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Modifiable risk factors of vaccine hesitancy: insights from a mixed methods multiple population study combining machine learning and thematic analysis during the COVID-19 pandemic
Abstract Background Vaccine hesitancy, the delay in acceptance or reluctance to vaccinate, ranks among the top threats to global health. Identifying modifiable factors contributing to vaccine hesitancy is crucial for developing targeted interventions to increase vaccination uptake. Methods This mixed-methods multiple population study utilized gradient boosting machines and thematic analysis to identify modifiable predictors of vaccine hesitancy during the COVID-19 pandemic. Predictors of vaccine hesitancy were investigated in 2926 Norwegian adults (M age = 37.91, 79.69% female), before the predictive utility of these variables was investigated in an independent sample of 734 adults in the UK (M age = 40.34, 57.08% female). Two independent teams of authors conducted the machine learning and thematic analyses, blind to each other’s analytic procedures and results. Results The machine learning model performed well in discerning vaccine hesitant (n = 248, 8.48% and n = 109, 14.85%, Norway and UK, respectively) from vaccine uptaking individuals (n = 2678, 91.52% and n = 625, 85.15%), achieving an AUC of 0.94 (AUPRC: 0.72; balanced accuracy: 86%; sensitivity = 0.81; specificity = 0.98) in the Norwegian sample, and an AUC of 0.98 (AUPRC: 0.89; balanced accuracy: 89%; sensitivity = 0.83; specificity = 0.97) in the out-of-sample replication in the UK. The mixed methods investigation identified five categories of modifiable risk tied to vaccine hesitancy, including illusion of invulnerability, doubts about vaccine efficacy, mistrust in official entities, minimization of the societal impact of COVID-19, and health-related fears tied to vaccination. The portrayal of rare incidents across alternative media platforms as fear amplifiers, and the mainstream media’s stigmatizing presentation of unvaccinated individuals, were provided as additional motives underlying vaccine reluctance and polarization. The thematic analysis further revealed information overload, fear of needles, previous negative vaccination experiences, fear of not getting healthcare follow-up after vaccination if needed, and vaccine aversion due to underlying (psychiatric) illness (e.g., eating disorders) as motives underlying vaccine hesitance. Conclusions The identified influential predictors were consistent across two European samples, highlighting their generalizability across European populations. These predictors offer insights about modifiable factors that could be adapted by public health campaigns in mitigating misconceptions and fears related to vaccination toward increasing vaccine uptake. Moreover, the results highlight the media’s responsibility, as mediators of the public perception of vaccines, to minimize polarization and provide accurate portrayals of rare vaccine-related incidents, reducing the risk aggravating fear and reactance to vaccination.
Protocol for the process evaluation for a cluster randomised controlled trial evaluating primary school-based screening and intervention delivery for childhood anxiety problems.
INTRODUCTION: Anxiety problems are prevalent in childhood and, without intervention, can persist into adulthood. Effective evidence-based interventions for childhood anxiety disorders exist, specifically cognitive-behavioural therapy (CBT) in a range of formats. However, only a small proportion of children successfully access and receive treatment. Conducting mental health screening in schools and integrating evidence-based interventions for childhood anxiety problems may be an effective way to ensure support reaches children in need. The Identifying Child Anxiety Through Schools-Identification to Intervention (iCATS i2i) trial involves screening for childhood anxiety problems and offering a brief online parent-led CBT intervention. This paper presents the protocol for the process evaluation of the iCATS i2i trial, which aims to examine the implementation and acceptability of the study procedures, the mechanisms of change and whether any external factors had an impact on procedure engagement or delivery. METHODS AND ANALYSIS: This process evaluation will use both quantitative and qualitative methods to evaluate the implementation and acceptability of and barriers/facilitators to engagement and delivery of the iCATS screening/intervention procedures. Quantitative data sources will include opt-out and completion rates of baseline measures and usage analytics extracted from the online intervention platform. Qualitative interviews will be conducted with children, parents, school staff, iCATS i2i clinicians and researchers delivering study procedures. The Medical Research Council framework for process evaluations will guide study design and analysis. ETHICS AND DISSEMINATION: This study has received ethical approval from the University of Oxford Research Ethics Committee (R66068_RE003). Findings from the study will be disseminated via peer-reviewed publications in academic journals, conferences, digital and social media platforms and stakeholder meetings. TRIAL REGISTRATION: ISRCTN76119074.
