The role of affective temperament and emotional expression in predicting chronic fatigue in patients with cancer hospitalized in Ardabil City, Iran, during the autumn of 2016

BACKGROUND: Affective temperament and emotional expression can be important in the mental and physical consequences of patients with cancer. This study aimed to determine the role of affective temperament and emotional expression in predicting chronic fatigue in patients with cancer.METHODS: 110 patients with cancer, hospitalized in the surgery and hematology wards of Fatemi and Imam Khomeini Hospitals in Ardabil City, Iran, in autumn of 2016, were selected by purposive sampling and participated in this cross-sectional study. The Affective and Emotional Composite Temperament Scale (AFECTS), Berkeley Expressivity Questionnaire (BEQ), and Chalder Fatigue Scale (CFQ) were used to collect data. The collected data were analyzed by correlation coefficient and multiple regression analysis using SPSS software.RESULTS: Chronic fatigue positively correlated with depressive (r = 0.69, P < 0.01), anxious (r = 0.59, P < 0.01), apathetic (r = 0.64, P < 0.01), dysphoric (r = 0.37, P < 0.01), volatile (r = 0.61, P < 0.01), irritable (r = 0.36, P < 0.01), disinhibited (r = 0.33, P < 0.01), and obsessive (r = 0.52, P < 0.01) affective temperaments, but it negatively correlated with cyclothymic (r = -0.35, P < 0.01), hyperthymic (r = -0.62, P < 0.01), euphoric (r = -0.69, P < 0.01), and euthymic (r = -0.21, P < 0.01) affective temperaments. Also, it was found that there was a negative relationship between chronic fatigue and emotional expression (r = -0.27, P < 0.01). Results of regression analysis showed that 79% of the total variance of chronic fatigue was explained by affective temperaments. In addition, 27% of the total variance of the chronic fatigue was explained by emotional expressiveness.CONCLUSION: These findings suggest that we can consider the affective temperament and emotional expression as psychological factors underlying the chronic fatigue in patients with cancer

The Mediating Role of Moral Apathy in the Relationship between Childhood Maltreatment and Peer Rejection with Conduct Disorder Symptoms in Adolescents

