Latina mothers, often essential workers, report COVID-19 took toll

UC Davis researchers found stimulus didn't relieve burdens

UNIVERSITY OF CALIFORNIA - DAVIS

 NEWS RELEASE 8-JAN-2021

Research News

 

IMAGE: FINANCIAL AND PSYCHOLOGICAL TOLL: THE PANDEMIC HAS FORCED MORE THAN 50 PERCENT OF THE FAMILIES IN A REGIONAL STUDY TO MAKE ECONOMIC CUTBACKS. view more 

CREDIT: UC DAVIS

More than half of Latina mothers surveyed in Yolo and Sacramento counties reported making economic cutbacks in response to the pandemic shutdown last spring -- saying they bought less food and missed rent payments. Even for mothers who reported receiving the federal stimulus payment during this time, these hardships were not reduced, University of California, Davis, researchers found in a recent study.

"Latino families are fighting the pandemic on multiple fronts, as systemic oppression has increased their likelihood of contracting the virus, having complications from the virus and having significant economic hardship due to the virus," said Leah C. Hibel, associate professor of human development and family studies at UC Davis and lead author of the study. "These factors are likely to have a significant psychological toll on these families."

The study was published Jan. 7 in the journal Traumatology. Researchers administered surveys to 70 Latina mothers March 18 through June 5 of last spring, after the "shelter-in-place" orders went into effect in California in response to the COVID-19 pandemic.

The survey sample consisted of Latina mothers, all of whom are low-income, with 92 percent of the families having an essential worker (either the mother or her partner), in Yolo and Sacramento counties, researchers said. The survey respondents were identified through an earlier UC Davis study on Mexican-origin families living in the region. Yolo and Sacramento counties are in Northern California, which has a higher cost of living than most of the country, but has a relatively high level of social services available, researchers added.

Researchers said that although it has been reported that the stimulus checks may have kept some from falling below the poverty level, cutbacks due to other economic factors still had an effect on these low-income families.

"In other words, though the stimulus may have prevented some families from falling below the poverty line, our analyses suggest that many low-income families are still facing significant financial hardship," researchers said in the study. "This hardship appears to be placing families on a trajectory toward hunger and eviction."

Less food, higher stress

Mothers who engaged in cutbacks reported significantly higher levels of stress, depression, and anxiety. Further, receiving the federal stimulus money administered to those whose income was less than $99,000 a year (through the Coronavirus Aid, Relief, and Economic Security Act) was not associated with lower cutbacks, stress, depression or anxiety. Of those surveyed, 65 percent had reported receiving their checks by the time the survey was administered.

Mothers' depressive symptoms were assessed through survey questions administered by phone. Most were in English, but in some cases, questions were asked in Spanish by native-speaking interviewers. Assessed on a five-point answer scale, mothers were asked such questions as:

• "How stressed are you because of the virus outbreak?"
• "How often have you felt or experienced depressed mood?"
• "How often have you felt panicky?"

Mothers were also asked to indicate whether or not they made any of 12 listed cutbacks (food, rent, cutting back on air conditioning, etc.) in previous weeks because of the pandemic. Of these mothers, 52 percent reported being forced to make economic cutbacks, and they reported higher stress, depressive symptoms and anxiety than those who reported not cutting back.

Researchers noted that the immediate economic impacts of the pandemic on low-income Latina mothers' well-being suggests that alleviating families' economic hardship might benefit mothers psychologically. Though the researchers did not find the stimulus payment to buffer the economic or psychological impacts, they suggest the stimulus money was simply not enough.

"Without additional local, state or federal aid, the pandemic is likely to cause severe hardship marked by homelessness, hunger and mental illness. Additional recurring monthly stimulus payments could be a lifeline for families who are struggling to make ends meet," the researchers wrote.

###

Additional authors of the study are Chase J. Boyer and Andrea C. Buhler-Wassmann, doctoral student researchers, and Blake J. Shaw, master's degree student researcher.

