Tag: statistics

Psychol Trauma. 2025 Jun 2. doi: 10.1037/tra0001949. Online ahead of print.

ABSTRACT

OBJECTIVE: In clinical trials for posttraumatic stress disorder (PTSD), reliable and valid assessment is essential. However, accuracy can be compromised due to site-level variation, assessor unmasking, and participant burden associated with multiple visits to a study site. We therefore created a centralized assessment hub in which raters were trained to administer the Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (Weathers et al., 2013) remotely via telephone.

METHOD: We developed a systematic training protocol for Veteran Affairs (VA) Cooperative Study 591, the largest multisite PTSD psychotherapy trial ever conducted (N = 916, Schnurr et al., 2022). We trained 15 raters, ranging from trainees to licensed clinical psychologists. Our protocol included three steps: (1) didactics, (2) scoring calibration, and (3) mock interviews. Step 3 was repeated until raters achieved 85% reliability with an expert. Randomly selected interviews (n = 200) were used to calculate interrater reliability.

RESULTS: Reliability was outstanding for both PTSD diagnosis (κ = .90) and total severity score (intraclass correlation = .98). Assessment time period did not impact PTSD diagnostic agreement (χ² = 5.60; p = .23) but did affect total symptom severity (F = 4.43; p = .002). In contrast, rater educational attainment impacted diagnostic (χ² = 5.00; p = .025) but not total severity score (t = .85; p = .39) agreement.

CONCLUSIONS: Our Clinician-Administered PTSD Scale for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition training protocol was used successfully in the largest PTSD clinical trial to date. The use of a centralized assessment hub ensured highly accurate assessment that likely could not have been achieved using site-based raters across multiple sites. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

PMID:40455531 | DOI:10.1037/tra0001949

Emotion. 2025 Jun 2. doi: 10.1037/emo0001551. Online ahead of print.

ABSTRACT

Social power (control over valued resources and outcomes) has pervasive effects on how people think, feel, and behave. One important domain likely to be influenced by power is emotion regulation (how people manage their emotions). Extending a small literature on power and emotion regulation, the present research (data collected between 2017 and 2019) examined whether experimentally manipulated power roles (e.g., being a boss vs. an employee) influence the regulation of anger and sadness, and whether emotion appropriateness norms (concerns about the appropriateness of emotions in particular contexts) might explain these effects. Using a within-subjects design, an exploratory study (Study 1, N = 207) asked participants to imagine themselves in three different power roles (i.e., high, equal, and low power) in scenarios that elicited either anger or sadness. They were then asked how they would regulate (via suppression, acceptance, and reappraisal) their emotions. Across anger and sadness scenarios, participants reported more suppression, less acceptance, and more reappraisal when imagining themselves in the high- and low-power roles compared to the equal-power role. Preregistered Study 2 (N = 447) replicated Study 1s effects and indicated that emotion appropriateness norms partially statistically mediated the effects of power role. Last, preregistered Study 3 (N = 291) replicated Studies 1 and 2. Overall, the findings suggest that unequal compared to equal power roles lead to more regulation (both suppression and reappraisal) and less acceptance of anger and sadness, and that emotion appropriateness norms partially explain these effects. This research provides novel insights into how and why power affects regulation of negative emotions. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

PMID:40455520 | DOI:10.1037/emo0001551

Biometrics. 2025 Apr 2;81(2):ujaf068. doi: 10.1093/biomtc/ujaf068.

ABSTRACT

Pathogens usually exist in heterogeneous variants, like subtypes and strains. Quantifying treatment effects on the different variants is important for guiding prevention policies and vaccine development. Here, we ground analyses of variant-specific effects on a formal framework for causal inference. This allows us to clarify the interpretation of existing methods and define new estimands. Unlike most of the existing literature, we explicitly consider the (realistic) setting with interference in the target population: even if individuals can be sensibly perceived as iid in randomized trial data, there will often be interference in the target population where treatments, such as vaccines, are rolled out. Thus, one of our contributions is to derive explicit conditions guaranteeing that commonly reported vaccine efficacy parameters quantify well-defined causal effects, also in the presence of interference. Furthermore, our results give alternative justifications for reporting estimands on the relative, rather than absolute, scale. We illustrate the findings with an analysis of a large HIV1 vaccine trial, where there is interest in distinguishing vaccine effects on viruses with different genome sequences.

