Edo S. Jaya

The Community Assessment of Psychic Experiences measures nine clusters of psychosis-like experiences: A validation of the German version of the CAPE.

AIM This study examined the factorial and criterion validity of the Community Assessment of Psychic Experiences (CAPE). We compared the validity of the original three-dimensional model and a recently proposed multidimensional model, in which positive symptoms are subdivided into the subfactors hallucinations, bizarre experiences, paranoia, grandiosity and magical thinking and negative symptoms are subdivided into social withdrawal, affective flattening and avolition. METHODS Eleven community (n=934) and three patient samples (n=112) were combined and the proposed models were tested using confirmatory factor analysis. Criterion validity was calculated based on self-report measures for depression and paranoia as well as observer-based ratings for positive and negative symptoms. RESULTS The multidimensional model showed better relative quality (AIC, BIC) than the original three-dimensional model of the CAPE, but both models showed acceptable absolute model-fit (RMSEA, SRMR). The criterion validity was good for the positive symptom scales and negative symptom subfactors social withdrawal and affective flattening. CONCLUSION Factorial validity was found for the three-dimensional and multidimensional model for the CAPE. The multidimensional model, however, shows better comparative fit and promising results in regard to criterion validity. Thus, we recommend a hierarchical multidimensional structure of positive and negative symptoms for future use of the CAPE.

Social Adversity and Psychosis: The Mediating Role of Cognitive Vulnerability.

Background Social adversity is a risk factor for psychosis, but the translating mechanisms are not well understood. This study tests whether the relationship between social adversity and psychosis is mediated by cognitive vulnerability in the form of low perceived social rank, negative schemas related to self and other, and loneliness and whether the putative mediations are specific to psychosis or are largely explained by depression. Methods The study was a survey in a community sample (N = 2350) from Germany (n = 786), Indonesia (n = 844), and the United States (n = 720). Mediation path analysis with structural equation modeling was used to test for the specificity of the hypothesized paths to psychosis controlling for depression. Results Social adversity had a significant medium to large effect on positive (R2 = .20) and negative symptoms (R2 = .38). Social rank, negative schemas, and loneliness significantly mediated the relationship between social adversity and negative symptoms and the models explained a large amount of the variance (R2 = .43-.44). For positive symptoms, only negative schemas were a significant mediator (R2 = .27). Discussion The results emphasize the role of social adversity in psychosis and support the assumption that cognitive vulnerability is a relevant translating mechanism as postulated by the social defeat hypothesis and cognitive models of psychosis. This underlines the relevance of the clinical practice of targeting beliefs in cognitive interventions for psychosis. It also indicates that targeting cognitive vulnerability in people experiencing social adversity could be a promising approach to prevention.

Childhood trauma and psychotic experiences in a general population sample: A prospective study on the mediating role of emotion regulation

BACKGROUND The causal role of childhood trauma for psychosis is well established, but the mechanisms that link trauma to psychosis are largely unknown. Since childhood trauma is known to cause difficulties in emotion regulation (ER) and patients with psychosis show impaired ER, we hypothesize that impaired ER explains why people with a background of trauma are prone to psychotic experiences. METHODS The study used a longitudinal cohort design based on a community sample (N=562) from Germany, Indonesia, and the United States. Childhood trauma was assessed at baseline. ER and psychotic experiences (defined as positive symptom frequency and related distress) were measured repeatedly at a 4-, 8-, and 12-month follow-up. Cross-lagged panel and longitudinal mediation analyses with structural equation modeling were used to test the predictive value of ER on psychotic experiences and its mediating role in the association of childhood trauma and psychotic experiences. RESULTS The cross-lagged paths from impaired ER to symptom distress (but not frequency) were significant. However, there was also evidence for the reverse causation from symptom frequency and distress to impaired ER. ER partially mediated the significant prospective paths from childhood trauma to symptom distress. CONCLUSION The findings demonstrate that ER plays a role in translating childhood trauma into distressing psychotic experiences in later life. Moreover, the findings point to a maintenance mechanism in which difficulties in ER and symptom distress exacerbate each other. Thus, ER could be a promising target for interventions aimed at prevention of psychosis.

The Development of Indonesian Online Game Addiction Questionnaire

Online game is an increasingly popular source of entertainment for all ages, with relatively prevalent negative consequences. Addiction is a problem that has received much attention. This research aims to develop a measure of online game addiction for Indonesian children and adolescents. The Indonesian Online Game Addiction Questionnaire draws from earlier theories and research on the internet and game addiction. Its construction is further enriched by including findings from qualitative interviews and field observation to ensure appropriate expression of the items. The measure consists of 7 items with a 5-point Likert Scale. It is validated by testing 1,477 Indonesian junior and senior high school students from several schools in Manado, Medan, Pontianak, and Yogyakarta. The validation evidence is shown by item-total correlation and criterion validity. The Indonesian Online Game Addiction Questionnaire has good item-total correlation (ranging from 0.29 to 0.55) and acceptable reliability (α = 0.73). It is also moderately correlated with the participants longest time record to play online games (r = 0.39; p<0.01), average days per week in playing online games (ρ = 0.43; p<0.01), average hours per days in playing online games (ρ = 0.41; p<0.01), and monthly expenditure for online games (ρ = 0.30; p<0.01). Furthermore, we created a clinical cut-off estimate by combining criteria and population norm. The clinical cut-off estimate showed that the score of 14 to 21 may indicate mild online game addiction, and the score of 22 and above may indicate online game addiction. Overall, the result shows that Indonesian Online Game Addiction Questionnaire has sufficient psychometric property for research use, as well as limited clinical application.

