Andrew Prestwich

Despite its prevalence, individuals can be reluctant to discuss depression with their general practitioners (GPs). Effective communication strategies can help but their relative impact on patients’ willingness to discuss their mental health and the underpinning theoretical mechanisms is unclear. Using the Morality–Agency–Communion (MAC) model as the theoretical basis, a UK-based online sample (N = 329) rated their respect, liking and trust for GPs (MAC model outcomes), along with their perceived competence, warmth, morality and assertiveness (MAC model trait mechanisms) and willingness to discuss depression (downstream outcome) before and after reading six hypothetical scenarios based on UK communication guidelines. Compared to baseline, following each recommendation improved all outcomes. Liking was the most consistent mediator on willingness to discuss depression; trust, and to a lesser extent, respect, also played a role. Trait mechanisms differed by outcome: warmth was the most robust mediator for liking; for trust, competence; for respect, morality was key. Of the six communication approaches, allowing patients time to describe and discuss any problems or concerns was the most impactful. Consistent with the MAC model, this study suggests that following communication guidelines can improve how much GPs are seen as moral, warm and competent and, in turn, how much they are respected, liked and trusted. GPs could utilise these approaches more consistently to increase how much they are liked and trusted as well as their patients’ willingness to discuss depression within their consultations.

UK-based patients can consult with, and be treated by, pharmacists for various minor medical conditions. However, research needs to identify the psychological factors that influence patients' decisions to consult with a pharmacist over alternative treatment responses. The current study addressed this gap. UK residents (N = 329) completed measures of respect and trust for general practitioners (GPs) and pharmacists, alongside other measures that could influence treatment choices. Participants then read vignettes describing symptoms of conjunctivitis, influenza, and contact dermatitis and were asked to choose how they would respond if they experienced those symptoms. Participants were nearly twice as likely to choose to see their pharmacist than GP. Respect and trust of pharmacists were higher for those choosing to see their pharmacist over those selecting treatment alternatives. GPs were respected more than pharmacists, an effect mediated by greater perceived assertiveness and morality of GPs. However, seeing pharmacists was rated less hassle and participants reported greater self-efficacy for seeing them compared to GPs. Strategies that increase pharmacists' perceived assertiveness and morality could enhance respect and trust of pharmacists. Such changes could facilitate the current drive in the UK to utilize pharmacies more to minimise GP service demand.

Background: Researchers often use composite variables (e.g., BMI and change scores). By combining multiple variables (e.g., height and weight or follow-up weight and baseline weight) into a single variable it becomes challenging to untangle the causal roles of each component variable. Composite variable bias—an issue previously identified for exposure variables that may yield misleading causal inferences—is illustrated as a similar concern for composite outcomes. We explain how this occurs for composite weight outcomes: BMI, ‘weight change’, their combination ‘BMI change’, and variations involving relative change. Methods: Data from the National Child Development Study (NCDS) cohort surveys (n = 9223) were analysed to estimate the causal effect of ethnicity, sex, economic status, malaise score, and baseline height/weight at age 23 on weight-related outcomes at age 33. The analyses were informed by a directed acyclic graph (DAG) to demonstrate the extent of composite variable bias for various weight outcomes. Results: Estimated causal effects differed across different weight outcomes. The analyses of follow-up BMI, ‘weight change’, ‘BMI change’, or relative change in body size yielded results that could lead to potentially different inferences for an intervention. Conclusions: This is the first study to illustrate that causal estimates on composite weight outcomes vary and can lead to potentially misleading inferences. It is recommended that only follow-up weight be analysed while conditioning on baseline weight for meaningful estimates. How conditioning on baseline weight is implemented depends on whether baseline weight precedes or follows the exposure of interest. For the former, conditioning on baseline weight may be achieved by inclusion in the regression model or via a propensity score. For the latter, alternative strategies are necessary to model the joint effects of the exposure and baseline weight—the choice of strategy can be informed by a DAG.

UK national guidelines recommend how healthcare professionals should communicate with patients. However, the impact of following, or violating, these guidelines on how much the healthcare professional is respected, liked, or trusted, and the mechanisms underpinning, and consequences of, these perceptions have not been tested. To address these gaps, two UK-based, pre-registered studies using within-subjects designs required participants to rate how much they respect, like and trust general practitioners (GPs), as well as how competent, assertive, moral, and warm they are, and their commitment to adhere to their advice. After these baseline assessments, participants were presented with a series of vignettes where hypothetical GPs violated (Study 1, N = 329, and Study 2, N = 329) and followed (Study 2 only) recommended communication guidelines. Violations reduced respect for GPs more than liking and liking more than trust. Following communication guidelines increased liking for GPs the most followed by trust and respect the least. Violations of, and following, communication guidelines impacted (reduced/increased, respectively) patients' commitment to treatment adherence via trust, primarily, as well as respect. Summarizing information and checking patients have understood the most important information impacted how GPs were evaluated more than the other tested communication recommendations, suggesting this specific recommendation could be prioritized over the other tested recommendations. Furthermore, by impacting how much patients trust and, to a lesser extent, respect their GP, how committed patients are to following treatment advice could be affected by how GPs communicate with their patients.