Emotions and individual differences shape human foraging under threat
Abstract A common behavior in natural environments is foraging for rewards. However, this is often in the presence of predators. Therefore, one of the most fundamental decisions for humans, as for other animals, is how to apportion time between reward-motivated pursuit behavior and threat-motivated checking behavior. To understand what affects how people strike this balance, we developed an ecologically inspired task and looked at both within-participant dynamics (moods) and between-participant individual differences (questionnaires about real-life behaviors) in two large internet samples (n = 374 and n = 702) in a cross-sectional design. For the within-participant dynamics, we found that people regulate task-evoked stress homeostatically by changing behavior (increasing foraging and hiding). Individual differences, even in superficially related traits (apathy–anhedonia and anxiety–compulsive checking) reliably mapped onto unique behaviors. Worse task performance, due to maladaptive checking, was linked to gender (women checked excessively) and specific anxiety-related traits: somatic anxiety (reduced self-reported checking due to worry) and compulsivity (self-reported disorganized checking). While anhedonia decreased self-reported task engagement, apathy, strikingly, improved overall task performance by reducing excessive checking. In summary, we provide a multifaceted paradigm for assessment of checking for threat in a naturalistic task that is sensitive to both moods as they change throughout the task and clinical dimensions. Thus, it could serve as an objective measurement tool for future clinical studies interested in threat, vigilance or behavior–emotion interactions in contexts requiring both reward seeking and threat avoidance.
Potential research priorities for understanding and treating severe paranoia (persecutory delusions): a priority-setting partnership between patients, carers, mental health staff, and researchers.
BACKGROUND: A persecutory delusion (severe paranoia) occurs when a person believes that others are trying to harm them when they are not. It is often a central difficulty for patients diagnosed with schizophrenia. OBJECTIVE: The objective is to identify potentially important research questions about severe paranoia. METHODS: A priority-setting partnership exercise was conducted involving people with lived experience, carers, mental health staff, and researchers. An initial survey identified research questions, and a second survey prioritised a refined list of questions. There was a project steering group. FINDINGS: 1480 responses were gathered from 146 people (56 people with lived experience, 23 family members, 78 mental health staff, and 21 researchers). Following refinement, 201 questions were rated by the steering group for priority to enter the second survey. 38 questions were rated in the second survey by 157 people (69 people with lived experience, 33 family members, 59 mental health staff, and 27 researchers). 15 questions were identified as research priorities, each endorsed to a largely similar extent across stakeholder groups. These covered a wide range of topics, including how to support family and carers, understanding the causes of paranoia, managing paranoid thoughts day-to-day, improving access to services, and developing psychological and pharmacological approaches. CONCLUSIONS: There was a good deal of consensus in key questions-covering many aspects of understanding, treatment, and support-to be answered about severe paranoia. Most questions were considered largely equally important. CLINICAL IMPLICATIONS: Numerous questions were identified that, if addressed, might improve clinical provision for persecutory delusions.
Testing the combination of Feeling Safe and peer counselling against formulation-based cognitive behaviour therapy to promote psychological wellbeing in people with persecutory delusions: study protocol for a randomized controlled trial (the Feeling Safe-NL Trial).
BACKGROUND: Persecutory delusions are strong threat beliefs about others' negative intentions. They can have a major impact on patients' day-to-day life. The Feeling Safe Programme is a new translational cognitive-behaviour therapy that helps patients modify threat beliefs and relearn safety by targeting key psychological causal factors. A different intervention approach, with growing international interest, is peer counselling to facilitate personal recovery. Combining these two approaches is a potential avenue to maximize patient outcomes. This combination of two different treatments will be tested as the Feeling Safe-NL Programme, which aims to promote psychological wellbeing. We will test whether Feeling Safe-NL is more effective and more cost-effective in improving mental wellbeing and reducing persecutory delusions than the current guideline intervention of formulation-based CBT for psychosis (CBTp). METHODS: A single-blind parallel-group randomized controlled trial for 190 out-patients who experience persecutory delusions and low mental wellbeing. Patients will be randomized (1:1) to Feeling Safe-NL (Feeling Safe and peer counselling) or to formulation-based CBTp, both provided over a period of 6 months. Participants in both conditions are offered the possibility to self-monitor their recovery process. Blinded assessments will be conducted at 0, 6 (post-treatment), 12, and 18 months. The primary outcome is mental wellbeing. The overall effect over time (baseline to 18-month follow-up) and the effects at each timepoint will be determined. Secondary outcomes include the severity of the persecutory delusion, general paranoid ideation, patient-chosen therapy outcomes, and activity. Service use data and quality of life data will be collected for the health-economic evaluation. DISCUSSION: The Feeling Safe-NL Trial is the first to evaluate a treatment for people with persecutory delusions, while using mental wellbeing as the primary outcome. It will also provide the first evaluation of the combination of a peer counselling intervention and a CBT-based program for recovery from persecutory delusions. TRIAL REGISTRATION: Current Controlled Trials ISRCTN25766661 (retrospectively registered 7 July 2022).