PMID:40455519 | DOI:10.1093/biomtc/ujaf068

Psychol Assess. 2025 Jun 2. doi: 10.1037/pas0001389. Online ahead of print.

ABSTRACT

The Inventory of Depression and Anxiety Symptoms-II (IDAS-II) addresses current clinical demands by providing individual scores for depressive, anxiety, and bipolar symptoms consistent with transdiagnostic approaches and the Hierarchical Taxonomy of Psychopathology. The general aim was to expand the clinical utility of the IDAS-II to assess changes in internalizing symptoms, quality of life (QoL), and disability. Participants included 1,072 community adults (50% women) and 289 patients (74% women) who completed the IDAS-II. Patients also completed the Short Form-36 Health Survey and World Health Organization Disability Assessment Schedule to evaluate QoL and disability, respectively. First, the sensitivity of the IDAS-II scores to treatment impact was assessed through statistical significance and reliable changes based on the internal consistency of the IDAS-II. Second, the relationship between changes in IDAS-II scores and changes in QoL and disability was analyzed using weighted Cohen’s κ and Spearman correlations. Third, an anchor-based longitudinal method determined the minimal clinically important difference in QoL and disability for the IDAS-II scales (i.e., the smallest difference in IDAS-II scores perceived as beneficial for QoL and disability). Reliable change index values and cutoff c were provided to identify reliable improvement, deterioration, no change, and clinically significant change for each symptom. Changes in general depression and dysphoria were most strongly associated with changes in QoL and disability. The minimal clinically important difference values for the IDAS-II provide insights into perceived QoL and disability improvement without requiring additional measures. Tracking symptom changes and their implications for QoL and disability is useful in guiding evidence-based decisions in clinical practice. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

PMID:40455509 | DOI:10.1037/pas0001389

J Fam Psychol. 2025 Jun 2. doi: 10.1037/fam0001361. Online ahead of print.

ABSTRACT

It is well-established that parenting plays a crucial role in shaping the mental health of adolescents. This study aimed to investigate the longitudinal association between adolescents’ perceived parental warmth, COVID-19 peritraumatic distress, and emotional problems. Participants were recruited from schools in Zhuhai, Xinyang, and Ningxiang. A total of 579 adolescents (55.4% girls, M_age = 12.83; SD_age = 0.76) took part in this three-wave study conducted in January 2023 (Time 1), March 2023 (Time 2), and May 2023 (Time 3), with each wave being 2 months apart. The results from the cross-lagged panel model supported significant bidirectional relations between emotional problems and COVID-19 peritraumatic distress. In addition, the influence of maternal or paternal warmth on subsequent emotional problems was not statistically significant. The COVID-19 peritraumatic distress at Time 2 mediated the longitudinal effect of emotional problems at Time 1 on paternal warmth at Time 3. Nevertheless, COVID-19 peritraumatic distress did not significantly influence subsequent maternal warmth. These findings contribute to our understanding of the varying responses to adolescents’ stress across parental gender. Furthermore, they imply potential strategies to protect the healthy development of adolescents. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

PMID:40455507 | DOI:10.1037/fam0001361

J Prosthodont. 2025 Jun 2. doi: 10.1111/jopr.14078. Online ahead of print.

ABSTRACT

PURPOSE: To evaluate and compare the clinical outcomes of translucent monolithic zirconia (TMZ) and metal-ceramic (MC) posterior crowns fabricated with digital workflow over a 5-year observation period.

MATERIALS AND METHODS: Fifty-two patients, in need of a posterior crown, were included in the study and randomly divided into 2 groups to receive either TMZ or MC crowns (n = 30 each). The restorations were fabricated with a digital workflow and cemented with resin cement. The clinical outcomes and periodontal parameters were assessed at baseline and yearly for 5 years. Statistical analysis was performed using the Wilcoxon signed-rank test, Friedman test, and Mann-Whitney U test.

