Rebecca Bendayan

New empirical evidence of the validity of the Chronic Pain Acceptance Questionnaire: The differential influence of activity engagement and pain willingness on adjustment to chronic pain

OBJECTIVEnThe aims of this study were to examine the internal structure of the Spanish version of the Chronic Pain Acceptance Questionnaire and present new empirical evidence regarding its validity.nnnDESIGN AND METHODSnA sample of 315 chronic pain patients attending a pain clinic completed a battery of instruments to assess pain acceptance, general psychological acceptance, depression, anxiety, pain intensity, functional impairment, and current functioning.nnnRESULTSnConfirmatory factor analysis supported the validity of a 20-item version with two subscales corresponding to two independent factors: Activity Engagement and Pain Willingness. Structural Equation Modelling showed that the association between pain intensity and anxiety and depression was fully mediated by Activity Engagement which partially mediated the association between pain intensity and functioning. Pain Willingness partially mediated the influence of pain intensity on functional impairment.nnnCONCLUSIONSnThese findings indicate the differential influence of both components on adjustment to chronic pain.

Using the linear mixed model to analyze nonnormal data distributions in longitudinal designs

Using a Monte Carlo simulation and the Kenward–Roger (KR) correction for degrees of freedom, in this article we analyzed the application of the linear mixed model (LMM) to a mixed repeated measures design. The LMM was first used to select the covariance structure with three types of data distribution: normal, exponential, and log-normal. This showed that, with homogeneous between-groups covariance and when the distribution was normal, the covariance structure with the best fit was the unstructured population matrix. However, with heterogeneous between-groups covariance and when the pairing between covariance matrices and group sizes was null, the best fit was shown by the between-subjects heterogeneous unstructured population matrix, which was the case for all of the distributions analyzed. By contrast, with positive or negative pairings, the within-subjects and between-subjects heterogeneous first-order autoregressive structure produced the best fit. In the second stage of the study, the robustness of the LMM was tested. This showed that the KR method provided adequate control of Type I error rates for the time effect with normally distributed data. However, as skewness increased—as occurs, for example, in the log-normal distribution—the robustness of KR was null, especially when the assumption of sphericity was violated. As regards the influence of kurtosis, the analysis showed that the degree of robustness increased in line with the amount of kurtosis.

Personality Predicts Mortality Risk: An Integrative Data Analysis of 15 International Longitudinal Studies

This study examined the Big Five personality traits as predictors of mortality risk, and smoking as a mediator of that association. Replication was built into the fabric of our design: we used a Coordinated Analysis with 15 international datasets, representing 44,094 participants. We found that high neuroticism and low conscientiousness, extraversion, and agreeableness were consistent predictors of mortality across studies. Smoking had a small mediating effect for neuroticism. Country and baseline age explained variation in effects: studies with older baseline age showed a pattern of protective effects (HR<1.00) for openness, and U.S. studies showed a pattern of protective effects for extraversion. This study demonstrated coordinated analysis as a powerful approach to enhance replicability and reproducibility, especially for aging-related longitudinal research.

The effect of skewness and kurtosis on the robustness of linear mixed models.

This study analyzes the robustness of the linear mixed model (LMM) with the Kenward–Roger (KR) procedure to violations of normality and sphericity when used in split-plot designs with small sample sizes. Specifically, it explores the independent effect of skewness and kurtosis on KR robustness for the values of skewness and kurtosis coefficients that are most frequently found in psychological and educational research data. To this end, a Monte Carlo simulation study was designed, considering a split-plot design with three levels of the between-subjects grouping factor and four levels of the within-subjects factor. Robustness is assessed in terms of the probability of type I error. The results showed that (1) the robustness of the KR procedure does not differ as a function of the violation or satisfaction of the sphericity assumption when small samples are used; (2) the LMM with KR can be a good option for analyzing total sample sizes of 45 or larger when their distributions are normal, slightly or moderately skewed, and with different degrees of kurtosis violation; (3) the effect of skewness on the robustness of the LMM with KR is greater than the corresponding effect of kurtosis for common values; and (4) when data are not normal and the total sample size is 30, the procedure is not robust. Alternative analyses should be performed when the total sample size is 30.