The full study is available here:
https://psycnet.apa.org/fulltext/2021-03003-001.html

SHOCKING! BUT TRUE 😲

Child marriage is legal and persists across Canada

Over 3,600 marriage certificates were issued to children under the age of 18 between 2000 and 2018

MCGILL UNIVERSITY

Research News

    SHARE

 PRINT  E-MAIL

IMAGE: FIGURE: TRENDS IN THE NUMBER OF CHILDREN GRANTED MARRIAGE CERTIFICATES PER 10,000 16-17-YEAR-OLDS IN FIVE PROVINCES BETWEEN 2000 AND 2018 view more 

CREDIT: ALISSA KOSKI AND SHELLEY CLARK

Canada is at the forefront of global efforts to end child marriage abroad. Yet this practice remains legal and persists across the country. In Canada, more than 3,600 marriage certificates were issued to children, usually girls, under the age of 18 between 2000 and 2018, according to a new study from researchers at McGill University. In recent years, an increasing number of child marriages have been common-law unions.

Child marriage, defined as formal or informal (common-law) marriage before the age of 18, is a globally-recognized indicator of gender inequality because the negative consequences for health and personal development disproportionately affect girls. While much research has focused on developing countries, in wealthier nations like Canada, child marriage practices are overlooked and understudied.

Using data from vital statistics agencies and recent censuses, the researchers found that child marriage remains in practice from coast to coast, with the highest estimates of formal marriage found in Alberta (0.03%) and Manitoba (0.04%), and the highest estimates of any type of child marriage (formal or common-law) in Saskatchewan (0.5%) and the territories (1.7%). The study, published in Population and Development Review, is the first to shed light on how common child marriages are in the country.

"Our results show that Canada has its own work to do to achieve its commitment to the United Nations Sustainable Development Goals, which call for an end to child marriage by the year 2030," says co-author Alissa Koski, Assistant Professor in Department of Epidemiology, Biostatistics and Occupational Health at McGill University.

The researchers found that Canadian-born children are slightly more likely to marry than those born outside of the country. More than 85% of all marriage certificates granted to children were issued to girls, who typically wed much older spouses. This gendered patterning is consistent with child marriage practices observed across the globe, according to the researchers.

Common-law unions more prevalent

The study shows most child marriages in recent years have been common-law. In 2006, formal marriage accounted for more than half of all child unions. By 2016, formal marriage accounted for only 5 percent and common-law unions were twenty times as prevalent.

"While the number of marriage certificates issued to children across the country has declined, it's possible that individuals are opting for more informal unions in response to growing social disapproval of child marriage," say the authors. This makes it increasingly challenging to determine to what extent child marriage has actually decreased or whether concerns about social or legal consequences have led to changes in reporting behaviors.

Informal unions can be just as harmful as formal marriages, the researchers say. In fact, informal unions often provide less social, legal and economic protection. In Quebec, for example, individuals in common-law unions are not entitled to alimony or division of property if the union ends. This raises questions about how best to address the issue. Preventing common-law unions among children will require different and innovative approaches that address the deeper motivations for this practice.

"The persistence of this practice within Canada highlights some of the inherent challenges to fully eradicating child marriage and reveals an important inconsistency between Canada's domestic laws and its global policies" says co-author Shelley Clark, James McGill Professor of Sociology at McGill University. The next steps will be to examine the mental health consequences of child marriage in Canada and to investigate motivations for the practice.

###

About the study

"Child Marriage in Canada" by Alissa Koski and Shelley Clark is published in Population and Development Review.

DOI: https://doi.org/10.1111/padr.12369

An analysis of 145 journals suggests peer review itself may not explain gender discrepancies in publication rates

Peer review and gender bias: A study on 145 scholarly journals

AMERICAN ASSOCIATION FOR THE ADVANCEMENT OF SCIENCE

Research News

 

