Publications by authors named "Markus Jokela"

220 Publications

Socioeconomic inequalities in impairment associated with depressive symptoms: Evidence from the National Survey on Drug Use and Health.

J Psychiatr Res 2021 Jun 21;141:74-80. Epub 2021 Jun 21.

Department of Psychology and Logopedics, University of Helsinki, Finland.

Objective: Individuals with low socioeconomic status have higher rates of depression, but it is unknown whether the socioeconomically disadvantaged also have more disabling depressive symptoms. We examined (1) the associations of three indicators of socioeconomic status with depression-related severe role impairment, and (2) whether socioeconomic factors moderate the association between individual depression symptoms and depression-related severe role impairment.

Methods: We used data from the National Survey on Drug Use and Health (NSDUH). Depressive symptoms, role impairment and socioeconomic indicators (poverty, participation in workforce, educational attainment) were self-reported by participants. The analytic sample consisted of participants who screened positive for a depressive episode during past 12 months (n = 32 661). We used survey-weighted logistic models to examine the associations of depressive symptoms with severe role impairment and the modifying effects of socioeconomic indicators.

Results: The association between depression symptom count and severe role impairment was stronger among those not in workforce (OR = 1.12[1.02-1.23]). The association between specific depression symptoms and severe role impairment was stronger for conditions of poverty (fatigue, OR = 2.97 [1.54-5.73]; and anhedonia, OR = 1.93[1.13-3.30]), workforce non-participation (inability to concentrate/indecisiveness, OR = 1.54[1.12-2.12]), and lower educational attainment (anhedonia, OR = 0.77 [0.59-0.99]). Feelings of worthlessness was the only symptom with independent associations for all socioeconomic groups (adjusted OR = 1.91[1.35-2.70]).

Conclusion: Depression was more frequent and also more disabling for socioeconomically disadvantaged groups, especially when assessed with workforce participation. Additionally, some specific symptoms showed socioeconomic differences. Our findings highlight the need to prioritize population groups with more severe impairment associated with depressive symptoms.
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http://dx.doi.org/10.1016/j.jpsychires.2021.06.029DOI Listing
June 2021

Subclinical hypothyroidism and symptoms of depression: Evidence from the National Health and Nutrition Examination Surveys (NHANES).

Compr Psychiatry 2021 Jun 12;109:152253. Epub 2021 Jun 12.

Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.

Background: Subclinical hypothyroidism has been associated with increased risk for depression, yet the findings remain controversial. It is possible that subclinical hypothyroidism is associated with some, but not all symptoms of depression. We examined symptom-specific associations between depression and subclinical hypothyroidism.

Methods: Participants (N = 7683 adults) were from the National Health and Nutrition Examination Surveys of 2007-2008, 2009-2010, and 2011-2012 We included participants who had data on their thyroid profile and depressive symptoms (measured using Patient Health Questionnaire), and excluded those with overt hypothyroidism or hyperthyroidism, and those on thyroid hormone replacement therapy. Logistic regression with sampling weights was used to examine the association between subclinical hypothyroidism and depression symptoms. We also ran sensitivity analysis using different cut-off points for defining subclinical hypothyroidism.

Results: Of all the participants, 208 (2.7%) had subclinical hypothyroidism and of them only six had depression. Subclinical hypothyroidism was not associated with depression (OR = 0.61, 95% CI 0.20-1.87) nor with the specific depression symptoms. Using lower criteria for subclinical hypothyroidism diagnosis resulted in similar findings.

Conclusions: In a nationally representative sample of US adults, we observed no association between subclinical hypothyroidism and overall depression risk or any of the individual symptoms of depression.
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http://dx.doi.org/10.1016/j.comppsych.2021.152253DOI Listing
June 2021

Predictive validity of psychosis risk models when applied to adolescent psychiatric patients.

Psychol Med 2021 May 24:1-12. Epub 2021 May 24.

Mental Health, Finnish Institute for Health and Welfare, Helsinki, Finland.

Background: Several multivariate algorithms have been developed for predicting psychosis, as attempts to obtain better prognosis prediction than with current clinical high-risk (CHR) criteria. The models have typically been based on samples from specialized clinics. We evaluated the generalizability of 19 prediction models to clinical practice in an unselected adolescent psychiatric sample.

Methods: In total, 153 adolescent psychiatric patients in the Helsinki Prodromal Study underwent an extensive baseline assessment including the SIPS interview and a neurocognitive battery, with 50 participants (33%) fulfilling CHR criteria. The adolescents were followed up for 7 years using comprehensive national registers. Assessed outcomes were (1) any psychotic disorder diagnosis (n = 18, 12%) and (2) first psychiatric hospitalization (n = 25, 16%) as an index of overall deterioration of functioning.

Results: Most models improved the overall prediction accuracy over standard CHR criteria (area under the curve estimates ranging between 0.51 and 0.82), although the accuracy was worse than that in the samples used to develop the models, also when applied only to the CHR subsample. The best models for transition to psychosis included the severity of positive symptoms, especially delusions, and negative symptoms. Exploratory models revealed baseline negative symptoms, low functioning, delusions, and sleep problems in combination to be the best predictor of psychiatric hospitalization in the upcoming years.

Conclusions: Including the severity levels of both positive and negative symptomatology proved beneficial in predicting psychosis. Despite these advances, the applicability of extended psychosis-risk models to general psychiatric practice appears limited.
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http://dx.doi.org/10.1017/S0033291721001938DOI Listing
May 2021

Post-traumatic stress disorder among immigrants living in Finland: Comorbidity and mental health service use.

Psychiatry Res 2021 Jun 16;300:113940. Epub 2021 Apr 16.

Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

The aim of this study was to compare differences in comorbidity between immigrants and Finnish-born controls, and to examine the treatment received by immigrants with PTSD. Our original data included all the immigrants living in Finland by the end of 2010 and matched controls. For this study, we selected individuals who had received a diagnosis of PTSD during 2010-2015 (immigrants: n = 754, Finnish-born controls: n = 311). We compared the frequency of different comorbid conditions between immigrants and natives. Multinomial logistic regression was used to predict categorized treatment intensity with the region of origin and length of residence among the immigrants. Psychiatric comorbidity was much more extensive among the Finnish-born controls than among immigrants. Immigrants from Africa and the Middle East more often received treatment of low intensity compared with immigrants from Western countries. The length of residence was associated with more frequent treatment. The important differences in comorbidity and background characteristics between immigrants and natives should be taken into account in planning treatment guidelines for PTSD. The disparities in treatment intensity across different immigrant groups indicate a need to improve the services for immigrants with PTSD.
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http://dx.doi.org/10.1016/j.psychres.2021.113940DOI Listing
June 2021

Depression and anxiety disorders among immigrants living in Finland: Comorbidity and mental health service use.

J Affect Disord 2021 05 23;287:334-340. Epub 2021 Mar 23.

Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland; Department of Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.

Background: The aims of this study were to (1) compare differences in psychiatric comorbidity of depression and anxiety disorders between immigrants and native Finns and to (2) compare differences in the intensity of psychiatric care received by different immigrant groups and Finnish-born controls with depression and/or anxiety disorders.

Methods: The study uses registered-based data, which includes all immigrants living in Finland at the end of 2010 and matched Finnish-born controls. For this study, we selected individuals who had received a diagnosis of depression and/or an anxiety disorder during the follow-up (2011-2015) (immigrants n = 6542, Finnish-born controls n = 9281). We compared differences in comorbidity between the immigrants and the Finnish-born controls using chi-squared tests. Multinomial logistic regression was used to predict psychiatric treatment intensity by immigrant status, region of origin, and other background factors.

Results: In both diagnosis groups, Finnish-born participants exhibited greater comorbidity of other psychiatric disorders. Immigrants more often received lower intensity treatment and less often higher intensity treatment. These differences were most striking among those from Eastern Europe, the Middle East, and Africa.

Limitations: We did not have the information on the perceived need for the services, which limits us from drawing further conclusions about the mechanisms behind the observed patterns.

Conclusions: Immigrants in Finland receive less intensive treatment for depression and anxiety disorders compared to the Finnish-born population. Since lower symptom levels can unlikely alone explain these differences, they could reflect a need for improvement in the psychiatric services for immigrants.
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http://dx.doi.org/10.1016/j.jad.2021.03.049DOI Listing
May 2021

A Changing Landscape of Health Opportunity in the United States: Increases in the Strength of Association Between Childhood Socioeconomic Disadvantage and Adult Health Between the 1990s and the 2010s.

Am J Epidemiol 2021 Mar 12. Epub 2021 Mar 12.

Department of Psychology, University of Wisconsin-Madison, Madison, Wisconsin.

Understanding the changing health consequences of childhood socioeconomic disadvantage (SED) is highly relevant to policy debates on inequality and national and state goals to improve population health. However, changes in the strength of association between childhood SED and adult health over historic time are largely unexamined in the United States. The current study begins to address this knowledge gap. Data were from two national samples of adults collected in 1995 (n = 7,108) and 2012 (n = 3,577) as part of the Midlife in the United States study. Three measures of childhood SED (parent occupational prestige, childhood poverty exposure, and parent education) were combined into an aggregate index and examined separately. The association between childhood SED (aggregate index) and five health outcomes (BMI, waist circumference, chronic conditions, functional limitations, and self-rated health) was stronger in the 2012 sample than the 1995 sample, with the magnitude of associations being approximately twice as large in the more recent sample. Results persisted after adjusting for age, sex, race, marital status, and number of children, and were similar across all three measures of childhood SED. The findings suggest that the socioeconomic circumstances of childhood may have become a stronger predictor of adult health in recent decades.
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http://dx.doi.org/10.1093/aje/kwab060DOI Listing
March 2021

Positive affect state is a good predictor of movement and stress: combining data from ESM/EMA, mobile HRV measurements and trait questionnaires.

Heliyon 2021 Feb 25;7(2):e06243. Epub 2021 Feb 25.

Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland.

Personality describes the behaviour and responses of individuals across situations; but personality traits are often poor predictors of behaviour in specific situations. This is known as the "personality paradox". We evaluated the interrelations between various trait and state variables in participants' everyday lives. As measures, we used 1) experience sampling methodology (ESM/EMA) to measure perceived affect, stress, and presence of social company; and 2) heart rate variability and 3) real-time movement (accelerometer data) to indicate physiological stress and physical movement. These data were linked with self-report measures of personality and personality-like . Trait variables predicted affect states and multiple associations were found: traits neuroticism and rumination decreased positive affect state and increased negative affect state. Positive affect state, in turn, was the strongest predictor of observed movement. Positive affect was also associated with heart rate and heart rate variability (HRV). Negative affect, in turn, was not associated with neither movement, HR or HRV. The study provides evidence on the influence of personality-like traits and social context to affect states, and, in turn, their influence to movement and stress variables.
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http://dx.doi.org/10.1016/j.heliyon.2021.e06243DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7930110PMC
February 2021

Specific symptoms of the General Health Questionnaire (GHQ) in predicting persistence of psychological distress: Data from two prospective cohort studies.

J Psychiatr Res 2020 Nov 12. Epub 2020 Nov 12.

Department of Psychology and Logopedics, University of Helsinki, Finland; Finnish Institute for Health and Welfare, Helsinki, Finland.

