ObjectiveSocial dysfunction and language abnormalities are core features of psychotic disorders that interfere with communication. Language studies in psychosis often utilize paradigms involving conversational exchange yet analyze only participant speech rather than understanding the broader participant-examiner discourse. Notably, humans naturally align their language to be more similar to their conversation partners during interaction-a process sometimes called language style matching (LSM). As individuals with psychosis face significant interpersonal challenges, understanding LSM in the context of social interaction is an important and unaddressed area of research. Methods: A total of 101 early psychosis-spectrum participants (early psychosis [EP;n = 24], high schizotypy [HS;n = 44], unaffected controls [UC;n = 33]) completed an audio-recorded social interaction task and an assessment of real-world social functioning. Transcribed speech from participant-examiner dyads underwent LSM analyses to assess interpersonal linguistic synchrony. Correlation and hierarchical regression analyses examined associations among LSM, performance on the social interaction task, and social functioning. Results: LSM was positively correlated with real-world social functioning and performance on the social task in EP and real-world social functioning in UC, but not HS. LSM further accounted for additional variance in social functioning, over-and-above performance on the social interaction task and relevant clinical and demographic variables (diagnostic status, age, sex). Conclusions: These results provide preliminary evidence that LSM during interpersonal interaction is linked to social dysfunction. Critically, LSM may measure features of interaction and social outcomes that are not captured by standard assessments. Collectively, conversational exchange is a promising area for future work assessing social dysfunction in emerging adults across the early psychosis-spectrum.
ObjectiveCaregivers' childhood trauma (CT) and autistic traits (AT) are thought to impair the social and emotional competencies essential for proficient parenting. The intergenerational associations through which these caregiver factors affect adolescents' attachment relationships to with both mothers and peers, as well as their internalizing symptoms, remain unexamined. This study examined the correlation between maternal CT/AT and adolescents' attachment styles, anxiety, and depression to address this notable gap. Methods: This cross-sectional study comprised 115 adolescent-mother dyads (aged 12-18, 38.3% male) who sought outpatient clinic services solely for counseling related to adolescent concerns and were without any psychiatric diagnoses. Mothers were evaluated for AT and CT, while adolescents were assessed for parental and peer attachment styles, as well as depressive and anxiety symptoms using standardized instruments. Correlational and serial mediation analyses were conducted. Results: Serial mediation analysis showed that maternal childhood trauma was directly associated with lower parental attachment (β = -0.281, p = .001) and indirectly through depression (β = -0.065, p = .025) and the sequential pathway via anxiety and depression (β = -0.030, p = .042), whereas anxiety alone was not significant. For peer attachment, neither direct nor indirect effects were significant. Maternal AT scores were not significantly associated with adolescent outcomes (all p > .05). Conclusions: Maternal CT was linked to adolescents' internalizing symptoms and parental attachment security, with depression mediating these associations. These findings underscore the potential relevance of trauma-informed and attachment-focused interventions, although longitudinal research is needed to clarify causal processes.
OBJECTIVE:This study examined the associations between childhood emotional maltreatment (CEM) and healthy diet among university students, and tested the roles of depression and physical exercise using a conditional process framework. METHOD:A cross-sectional survey was conducted among 3,007 Chinese undergraduates (42.1% male; mean age = 19.03 ± 1.18 years). CEM, depressive symptoms (PHQ-2), physical exercise, and healthy diet were assessed via self-report. Demographic variables were controlled. PROCESS macro Model 14 in SPSS 29.0 was used with 5,000 bootstrap samples to test moderated mediation models. RESULTS:Across three independently estimated models (overall CEM, childhood emotional abuse, and childhood emotional neglect), CEM and its subdimensions were positively associated with depressive symptoms (β = 0.300-0.373, p < .001) and negatively associated with healthy diet (β = -0.192 to -0.222, p < .001). Depression was negatively associated with healthy diet (β = -0.148 to -0.162, p < .001) and statistically mediated the association between CEM and healthy diet. Physical exercise was positively associated with healthy diet (β = 0.174-0.175, p < .001) and showed a small but significant moderating association in the depression-healthy diet relationship in the overall CEM and emotional abuse models, but not in the emotional neglect model. CONCLUSIONS:CEM was associated with poorer healthy diet partly through elevated depressive symptoms. Physical exercise demonstrated a limited buffering association. These findings underscore the relevance of integrating psychological support with physical activity and nutrition interventions to promote healthier eating among university students.