RESULTS: The survival rate at 5 years was 100% for both groups. Mechanical complications were detected in the MC group due to minor ceramic chipping. No biological complications were observed. All crowns were assessed as satisfactory in both groups. A significant variation in gingival index (GI) scores was observed in both groups throughout the observation period.

CONCLUSIONS: Translucent monolithic zirconia may be considered a reliable alternative to MC posterior crowns within the assessed follow-up period. The digital workflow provided satisfactory clinical performance.

PMID:40455497 | DOI:10.1111/jopr.14078

JAMA Intern Med. 2025 Jun 2. doi: 10.1001/jamainternmed.2025.1380. Online ahead of print.

ABSTRACT

IMPORTANCE: A single text-only e-cigarette warning about nicotine addiction is required by the US Food and Drug Administration in the US, yet little is known about whether health harms warnings are more effective than the required nicotine addiction warning.

OBJECTIVE: To assess the effectiveness of text-only e-cigarette warnings on message processing, risk belief, and behavioral intention outcomes, as well as the impact of health harm warnings and the required nicotine addiction warning or similar addiction warnings.

DATA SOURCES: A comprehensive search was conducted using PubMed, Embase, Scopus, PsycINFO, and Business Source Premier from inception through February 2024. Review articles were also examined for potential studies.

STUDY SELECTION: Experimental studies that randomized participants to view nicotine addiction or health harms e-cigarette warnings were included. Studies had to report 1 or more message processing, risk perception, or behavioral intention outcomes.

DATA EXTRACTION AND SYNTHESIS: Using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines, 2 independent coders (Y.J. and J.S.) screened and coded all studies. Effect sizes characterizing overall warning effects and health harm vs addiction warning effects were calculated using the standardized mean difference (d). Effect sizes were pooled using random-effects models and tested for heterogeneity using the Q statistic and I2. Effect sizes with their 95% CIs, as well as prediction intervals, are reported.

MAIN OUTCOMES AND MEASURES: The outcomes were attention, negative affect, and effects perceptions (message processing); addiction, risk, and relative risk beliefs (risk perceptions); and intentions to vape and intentions to quit vaping (behavioral intentions).

RESULTS: Across 24 studies with 22 549 participants (mean [SD] age, 27.91 [6.36] years; 53.9% female), e-cigarette text-only warnings were associated with improvement of most outcomes. Compared to control, e-cigarette warnings were associated with greater attention (d, 0.52; 95% CI, 0.33-0.70), negative affect (d, 0.65; 95% CI, 0.49-0.81), and effects perceptions (d, 0.95; 95% CI, 0.69-1.21), as well as increased addiction beliefs (d, 0.24; 95% CI, 0.05-0.42) and risk beliefs (d, 0.26; 95% CI, 0.16-0.36) but not relative risk beliefs (d, 0.00; 95% CI, -0.11 to 0.12). E-cigarette warnings also were associated with reduced intentions to vape (d, -0.14; 95% CI, -0.27 to -0.01) and increased intentions to quit vaping (d, 0.34; 95% CI, 0.09-0.58). Health harm warnings outperformed nicotine addiction warnings on many outcomes. Compared to addiction warnings, health harm warnings were associated with more negative affect (d, 0.44; 95% CI, 0.32-0.52), attention (d, 0.37; 95% CI, 0.26-0.49), and effects perceptions (d, 0.36; 95% CI, 0.23-0.49), as well as increased risk beliefs (d, 0.07; 95% CI, 0.00-0.13) and intentions to quit vaping (d, 0.17; 95% CI, 0.06-0.27). There were no differences in addiction beliefs, relative risk beliefs, or intentions to vape for health harms vs addiction warnings.

CONCLUSIONS AND RELEVANCE: In this meta-analysis of experimental studies, text-only e-cigarette warnings were associated with increased beliefs about the harm and addictiveness of e-cigarettes without creating the misperception that e-cigarettes are more harmful than cigarettes. Warnings were also associated with reduced intentions to vape and increased intentions to quit vaping. These findings support adding health harms to e-cigarette warnings and have important implications for warning policy.

PMID:40455487 | DOI:10.1001/jamainternmed.2025.1380

JAMA Netw Open. 2025 Jun 2;8(6):e2513177. doi: 10.1001/jamanetworkopen.2025.13177.