Persistent psychological distress is more harmful than transient psychological distress, but little is known about the development of persistent distress. We examined whether some specific symptoms of the 12-item General Health Questionnaire (GHQ-12) were more important than others in predicting the persistence of psychological distress over a 3-year follow-up period among individuals who had at least moderate psychological distress at baseline (GHQ≥3). Participants were from the UK Household Longitudinal Study (UKHLS; n = 6430) and British Household Panel Survey (BHPS; n = 5954). Sense of worthlessness, loss of self-confidence, loss of sleep over worry, and feelings of strain were associated with increasingly persistent distress. General happiness, feelings of unhappiness or depressed mood, and enjoyment of activities showed no such increasing associations. Symptoms of social functioning (capability of making decisions, concentration problems, feelings of usefulness, ability to face problems) showed some but not consistent associations. These results suggest that feelings of worthlessness, loss of self-confidence, loss of sleep over worry, and strain may be particularly important markers for persistent psychological distress.
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http://dx.doi.org/10.1016/j.jpsychires.2020.11.026DOI Listing
November 2020

Association of depressive symptoms with health care utilization in older adults: Longitudinal evidence from the Survey of Health, Aging, and Retirement in Europe.

Int J Geriatr Psychiatry 2021 04 26;36(4):521-529. Epub 2020 Oct 26.

Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.

Objectives: Many older adults with depression do not receive adequate treatment. Differences in treatment utilization may reflect the heterogeneous nature of depression, encompassing multiple distinct symptoms. We assessed whether depressive symptoms are differentially associated with subsequent health care utilization with respect to three outcomes as follows: (1) contact with a medical doctor (MD), (2) depression-specific treatment, and (3) inpatient psychiatric admission.

Methods/design: Longitudinal analyses were based on data from three follow-up cycles conducted between 2004 and 2013 among 53,139 participants from the Survey of Health, Aging, and Retirement in Europe. Depressive symptoms were self-reported at baseline of each follow-up cycle using the 12-item EURO-D scale. Health care utilization was self-reported at the end of each follow-up cycle.

Results: After adjustment for sex, age, country of interview, follow-up time, educational attainment, presence of a partner in household, body-mass index, the number of chronic diseases, disability, average/prior frequency of contact with an MD, and all other depressive symptoms, people with more frequent contact with an MD had most often reported sleep problems (IRR = 1.10) and fatigue (IRR = 1.10), followed by sad/depressed mood, tearfulness, concentration problems, guilt, irritability, and changes in appetite. Those treated for depression had most often reported sad/depressed mood (OR = 2.18) and suicidal ideation (OR = 1.72), but also sleep problems, changes in appetite, fatigue, concentration problems, hopelessness, and irritability. Sad/depressed mood (OR = 2.87) was also associated with psychiatric inpatient admission. Similarly to other outcomes, appetite change, fatigue, and sleep problems were associated with inpatient admission.

Conclusions: Specific symptoms of depression may determine utilization of different types of health care among elderly.
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http://dx.doi.org/10.1002/gps.5447DOI Listing
April 2021

Longitudinal associations between specific symptoms of depression: Network analysis in a prospective cohort study.

J Affect Disord 2021 01 15;278:99-106. Epub 2020 Sep 15.

Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland.

Background: Network perspective to mental disorders suggests that depression develops due to interrelated associations between individual symptoms rather than due to a common cause. However, it is unclear whether long-term longitudinal associations between specific symptoms of depression demonstrate coherent patterns. We examined the temporal sequences and changes in depressive symptoms over time, and whether some symptoms are more central than others in inducing changes in the rest of the symptoms over time. We also compared the network structure of depressive symptoms between people who were and were not taking medication for depression or anxiety.

Methods: Data were from the Survey of Health, Aging and Retirement in Europe, with five follow-ups conducted between 2004 and 2017. Participants who had data on depressive symptoms from at least two study waves were analyzed (n = 72,971). Depressive symptoms were self-reported using the 12-item EURO-D scale.

Results: All individual symptoms were longitudinally associated with each other. Changes in sad or depressed mood, diminished interest, and suicidal ideation were the most strongly associated with changes in other symptoms. There were no consistent differences in symptom associations between individuals taking versus not taking psychotropic medication.

Limitations: Depressive symptoms were self-reported and measured every two years, which may dilute some short-term temporal sequences of the symptoms.

Conclusions: Our findings demonstrate differences between depressive symptoms in their long-term associations with other depressive symptoms in the general population. Changes in sad or depressed mood, diminished interest, and suicidal ideation have the strongest associations with changes in the rest of the symptoms.
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http://dx.doi.org/10.1016/j.jad.2020.09.024DOI Listing
January 2021

Network dynamics of depressive symptoms in antidepressant medication treatment: secondary analysis of eight clinical trials.

Mol Psychiatry 2020 Sep 16. Epub 2020 Sep 16.

Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland.

Depression can be viewed as a network of depressive symptoms that tend to reinforce each other via feedback loops. Specific symptoms of depression may be differently responsive to antidepressant treatment, and some symptoms may be more important than others in the overall improvement of depression associated with treatment. We pooled prospective data from eight industry-sponsored placebo-controlled trials for paroxetine, fluoxetine and imipramine (total n = 3559) to examine whether improvements in specific depressive symptoms were more strongly related to improvements in other depressive symptoms among patients on active antidepressant treatment as compared to placebo. Depressive symptoms were assessed with the 17-item Hamilton Depression Rating Scale. Data on treatment was dichotomized into active treatment (receiving any antidepressant agent) vs. placebo. Time-lagged longitudinal analyses suggested that improvement in three symptoms-depressed mood, insomnia, and suicidality-had a broader overall impact on subsequent improvement in other depressive symptoms in the antidepressant condition compared to placebo (i.e., greater out-strength). Moreover, improvements in depressed mood and insomnia were more likely to follow the improvements in other symptoms in the antidepressant condition compared to placebo (i.e., greater in-strength). These results from clinical trial data suggest that depressed mood, insomnia, and suicidality may be particularly important in accounting for the remission and recovery in response to antidepressant treatment.
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http://dx.doi.org/10.1038/s41380-020-00884-3DOI Listing
September 2020

Association of Alcohol-Induced Loss of Consciousness and Overall Alcohol Consumption With Risk for Dementia.