An analysis of 145 scholarly journals found that, among various factors that could contribute to gender bias and lesser representation of women in science, the peer review process itself is unlikely to be the primary cause of publishing inequalities. However, Flaminio Squazzoni and colleagues emphasize that the study does not account for many other factors that may affect women's representation in academia, including educational stereotypes and academic choices of priorities and specialties. Even as female representation has improved in fields such as the humanities, psychology, and the social sciences, a publication gap persists, with male authors continuing to publish more manuscripts in more prestigious journals. To better understand whether peer review and editorial processes contribute to these gender discrepancies, Squazzoni et al. leveraged an agreement on data sharing with several large scholarly publishers; the team includes authors from the publishing companies Elsevier, John Wiley & Sons, and Springer Nature. The researchers collected and analyzed almost 350,000 submissions to 145 journals by about 1.7 million authors, as well as more than 760,000 reviews completed by about 740,000 referees. The sampled journals were identified by publishers so as to maximize coverage of research fields, although journals from learned societies, among others, were not considered. They then analyzed each step of the editorial process for bias, including the selection of referees, referee recommendations, and the editorial decision for each manuscript. They also accounted for each submission's research field, its proportion of women authors, and the position of women in the author list, while controlling for the proportion of women among referees, journal impact factors, the number of authors per manuscript, and the type of peer review adopted by each journal (single-blind or double-blind). The authors note, however, that it was not possible to directly estimate the quality of each submission. Author gender did not appear to affect how frequently manuscripts were accepted in the life sciences and social sciences, while manuscripts with higher proportions of female authors were in fact more likely to succeed in biomedicine, health, and physical sciences. "Our findings do not mean that peer review and journals are free from biases," the authors write. "For instance, the reputation of certain authors and the institutional prestige of their academic affiliation, not to mention authors' ethnicity or the type of research submitted, could influence the process, and these factors could also have gender implications." The researchers note that collaborative data sharing efforts from funding agencies, academic institutions, and scholarly citation databases will be necessary to further elucidate how existing structures determine academic opportunities.

Exposure to Common Geographic COVID-19 Prevalence Maps and Public Knowledge, Risk Perceptions, and Behavioral Intentions

Alistair Thorpe, PhD¹; Aaron M. Scherer, PhD²; Paul K. J. Han, MD, MA, MPH³; et alNicole Burpo, MS⁴; Victoria Shaffer, PhD⁵; Laura Scherer, PhD⁶; Angela Fagerlin, PhD^1,7

Author Affiliations Article Information

JAMA Netw Open. 2021;4(1):e2033538. doi:10.1001/jamanetworkopen.2020.33538

COVID-19 Resource Center 

 

January 6, 2021

Introduction

Several organizations have produced maps showing the prevalence of confirmed coronavirus disease 2019 (COVID-19) cases across the United States, but there is limited data on what map features are most effective at informing the public about infectious disease risk and motivating engagement with recommended health behaviors.¹ We assessed the association of 6 different COVID-19 maps with knowledge, risk perceptions, and behavioral intentions.

Methods

This survey study included US adults recruited between May 18 and 28, 2020, by Qualtrics Online Panels. This study was deemed exempt by the University of Iowa institutional review board, given the minimal risk to participants and collection of deidentified information. All respondents provided informed consent and were compensated for their participation. The survey was conducted online in English. This study follows the American Association for Public Opinion Research (AAPOR) reporting guideline.

After providing informed consent, respondents were randomized to see 1 of 6 maps (Figure) or to not receive any information (no map) using an automated function within the Qualtrics software.

Respondents answered questions assessing their knowledge of confirmed cases of COVID-19 across the US (total cases and cases per capita), their perceived risk of COVID-19 (individual and societal), and their intentions to adhere to infection control guidelines.² Total cases and cases per capita knowledge were each assessed on scales of 4 items specifically about the total or per capita confirmed cases. Scores ranged from 0 to 1, with higher scores indicating greater knowledge about total or per capita numbers of confirmed COVID-19 cases. Individual risk perception was assessed on a scale of 9 items about perceived susceptibility and severity of getting COVID-19. Scores ranged from 1 to 7, with higher scores indicating greater perceived susceptibility and severity of getting COVID-19. Societal risk perception was assessed on a single item about whether the pandemic would be better or worse in 2 weeks. Scores ranged from 1, (indicating that the COVID-19 pandemic would be much worse in 2 weeks) to 7 (indicating the COVID-19 pandemic would be much better in 2 weeks). Intentions to adhere to COVID-19 guidelines were assessed on a scale of 15 guidelines (eg, “avoid gatherings of >10 people”). Scores ranged from 0 to 100, with higher scores indicating greater intent to adhere to the guidelines. Maps were available alongside questions for reference. Using planned contrasts, we compared these outcomes at 4 levels: map intervention (no map vs maps), visualization type (heat vs bubble), geographic level (state vs county), and case format (total vs per capita). Respondents self-reported demographic information, including age, gender, and race/ethnicity.