INTRODUCTION ... [1]. Individuals with conduct disorder exhibit a repetitive and persistent pattern of behavior in which the basic rights of others or age-appropriate social norms and regulations are violated [2]. Conduct disorder usually appears in childhood or adolescence and affects between 2 and 10% of the general population and an average of 4% of people [2]. Significantly, both factors of childhood maltreatment and childhood conduct disorder increase the risk of recidivism. ... [3]. Childhood maltreatment is also considered a clear risk for violence against parents among adolescents [4, 5] and adults [6]. ... [7]. Children and adolescents with conduct disorder have more verbal and physical aggression and poor social skills compared to their peers, as a result, most of them are rejected by their peers [8]. ... [9, 10]. One-third of children and adolescents in school report social rejection by their peers [11]. Dodge et al. [12] have shown that peer rejection in middle childhood predicts current and future antisocial behavior. Longitudinal studies show that socially deprived children are at high risk of social maladjustment and maladaptive thinking patterns in adulthood [10, 13]. Massing-Schaffer et al. [14] and Cheek et al. [15] have also shown in a study aimed at investigating the relationship between social rejection and suicidal ideation that there is a relationship between acute cases of social rejection and suicidal ideation. ... [16]. People with conduct disorder usually engage in unethical behavior using moral apathy, without feeling guilt or self-blame. Loss aversion includes a series of cognitive mechanisms (such as moral justification, thoughtful labeling, dehumanization, and shame attributions) that allow people to engage in unethical behavior and avoid its negative consequences on their self-esteem. Previous studies show that adolescents who resort to moral apathy to a large extent engage in more aggressive behaviors [17]. ... [18, 19]. Also, moral apathy is related to peer rejection in school [20]. ... [21-23]. AIM(s) The present study was conducted to determine the mediating role of moral apathy in the relationship between child abuse and peer rejection with conduct disorder symptoms in adolescents. RESEARCH TYPE The method of this research is descriptive-correlation of structural equation modeling type. RESEARCH SOCIETY, PLACE & TIME The statistical population of this research was all the students of the first and second grades of high school who were studying in Urmia, Iran in the academic year of 2020-2021. SAMPLING METHOD & NUMBER Considering that in modeling studies, the minimum sample size is 10-40 people for each observed variable [24], in this study 15 samples were considered for each observed variable. Therefore, the sample size was selected according to the presence of 14 observed variables, and taking into account the attrition of subjects, 220 people were selected by the multi-stage sampling method. USED DEVICES & MATERIALS To collect data, the self-report version of the Strengths and Difficulties Questionnaire (SDQ) [25, 26], the Childhood Injuries Questionnaire [27, 28], the peer social rejection scale [10], and the moral apathy scale [29, 30] were used. METHODS After receiving permission from Mohaghegh Ardabili University, Department of Education of West Azerbaijan Province in Iran was approached and one district was randomly selected from the two education districts of Urmia, Iran. Then, the selected district was referred and a list of all girls' and boys' schools for the first and second grades of high school was obtained. In the next step, one girls' and one boys' school from each grade (four schools), and after referring to the selected schools from each of the three grades, one class was selected and the link of the research questionnaires was sent to them through the Shad application for answering. ETHICAL PERMISSION This research was approved by the ethics committee of Ardabil University of Medical Sciences with the code of ethics IR.ARUMS.REC.1400.088. STATISTICAL ANALYSIS Data were analyzed using descriptive statistical tools and to test hypotheses structural equation modeling was used through SmartPLS 3 software. FINDING by TEXT In this research, 220 students from the first and second grades of high school in the age range of 12-19 years old with an average age of 16.15±1.54 years participated. The frequency of subjects based on demographic variables is shown in Table 1. According to Table 2, the values of skewness and kurtosis of some variables were not in the range of -2 to +2, therefore, the data did not have a normal distribution, and PLS software was used to perform structural equations for abnormal data. The obtained results showed that all values of Cronbach's alpha and composite reliability of the research constructs were more than 0.7. Also, the value of AVE for the constructs was more than 0.5, which indicated the convergent validity and reliability of the research model. The results of the divergent validity of the variables showed that the average square root of the variance extracted for each of the constructs was higher compared to the correlation of that construct with other constructs; therefore, it can be said that in the research model, the existing variables interacted more with the items related to themselves than with other structures. In other words, the model had good validity. Also, the value of R square for the structure of moral apathy was 0.34 and the structure of symptoms of conduct disorder was 0.56, which indicated a suitable value. The Q2 values showed that the endogenous variables of both constructs had a good predictive ability with their respective constructs. The effect size values in Table 3 indicated the appropriate effect size for the constructs of peer rejection, childhood maltreatment, and moral apathy, and the greatest effect was related to moral apathy on symptoms of conduct disorder. According to charts 1 and 2 and table 4, the results of the bootstrap significance test for the significance test of the path coefficients showed that the direct path coefficients of childhood maltreatment (p<0.001; β=0.38) and moral apathy (p<0.001; 40 (β=0) were significant to the symptoms of conduct disorder. Also, the direct path coefficients of childhood maltreatment (p<0.001; β=0.42) and peer rejection (p<0.01; β=0.23) on moral apathy were significant. In addition, childhood maltreatment (p<0.01; β=0.10) and peer rejection (p<0.01; β=0.06) had an indirect effect on conduct disorder symptoms through the mediation of moral apathy. MAIN COMPARISION to the SIMILAR STUDIES The results of this study showed that childhood maltreatment had a direct effect on the symptoms of conduct disorder. These results are consistent with the results of the study by Desanctisa et al. [3] who showed that moderate to severe childhood maltreatment increases the risk of childhood conduct disorder, and both factors of childhood maltreatment and conduct disorder significantly increases the risk of recidivism. Hoeve et al. [4], Wang et al. [5], and Richey et al. [6] have also shown that childhood maltreatment is a clear risk factor for committing violence against parents and adults. Schwartz et al. [7] have also stated that exposure to adverse childhood experiences is associated with alcohol use problems and high levels of antisocial behavior. ... [31]. The obtained results showed that the direct path of peer rejection to conduct disorder symptoms was not significant. These results are inconsistent with the results of Dodge et al. [12] who showed that peer rejection in middle childhood predicts current and future antisocial behavior. These results are also inconsistent with the results of Massing-Schaffer et al. [14] and Cheek et al. [15], which revealed the association between social exclusion and negative psychological outcomes. The lack of a direct relationship between peer rejection and behavior disorder symptoms in this study can be related to the collection of data in this study during the Corona epidemic period, in which due to compliance with social distancing guidelines, students had less contact with their peers, in this way, they were less likely to be rejected by their peers. On the other hand, the important affecting factor of social exclusion on behavioral abnormalities is the level of emotional arousal, and this level of arousal is also dependent on the degree of intimacy with the rejecter's peer and their social status. Therefore, in addition to experiencing less social rejection in Corona conditions, the subjects of the present study may have lacked deep intimacy with their peers and experienced less emotional arousal in the event of rejection, and this factor may have reduced the negative consequences of rejection. According to the results of this study, moral apathy had a direct effect on the symptoms of conduct disorder. These results are in line with the results of Shulman et al. [21] and Espejo-Siles et al. [22] who showed that moral apathy is an important predictor of aggressive behavior and violence towards peers in children and adolescents. Also, the results of this study showed that childhood maltreatment has an indirect effect on conduct disorder symptoms due to moral apathy. These results are consistent with the results of Wang et al. [5] and Fang et al. [19]. Also, peer rejection through moral apathy had an indirect effect on conduct disorder symptoms. These results are in line with the results of Gini et al. [17] and Muratori et al. [18] who have shown that in adolescents with disruptive behavior disorders, more tendencies of moral apathy are related to high levels of inclemency traits. Fontaine et al. [33] have also shown that adolescents who experience high social rejection from their peers resort to moral apathy processes more than other adolescents. In the explanation of this hypothesis, it can be said that the person's concern about social life or the person's previous memories of rejection may reduce their attention on the self-regulation of their disorder and lead them to maladaptive coping strategies such as the use of moral apathy mechanisms and have an indirect effect on conduct disorder problems. LIMITATIONS This study had several limitations. First, the measurement of childhood maltreatment in this study was only based on the subjects' self-report. Although many studies confirm the reliability and validity of the childhood injury questionnaire, any self-report instrument is vulnerable to many biases such as social desirability, the person's mood at the time of reporting, and the person's memory. The lack of use of clinical samples with conduct disorder was another limitation of the present study. SUGGESTIONS It is suggested that in future studies, other tools such as observation and interview be used to measure the variables, and to increase the generalizability of the results to those suffering from conduct disorder, clinical samples with this disorder be used. CONCLUSIONS The results of this study show that in addition to the direct effect of childhood maltreatment on conduct disorder symptoms, moral apathy acts as a mediator of the effects of childhood maltreatment and peer social rejection on conduct symptoms. CLINICAL & PRACTICAL TIPS in POLICE MEDICINE Considering the greater involvement of those with conduct disorder with the law and their high vulnerability for antisocial behavior in the present and future, the results of this study can be used in the design of preventive programs and early intervention in conduct disorder. ACKNOWLEDGMENTS The authors of the article express their gratitude to the management of the Education Department of West Azerbaijan province in Iran and all school principals and students participating in this research. CONFLICT of INTEREST The authors state that there is no conflict of interest in the present study. FUNDING SOURCES This research is a part of the findings of the Ph.D. thesis of the first author of this article, which was implemented with the financial support of the Research Vice-Chancellor of Mohaghegh Ardabili University

