Takaki Fukumori

Background/Objectives: Automatically estimated affective states are increasingly used to monitor mental health, yet such indices are rarely validated against expert clinical judgement of the same recordings. When an automated index fails to match self-report, the source of the failure is ambiguous: the recordings may not contain the relevant signal, or the model may fail to recover a signal that is present. This exploratory study introduced an independent observer standard to separate these possibilities, and examined how expert ratings, brief personality measures and a multimodally estimated stress index each relate to day-to-day self-reported depressive symptoms in school employees without psychiatric diagnosis or treatment contact. Methods: School employees completed daily assessments comprising a fixed three-turn recorded dialogue with a conversational agent followed by the nine-item Patient Health Questionnaire (PHQ-9). Ten participants with baseline trait data and at least four person-days (153 person-days, median 10.5, range 4–44) formed the primary sample; autistic traits (Autism-Spectrum Quotient, AQ) and personality (Japanese Ten Item Personality Inventory, TIPI-J) were measured once at baseline. Three clinicians independently rated 47 recorded sessions from seven participants on Item 1 (Apparent Sadness) of the Montgomery–Åsberg Depression Rating Scale across facial, acoustic, linguistic and overall channels, yielding 41 person-days with a concurrent PHQ-9 and a valid automated index. The index was produced by LightGBM classifiers over speech, facial and linguistic features, trained on binarised PHQ-9/GAD-7 labels from counselling interviews. Associations were tested with permutation-based Spearman correlations, linear mixed models with within-participant permutation tests and cluster bootstrap intervals, and area under the curve (AUC), with false discovery rate (FDR) correction. Results: In the ten-participant trait sample, neuroticism correlated with mean PHQ-9 (ρ = 0.90, q = 0.019) and agreeableness inversely (ρ = −0.84, q = 0.027); both associations persisted when any one participant was omitted. Associations with symptom variability did not survive adjustment for symptom level, to which variability was tightly coupled (ρ = 0.92). In the seven-participant validation subsample, expert ratings of spoken content were associated with same-day PHQ-9 (b = 3.13, cluster bootstrap 95% CI 1.46 to 3.48, permutation p = 0.013) and the association withstood tests for serial dependence, but it was sensitive to which clinicians’ ratings were included, and averaged ratings reached only moderate reliability (ICC(2,3) 0.49–0.56); facial, vocal and overall ratings were not significantly associated. The automated index showed no association with expert ratings after FDR correction (smallest q = 0.22), showed no demonstrable association with concurrent PHQ-9 (withinperson r = 0.08, 95% CI −0.14 to 0.31) and did not discriminate PHQ-9 ≥ 5 above chance (AUC 0.59, 95% CI 0.44–0.77). Only 13.2% of its variance lay between participants, versus 81.3% for PHQ-9. Conclusions: In this small sample, brief personality measures tracked the level of self-reported depressive symptoms, and expert ratings of spoken content were associated with daily symptoms, although the latter association depended on which clinicians’ ratings were included; concurrent validity of the automated index was not demonstrated against either standard. Inspection of the deployed pipeline indicated output saturation arising from a high-sensitivity operating point. Classifier outputs optimised for case detection should not be repurposed as graded severity indices without recalibration. These hypothesis-generating findings require replication in adequately powered samples.

Background: Continuous interaction with patients with cancer is key in the onset of compassion fatigue (CF) among nurses, and cognitive reactions are hypothesized to mediate the relationship between patient interactions and CF. This study develops and evaluates a model addressing traumatic events in patients with cancer, nurses’ cognitive reactions, and professional quality of life, including CF. Methods: A cross-sectional survey was conducted among nurses working at designated cancer hospitals. The Professional Quality of Life Scale was used to measure CF, while items assessing patient traumatic events and nurses’ cognitive reactions were developed based on previous qualitative findings. Structural equation modeling was employed to examine associations among variables. Results: Data from 536 participants were analyzed. Among five event categories, “bad news from doctors” directly affected CF; the others indirectly affected CF, mediated by four subfactors of cognitive reactions: “reconsideration of the meaning of life,” “desire to avoid one’s professional duties,” “sense of professional mission,” and “compassion for patients and their families.” All effects on CF, except “compassion for patients and their families” ( β =-0.357, p = 0.001), were positive. Conclusions: These findings highlight the significance of specific traumatic events experienced by patients and cognitive reactions to these events at the onset of CF among cancer care nurses. Preventing CF is conceivable by targeting nurses’ cognitive reactions—especially thoughts confronting life’s meaning, desire to avoid or escape professional duties, and a sense of mission as a nurse—while promoting compassionate thoughts toward patients and their families.