All tests were 2-sided with P values adjusted using Holm-Bonferroni³ correction for multiple comparisons. Significance was set at α = .05. Analyses were performed using R Studio statistical software version 1.1.463 (R Project for Statistical Computing).

Results

After excluding 2062 respondents who did not complete the survey, completed the survey in an unrealistically short time (ie, <9 minutes), or indicated that they did not provide high-quality answers (ie, respondents who answered “I will not provide my best answers” or “I can’t promise either way” to the question “Do you commit to thoughtfully provide your best answers to each question in this survey?”), our final sample included 2676 respondents (completion rate, 57%).

In the final sample, the mean (SD) age was 46 (17) years (range, 18-91 years); 1575 respondents (59%) were women, while 933 respondents (35%) were men, 28 respondents (1%) were transgender or another gender identity, and 140 respondents (5%) did not answer this question. A total of 1663 respondents (62%) were non-Hispanic White, 464 respondents (17%) were Hispanic, 315 respondents (12%) were non-Hispanic Black, 153 respondents (6%) were Asian or Asian American, 34 respondents (1%) were another race, and less than 1% of respondents were American Indian/Alaskan Native or Native Hawaiian/other Pacific Islander. Thirty-one respondents (1%) did not report their race/ethnicity. Education was heterogenous: 1022 respondents (38%) had a high school education or less, 1254 respondents (47%) had some college or a 2-year degree, and 400 respondents (15%) had a 4-year degree or higher.

Compared with participants who viewed a map, not viewing a map was associated with greater knowledge about total cases (mean [SD] score, 0.60 [0.28] vs 0.55 [0.30]; difference, 0.05 [95% CI, 0.01 to 0.09]) (Table). However, knowledge about total cases was significantly better for maps showing total cases compared with maps showing per capita cases (mean [SD] score, 0.60 [0.30] vs 0.46 [0.28]; difference, 0.14 [95% CI, 0.11 to 0.17]).

Viewing any map (vs no map) was not associated with knowledge about cases per capita. However, per capita knowledge was significantly better among respondents who viewed a heat map compared with those who viewed a bubble map (mean [SD] score, 0.48 [0.26] vs 0.44 [0.24]; difference, 0.04 [95% CI, 0.01 to 0.06]), the state-level map vs county-level map (mean [SD] score, 0.49 [0.26] vs 0.45 [0.24]; difference, 0.04 [95% CI, 0.01 to 0.07]), and the per capita map vs the total cases map (mean [SD] score, 0.42 [0.24] vs 0.56 [0.26]; difference, −0.13 [95% CI, −0.16 to −0.11]).

Respondents’ perception of their personal risk of getting COVID-19 was not associated with the presence or the type of map. Respondents who saw a map had lower societal risk perceptions, with more optimism that the pandemic would be better in 2 weeks, compared with those who did not see a map (mean [SD] score, 3.77 [1.60] vs 4.02 [1.62]; difference, −0.25 [95% CI, −0.48 to −0.02]). Overall, respondents reported high willingness to adhere to COVID-19 guidelines (mean [SD] score, 86.33 [17.05]), and scores were not significantly different by map provision or type.

Discussion

The findings of this survey study suggest that simply providing maps with COVID-19 case information was not necessarily associated with improved public knowledge, risk perception, or reported intent to adhere to health guidelines.

Limitations of this study include reliance on self-report and potential limited participation from individuals without internet access and lower English proficiency.

Based on the findings of our survey study, we encourage map developers to be mindful of the potential influence of reporting strategies on public knowledge and perception of the pandemic. We suggest developers present cases per capita using state-level heat maps rather than county-level bubble maps, because the former may be associated with improving (or at least maintaining) public knowledge. Knowledge about strategies for effective communication of COVID-19 case information would benefit from research with other stakeholders, such as government officials or policy makers.

Back to top

Article Information

Accepted for Publication: November 23, 2020.

Published: January 6, 2021. doi:10.1001/jamanetworkopen.2020.33538

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Thorpe A et al. JAMA Network Open.