JAMA Netw Open 2020 09 1;3(9):e2016084. Epub 2020 Sep 1.

Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.

Importance: Evidence on alcohol consumption as a risk factor for dementia usually relates to overall consumption. The role of alcohol-induced loss of consciousness is uncertain.

Objective: To examine the risk of future dementia associated with overall alcohol consumption and alcohol-induced loss of consciousness in a population of current drinkers.

Design, Setting, And Participants: Seven cohort studies from the UK, France, Sweden, and Finland (IPD-Work consortium) including 131 415 participants were examined. At baseline (1986-2012), participants were aged 18 to 77 years, reported alcohol consumption, and were free of diagnosed dementia. Dementia was examined during a mean follow-up of 14.4 years (range, 12.3-30.1). Data analysis was conducted from November 17, 2019, to May 23, 2020.

Exposures: Self-reported overall consumption and loss of consciousness due to alcohol consumption were assessed at baseline. Two thresholds were used to define heavy overall consumption: greater than 14 units (U) (UK definition) and greater than 21 U (US definition) per week.

Main Outcomes And Measures: Dementia and alcohol-related disorders to 2016 were ascertained from linked electronic health records.

Results: Of the 131 415 participants (mean [SD] age, 43.0 [10.4] years; 80 344 [61.1%] women), 1081 individuals (0.8%) developed dementia. After adjustment for potential confounders, the hazard ratio (HR) was 1.16 (95% CI, 0.98-1.37) for consuming greater than 14 vs 1 to 14 U of alcohol per week and 1.22 (95% CI, 1.01-1.48) for greater than 21 vs 1 to 21 U/wk. Of the 96 591 participants with data on loss of consciousness, 10 004 individuals (10.4%) reported having lost consciousness due to alcohol consumption in the past 12 months. The association between loss of consciousness and dementia was observed in men (HR, 2.86; 95% CI, 1.77-4.63) and women (HR, 2.09; 95% CI, 1.34-3.25) during the first 10 years of follow-up (HR, 2.72; 95% CI, 1.78-4.15), after excluding the first 10 years of follow-up (HR, 1.86; 95% CI, 1.16-2.99), and for early-onset (<65 y: HR, 2.21; 95% CI, 1.46-3.34) and late-onset (≥65 y: HR, 2.25; 95% CI, 1.38-3.66) dementia, Alzheimer disease (HR, 1.98; 95% CI, 1.28-3.07), and dementia with features of atherosclerotic cardiovascular disease (HR, 4.18; 95% CI, 1.86-9.37). The association with dementia was not explained by 14 other alcohol-related conditions. With moderate drinkers (1-14 U/wk) who had not lost consciousness as the reference group, the HR for dementia was twice as high in participants who reported having lost consciousness, whether their mean weekly consumption was moderate (HR, 2.19; 95% CI, 1.42-3.37) or heavy (HR, 2.36; 95% CI, 1.57-3.54).

Conclusions And Relevance: The findings of this study suggest that alcohol-induced loss of consciousness, irrespective of overall alcohol consumption, is associated with a subsequent increase in the risk of dementia.
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http://dx.doi.org/10.1001/jamanetworkopen.2020.16084DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7489835PMC
September 2020

Why stop at two opinions? Reply to McCrae (2020).

Am Psychol 2020 Jul-Aug;75(5):731-732

Department of Psychology, University of Illinois at Urbana-Champaign.

McCrae (2020) argues that it is premature to explore interventions focused on personality change. In his commentary, he suggests that interventions should be promoted only if their effects in self-report data are confirmed by the additional opinion of informants. We agree with the essence of his position and would go further by envisioning a new framework for rigorous collaborative research on personality change (Bleidorn et al., 2020). We nevertheless maintain that policymakers would benefit from considering the additional opinion of personality scientists. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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http://dx.doi.org/10.1037/amp0000676DOI Listing
July 2020

General psychopathology factor and borderline personality disorder: Evidence for substantial overlap from two nationally representative surveys of U.S. adults.

Personal Disord 2021 01 25;12(1):86-92. Epub 2020 Jun 25.

Department of Psychology and Logopedics.

A general psychopathology factor reflects an underlying liability for a wide range of mental disorders. There is suggestive evidence that borderline personality disorder (BPD) may be strongly associated with the general psychopathology factor, but there are no detailed data on the degree of overlap between the general psychopathology factor and BPD or its individual symptoms. This study examined the overlap between the general psychopathology factor and BPD using cross-sectional survey data from two nationally representative samples of U.S. adults, the National Comorbidity Survey Replication ( = 5,692) and the National Comorbidity Survey follow-up ( = 5,001). Structural equation modeling was used to fit a bifactor general psychopathology model and to examine the general psychopathology factor's associations with (a) a series of Clusters A, B, and C personality disorder symptoms including BPD symptoms and (b) a latent BPD. Results showed that the shared variance between the general psychopathology factor and a latent BPD was 56% in the National Comorbidity Survey Replication and 71% in the National Comorbidity Survey follow-up. The correlation between the general factor and BPD could be set to unity without worsening model fit, suggesting that BPD closely reflects a general liability to psychopathology. The affective features of BPD were particularly strongly associated with the general psychopathology factor. Findings are discussed with respect to the nosology of BPD and the treatment of mental disorders. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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http://dx.doi.org/10.1037/per0000405DOI Listing
January 2021

Homophily in Personality Enhances Group Success Among Real-Life Friends.

Front Psychol 2020 4;11:710. Epub 2020 May 4.

Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom.