ObjectiveThe aim of this study was to evaluate the relationships between attempted suicide and depression, non-suicidal self-injury, temperament, defence styles, and impulsivity Method: The study included 60 individuals aged 18-60 years who had attempted suicide (30 diagnosed with depressive disorder and 30 without mental disorder), recruited from referrals, walk-in clinics, and inpatients, all of whom had normal mental capacity, were not using drugs that could affect cognitive functions, and had no physical or neurological disease, as well as 30 healthy controls. The Temperament Evaluation Inventory, the Defense Style Questionnaire, and the Beck Depression Inventory were administered to all participants. The Tower of London test and the Go/NoGo test were applied as neuropsychological tests. Results: The suicide attempters were found to have higher levels of dysthymic temperament (p=0.003), irritable temperament (p=0.025), anxious temperament (p=0.008), and non suicidal self-injury (p=0.000) than the healthy controls. Those with a history of attempted suicide used immature defences more than the healthy controls (p=0.003). In the group of all attempted suicides, the scores for attention deficits and impulsivity were found to be higher than those of the healthy controls. The Go/NoGo test was determined to be able to differentiate those with attempted suicide from the controls (p=0.041). Conclusions: The study findings showed that temperament characteristics, non-suicidal self-injury, executive function deficits, and impulsivity could be risk factors for suicide attempts. Depressed suicide attempters exhibited greater deficits in planning and problem-solving.This study provides evidence regarding the usability of neurocognitive tests in evaluating future suicide risk. Key Words: Attempted suicide, temperament, defence styles, executive functions, non-suicidal self-injury.
ObjectiveChildhood maltreatment is a well-established risk factor for the development of mental disorders. Interpretation bias has been proposed as a potential mechanism mediating the relationship between childhood maltreatment and subsequent psychopathology. This study investigated differences in interpretation bias and psychopathology symptoms based on experiences of childhood abuse and neglect. It also examined whether interpretation bias mediates the relationship between childhood maltreatment and symptoms of psychopathology using network analysis.Methods:A cross-sectional sample of 123 university students aged 19 to 25 participated. Childhood maltreatment was assessed using the Childhood Maltreatment Experiences Scale, and psychopathological symptoms were measured with the Symptom Checklist-90-Revised. Interpretation bias was assessed using a facial emotion judgment task involving morphed anger-happiness and anger-sadness expressions presented at varying intensity levels.Results:Participants with a history of abuse were more likely to interpret ambiguous anger-happiness expressions as anger, especially at the most ambiguous levels, and reported higher symptoms across all domains of psychopathology compared to those without maltreatment experiences. Participants with a history of neglect showed elevated depression and paranoid ideation but did not show significant interpretation bias. Network analysis revealed that abuse was directly connected to interpretation bias, somatization, and phobic anxiety. Interpretation bias and somatization served as bridge nodes, with anxiety emerging as the most central symptom.Conclusions:Interpretation bias may serve as a transdiagnostic factor linking childhood abuse to various forms of psychopathology, highlighting its importance for early identification and intervention in individuals with childhood abuse histories.
ObjectiveIdentification-the experience of perceiving oneself as like another-is a central process in human relatedness, empathy, and emotion regulation. Although well-established in psychoanalytic and developmental theory, its function under stress and trauma has received limited systematic attention. This paper integrates interpersonal, cognitive, and neurobiological perspectives to conceptualize identification as a core mental operation and to propose thinking by similarity as its underlying cognitive process.MethodThrough focused conceptual synthesis, the manuscript draws on psychoanalytic, developmental, social-cognitive, and neurobiological research to examine the origins, mechanisms, and manifestations of identification across the life span and following high-stress and traumatic events.ResultsIdentification emerges early in development through attachment and imitation, shaping empathy and social understanding. Neurobiological evidence, including mirror neurons and limbic system activation, demonstrates shared brain activations that ground identification biologically. Under threat or trauma, cognition may shift to thinking by similarity, facilitating appraisal of safety and danger but also increasing vulnerability to distress and cognitive rigidity. Following traumatic events, this process may yield adaptive empathy and solidarity or maladaptive over-identification with victims and aggressors and posttraumatic stress disorder.ConclusionsIdentification is a fundamental psychological and neurobiological process. The concept of identification as thinking by similarity offers a unifying linking of psychodynamic, developmental, and neurobiological models. This framework advances understanding of empathy, resilience, and vulnerability under stress, with implications for trauma-informed clinical practice and research.