Corresponding Author: Angela Fagerlin, PhD, Department of Population Health Sciences, School of Medicine, University of Utah, 295 Chipeta Way, Williams Bldg, Room 1N410, Salt Lake City, UT 84108 (angie.fagerlin@hsc.utah.edu).

Author Contributions: Dr Thorpe had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Thorpe, A. M. Scherer, Han, L. Scherer, Fagerlin.

Drafting of the manuscript: Thorpe, L. Scherer.

Critical revision of the manuscript for important intellectual content: Thorpe, A. M. Scherer, Han, Burpo, Shaffer, Fagerlin.

Statistical analysis: Thorpe.

Administrative, technical, or material support: L. Scherer.

Supervision: Han, Fagerlin.

Conflict of Interest Disclosures: None reported.

Funding/Support: Dr Thorpe was supported by grant No. 51300302 from the American Heart Association Children’s Strategically Focused Research Network fellowship.

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: Karina Pritchett, BA (Department of Population Health Sciences, School of Medicine, University of Utah), assisted with development of the maps and was not compensated for this work.

References

1.

Fagerlin  A, Valley  TS, Scherer  AM, Knaus  M, Das  E, Zikmund-Fisher  BJ.  Communicating infectious disease prevalence through graphics: results from an international survey.   Vaccine. 2017;35(32):4041-4047. doi:10.1016/j.vaccine.2017.05.048PubMedGoogle ScholarCrossref

2.

The White House. The president’s coronavirus guidelines for America: 30 days to slow the spread. Accessed August 7, 2020. https://www.whitehouse.gov/wp-content/uploads/2020/03/03.16.20_coronavirus-guidance_8.5x11_315PM.pdf

3.

Holm  S.  A simple sequentially rejective multiple test procedure.   Scand J Stat. 1979;6(9):65-70.Google Scholar

 

Study: Black Americans, women, conservatives more hesitant to trust COVID-19 vaccine

Thirty-one percent of respondents to a Texas A&M-led survey said they don't intend to be vaccinated against COVID-19

TEXAS A&M UNIVERSITY

Research News

 

A survey of approximately 5,000 Americans suggests that 31.1 percent of the U.S. public does not intend to get the COVID-19 vaccine once it becomes available to them - and the likelihood of vaccine refusal is highest among Black Americans, women and conservatives.

Timothy Callaghan, assistant professor at the Texas A&M University School of Public Health, led the study with the aim of better understanding the intentions of the American public regarding vaccines. The results were recently published in Social Science and Medicine.

According to the study, survey respondents answered a series of questions about their behaviors and attitudes about COVID-19, including why or why not they intend to pursue vaccination. Women are 71 percent more likely to not to pursue vaccination, researchers found, followed by Blacks at 41 percent.

Survey results also showed that politics play a role: each one-point increase in conservatism increases the odds of vaccine refusal by 18 percent. Those who said they intended to vote for President Donald Trump in the presidential election - the survey was conducted in mid-2020 - were 29 percent more likely to refuse vaccination.

The study revealed two top reasons for vaccine refusal: concerns about safety and effectiveness. However, reasons for vaccine reluctance varied across sub-populations.

For instance, women who were surveyed said they are hesitant based on safety concerns and effectiveness, while surveyed Black Americans said their hesitancy stems from similar concerns plus a lack of financial resources or health insurance.

For conservatives, Callaghan points to previous studies that have shown these people are generally less trusting of vaccines, as well as medical and scientific professionals.

The finding that most surprised Callaghan is that Black individuals, who are being infected with COVID-19 and dying at higher rates, are less likely to vaccinate because of a combination of concerns, including those related to safety and affordability.

"This points to the need for the medical community and policymakers to find ways to both build trust in the vaccine in the African American community and to ensure that it is delivered affordably," Callaghan said.

The authors of the study also state that anti-vaccine advocacy groups "have made a concerted effort" to target Black Americans, writing that if they are successful in framing COVID-19 vaccination in terms of past medical abuses against minority groups, it could decrease the likelihood that racial minorities will pursue COVID-19 vaccination, particularly in light of recent findings emphasizing the implications of peripheral trauma."