Should we rely on the Kenward–Roger approximation when using linear mixed models if the groups have different distributions?

The study explores the robustness to violations of normality and sphericity of linear mixed models when they are used with the Kenward-Roger procedure (KR) in split-plot designs in which the groups have different distributions and sample sizes are small. The focus is on examining the effect of skewness and kurtosis. To this end, a Monte Carlo simulation study was carried out, involving a split-plot design with three levels of the between-subjects grouping factor and four levels of the within-subjects factor. The results show that: (1) the violation of the sphericity assumption did not affect KR robustness when the assumption of normality was not fulfilled; (2) the robustness of the KR procedure decreased as skewness in the distributions increased, there being no strong effect of kurtosis; and (3) the type of pairing between kurtosis and group size was shown to be a relevant variable to consider when using this procedure, especially when pairing is positive (i.e., when the largest group is associated with the largest value of the kurtosis coefficient and the smallest group with its smallest value). The KR procedure can be a good option for analysing repeated-measures data when the groups have different distributions, provided the total sample sizes are 45 or larger and the data are not highly or extremely skewed.

Sexist attitudes and beliefs during adolescence: A longitudinal study of gender differences

Abstract The aim of this study was to examine changes in sexist attitudes and beliefs in a group of Spanish adolescents over a period of three consecutive years, with specific attention being paid to gender differences. Participants were 279 students (mean age at first assessment of 12.10 years) who, in each of the three years, completed the Ambivalent Sexism Inventory and the Questionnaire on Attitudes towards Diversity and Violence. Longitudinal analysis showed that hostile sexism did not vary over time, whereas scores on benevolent sexism and on sexist beliefs and justification of violence all fell between the ages of 12 and 14, there being an equivalent decrease in boys and girls. Boys scored significantly higher than girls on hostile sexism, as well as on sexist beliefs. These results illustrate how sexist attitudes and beliefs change during adolescence and provide further confirmation that these variables show gender differences from an early age.

The effect of skewness and kurtosis on the Kenward-Roger approximation when group distributions differ

BACKGROUNDnThis study examined the independent effect of skewness and kurtosis on the robustness of the linear mixed model (LMM), with the Kenward-Roger (KR) procedure, when group distributions are different, sample sizes are small, and sphericity cannot be assumed.nnnMETHODSnA Monte Carlo simulation study considering a split-plot design involving three groups and four repeated measures was performed.nnnRESULTSnThe results showed that when group distributions are different, the effect of skewness on KR robustness is greater than that of kurtosis for the corresponding values. Furthermore, the pairings of skewness and kurtosis with group size were found to be relevant variables when applying this procedure.nnnCONCLUSIONSnWith sample sizes of 45 and 60, KR is a suitable option for analyzing data when the distributions are: (a) mesokurtic and not highly or extremely skewed, and (b) symmetric with different degrees of kurtosis. With total sample sizes of 30, it is adequate when group sizes are equal and the distributions are: (a) mesokurtic and slightly or moderately skewed, and sphericity is assumed; and (b) symmetric with a moderate or high/extreme violation of kurtosis. Alternative analyses should be considered when the distributions are highly or extremely skewed and samples sizes are small.

Chronic physical illness in early life and risk of chronic widespread and regional pain at age 68: evidence from the 1946 British birth cohort.

