeat Donors

The conversion rate of 1st time donors to their 2nd and 3rd donation is low creating a significant problem to transfusion services. We hypothesise that feelings of warm-glow associated with donating blood, contribute to the differentiation between 1st time donors from those making 2nd or 3rd donations. To test this free-response motivations were examined a sample of 309 blood donors, categorised as 1st time donors and two categories of repeat donor: (1) those making their 2nd or 3rd donation and (2) those making their 4th or subsequent donation. We identified 33 categories of motivation for donating blood were identified. Pure altruism and warm-glow were mentioned in the top ten most frequent motivations. While pure-altruism did not differentiate 1st time from the repeat donors, warm-glow did, with those with those making their 2nd or 3rd donations being 5 time more likely to express warm-glow and those making their 4th or subsequent donations 3 times more likely. These results add to the growing body of evidence that regular blood donors are more likely to express impure altruistic motives and that focusing on warm-glow interventions may offer the possibility to enhance the retention of blood donors

The development and evaluation of the paediatric index of emotional distress (PI-ED)

Purpose: Current measures of anxiety and depression for children and young people (CYP) include somatic symptoms and can be lengthy. They can inflate scores in cases where there is also physical illness, contain potentially distressing symptoms for some settings and be impractical in clinical practice. The present study aimed to develop and evaluate a new questionnaire, the paediatric index of emotional distress (PI-ED), to screen for emotional distress in CYP, modelled on the hospital anxiety and depression scale. Methods: A school-based sample (n = 1026) was employed to examine the PI-ED’s psychometric properties and a clinical sample of CYP (n = 143) was used to establish its sensitivity and specificity. Results: Exploratory and confirmatory factor analyses identified a bi-factor model with a general emotional distress factor (‘cothymia’) and anxiety and depression as co-factors. The PI-ED demonstrated good psychometric properties and clinical utility with a cutoff score of 20. Conclusion: The PI-ED is a brief, valid and reliable clinical screening tool for emotional distress in CYP

An international comparison of deceased and living organ donation/transplant rates in opt-in and opt-out systems: a panel study

Background: Policy decisions about opt-in and opt-out consent for organ donation are based on limited evidence. To fill this gap we investigated the difference between deceased and living organ donation rates in opt-in and opt-out consent systems across a 13 year period. We controlled for extensive covariates and estimated the causal effect of consent with instrumental variables analysis. Method: This panel study used secondary data analysis to compare organ donor and transplant rates in 48 countries that had either opt-in or opt-out consent. Organ donation data were obtained over a 13-year period between 2000 and 2012. The main outcome measures were the number of donors, number of transplants per organ and total number (deceased plus living) of kidneys and livers transplanted. The role of consent on donor and transplant rates was assessed using multilevel modeling and the causal effect estimated with instrumental variables analysis. Results: Deceased donor rates (per-million population) were higher in opt-out (M = 14.24) than opt-in consent countries (M = 9.98; Β = -4.27, 95% confidence interval (CI) = -8.08, -0.45, P = .029). However, the number of living donors was higher in opt-in (M = 9.36) than opt-out countries (M = 5.49; B = 3.86, 95% CI = 1.16, 6.56, P = .006). Importantly, the total number of kidneys transplanted (deceased plus living) was higher in opt-out (M = 28.32) than opt-in countries (M = 22.43; B = -5.89, 95% CI = -11.60, -0.17, P = .044). Similarly, the total number of livers transplanted was higher in opt-out (M = 11.26) than opt-in countries (M = 7.53; B = -3.73, 95% CI = -7.47, 0.01, P = .051). Instrumental variables analysis suggested that the effect of opt-in versus opt-out consent on the difference between deceased and living donor rates is causal. Conclusions: While the number of deceased donors is higher than the number of living donors, opt-out consent leads to a relative increase in the total number of livers and kidneys transplanted

Inequality averse and compassionate blood donor: implication for interventions

Background and Objectives: Blood donors, compared to non-donors, are more likely to show a preference to help others either sharing resources to directly compensate those in need or indirectly by punishing those who act unfairly. Knowing the dominant cooperative preference for blood donors will help inform the development of targeted interventions. We test which preference dominates and an initial intervention based on these findings. Materials and Methods: We report two studies. The first compares compensation and punishment preferences in blood donors and non-donors (N= 372) using a 3rd party compensation and punishment game. Based on the results of Study 1, Study 2 (N = 151) is a feasibility experiment of an intervention based advantageous-inequality-aversion ( “As a healthy person, you can give blood and help those less healthy than you.”).Results: Blood donors, compared to non-donors have a preference for compensation. Organ donors have a preference for punishment. Those exposed to the advantageous-inequality-aversion intervention, compared to control conditions, show a greater behavioural propensity to donate blood (this was especially the case for non-donors). Conclusion: Blood donors have a clear preference for direct helping through compensation that can be translated into a simple effective intervention to enhance blood donor recruitment and retention