Now that COVID-19 vaccine-hesitant populations have been identified, Callaghan plans to explore what kind of health interventions and health promotion efforts are most effective in promoting the vaccine to these populations. Additionally, he said it is important to explore the similarities and differences between populations that are generally vaccine hesitant and populations that are hesitant specifically toward the COVID-19 vaccine.

###

Why we use our smartphone at cafés

NORWEGIAN UNIVERSITY OF SCIENCE AND TECHNOLOGY

Research News

 

Maybe you're like us. We're the folks who are on our smartphones almost all the time, even when we're with others. We know it annoys a lot of people, but we do it anyway. Why?

Researchers at the Norwegian University of Science and Technology (NTNU) have looked at why people in cafés pull out their phones, and how this affects café life. Three main reasons they identified are: to delay or pause a conversation (interaction suspension); to get out of a conversation (deliberately shielding interaction); and to share something with others (accessing shareables).

But what does that actually mean?

The smartphone is the world's most ubiquitous personal tech gizmo. The vast majority of adults have one.

"This makes the smartphone important, both socially and sociologically," says postdoctoral fellow and first author Ida Marie Henriksen.

She is affiliated with NTNU's Department of Interdisciplinary Studies of Culture, and has written an article with Professor Aksel Tjora and PhD candidate Marianne Skaar from the Department of Sociology and Political Science.

The use of smartphones is connected to so many of our activities, both ones we do alone and ones we do with others. We look for tempting cafés online, pay for the bus ticket to the café with it, invite friends to come join us, use the phone to identify the music that the café is playing, and lots of other things.

Smartphones give us even better opportunities to be social. But they also enable us to distance ourselves from others.

The researchers visited 52 people at cafés in Trondheim, and interviewed them in depth about their mobile phone use and how they interacted with other people.

"We focused exclusively on people who seemed to know each other from before and who met to socialize. In addition, we observed 108 other meetings at a distance, kind of like research flies on the wall," says Skaar.

By design, cafés are a place where you can be especially social with others. But some people use it instead as a place to hide away with a good drink for a while and keep a suitable distance from people, or as a workplace, preferably with a laptop or tablet in addition to the ubiquitous mobile phone.

So what do the three main types of cell phone use involve?

Delaying interaction is what happens when we interrupt a conversation with our café partner to check an email, a phone conversation, a picture on Snap or just to make sure we haven't missed anything on social media the last few minutes.

This is also called "phubbing" (from phone + snubbing), when the phone gets your attention instead of the live person you're with.

How this behaviour is perceived depends on how the conversation partners understand the situation. You can get annoyed about it and see it as rude. But that's not necessarily the case.

"On the one hand, how you suspend your interaction plays a role. If you explain to the person you're with why you have to postpone your physical interaction, it's perceived as more polite than if you just disappear and start "phubbing," that is, phoning someone else and ignoring the person who's physically present. At the same time, some people may appreciate a short break from a longer conversation, and using the phone can also be a natural, interwoven part of the social interaction that takes place in the café," says Tjora.

Deliberately shielding interaction is a slightly different, more subtle way of using the phone than suspending interaction exposure.

"When the person you're with gets busy on their smartphone, the other person in the social setting can pick up their smartphone to demonstrate that they're busy too and not being involuntarily left to themselves. Or if you're in a group, you can pick up your phone to avoid a conversation topic by signalling that you are busy. The smartphone offers a break from face-to-face social situations," says Henriksen.

Some of us take this a step further by keeping our cell phone in silent mode. Then we can pretend we've received an important message or conversation, and that we have to hurry to answer it, maybe even leaving the company we're sitting with.

You can escape a lot of boring meetings this way. But it's not exactly pleasant.

Content sharing is the more pleasant or useful sharing side of using a phone and can sometimes be almost the opposite of taking a break from interacting.

"When you take a selfie together, or show pictures of your new girlfriend or kids, or of the house you want to bid on, or the map of where you were on holiday, you're sharing content," says Tjora.

Maybe you have an email, an SMS or a document that you want to show your café partner. That belongs in this category, too. Or when you disagree about what that actor or musician's name was, and a quick web search can tell you which one of you was right.

Content sharing in a café setting often raises new conversation topics and can enrich the interaction. Sharing is probably also the most socially accepted use of mobile phones.