Abstract This study aimed to examine the associations between serious illness in earlier life and risk of pain in old age using data from a large nationally representative British birth cohort, the Medical Research Council (MRC) National Survey of Health and Development (NSHD). Serious illness was defined as any experience of illness before age 25 requiring hospital admission of ≥28 days. Pain was self-reported at age 68, with chronic widespread pain (CWP) defined according to American College of Rheumatology criteria. Multinomial logistic regression was used to test associations of serious illness in early life with CWP, chronic regional pain (CRP), and other pain, with no pain as the referent category. Adjustment was made for sex, socioeconomic position, adult health status, health behaviours, and psychosocial factors. Of 2401 NSHD participants with complete data, 10.5% reported CWP (13.2% of women and 7.7% of men), 30.2% reported CRP, and 14.8% other pain. Compared with those with no history of serious illness, those who experienced serious illness in early life had a higher likelihood of CWP (relative risk ratio [RRR] = 1.62 [95% CI: 1.21-2.17]) and of CRP (RRR = 1.25 [95% CI: 1.01-1.54]) after adjusting for sex. In fully adjusted models, serious illness in early life remained associated with CWP (RRR = 1.43 [95% CI: 1.05-1.95]), but associations with CRP were attenuated (RRR = 1.19 [95% CI: 0.96-1.48]). There were no associations with other pain. These findings suggest that those who have experienced serious illness in earlier life may require more support than others to minimise their risk of CWP in later life.

From acute to chronic back pain: Using linear mixed models to explore changes in pain intensity, disability, and depression

Abstract Background/aims This longitudinal study investigated the pattern of change in pain intensity, disability, and depression in 232 chronic pain patients who were followed up for 2 years since pain onset. Most studies that have investigated changes in these variables over time have used participants who had already been in pain for more than 3 months. Few studies have followed up individuals from the acute phase onward and such studies used traditional statistical methods that cannot identify transition points over time or measure inter-individual variability. Methods We followed up individuals with chronic pain from pain onset up to 18 months and we examined their pain intensity, disability and depression trajectories using a modelling approach that allows to account for between and within-individual variability. We compared three patterns of change based on theoretical criterions: a simple linear growth model; a spline model with a 3-month transition point; and a spline model with a 6-month transition point. Time with pain was selected as time metric to characterise the change in these variables in the transition from acute to chronic pain. Sex and age differences were also examined. Results The results showed that the pain intensity trajectory was best represented by the spline model with a 3-month transition point, whereas disability and depression were best explained by linear growth models. There were sex differences at intercept level in all the models. There were age differences at baseline for pain intensity. No sex or age differences were found for the slope. Conclusions Pain intensity decreased in the first 3 months but underwent no further change. Disability and depression slightly but constantly decreased over time. Although women and older individuals are more likely to report higher pain intensity or pain-related disability in the first three months with pain, no differences by sex or age appear to be associated with the changes in pain intensity, depression and disability through the process of chronification. Implications Our findings suggest that pain chronification could be considered a continuous process and contribute to the ongoing discussion on the utility of standard classifications of pain as acute or chronic from a clinical point of view. Clinical and intervention decisions based in these standard classifications should consider the differences in the trajectories of pain related variables over time. In addition, this article illustrates a statistical procedure that can be of utility to pain researchers.

Decline in Search Speed and Verbal Memory Over 26 Years of Midlife in a British Birth Cohort

Background: Cognitive capabilities change in later life, although their onset and rate of decline, and how they are shaped by lifetime socioeconomic position, childhood cognition and adult health status are all unclear. Methods: From the Medical Research Council National Survey of Health and Development, we analysed 3,192 participants undergoing one or more cognitive assessments at ages 43, 53, 60–64 and 69. Linear mixed models described cognitive trajectories, adjusting for factors across the life course. Results: For both search speed and verbal memory, better performance at age 43 (the intercept) was associated with higher paternal and own education, childhood cognition, and adult occupational class. For search speed, the trajectory was best described as a quadratic function (decline of 45.6 letters/5-years + 4.6 letters). Verbal memory showed a linear decline of 0.20 words/5-years between ages 43 and 60 and a steeper linear decline of 0.95 words/5-years between ages 60 and 69. Decline in verbal memory in the latter period was steeper in those with higher educational achievements at age 26 (additional 0.28 words/5-years for highest attainment). Conclusions: Decline in verbal memory and search speed across midlife is evident, though with different non-linear trajectories. By implication, pathways to cognitive impairment and dementia in older age may have their origins in this period.