A path analysis of the effects of emotional temperaments on symptoms of conduct disorder in adolescents: An investigation of the mediating role of anger rumination

Introduction: Emotional temperaments are consistently associated with psychopathology and recognized as a risk factor for many psychological disorders. However, the underlying mechanisms of this relationship remain unclear. Aim: This study aimed to conduct a path analysis of the effects of emotional temperaments on the symptoms of conduct disorder in adolescents by investigating the mediating role of anger rumination. Method: This descriptive, correlational study was conducted by the structural equation modeling method. The statistical population consisted of all first- and second-grade high school students in Urmia, Iran, in 2020-2021 academic years. A total of 220 students were selected by the multistage random sampling method and completed the Strengths and Difficulties Questionnaire (2003), Affective and Emotional Composite Temperaments Scale (2011), and Anger Rumination Scale (2001). Descriptive statistics were calculated to analyze the collected data in SPSS version 27, and a path analysis was performed using SmartPLS version 3 to test the study hypotheses. Results: The emotional temperaments of activation (β=0.21, p<0.01) and sensitivity (β=0.26, p<0.01) had direct positive effects on the symptoms of conduct disorder, whereas temperaments of control (β=-0.29, p<0.01), coping (β=-0.18, p<0.01), and inhibition (β=-0.11, p<0.01) had direct negative effects on these symptoms. The temperaments of activation (β=0.21, p<0.05), inhibition (β=0.11, p<0.01), and sensitivity (β=0.36, p<0.01) had direct positive effects on anger rumination, while the temperaments of control (β=-0.45, p<0.01) and coping (β=-0.28, p<0.05) had direct negative effects on this variable. The results pertaining to the indirect effects of temperaments also indicated that anger rumination mediated the relationship between emotional temperaments and symptoms of conduct disorder (p<0.05). Conclusion: The results of the present study revealed that the temperaments of activation and sensitivity were risk factors for conduct disorder, whereas the temperaments of control, coping, and inhibition were protective factors for it. Besides, anger rumination mediated the effects of emotional temperaments on conduct disorder