ABSTRACT

IMPORTANCE: Musculoskeletal injuries (MSKIs) are pervasive problems in novice training environments. Evaluation of modifiable and nonmodifiable risk factors of MSKI risk prior to entry into these environments is largely understudied.

OBJECTIVE: To provide military leaders, civilian and military clinicians, and physical training instructors with an MSKI risk model for identifying low-, moderate-, and high-risk profiles among individuals starting US Army Basic Combat Training (BCT) or a physical training program.

DESIGN, SETTING, AND PARTICIPANTS: In this prospective cohort study, data collection was conducted between August 5, 2017, and April 15, 2023, at 2 US Army BCT sites. The sample consisted of volunteer trainees between the ages of 17 and 41 years. They were followed up from the start of BCT. Data analyses were conducted from April to September 2024.

EXPOSURES: Data for the factors potentially associated with MSKI were collected during the first week of BCT and included blood draws, total body dual-energy x-ray absorptiometry, and muscle power test results; surveys of demographics, medical history, physical activity, psychological characteristics, and sleep patterns; and physical fitness results.

MAIN OUTCOMES AND MEASURES: MSKIs identified using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes. Logistic regression-based models estimating the risk of MSKI were generated using 5-fold internal cross-validation for the total cohort, males, and females. Traffic light model examples of low (green), moderate (amber), and high (red) MSKI risk tiers were produced.

RESULTS: In this cohort study of 2988 Army trainees (median [IQR] age, 19.0 [19.0-22.0] years; 1880 males [62.9%]), 729 females (49.0%) and 758 males (51.0%) had an ICD-10 code-identified MSKI, and 1067 (35.7%) had more than 1 ICD-10 code-identified MSKI. Factors associated with increased MSKI risk in the total cohort and female- and male-specific MSKI risk models (with areas under the receiver operator characteristic curve of 0.701, 0.678, and 0.661, respectively) encompassed 7 variable categories: demographics; anthropometrics and body composition; nutritional status; medical and health history; history of sports and past or current physical activity or fitness; psychological factors (ie, pain, grit, and hardiness); and sleep parameters.

CONCLUSIONS AND RELEVANCE: This cohort study presents a tiered approach to identifying persons at increased MSKI risk before the start of a physical training program. Applying a tiered quantification risk metric and incorporating multifactorial interventions from these findings may play a role in reduced MSKI risk.

PMID:40455447 | DOI:10.1001/jamanetworkopen.2025.13177

JAMA Netw Open. 2025 Jun 2;8(6):e2513274. doi: 10.1001/jamanetworkopen.2025.13274.

ABSTRACT

IMPORTANCE: As a result of consolidation in the health care delivery system, most very preterm infants in the US are born and receive care in multihospital health systems. The extent of variation in patient outcomes and length of stay for this vulnerable population across health systems and across hospitals within systems is not known.

OBJECTIVE: To evaluate the extent of variation in mortality and length of stay within and across health systems for infants born very preterm (gestational age 24-29 weeks).

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study examined data contributed by Vermont Oxford Network US member hospitals in 224 health systems that delivered care to very preterm infants born between January 1, 2021, and December 31, 2022.

EXPOSURE: Receipt of neonatal intensive care unit (NICU) care in a horizontally integrated multihospital health system.

MAIN OUTCOMES AND MEASURES: Mortality rates and length of stay among surviving infants were estimated using multilevel logistic and linear models.

RESULTS: The sample included 38 501 infants (median [IQR] gestational age, 27 [26-28] weeks; 52.8% boys). The median (IQR) number of infants receiving care at a hospital system during the 2-year period was 108 (59-198); 91.0% were born at the reporting hospital, and 95.4% were born in the reporting system. The mean adjusted mortality rate in the highest performing quartile of systems was 7.8% (95% credible interval [CrI], 7.3%-8.3%) compared with 9.8% (95% CrI, 9.1%-10.7%) for the lowest performing quartile. The mean adjusted length of stay for surviving infants ranged from 78 days (95% CrI, 77-79 days) to 90 days (95% CrI, 88-91 days) between the highest and lowest performing quartiles of systems, respectively.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of very preterm infants, there was a 2-percentage point difference in mortality between systems in the highest and lowest performing quartiles and a 12-day difference in mean length of stay among surviving infants, which are potentially clinically meaningful. Opportunities exist for health systems to improve quality at the health system level to decrease mortality among infants born very preterm and reduce resources used in patient care.