Social adversities and psychotic symptoms: A test of predictions derived from the social defeat hypothesis.

Based on the social defeat (SD) hypothesis, this study examines the postulate that various social adversities converge into one common factor, and whether this factor has an effect on psychotic symptoms while controlling for its effect on depression and anxiety. Competing hypotheses arguing for the reverse effect were also tested. The study was a cross-sectional survey in a community sample (N =2350) from Germany (n=786), Indonesia (n=844), and the United States (n=720). Confirmatory factor analysis (CFA) and path analysis with structural equation modeling were used to test the hypotheses. In the CFA two factors reflecting current and past experiences of SD could be identified with acceptable fit. Path analysis indicated acceptable fit for both SD and reverse models, and both the path from current SD to psychotic symptoms and the reverse one were significant, although the former was stronger than the latter. Interestingly, the current but not the past SD factor was significantly associated with psychotic symptoms. Overall, the results indicate that postulates derived from the SD hypothesis fit the data. However, longitudinal research is needed to further confirm the postulated directionality of the associations.

Psychotic Experiences and Related Distress: A Cross-national Comparison and Network Analysis Based on 7141 Participants From 13 Countries

Psychotic experiences (PEs) are common in the general population but do not necessarily reflect a risk status if they occur in relative isolation or are not distressing. Emerging evidence suggests that PEs might be experienced as more benign for individuals from collectivistic low- and middle-income countries (LAMIC) compared with individualistic high-income countries (HIC). The aim of this study was to determine whether: (1) self-reported PEs are less distressing in community samples from LAMIC than from HIC; (2) the network of PEs is significantly less connected in a sample from LAMIC than from HIC. Adults from 8 HIC (n = 4669) and 5 LAMIC (n = 2472) were compared. The lifetime frequency of PEs and related distress were assessed with the Community Assessment of Psychic Experiences. We analyzed the associations of PEs with distress and country type. The interconnection of PEs was visualized by a network analysis and tested for differences in global connection strengths. The average endorsement rates of PEs were significantly higher in LAMIC than in HIC (χ2 = 1772.87, P < .01, Φcramer = 0.50). There was a universal positive correlation between higher frequency of PEs and more distress, but the distress levels controlled for frequency were significantly higher in HIC (R2 = 0.11; b = 0.26; SE = 0.01; T = 17.68; P < .001). Moreover, the network of PEs was significantly less connected in LAMIC (S = 0.40, P < .05). The findings indicate that PEs are of less clinical relevance in LAMIC compared with HIC. The universal use of current high-risk criteria might thus not be adequate without consideration of associated distress and cultural values.

Bullying Mediates Between Attention-Deficit/Hyperactivity Disorder in Childhood and Psychotic Experiences in Early Adolescence

Although a childhood diagnosis of attention-deficit/hyperactivity disorder (ADHD) is known to be linked to psychotic experiences and psychotic disorders in later life, the developmental trajectories that could explain this association are unknown. Using a sample from the prospective population-based Avon Longitudinal Study of Parents and Children (ALSPAC) (N = 8247), we hypothesized that the previously reported association of ADHD combined subtype in childhood and psychotic experiences in early adolescence is mediated by traumatic events and by involvement in bullying. Moreover, we expected this mediation to be specific to ADHD and tested this by comparison with specific phobia. Children with ADHD combined subtype at age 7 were more often involved in bullying at age 10 (OR 3.635, 95% CI 1.973-6.697) and had more psychotic experiences at age 12 (OR 3.362, 95% CI 1.781-6.348). Moreover, children who were involved in bullying had more psychotic experiences (2.005, 95% CI 1.684-2.388). Bullying was a significant mediator between ADHD and psychotic experiences accounting for 41%-50% of the effect. Traumatic events from birth to age 11 were also significantly associated with ADHD combined subtype and psychotic experiences; however, there was no evidence of mediation. Specific phobia was significantly associated with psychotic experiences, but not with bullying. To conclude, bullying is a relevant translating mechanism from ADHD in childhood to psychotic experiences in early adolescence. Interventions that eliminate bullying in children with ADHD could potentially reduce the risk of having psychotic experiences in later life by up to 50%. Clinicians should thus screen for bullying in routine assessments of children with ADHD.

Targeting the link between loneliness and paranoia via an interventionist-causal model framework

Targeting the antecedents of paranoia may be one potential method to reduce or prevent paranoia. For instance, targeting a potential antecedent of paranoia - loneliness - may reduce paranoia. Our first research question was whether loneliness heightens subclinical paranoia and whether negative affect may mediate this effect. Second, we wondered whether this potential effect could be targeted via two interventionist pathways in line with an interventionist-causal model approach: (1) decreasing loneliness, and (2) intervening on the potential mediator - negative affect. In Study 1 (N = 222), recollecting an experience of companionship reduced paranoia in participants high in pre-manipulation paranoia but not in participants low in pre-manipulation paranoia. Participants recollecting an experience of loneliness, on the other hand, exhibited increased paranoia, and this effect was mediated by negative affect. In Study 2 (N = 196), participants who utilized an emotion-regulation strategy, cognitive reappraisal, to regulate the negative affect associated with loneliness successfully attenuated the effect of loneliness on paranoia. Targeting the effect of loneliness on paranoia by identifying interventionist pathways may be one promising route for reducing and preventing subclinical paranoia.