Personality affects dyadic relations and teamwork, yet its role among groups of friends has been little explored. We examine for the first time whether similarity in personality enhances the effectiveness of real-life friendship groups. Using data from a longitudinal study of a European fraternity (10 male and 15 female groups), we investigate how individual Big Five personality traits were associated with group formation and whether personality homophily related to how successful the groups were over 1 year ( = 147-196). Group success was measured as group performance/identification (adoption of group markers) and as group bonding (using the inclusion-of-other-in-self scale). Results show that individuals' similarity in neuroticism and conscientiousness predicted group formation. Furthermore, personality similarity was associated with group success, even after controlling for individual's own personality. Especially higher group-level similarity in conscientiousness was associated with group performance, and with bonding in male groups.
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http://dx.doi.org/10.3389/fpsyg.2020.00710DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7212830PMC
May 2020

Association of Healthy Lifestyle With Years Lived Without Major Chronic Diseases.

JAMA Intern Med 2020 05;180(5):760-768

Division of Surgery & Interventional Science, Faculty of Medical Sciences, University College London, London, United Kingdom.

Importance: It is well established that selected lifestyle factors are individually associated with lower risk of chronic diseases, but how combinations of these factors are associated with disease-free life-years is unknown.

Objective: To estimate the association between healthy lifestyle and the number of disease-free life-years.

Design, Setting, And Participants: A prospective multicohort study, including 12 European studies as part of the Individual-Participant-Data Meta-analysis in Working Populations Consortium, was performed. Participants included 116 043 people free of major noncommunicable disease at baseline from August 7, 1991, to May 31, 2006. Data analysis was conducted from May 22, 2018, to January 21, 2020.

Exposures: Four baseline lifestyle factors (smoking, body mass index, physical activity, and alcohol consumption) were each allocated a score based on risk status: optimal (2 points), intermediate (1 point), or poor (0 points) resulting in an aggregated lifestyle score ranging from 0 (worst) to 8 (best). Sixteen lifestyle profiles were constructed from combinations of these risk factors.

Main Outcomes And Measures: The number of years between ages 40 and 75 years without chronic disease, including type 2 diabetes, coronary heart disease, stroke, cancer, asthma, and chronic obstructive pulmonary disease.

Results: Of the 116 043 people included in the analysis, the mean (SD) age was 43.7 (10.1) years and 70 911 were women (61.1%). During 1.45 million person-years at risk (mean follow-up, 12.5 years; range, 4.9-18.6 years), 17 383 participants developed at least 1 chronic disease. There was a linear association between overall healthy lifestyle score and the number of disease-free years, such that a 1-point improvement in the score was associated with an increase of 0.96 (95% CI, 0.83-1.08) disease-free years in men and 0.89 (95% CI, 0.75-1.02) years in women. Comparing the best lifestyle score with the worst lifestyle score was associated with 9.9 (95% CI 6.7-13.1) additional years without chronic diseases in men and 9.4 (95% CI 5.4-13.3) additional years in women (P < .001 for dose-response). All of the 4 lifestyle profiles that were associated with the highest number of disease-free years included a body-mass index less than 25 (calculated as weight in kilograms divided by height in meters squared) and at least 2 of the following factors: never smoking, physical activity, and moderate alcohol consumption. Participants with 1 of these lifestyle profiles reached age 70.3 (95% CI, 69.9-70.8) to 71.4 (95% CI, 70.9-72.0) years disease free depending on the profile and sex.

Conclusions And Relevance: In this multicohort analysis, various healthy lifestyle profiles appeared to be associated with gains in life-years without major chronic diseases.
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http://dx.doi.org/10.1001/jamainternmed.2020.0618DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7136858PMC
May 2020

Connectivity of depression symptoms before and after diagnosis of a chronic disease: A network analysis in the U.S. Health and Retirement Study.

J Affect Disord 2020 04 29;266:230-234. Epub 2020 Jan 29.

Medicum, University of Helsinki, Helsinki, Finland.

Background: Many chronic diseases increase the risk of depressive symptoms, but few studies have examined whether these diseases also affect the composition of symptoms a person is likely to experience. As the risk and progression of depression may vary between chronic diseases, we used network analysis to examine how depression symptoms are connected before and after the diagnosis of diabetes, heart disease, stroke, and cancer.

Methods: Participants (N = 7779) were from the longitudinal survey of the Health and Retirement Study. Participants were eligible if they had information on depression symptoms two and/or four years before and after the diagnosis of either diabetes, heart disease, cancer or stroke. We formed a control group with no chronic disease that was matched on age, sex and ethnic background to those with a disease. We constructed depression symptom networks and compared the overall connectivity of those networks, and depression symptom sum scores, for before and after the diagnosis of each disease.

Results: Depression symptom sum scores increased with the diagnosis of each disease. The connectivity of depression symptoms remained unchanged for all the diseases, except for stroke, for which the connectivity decreased with the diagnosis.

Limitations: Comorbidity with other chronic diseases was not controlled for as we focused on the onset of specific diseases.

Conclusions: Our results suggest that although the mean level of depression symptoms increases after the diagnosis of chronic disease, with most chronic diseases, these changes are not reflected in the network structure of depression symptoms.
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http://dx.doi.org/10.1016/j.jad.2020.01.170DOI Listing
April 2020

Shorter birth intervals between siblings are associated with increased risk of parental divorce.

PLoS One 2020 31;15(1):e0228237. Epub 2020 Jan 31.

Population Research Institute, Väestöliitto, Helsinki, Finland.