This study aimed to examine the reliability and validity of the Japanese version of the Chronic Pain Acceptance Questionnaire (CPAQ-8J). A total of 108 outpatients with chronic pain completed the CPAQ-8 questionnaire, along with the Acceptance and Action Questionnaire-II, Hospital Anxiety and Depression Scale, Pain Disability Assessment Scale, Numerical Rating Scale, and EuroQol 5 dimensions 5-level. Confirmatory factor analyses examined the factor structure. Results indicated that the CPAQ-8J comprised a two-component factor structure. Correlations between the CPAQ-8J and each variable were as expected, except between the “pain willingness” subscale and other scales ; thus, the CPAQ-8J had a certain degree of convergent validity. Internal consistency and test-retest reliability suggest that the CPAQ-8J is reliable. The psychometric properties of the CPAQ-8J meet a certain standard ; meanwhile, some issues must be addressed for its practical application. Further research should consider the influence of cultural characteristics in practical application. J. Med. Invest. 70 : 88-93, February, 2023

After the Great East Japan Earthquake (March 11, 2011), the fatigue of relief workers became a major problem in affected areas. In the present study, we conducted a questionnaire survey 2.5 years post-disaster identifying factors related to the fatigue of relief workers. This survey was cross-sectional and participants (N = 119) were relief workers living in affected areas. We used a self-administered questionnaire which included participants’ current problems, sources of strong feeling of loss, psychological distress and compassion fatigue. Based on answers (Yes/No) to the fatigue item, we created 2 groups; a Fatigue-group and a Non-fatigue group. We employed bivariate analysis on items with significant differences between the two groups and entered them into a multivariable logistic regression model. Fifty-seven (48%) reported that they were “very tired” and were assigned to the Fatigue group. The total score of the 6-item Kessler Psychological Distress Scale (K6) and each subscale score (burnout, secondary trauma, and compassion satisfaction) of the Professional Quality of Life measure (Pro-QOL) in the Fatigue group were significantly higher than those in the Non-fatigue group. There were significant differences between the two groups for 11 items relating to current problems and sources of strong feelings of loss, and the following items were extracted as factors related to the fatigue of relief workers: loss of trust in others (adjusted OR, 10.03: 95%CI, 2.30–43.79), no confidence to continue work (adjusted OR, 6.27: 95%CI, 1.72–22.83), loss of important person(s) (adjusted OR, 5.58: 95%CI, 2.05–15.19), and sleep disturbance (adjusted OR, 5.14: 95%CI, 1.93–13.67). Many relief workers who reported fatigue had experienced various losses and current problems. Adequate consideration and care systems for local relief workers with fatigue should be given for a long-period after a disaster and it is important for the workers themselves to continue accepting support from others and maintaining self-care habits.

Objective: Nurses in cancer care are considered to be at risk for compassion fatigue because they are frequently exposed to patients' traumatic experiences. However, only a few effective empirical studies have been conducted in this field, and cognitive factors in particular have not been sufficiently studied. This study aims to describe the components of nurses' cognitive reactions from their exposure to cancer patients' traumatic experience to the onset of compassion fatigue.Methods: In this qualitative study, 30 nurses in cancer care were purposively selected. Data were collected through semistructured interviews and analyzed by using content analysis and the constant comparative method.Results: Forty attributes were identified from 613 statements and classified into 11 categories: sense of professional inadequacy, compassion for patients and their families, desire to support patients and their families, rumination on oneself or one's family, sense of professional mission, dissatisfaction with medical staff, desire to integrate with colleagues, desire to avoid one's duties, conflict between one's belief and reality, reconsideration of the meaning of life, and sense of powerlessness over cancer.Conclusions: This study identified important components of cognitive reactions of nurses who encounter the traumatic experiences of cancer patients in Japan. This information can contribute to the understanding of the onset of compassion fatigue and provide the foundation for nurses in cancer care to avoid and recover from compassion fatigue.