Of course, there are overlapping and grey areas too.

"For example, a mutual understanding can allow those who are meeting to take pictures of the coffee cup at the very beginning of the conversation and perhaps share the picture on social media for uninterested acquaintances. But then they put away their phones, either until a message appears, or perhaps even until the physical meeting comes to an end. If you go to a café to be social, the person with you in real life is the focus," says Henriksen.

Sometimes there are also situations where café partners jointly agree to check this and that on their phones for a short while, but then put them away and concentrate on each other.

Others use their phone while the café partner is ordering at the counter or going to the toilet, simply to have something to do while the other person is away. This is almost like a kind of addiction, where we constantly have to be doing something and fill in all the breaks. The phone is immediately available, willing and able to satisfy this aversion to silence.

The smartphone is a tool for signalling interest or distance, but it can also enrich conversations and be used to share experiences with other people than only those who are physically present.

"The study dispels the myth that everyone is constantly staring at their screens no matter the occasion, and shows that a form of courtesy with the phone has been established, at least in situations where the social aspect is prioritized," says Tjora.

"Whatever the reasons, one thing seems certain: smartphones have changed how we behave socially, for better or for worse. But maybe socializing has just become different in a way we need to become conscious of.

###

Reference: Henriksen, I.M .; Skaar, M .; Tjora, A. The Constitutive Practices of Public Smartphone Use. Societies 2020, 10 (4), 78; https://doi.org/10.3390/soc10040078

How can we help victims of torture?

Chronic pain may complicate mental health treatment

NORWEGIAN UNIVERSITY OF SCIENCE AND TECHNOLOGY

Research News

 

Post-traumatic stress disorder, or PTSD, affects many people who are exposed to extreme situations, such as torture. Recent research suggests that chronic pain may make it more difficult to treat trauma.

"Trauma-focused therapy is effective for many patients with PTSD, enabling them to talk through the trauma they experienced", according to Iselin Solerød Dibaj, a psychologist at Oslo University Hospital.

However, not everyone benefits equally from this form of therapy.

"Torture victims who struggle with both chronic pain and PTSD unfortunately often reap less benefit from ordinary treatment," says Dibaj.

The Red Cross estimates that between 10 000 and 35 000 people with a refugee background who have come to Norway have experienced torture, reflecting the great need for effective treatment in this country as well.

"Torture is one of the most extreme abuses a person can experience. Physical and mental pain is inflicted with the intention of breaking a person down or obtaining information," says Håkon Stenmark, a specialist in clinical psychology at RVTS Midt, a regional resource centre for violence, traumatic stress and suicide prevention in central Norway.

"Mental health therapists find it difficult to provide effective help to victims of torture. They are pushing to increase their knowledge and find more effective methods," says Stenmark.

Now Dibaj and Stenmark, along with Professor Leif Edward Ottesen Kennair and Joar Øveraas Halvorsen, a specialist in clinical psychology and PhD  at the Regional Unit for Trauma Treatment at St. Olavs Hospital, have published an article in the journal Torture about treating this patient group.

Professor Kennair, from the Norwegian University of Science and Technology, has been a supervisor and the driving force behind the research project that might lead to better treatment of torture victims.

"Exposure therapy" involves delving into patients' memories and trying to talk through the trauma.

"But trauma-focused treatment for torture victims has been criticized in several clinical and academic settings for being too concerned with the traumas and not taking context into account, such as social, political and historical factors," says Dibaj.

Dibaj says they understand this criticism, at the same time as they do not want to write off a trauma treatment for this group that has documented effectiveness in other patient groups.

Other trauma-exposed groups in recent years have shown evidence that chronic pain and PTSD mutually contribute to reinforcing the other condition. One disorder can trigger the other, ensuring that neither disappears.

"So people with both disorders have worse treatment results with both the trauma condition and the chronic pain than if they only had one disorder," says Kennair.

Having both disorders also brings with it a number of additional challenges that therapists do not address specifically and purposefully in either trauma treatment or pain treatment.

"So we're questioning whether these factors are partly to blame for the trauma treatment being less effective for victims of torture," Kennair says.

Effective trauma treatment is largely about experiencing mastery and learning new ways to deal with painful memories.