A mixed methods investigation of end-of-life surrogate decisions among older adults

Background: A large number of end-of-life decisions are made by a next-of-kin for a patient who has lost their decision-making capacity. This has given rise to investigations into how surrogates make these decisions. The experimental perspective has focused on examining how the decisions we make for others differ from our own, whereas the qualitative perspective has explored surrogate insights into making these decisions. Methods: We conducted a mixed methods study to bring these two perspectives together. This is crucial to comparing decision outcomes to the decision process. We asked older adult partners to make end-of-life decisions for each other. They then took part in a semi-structured interview about their decision process. Transcripts were analysed using thematic analysis. Results: 24 participants took part in the study. Surrogates were more likely to take a life-saving treatment at the risk of a diminished quality of life for their partner than for themselves. This was consistent with their transcripts which showed that they wanted to give their partner a better chance of living. Although there was evidence of surrogate inaccuracy in the decision task, participants overwhelmingly reported their intention to make a decision which aligns with the substituted judgment standard. However, uncertainty about their wishes pushed them to consider other factors. Conclusions: Taking a mixed methods approach allowed us to make novel comparisons between decision outcome and process. We found that the intentions of surrogates broadly align with the expectations of the substituted judgment standard and that previous discussions with their partner helps them to make a decision

Can the 12-item general health questionnaire be used to identify medical students who might ‘struggle’ on the medical course? A prospective study on two cohorts

BACKGROUND: Students who fail to thrive on the Nottingham undergraduate medical course frequently suffer from anxiety, depression or other mental health problems. These difficulties may be the cause, or the result of, academic struggling. Early detection of vulnerable students might direct pastoral care and remedial support to where it is needed. We investigated the use of the short-form General Health Questionnaire (GHQ-12) as a possible screening tool. METHODS: Two consecutive cohorts (2006 and 2007) were invited to complete the GHQ-12. The questionnaire was administered online, during the second semester (after semester 1 exams) for the 2006 cohort and during the first semester for the 2007 cohort. All data were held securely and confidentially. At the end of the course, GHQ scores were examined in relation to course progress. RESULTS: 251 students entered the course in 2006 and 254 in 2007; 164 (65%) and 160 (63%), respectively, completed the GHQ-12. In both cohorts, the study and non-study groups were very similar in terms of pre-admission socio-demographic characteristics and overall course marks. In the 2006 study group, the GHQ Likert score obtained part-way through the first year was negatively correlated with exam marks during Years 1 and 2, but the average exam mark in semester 1 was the sole independent predictor of marks in semester 2 and Year 2. No correlations were found for the 2007 study group but the GHQ score was a weak positive predictor of marks in semester 2, with semester 1 average exam mark again being the strongest predictor. A post-hoc moderated-mediation analysis suggested that significant negative associations of GHQ scores with semester 1 and 2 exams applied only to those who completed the GHQ after their semester 1 exams. Students who were identified as GHQ ‘cases’ in the 2006 group were statistically less likely to complete the course on time (OR = 4.74, p 0.002). There was a non-significant trend in the same direction in the 2007 group. CONCLUSIONS: Results from two cohorts provide insufficient evidence to recommend the routine use of the GHQ-12 as a screening tool. The timing of administration could have a critical influence on the results, and the theoretical and practical implications of this finding are discussed. Low marks in semester 1 examinations seem be the best single indicator of students at risk for subsequent poor performance

The dynamic relationship between pain, depression and cognitive function in a sample of newly diagnosed arthritic adults: a cross-lagged panel model

Background: Pain and depression are common in the population and co-morbid with each other. Both are also predictive of one another other, and are also associated with cognitive function; people who are in greater pain and more depressed respectively perform less well on tests of cognitive function. It has been argued that pain might cause deterioration in cognitive function, as well as better cognitive function earlier in life might be a protective factor against the emergence of disease. When looking at the dynamic relationship between these in chronic diseases, studying samples that already have advanced disease progression often confounds this relationship. Methods: Using data from waves 1 to 3 of the English Longitudinal Study of Ageing (ELSA) (n = 516), we examined the interplay between pain, cognitive function and depression in a subsample of respondents reporting their diagnosis of arthritis at Wave 2 of the ELSA using cross-lagged panel models.Results: The models showed that pain, cognitive function and depression at wave 1, prior to diagnosis, predict pain at wave 2, and that pain at wave 1 predicts depression at wave 2. Pain and depression at wave 2 predict cognitive function at wave 3. Conclusions: The results indicate that better cognitive function might be protective against the emergence of pain prior to an arthritis diagnosis, but cognitive function is subsequently impaired by pain and depression. Furthermore, higher depression predicts lower cognitive function, but not vice versa. This is discussed in the context of the emerging importance of inflammation in depression