Birth intervals are a crucial component of fertility behaviour and family planning. Short birth intervals are associated-although not necessarily causally-with negative health-related outcomes, but less is known about their associations with family functioning. Here, the associations between birth intervals and marital stability were investigated by Cox regression using a nationally representative, register-based sample of individuals with two (N = 42,481) or three (N = 22,514) children from contemporary Finland (observation period 1972-2009). Shorter interbirth intervals were associated with an increased risk of parental divorce over a ten-year follow-up. Individuals with birth intervals of up to 1.5 years had 24-49 per cent higher divorce risk compared to individuals whose children were born more than 4 years apart. The pattern was similar in all socioeconomic groups and among individuals with earlier and later entry to parenthood. Our results add to the growing body of research showing associations between short birth intervals and negative outcomes in health and family functioning.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0228237PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6993964PMC
April 2020

The policy relevance of personality traits.

Am Psychol 2019 12;74(9):1056-1067

Department of Psychology, University of Illinois at Urbana-Champaign.

Personality traits are powerful predictors of outcomes in the domains of education, work, relationships, health, and well-being. The recognized importance of personality traits has raised questions about their policy relevance, that is, their potential to inform policy actions designed to improve human welfare. Traditionally, the use of personality traits in applied settings has been predicated on their ability to predict valued outcomes, typically under the assumption that traits are functionally unchanging. This assumption, however, is both untrue and a limiting factor on using personality traits more widely in applied settings. In this article, we present the case that traits can serve both as relatively stable predictors of success and actionable targets for policy changes and interventions. Though trait change will likely prove a more difficult target than typical targets in applied interventions, it also may be a more fruitful one given the variety of life domains affected by personality traits. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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http://dx.doi.org/10.1037/amp0000503DOI Listing
December 2019

Long working hours and change in body weight: analysis of individual-participant data from 19 cohort studies.

Int J Obes (Lond) 2020 06 25;44(6):1368-1375. Epub 2019 Nov 25.

Stress Research Institute, Stockholm University, Stockholm, Sweden.

Objective: To examine the relation between long working hours and change in body mass index (BMI).

Methods: We performed random effects meta-analyses using individual-participant data from 19 cohort studies from Europe, US and Australia (n = 122,078), with a mean of 4.4-year follow-up. Working hours were measured at baseline and categorised as part time (<35 h/week), standard weekly hours (35-40 h, reference), 41-48 h, 49-54 h and ≥55 h/week (long working hours). There were four outcomes at follow-up: (1) overweight/obesity (BMI ≥ 25 kg/m) or (2) overweight (BMI 25-29.9 kg/m) among participants without overweight/obesity at baseline; (3) obesity (BMI ≥ 30 kg/m) among participants with overweight at baseline, and (4) weight loss among participants with obesity at baseline.

Results: Of the 61,143 participants without overweight/obesity at baseline, 20.2% had overweight/obesity at follow-up. Compared with standard weekly working hours, the age-, sex- and socioeconomic status-adjusted relative risk (RR) of overweight/obesity was 0.95 (95% CI 0.90-1.00) for part-time work, 1.07 (1.02-1.12) for 41-48 weekly working hours, 1.09 (1.03-1.16) for 49-54 h and 1.17 (1.08-1.27) for long working hours (P for trend <0.0001). The findings were similar after multivariable adjustment and in subgroup analyses. Long working hours were associated with an excess risk of shift from normal weight to overweight rather than from overweight to obesity. Long working hours were not associated with weight loss among participants with obesity.

Conclusions: This analysis of large individual-participant data suggests a small excess risk of overweight among the healthy-weight people who work long hours.
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http://dx.doi.org/10.1038/s41366-019-0480-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7260128PMC
June 2020

Childhood Psychosocial Environment and Adult Cardiac Health: A Causal Mediation Approach.

Am J Prev Med 2019 12;57(6):e195-e202

Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.

Introduction: This study used causal mediation analysis to assess the life-course associations of a favorable childhood psychosocial environment with left ventricular mass and diastolic function in adulthood and the extent to which adult health behaviors mediate these associations.

Methods: The sample included 880 participants (56% women) from the Young Finns Study with data on the childhood environment from 1980, adult health behaviors (smoking, physical activity, diet, and BMI) from 2001 and an echocardiographic assessment of the left ventricular mass (g/m) and diastolic function (E/e' ratio; higher values indicating a lower diastolic function) from 2011. The associations of the childhood environment with the left ventricular mass and E/e' ratio and mediation pathways through health behaviors were assessed using marginal structural models that were controlled for age, sex, and time-dependent confounding by adult socioeconomic position (measured as educational attainment) via inverse probability weighting. The data were analyzed in 2018-2019.

Results: The mean age in 2011 was 41 (range 34-49) years. Those above versus below the median childhood score had a 1.28 g/m lower left ventricular mass (95% CI= -2.63, 0.07) and a 0.18 lower E/e' ratio (95% CI= -0.39, 0.03). There was no evidence for indirect effects from childhood environments to left ventricular outcomes through adult health behaviors after controlling for time-dependent confounding by the adult socioeconomic position (indirect effect β= -0.30, 95% CI= -1.22, 0.63 for left ventricular mass; β= -0.04, 95% CI= -0.18, 0.11 for E/e' ratio). The results after multiple imputation were similar.

Conclusions: A favorable childhood environment is associated with more optimal cardiac structure and function in adulthood. After accounting for socioeconomic positions, adult health behaviors explain little of the associations.
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http://dx.doi.org/10.1016/j.amepre.2019.08.018DOI Listing
December 2019

The General Psychopathology Factor: Structural Stability and Generalizability to Within-Individual Changes.

Front Psychiatry 2019 30;10:594. Epub 2019 Aug 30.

Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.