The Morality‐Agency‐Communion (MAC) model of respect and liking suggests that traits linked with morality are important for respect and liking; traits related to competence or assertiveness are important for respect and traits related to warmth are important for liking. However, tests of this model have tended not to consider traits related to immorality, incompetence, lack of assertiveness or coldness. This study addressed this issue by utilizing a within‐subjects design in which participants were required to rate their respect and liking for individuals with specific trait types across four categories (moral; competence; assertiveness; and warmth) at three levels (positive, negative and neutral). The central tenets of the MAC model were supported for ‘positive’ traits (morality, competence, assertiveness and warmth). However, for ‘negative’ traits (immorality, incompetence and lack of assertiveness), individuals were similarly not liked and not respected. Individuals who were cold were respected more than liked. The findings of this study extend the MAC model by indicating that the amount that individuals are respected versus liked depends not only on trait type but also whether a trait is positive or negative.

Objective: Job strain has been implicated in a variety of adverse health outcomes, particularly cardiometabolic and inflammatory diseases. However, the mechanisms underlying these effects remain largely unknown. One possibility is that the maladaptive coping response to stress, (perseverative cognition (PC); the cognitive representation of past stressful events (rumination) or feared future events (worry)), either in work or more generally, mediates the relationship between job strain and physical disease. The aim of this study was thus to test the potential role of both general, and work- related PC as a mediating, or potentially moderating, mechanism between job strain and ill- health outcomes. Design & Measures: Using an online cross- sectional design, 650 full- time employees completed measures of job strain, general and work- related PC (rumination & worry) and health outcomes (burnout, somatization, health behaviours & sleep quality). Results: General and work- related worry and rumination significantly mediated, often independently, the relationship between job strain and burnout, somatization, and sleep quality. No significant mediation effects were observed for health behaviours and no type of PC (general or work- related) moderated job strain- health outcome relations. Conclusion: Both general and work- related worry and rumination are likely to play important, and partly independent, roles in understanding the adverse relationships between job strain and various health outcomes.

Worry and rumination (Perseverative Cognition, PC) have been associated with health behaviours, but the underlying mechanisms are unknown. Given the role of physiological experiences on perceived b...

Goal prioritization is a promising strategy for promoting health behavior change. The present research (a) tested whether goal prioritization engenders change in multiple health behaviors, (b) compared the effectiveness of prioritizing one versus two health behavior goals, and (c) assessed whether prioritization compromises the performance of nonprioritized behaviors. Participants (N = 1,802) were randomly allocated to one of two intervention conditions (prioritize one vs. two behaviors) or two no-prioritization, control conditions. Participants in the intervention conditions self-selected the behavior(s) to prioritize from a given set. Goal priority and behavioral performance were assessed 8 weeks later. The prioritization interventions were successful in promoting goal priority and led to significantly greater behavior change compared to both control conditions. Prioritizing two health behavior goals led to increased behavioral performance compared to prioritizing a single goal. Goal prioritization did not lead to a decline in rates of performance of nonprioritized behaviors. The present findings offer new evidence that goal prioritization is effective in promoting health behavior change. Prioritizing health goals engenders behavior change for both one and two focal behaviors and does so without adversely affecting the performance of nonprioritized health behaviors. Further tests of interventions to promote the priority of health goals are warranted. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Traits can primarily facilitate one's own goals (agentic) or those of others (communal) with the former linked with respect and the latter with liking. However, communal traits vary in morality, which has been associated with respect. Four studies tested the impact of traits varying in morality, agency (competence or assertiveness) and communion (warmth) on ratings of respect and liking. Studies 1 and 2 used vignettes targeting integrity (communion‐moral), competency (agency‐competence) and friendliness (communion‐warmth), while Studies 3 and 4 considered a broader range of pre‐rated traits (Studies 3 and 4). Communal traits with a limited moral component were associated more with liking than with respect. Communal traits with a stronger moral component were associated at least as, and sometimes more, strongly with respect than liking. Moral traits were the most respected trait type and were similarly liked as warmth traits. Morality influences whether communal traits primarily influence liking and/or respect.