ObjectiveLittle is known about the day-to-day variation in suicide ideation (SI) associated with posttraumatic stress disorder (PTSD). This study examined daily variations in SI frequency and intensity in individuals with and without PTSD. Methods: Using an ecological momentary assessment methodology, participants (N = 156; 78 with probable PTSD, 78 without PTSD) completed self-report assessments of SI four times daily for 15 days. SI was measured by Patient Health Questionnaire (PHQ-9) item 9. The SI assessment adherence rate was 80.0%. For each person, overall and daily measures of frequency of endorsing SI (FSI), mean SI intensity (MSI intensity; range 0-10), and highest SI intensity (HSI intensity; range 0-10) were obtained. Linear mixed models were used to examine associations between the 7 days of the week and weekday/weekend variations in FSI, MSI intensity, and HSI intensity and PTSD. Results: Individuals with PTSD (vs. those without) reported a higher overall FSI (23.2% vs. 2.0%, t = 5.44, p < .001), MSI intensity (1.01 vs. 0.04, t = 4.17, p < .001), and HSI intensity (3.26 vs. 0.87, t = 4.97, p < .001). Among those with PTSD and SI, 10.9% had overall MSI intensity scores between 5 and 10 (range 0-10) and 32.6% had overall HSI intensity scores of 8-10. Among the latter group, the overall HSI intensity was episodic for 60.0% and persistent for 40.0% of individuals. No day of the week or weekday versus weekend differences were found. Conclusions: Understanding the characteristics of SI frequency and intensity will aid in understanding the transition from SI to suicide attempts and may inform interventions and clinical care.
ObjectiveWe assessed the impact of the COVID-19 pandemic on the implementation of a peer-integrated enhancement of integrated clinical care intervention to address the mental health needs of 450 patients undergoing treatment for a physical injury.MethodsQualitative data were collected by 7 clinician investigators of a randomized controlled trial acting as participant observers in a trauma care setting of a major U.S. metropolitan hospital and analyzed in collaboration with an external mixed methods specialist.ResultsThe pandemic created or exacerbated several implementation barriers, including increased risk of infection, homelessness, hospitalizations and comorbid conditions such as fentanyl overdoses that increased demand on emergency department and Trauma Center services, imposition of safety measures to reduce risk of infection in clinical settings, transition from face-to-face to virtual interactions with study patients, shortages of specialty mental health providers, suspension of recruitment of patients into the study, scheduling calls with patients, and an increased workload for the study clinical interventionists. Peer specialists perceived the transition to virtual interactions with patients reduced their effectiveness; however, this was not reflected in assessments of patient satisfaction with services received and may have inadvertently increased adoption by Trauma Center staff. Reduction in reach of the intervention to target population was temporary.ConclusionsThe COVID-19 pandemic exacerbated existing barriers and created new barriers to successfully implementing evidence-based practices in trauma care settings, resulting in an attenuation of their effectiveness. However, the shift from face-to-face to virtual services delivery may have actually led to improved implementation outcomes.Trial RegistrationClinicalTrials.gov identifier: NCT03569878. Registered June 15, 2018.