"But if the patient experiences unmanageable pain, without the tools to deal with it, he or she risks not having this experience. The patient might then drop out or not be willing to delve into the memories," says Dibaj.

In the same way, pain treatment with the physiotherapist rarely works directly with trauma memories. Thus, this therapy can fall into the same trap - that the patient doesn't dare to do the rehabilitative exercises for fear of re-experiencing the trauma.

"We're criticizing the current 'gold standard trauma therapies' for not working purposefully and specifically enough with important maintenance mechanisms for patients who have both pain and PTSD," says Dibaj.

But these patients might actually achieve better outcomes if the therapists worked with the pain and trauma simultaneously.

"In other words, psychologists and physiotherapists should collaborate more in treating these patients," Dibaj says.

"We also have to remember that torture is such an extreme and unique experience that we can't just conclude that the pain problems in these patients are the same as we see in other patients with the same problem," says Dibaj.

Norway has ratified the UN Convention against Torture. It states that people who have been subjected to torture have the right to rehabilitation. In a report from earlier this year, the Red Cross found the services offered to torture victims in Norway to be fragmented and highly person-dependent.

"At the same time, those of us working in the health care services are obliged to offer evidence-based treatment and equal health services," says Halvorsen.

This means that patients with PTSD need to be offered the form of treatment that currently seems to have the best documented effect. This guideline applies regardless of background. The treatment has to be adapted to each individual patient.

"International guidelines for the rehabilitation of torture victims recommend interdisciplinary, specialized follow-up of these patients. However, studies show that even patients who receive such multi-faceted treatment experience only modest effects. We simply need to gain more knowledge about how we can help this group," says Dibaj.

"We've been pointing out that Norway lacks specialized rehabilitation services for victims of torture for a long time. But since we still have limited knowledge of what characterizes effective rehabilitation for this group, funding and implementing clinical studies need to become an integral part of a specialized rehabilitation programme," Halvorsen says.

But why do some people suffer from PTSD?

"From an evolutionary perspective, we can understand the function of both pain and anxiety. These are alarm systems that signal us that something could potentially pose a danger to us. These signals cause us to avoid that situation. This can be adaptive in the short term, so that we steer clear of potential harm," says Dibaj.

With PTSD and/or chronic pain, our alarm system is overactive and fires a series of false alarms about danger.

Avoidance normally decreases when the acute danger is over, but with PTSD and/or chronic pain, our alarm system is overactive and fires a series of false alarms about danger.

"If we respond to these alarms as a real danger and avoid what's triggering the alarm, we risk making the alarm system more sensitive," Dibaj says.

"Research indicates that post-traumatic cognitions or thoughts - that is, thoughts that come up after experiencing a trauma - play an important role in developing and prolonging post-traumatic distress. Examples of this kind of post-traumatic cognition might be, 'The world is a dangerous place' or 'I'm a broken person,'" says Halvorsen.

Both PTSD and chronic pain are characterized by numerous such false alarms. The affected person might have flashbacks, for example, where something dangerous from the past is perceived as dangerous now. Victims can also experience pain signals without connecting them to something actually being wrong in their body.

"Torture is designed to create this form of distress and, especially in recent times, to create pain that doesn't result in visible scars," says Dibaj.

Many victims of torture experience that completely normal movements trigger their alarm system. This naturally leads to less physical activity and also makes a lot of people afraid to move. This condition is called kinesiophobia, when normal activities can lead to severe pain and re-experiencing the trauma.

"When patients develop a fear of completely normal movements, it's difficult to do physiotherapy or other things that could help them get better - and that's why we think that kinesiophobia contributes to reinforcing the ailments. But this is something we rarely focus on in ordinary trauma treatment. Therapists therefore need to broaden their understanding of these connections," says Stenmark.

###

References: Iselin Dibaj, M.Sc., Psych., Joar Øveraas Halvorsen, M.Sc., PhD, Leif Edward Ottesen Kennair, M.Sc., Håkon Inge Stenmark, M.Sc. PhD. Painful memories: Challenges in trauma-focused therapy for torture survivors with PTSD and chronic pain - a narrative review. Torture: Journal on Rehabilitation of Torture Victims and Prevention of Torture, 30 (2), 35-57.