Although cross-sectional investigations have found a bifactor structure of psychiatric comorbidity that includes a general psychopathology factor plus more specific factors, prospective evidence supporting the bifactor structure is still limited. We evaluated the structural stability (i.e., longitudinal invariance) of the bifactor model in comparison to an alternative structure, a correlated factors model without a general psychopathology factor. We also investigated the models' generalizability to change processes in psychopathology. The analyses were conducted on 10-year follow-up data from 5,001 respondents in the US National Comorbidity Survey. Invariance was evaluated through a series of nested invariance tests using confirmatory factor analysis, and the models' generalizability to change processes was investigated using change scores of disorder status. The bifactor model and the correlated factors model exhibited an equal degree of strong structural stability over time. Only the bifactor model satisfactorily characterized the structure of temporal changes in psychopathology. The bifactor structure with a general psychopathology factor is stable over time and describes temporal changes in psychopathology. The findings support the notion that the general psychopathology factor describes a transdiagnostic etiology and may therefore provide a useful target for intervention and treatment.
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http://dx.doi.org/10.3389/fpsyt.2019.00594DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6728891PMC
August 2019

Immigrants' mental health service use compared to that of native Finns: a register study.

Soc Psychiatry Psychiatr Epidemiol 2020 Apr 21;55(4):487-496. Epub 2019 Sep 21.

Department of Psychiatry, Helsinki University Hospital and University of Helsinki, P.O. Box 100, 00029, Helsinki, Finland.

Purpose: Many aspects related to migration might predispose immigrants to mental health problems. Yet immigrants have been shown to underuse mental health services. The aim of this study was to compare the intensity of psychiatric care, as an indicator of treatment adequacy, between natives and immigrants living in Finland.

Methods: We used nationwide register data that included all the immigrants living in Finland at the end of 2010 (n = 185,605) and their matched controls. Only those who had used mental health services were included in the analyses (n = 14,285). We used multinomial logistic regression to predict the categorized treatment intensity by immigrant status, region and country of origin, length of residence, and other background variables.

Results: Immigrants used mental health services less than Finnish controls and with lower intensity. The length of residence in Finland increased the probability of higher treatment intensity. Immigrants from Eastern Europe, sub-Saharan Africa, the Middle East, and Northern Africa were at the highest risk of receiving low-intensity treatment.

Conclusions: Some immigrant groups seem to persistently receive less psychiatric treatment than Finnish-born controls. Identification of these groups is important and future research is needed to determine the mechanisms behind these patterns.
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http://dx.doi.org/10.1007/s00127-019-01774-yDOI Listing
April 2020

Transition to Grandparenthood and Subjective Well-Being in Older Europeans: A Within-Person Investigation Using Longitudinal Data.

Evol Psychol 2019 Jul-Sep;17(3):1474704919875948

University of Helsinki, Finland.

The transition to grandparenthood, that is the birth of the first grandchild, is often assumed to increase the subjective well-being of older adults; however, prior studies are scarce and have provided mixed results. Investigation of the associations between grandparenthood and subjective well-being, measured by self-rated life satisfaction, quality of life scores, and depressive symptoms, used the longitudinal Survey of Health, Ageing and Retirement in Europe from 13 countries, including follow-up waves between 2006 and 2015 ( = 64,940 person-observations from 38,456 unique persons of whom 18,207 had two or more measurement times). Both between-person and within-person (or fixed-effect) regression models were executed, where between-person associations represent results across individuals, that is, between grandparents and non-grandparents; within-person associations represent an individual's variation over time, that is, they consider whether the transition to grandparenthood increases or decreases subjective well-being. According to the between-person models, both grandmothers and grandfathers reported higher rate of life satisfaction and quality of life than non-grandparents. Moreover, grandmothers reported fewer depressive symptoms than women without grandchildren. The within-person models indicated that entry into grandmotherhood was associated with both improved quality of life scores and improved life satisfaction. These findings are discussed with reference to inclusive fitness theory, parental investment theory, and the grandmother hypothesis.
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http://dx.doi.org/10.1177/1474704919875948DOI Listing
February 2020

Personality, disability-free life years, and life expectancy: Individual participant meta-analysis of 131,195 individuals from 10 cohort studies.

J Pers 2020 06 12;88(3):596-605. Epub 2019 Sep 12.

Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland.

Objective: We examined how personality traits of the Five Factor Model were related to years of healthy life years lost (mortality and disability) for individuals and the population.

Method: Participants were 131,195 individuals from 10 cohort studies from Australia, Germany, the United Kingdom, and the United States (n = 43,935 from seven cohort studies for the longitudinal analysis of disability, assessed using scales of Activities of Daily Living).

Results: Lower Conscientiousness was associated with higher mortality and disability risk, but only when Conscientiousness was below its median level. If the excess risk associated with low Conscientiousness had been absent, population life expectancy would have been 1.3 years longer and disability-free life 1.0 years longer. Lower emotional stability was related to shorter life expectancy, but only among those in the lowest 15% of the distribution, and disability throughout the distribution: if the excess risk associated with low emotional stability had been absent, population life expectancy would have been 0.4 years longer and disability-free life 2.4 years longer.

Conclusions: Personality traits of low Conscientiousness and low emotional stability are associated with reduced healthy life expectancy of individuals and population.
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http://dx.doi.org/10.1111/jopy.12513DOI Listing
June 2020

Neighborhoods, psychological distress, and the quest for causality.

Authors:
Markus Jokela

Curr Opin Psychol 2020 04 28;32:22-26. Epub 2019 Jun 28.

Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, Finland. Electronic address:

Neighborhood characteristics have been associated with psychological distress, but it is uncertain whether these associations are causal. The current article reviews data from interventions and quasi-experimental studies that have addressed the question of causality of neighborhood associations. Overall, data from neighborhood interventions, longitudinal studies, and twin studies have provided only limited and inconsistent evidence to support causal interpretation of neighborhood associations with psychological distress: very few findings have been replicated across different samples, and many associations have been observed only with some of the multiple measures included the studies. Studies that examine the effects of neighborhood change on people's wellbeing are needed to improve causal inference and policy relevance of neighborhood studies.
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http://dx.doi.org/10.1016/j.copsyc.2019.06.009DOI Listing
April 2020

Health behaviors and psychological distress: changing associations between 1997 and 2016 in the United States.