OBJECTIVE:Digital social technologies, such as social media and online multiplayer video games (MVGs), have ushered in an era of peer relationships that evolve online, in addition to in person. This report reviews existing research about the dual role of social media and MVGs in shaping youth social connectedness, recognizing both their potential benefits and their associated risks on youth mental health. By providing evidence-based insights, it aims to inform strategies that optimize these technologies' advantages while safeguarding youth mental health and well-being. METHOD:This report reviews peer-reviewed literature, clinical recommendations, reports, and surveys that assess youth usage of social media and MVGs and their associated psychological and physical health outcomes. RESULTS:Social media provides many opportunities for peer connection, including self-expression and social support, fostering positive social development and well-being. MVGs combine entertainment with collaboration, further strengthening social bonds. However, the use of these technologies has also been linked to negative outcomes, including social isolation, depression, anxiety, and sleep disorders. Publically-available, evidence-based resources can provide caregivers and professionals with guidance and clinical recommendations regarding youth social media and MVG use. CONCLUSIONS:Digital social technologies have become increasingly user-specific and immersive as the internet evolves and social media algorithms become more powerful. Additional research is required to understand how current youth usage of these technologies impacts physical and psychological outcomes. Future research should also investigate the differences in usage, outcomes, and the efficacy of treatments across youth sex and age.
Objective: Resistance to unwanted sexual advances decreases likelihood of completed sexual victimization (SV), with psychological barriers to resistance (PBRs; i.e. fear of injury, concern for preserving the relationship, and self-consciousness) reducing likelihood of resisting. Prior SV is associated with distress, which could increase revictimization risk. Method: A cross-sectional survey was utilized to examine associations among history of SV, psychological distress (defined as symptoms of depression, anxiety, symptoms of post-traumatic stress disorder [PTSD], and alcohol use problems), and PBRs in a sample of college women (N = 374). It was hypothesized: 1) severity of SV would be associated with PBRs, 2) psychological distress would be associated with severity of SV, 3) psychological distress would be associated with each type of PBR, and 4) psychological distress would mediate associations between severity of SV and PBRs. Results: Severity of SV was associated with fear of injury exacerbation and concerns for relationship preservation as well as higher levels of psychological distress. Concerns for relationship preservation and self-consciousness were associated with more alcohol problems. Depression mediated severity of SV and PBR due to concern for relationship preservation. Conclusion: Risk reduction programs should address how the intersection of psychological distress and PBR influences resistance behavior, especially among women with a history of SV.
ObjectiveIn this article, we review the effects of war on children via their impact on parenting and propose a novel family stress model to inform research and intervention development. Method: Focusing specifically on families living in active war zones, we conducted a review of the empirical literature on parenting and child adjustment, and parenting interventions during wartime. We excluded parental deployment to war if the family at home was not residing in the war zone. Results: A growing body of literature highlights challenges to parenting practices, cognitions and emotions during war, and parental adaptations to living in a war zone but we could find no parenting intervention research reporting outcomes of programs during war. Conclusions: While emerging literature highlights the impact of war on parenting and potential targets for intervention, there is a critical dearth of research on strategies and programs to support parents during wars. We propose a model to guide future research and intervention development for parenting during war and some examples of ways to accomplish this.
Objective: Between 2005 and 2022, more than 315,000 grave violations were verified against children in wartime, including killing, physical maiming, exploitation, and forced displacement. While the resulting harm to children is widely recognized, the profound toll on professionals who witness and respond to these tragedies remains under examined. This article explores the psychological and occupational impacts of exposure to child casualties during wartime on healthcare providers, military personnel, journalists, and mortuary affairs workers. Method: Google Scholar, PsycINFO, PsychNET, and PubMed were searched for literature examining the impact of pediatric death and injury on healthcare professionals, service members, journalists, and mortuary affairs workers in wartime settings. Supplementary searches were conducted to identify supportive evidence from literature addressing impacts in non-conflict contexts. Results: Evidence varied across professions, but impacts examined included moral injury, secondary traumatic stress, heightened emotions, including guilt, anger, helplessness, and grief, as well as professional challenges such as self-questioning, and burnout. Potential mechanisms exacerbating distress include loss of trust in the goodness of the world, cynicism, and hopelessness, personal identification with children, and perceived lack of adequate skills or a sense of professional failure. Conclusions: Findings underscore the urgent need for tailored strategies to sustain the well-being and effectiveness of professionals confronted with child casualties in war. In response, the article highlights promising individual-level and organization-level strategies for building resilience and growth, and promising interventions for professionals requiring clinical care.