The European Schizophrenia Cohort (EuroSC): A naturalistic prognostic and economic study
Background: Schizophrenia has a variety of clinical profiles, disabilities and outcomes requiring responsive management and the devotion of considerable resources. The primary objective of the European Schizophrenia Cohort (EuroSC) is to relate the types of treatment and methods of care to clinical outcome. Secondary objectives include the assessment of treatment needs in relation to outcome, the calculation of resource consumption associated with different methods of care, and the identification of prognostic factors. Method: EuroSC is a naturalistic follow-up of a cohort of people aged 18 to 64 years, suffering from schizophrenia and in contact with secondary psychiatric services. The study was done in nine European centres, in France (N=288), Germany (N=618), and Britain (N=302). Participants were interviewed at 6-monthly intervals for a total of 2 years. This initial paper describes the methods used and presents clinical and social baseline data. Results: The clinical and socio-demographic differences between patients from the different countries were small. However, patients from Britain were considerably more likely than their continental counterparts to have a history of homelessness, rooflessness or imprisonment, even when social and clinical differences between the samples were controlled. Conclusions: The samples were largely similar in clinical terms. Thus, the social differences between the samples seem likely to be due more to the societal context and may reflect relatively benign situations in the continental locations of our study. © Springer-Verlag 2005.
Basis functions for complex social decisions in dorsomedial frontal cortex
Abstract Navigating social environments is a fundamental challenge for the brain. It has been established that the brain solves this problem, in part, by representing social information in an agent-centric manner; knowledge about others’ abilities or attitudes is tagged to individuals such as ‘oneself’ or the ‘other’1–6. This intuitive approach has informed the understanding of key nodes in the social parts of the brain, the dorsomedial prefrontal cortex (dmPFC) and the anterior cingulate cortex (ACC)7–9. However, the patterns or combinations in which individuals might interact with one another is as important as the identities of the individuals. Here, in four studies using functional magnetic resonance imaging, behavioural experiments and a social group decision-making task, we show that the dmPFC and ACC represent the combinatorial possibilities for social interaction afforded by a given situation, and that they do so in a compressed format resembling the basis functions used in spatial, visual and motor domains10–12. The basis functions align with social interaction types, as opposed to individual identities. Our results indicate that there are deep analogies between abstract neural coding schemes in the visual and motor domain and the construction of our sense of social identity.
Theoretical limitations on mindreading measures: Commentary on Wendt et al. (2024).
In this Commentary article, we expand on issues in the theory of mind literature raised by Wendt et al. (2024) that limit progress in our understanding of how people read other minds. We critically assess how they categorized tasks in their study and, in so doing, raise deeper questions that need addressing: What exactly are mental states; how can we accurately measure mindreading when the "correct" answer lacks ground truth; and what are the contributions to individual differences in mindreading of general cognitive ability and specific experience in the kinds of minds being read? We conclude that developing a psychological theory of how people read other minds would advance ways in which we can better measure and explain what it means to be better or worse at mindreading and how general cognitive ability relates to this sociocognitive skill. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
Eudaimonia in Sourdough: Understanding Well-Being in the Sensory Experiences of Artisanal Activities
Abstract The well-being effects of artisanal food production activities remain understudied despite growing interest in the relation between well-being and food. A study was therefore designed to investigate the impact of taking part in a sourdough bread-making workshop on mood status, the hypothesis being that the rich multisensory stimulation involved might contribute positively to enhancing participants’ emotional states. A total of three sourdough making workshops (N = 52 participants) were conducted in Berlin, each lasting 2–2.5 h. The participants mixed ingredients, kneaded and shaped the dough, and tasted freshly-baked bread samples. Mood assessments were collected at four time points during the course of each workshop. The results demonstrated significant improvements in several self-reported mood states measures, including increased relaxation, reduced stress and nervousness, and an enhanced feeling of being connected to nature. The multisensory experiences of the sourdough making process, particularly the olfactory, auditory, and visual aspects, were identified as key contributors to these effects. More specifically, the aroma from sourdough ingredients, the sound of mixing, and the sight of sourdough slices were found to be especially effective in inducing positive emotional states. The results of this study therefore contribute new empirical evidence supporting the potential of artisanal bread making as a eudaimonic activity, offering insights into the relationship between sensory-rich food preparation and psychological well-being. These findings have implications for understanding the therapeutic potential of culinary activities in promoting positive mental health outcomes.