Soc Psychiatry Psychiatr Epidemiol 2020 Mar 26;55(3):385-391. Epub 2019 Jul 26.

Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, PO Box 63, 00014, Helsinki, Finland.

Objectives: Smoking rates have declined with a slower pace among those with psychological distress compared to those without. We examined whether other health behaviors (heavy alcohol consumption, physical inactivity, short sleep duration) showed similar trends associated with psychological distress. We also examined differences by age and birth cohort.

Methods: Data were from the annually repeated cross-sectional U.S. National Health Interview Surveys (NHIS) of 1997-2016 (total n = 603,518). Psychological distress was assessed with the 6-item Kessler Psychological Distress Scale (K6).

Results: Psychological distress became more strongly associated with smoking (OR 1.09 per 10 years; 95% CI 1.07, 1.12), physical inactivity (OR 1.08; 1.05, 1.11), and short sleep (OR 1.12; 1.06, 1.18), but less strongly associated with heavy alcohol consumption (OR 0.93; 0.89, 0.98). The associations of smoking and alcohol consumption attenuated with age, whereas the association with physical inactivity strengthened with age. Compared to older birth cohorts, smoking became more strongly associated with psychological distress among younger birth cohorts up to those born in the 1980s.

Conclusions: The strength of associations between psychological distress and health behaviors may vary by time period, age, and birth cohort.
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http://dx.doi.org/10.1007/s00127-019-01741-7DOI Listing
March 2020

The role of oxytocinergic genes in the intergenerational transmission of parent-child relationship qualities.

Horm Behav 2019 08 20;114:104540. Epub 2019 Jul 20.

Department of Psychology and Logopedics, Faculty of Medicine, University of Helsinki, P.O. Box 21, Haartmaninkatu 3, 00014 Helsinki, Finland. Electronic address:

Parenting qualities are known to transmit across generations, but less is known about genetic processes that may modify how strongly parenting quality carries across generations. We examined in prospective data whether oxytocinergic genes of offspring moderate the intergenerational transmission of warm and accepting parent-child relationship qualities. The sample comprised 1167 Finnish parents (G2, 62% female) and their mothers (G1). At the study baseline, G1 mothers (Mage = 38) reported parent-child relationship qualities towards G2 children (age range 3-18). After 28-34 years, G2 offspring reported parent-child relationship qualities towards their own children using the same questionnaire. A cumulative genetic score was computed for G2 by summing up previously identified four alleles associated with non-optimal parenting or social impairments across OXTR (rs1042778, rs2254298, rs53576) and CD38 (rs3796863) genes. Results indicated no interaction effects of G2 cumulative genetic score on the transmission of parent-child relationship qualities. Among single polymorphisms in OXTR, the interaction effects of rs53576 and rs1042778 were found. G1 maternal emotional warmth was associated with higher G2 emotional warmth among G2 participants with the OXTR rs53576 AA/AG genotype, but not among those with the GG genotype. G1 maternal acceptance was associated with higher G2 acceptance among those G2 participants with the OXTR rs1042778 GG/GT genotype, but not among those with the TT genotype. Oxytocinergic genes may influence sensitivity to quality of parent-child relationship, although this needs replication in future studies.
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http://dx.doi.org/10.1016/j.yhbeh.2019.06.004DOI Listing
August 2019

Influence of Personality and Differences in Stress Processing Among Finnish Students on Interest to Use a Mobile Stress Management App: Survey Study.

JMIR Ment Health 2019 May 13;6(5):e10039. Epub 2019 May 13.

University of Helsinki, Helsinki, Finland.

Background: Excessive stress has a negative impact on many aspects of life for both individuals and societies, from studying and working to health and well-being. Each individual has their unique level of stress-proneness, and positive or negative outcomes of stress may be affected by it. Technology-aided interventions have potential efficacy in the self-management of stress. However, current Web-based or mobile stress management solutions may not reach the individuals that would need them the most, that is, stress-sensitive people.

Objective: The aim of this study was to examine how personality is associated with stress among Finnish university students and their interest to use apps that help in managing stress.

Methods: We used 2 structured online questionnaires (combined, n=1001) that were advertised in the University of Helsinki's mailing lists. The first questionnaire (n=635) was used to investigate intercorrelations between the Big Five personality variables (neuroticism, extraversion, openness, agreeableness, and conscientiousness) and other stress-related background variables. The second questionnaire (n=366) was used to study intercorrelations between the above-mentioned study variables and interest in using stress management apps.

Results: The quantitative findings of the first questionnaire showed that higher levels of extraversion, agreeableness, and conscientiousness were associated with lower self-reported stress. Neuroticism, in turn, was found to be strongly associated with rumination, anxiety, and depression. The findings of the second questionnaire indicated that individuals characterized by the Big Five personality traits of neuroticism and agreeableness were particularly interested to use stress management apps (r=.27, P<.001 and r=.11, P=.032, respectively). Moreover, the binary logistic regression analysis revealed that when a person's neuroticism is one SD above average (ie, it is higher than among 84% of people), the person has roughly 2 times higher odds of being interested in using a stress management app. Respectively, when a person's agreeableness is one SD above average, the person has almost 1.4 times higher odds of being interested in using a stress management app.

Conclusions: Our results indicated that personality traits may have an influence on the adoption interest of stress management apps. Individuals with high neuroticism are, according to our results, adaptive in the sense that they are interested in using stress management apps that may benefit them. On the contrary, low agreeableness may lead to lower interest to use the mobile stress management apps. The practical implication is that future mobile stress interventions should meaningfully be adjusted to improve user engagement and support health even among less-motivated users, for instance, to successfully engage individuals with low agreeableness.
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http://dx.doi.org/10.2196/10039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6707572PMC
May 2019
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