Objective: This literature review summarizes findings regarding the effects of war-related bereavement and other losses in children and adolescents-including both negative consequences and protective factors that may mitigate their effects. This review also explores strategies for improving mental health and developmental outcomes among youth experiencing war-related losses. Method: This literature review synthesizes research studies examining psychological and developmental consequences of war-related bereavement. These include studies assessing mental health risks, protective factors, and effective interventions for children and adolescents bereaved by the loss of family members due to war. Results: The literature consistently shows that children and adolescents who experience war-related bereavement are at a significantly higher risk for developing psychological disorders, including posttraumatic stress disorder (PTSD), depression, anxiety, prolonged grief disorder, and suicidal ideation. The findings also highlight individual, family, and community factors-including self-esteem, self-efficacy, adaptive coping skills, social support, and cultural values-that may buffer these risks and enhance resilience. Conclusions: To mitigate the negative impact of war-related bereavement, early identification of grief reactions is critical. A developmentally-informed approach to assessment and intervention, involving mental health professionals, paraprofessionals, school personnel, and policymakers, is essential to support resilience and foster developmental recovery in bereaved youth. Research and intervention efforts should focus on enhancing protective factors and implementing flexibly-tailored strategies (including group, school-based, and telehealth) to aid children affected by war-related bereavement and other losses.
ObjectiveAn exploratory-descriptive three-wave survey was designed to explore the nature of wartime and postwar trauma, bereavement, grief, and developmental disruptions in war-exposed Bosnian adolescents; and to guide theory building, intervention, and policy. Specific aims included describing: Prevalence rates of war exposure types, war-related disruptions to social networks (traumatic deaths, disappearances, natural deaths, separations), short- and long-term postwar adversities, adolescent postwar grief reactions, and war-related disruptions in developmentally sensitive life domainsg. Method: A three-wave self-report survey (conducted 1.5-2.5 years after the Bosnian civil war, across multiple geographic/ethnic regions) assessed prewar, wartime, and postwar experiences and psychosocial adjustment in war-exposed Bosnian secondary school students. Results: Students reported: (a) high rates of exposure to both high-magnitude types of war trauma (including traumatic losses) and postwar adversities; (b) extensive war-related disruptions to their social networks, including deaths to natural and unnatural causes, and separation from loved ones. Significant effects were found for sex, type of death, and type of grief; but not for their interaction, age, or geographic region/ethnicity. (c) Pervasive war-related developmental impacts-primarily slowdowns-were reported for impulse control, help-seeking, identity formation, moral development, and understanding political issues. Conclusions: Many families were struggling economically and interpersonally 2.5 years after the war. Pervasive disruptions in youths' social networks persisted. Interventions for war-exposed youth should address a diverse array of problems including traumatic losses, ongoing separations, interpersonal conflict, and disruptions in developmentally important life domains. Balanced, strength-based grief interventions should both facilitate adaptive grief reactions and therapeutically reduce unhelpful grief reactions.
ObjectiveCurrently, 47.2 million children worldwide are displaced due to conflict and violence. Most refugees (69%) are relocated to neighboring countries and often live in refugee camps or informal settlements. The transition period during displacement can have significant effects on youth wellbeing and psychosocial development. The paper explores how displacement due to conflict and violence impacts the mental health and wellbeing of children, particularly those living in refugee camps or informal settlements. It aims to guide the development of effective mental health programs and interventions by examining the role of the social environment in shaping the psychosocial development of displaced youth. Method: The Four Core Stressor Framework is introduced and applied to assess the mental health challenges faced by refugee youth, focusing on the effects of conflict and displacement on their psychosocial development. Conclusion: The paper highlights promising psychosocial interventions that address the political, structural, and social challenges faced by displaced youth. These interventions aim to support their mental health, promote resilience, and foster positive growth during displacement.