PMID:40455446 | DOI:10.1001/jamanetworkopen.2025.13274

JAMA Netw Open. 2025 Jun 2;8(6):e2513280. doi: 10.1001/jamanetworkopen.2025.13280.

ABSTRACT

IMPORTANCE: Understanding the primary social drivers of unsafe firearm storage practices is essential for preventing firearm-related injuries.

OBJECTIVE: To examine household firearm ownership and storage practices, assess their association with social drivers of health (SDOH), and identify factors associated with unsafe storage practices among adult residents.

DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional analysis used 2022 Behavioral Risk Factor Surveillance System data from adults in 5 US states. Data analysis occurred from April 1 to October 2, 2024.

EXPOSURES: Participation in the Behavioral Risk Factor Surveillance System. SDOH include food insecurity, housing insecurity, social isolation, job loss or employment insecurity, feeling stressed, transportation barriers, and financial hardship.

MAIN OUTCOMES AND MEASURES: Firearm ownership and storage were assessed using structured questions. Storage practices were categorized as safest (all firearms unloaded), intermediate risk (at least 1 loaded and locked), and unsafe (at least 1 loaded and unlocked). Multivariable weighted logistic regression models estimated adjusted odds ratios (aORs) for firearm ownership and storage practices, accounting for demographic, socioeconomic, behavioral and mental health characteristics, and state firearm policies.

RESULTS: The unweighted study included 44 736 adults. The weighted population was 52.5% (95% CI, 51.5%-53.5%) female; 1.6% (95% CI, 1.4%-1.9%) American Indian, Alaska Native, and Pacific Islander; 10.0% (95% CI, 9.2%-10.8%) Asian non-Hispanic; 7.7% (95% CI, 7.2%-8.3%) Black non-Hispanic; 25.1% (95% CI, 24.1%-26.1%) Hispanic; 52.5% (95% CI, 51.5%-53.5%) White non-Hispanic; and 3.1% (95% CI, 2.7%-3.6%) multiracial. Firearms were owned in 29.3% of households (17 146 respondents), with 67.9% (11 396 respondents) storing them unloaded, 15.9% (2391 respondents) storing them loaded and locked, and 16.4% (2816 respondents) storing them loaded and unlocked. Unsafe storage was most common among non-Hispanic Black firearm owners (aOR, 2.23; 95% CI, 1.39-3.57). Food insecurity (aOR, 3.09; 95% CI, 1.29-7.40), housing insecurity (aOR, 1.66; 95% CI, 1.01-2.79), transportation barriers (aOR, 2.16; 95% CI, 1.19-3.90), and financial hardship (aOR, 2.22; 95% CI, 1.16-4.28) were significantly associated with unsafe storage practices. Households with children had higher odds of firearm ownership (aOR, 1.22; 95% CI, 1.05-1.43), but lower odds of unsafe storage (aOR, 0.38; 95% CI, 0.26-0.55). Child access prevention laws were associated with lower odds of firearm ownership (aOR, 0.57; 95% CI, 0.51-0.63) and unsafe storage (aOR, 0.52; 95% CI, 0.40-0.68). Behavioral risks like binge alcohol use (aOR, 1.39; 95% CI, 1.01-1.93) and life dissatisfaction (aOR, 1.81; 95% CI, 1.05-3.11) were associated with increased firearm ownership and unsafe storage.

CONCLUSIONS AND RELEVANCE: In this cross-sectional study of US adults, firearm ownership was more prevalent among non-Hispanic White, higher-income, and highly educated households, but unsafe storage was more common among non-Hispanic Black and lower-income households. SDOH and high-risk behaviors, including alcohol misuse and life dissatisfaction, were linked to unsafe storage. Targeted public health initiatives are crucial for improving firearm safety.

PMID:40455445 | DOI:10.1001/jamanetworkopen.2025.13280