OBJECTIVE:Given the prevalence of conflict-related sexual violence, tens of thousands of children are estimated to have been born from wartime mass rape campaigns, sexual violence, and forced pregnancy in conflicts around the globe. Despite their vital interconnection, the existing empirical literature has tended to examine either the realities of women survivors of conflict-related sexual violence, or children born of war rape. Much less literature has addressed the realities of both mothers and children and their shared and interrelated experiences. This paper explores the shared post-conflict experiences and realities of children born of conflict-related sexual violence and mothers in post-genocide Rwanda. METHODS:The paper draws on a case study of one mother and her now adult child living in Rwanda. The case study draws from a larger qualitative study using in-depth interviews with 44 mothers and 60 adult children born of conflict-related sexual violence in Rwanda. RESULTS:Participants revealed their shared, long-term post-conflict challenges, which included family and community stigma, marginalization, poverty and health issues. Participants also highlighted their shared strengths and the ways in which they drew enormous strength from one another, facilitating empathy, pride and hope for the future. CONCLUSIONS:Given their shared realities, service provision should aim to engage both mothers and children together, enabling both parties to draw upon shared strengths and mutual support. Moreover, interventions that are community-driven, family-oriented, and culturally-attuned should be adapted to mothers and children, addressing the complexities, and potential ambivalences in their relationship.
ObjectiveFormer children associated with armed forces and armed groups (CAAFAG) have been affected by violence and adversity and often experience challenges when reintegrating into their communities. Many former CAAFAG demonstrate pervasive mental health concerns, which disrupt functioning and impact successful reintegration. Addressing mental health needs is imperative to ensure successful reintegration. Method: This report reviews risk and protective factors of mental health outcomes and evidence-based intervention approaches for former CAAFAG. Results: The mental health needs of former CAAFAG vary depending on risk and protective factors prior to, during, and after involvement in the armed forces. Effective interventions that address mental health concerns and promote resilience apply a socioecological approach, such that interventions are implemented at the individual, family, and community levels. Further, interventions should apply a community-participatory model that prioritizes community members' and consumers' input during intervention development and implementation. This includes ensuring interventions are appropriately adapted for the context. Conclusion: Research evidence that highlights addressing risk and protective factors and the effectiveness of intervention approaches for former CAFAAG is growing; however, additional research is needed.
ObjectiveThis article reviews international research on the mental health of children of military service members, with a focus on the United States, United Kingdom, Canada, and Australia. It highlights the unique service-related stressors these children experience and presents Bronfenbrenner's Ecological Systems Theory as a framework for understanding how various risk and protective factors interact to influence mental health outcomes. The article also explores prevention and intervention strategies that support resilience and psychological well-being in this population. Method: A comprehensive review of empirical studies was conducted using peer-reviewed journal articles, governmental reports, and institutional research databases. The review examined key variables including rates of mental health concerns, contributing risk and protective factors linked to military service, and best practice prevention and intervention approaches. Country-specific trends and gaps in research were also analyzed. Results: In addition to extensive research from the United States, a smaller but growing body of work from Canada, Australia, and the United Kingdom was identified. Findings consistently show that children of military service members face increased risks of depression, anxiety, and behavioral challenges. However, protective factors such as strong family cohesion, supportive parental mental health, and access to structured services can buffer these risks. Ecological frameworks help capture how personal, family, and societal systems intersect in shaping outcomes. Conclusions: Continued research is needed to develop and evaluate scalable, evidence-based interventions tailored to military families. A family-centered and ecologically informed approach is essential to fostering resilience and improving long-term psychological outcomes for children of military service members.
ObjectiveThe proliferation of access to generative AI tools has the potential to radically alter the process of writing manuscripts. This report evaluates NotebookLM as a tool for conducting a literature review in an ethical and responsible manner. Method: We uploaded 22 relevant papers from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS) to NotebookLM and asked questions pertaining to a hypothetical research paper. We investigated the capabilities, limitations, ethical considerations, and privacy implications of using NotebookLM and engaged in a dialogue with the tool through a series of user-written prompts and AI responses. Results: We found that the variability and utility of responsesweres determined in large part by the ability to write meaningful prompts and the extent to which new prompts provided additional information. Investigating how NotebookLM identified key findings enhanced our prompt generation and subsequently the iterative refinement of output to produce information relevant to our mock literature review. Conclusions: The utility of NotebookLM will likely vary by the quality of source material uploaded into the program and the researcher's familiarity with prompt generation. There are a number of benefits and drawbacks to using this tool as a search engine or conversation partner. Ethical considerations and privacy implications of using NotebookLM are discussed.
