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Past research has identified that some individuals with intellectual and developmental disabilities who engage in target behavior (e.g., aggression, self-injury) maintained by negative reinforcement engage in the behavior to escape or avoid social interaction specifically (i.e., social avoidance). However, assessment and treatment strategies for this function are understudied when compared to target behavior maintained by other forms of negative reinforcement. The current study builds on this limited research and demonstrates (a) a replication of functional analysis conditions and a negative reinforcement latency assessment to identify the specific types of social interaction that evoke target behavior, and (b) an intervention that includes stimulus fading, social conditioning, and differential reinforcement for five participants with autism spectrum disorder. Participant target behavior decreased within the intervention phase for four out of five participants. The implications of strategies to guide the use of antecedent-based treatment strategies are discussed for target behavior maintained by social avoidance.

Psychological stress induces neuroinflammatory responses, which are associated with the pathogenesis of various psychiatric disorders, such as posttraumatic stress disorder and anxiety. Osthole-a natural coumarin isolated from the seeds of the Chinese herb Cnidium monnieri-exerts anti-inflammatory and antioxidative effects on the central nervous system. However, the therapeutic benefits of osthole against psychiatric disorders remain largely unknown. We previously demonstrated that mice subjected to repeated social defeat stress (RSDS) in the presence of aggressor mice exhibited symptoms of posttraumatic stress disorder, such as social avoidance and anxiety-like behaviors. In this study, we investigated the therapeutic effects of osthole and the underlying molecular mechanisms. Osthole exerted therapeutic effects on cognitive behaviors, mitigating anxiety-like behaviors and social avoidance in a mouse model of RSDS. The anti-inflammatory response induced by the oral administration of osthole was strengthened through the upregulation of heme oxygenase-1 expression. The expression of PPARα was inhibited in mice subjected to RSDS. Nonetheless, osthole treatment reversed the inhibition of PPARα expression. We identified a positive correlation between heme oxygenase-1 expression and PPARα expression in osthole-treated mice. In conclusion, osthole has potential as a Chinese herbal medicine for anxiety disorders. When designing novel drugs for psychiatric disorders, researchers should consider targeting the activation of PPARα., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Chronic social defeat stress (CSDS), a widely used rodent model of stress, reliably leads to decreased social interaction in stress susceptible animals. Here, we investigate a role for fear learning in this response using male 129 Sv/Ev mice, a strain that is more vulnerable to CSDS than the commonly used C57BL/6 strain. We first demonstrate that defeated 129 Sv/Ev mice avoid a CD-1 mouse, but not a conspecific, indicating that motivation to socialize is intact in this strain. CD-1 avoidance is characterized by approach behavior that results in running in the opposite direction, activity that is consistent with a threat response. We next test whether CD-1 avoidance is subject to the same behavioral changes found in traditional models of Pavlovian fear conditioning. We find that associative learning occurs across 10 days CSDS, with defeated mice learning to associate the color of the CD-1 coat with threat. This leads to the gradual acquisition of avoidance behavior, a conditioned response that can be extinguished with 7 days of repeated social interaction testing (5 tests/day). Pairing a CD-1 with a tone leads to second-order conditioning, resulting in avoidance of an enclosure without a social target. Finally, we show that social interaction with a conspecific is a highly variable response in defeated mice that may reflect individual differences in generalization of fear to other social targets. Our data indicate that fear conditioning to a social target is a key component of CSDS, implicating the involvement of fear circuits in social avoidance., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Psychological stress affects the neuroendocrine regulation, which modulates mental status and behaviors. Melatonin, a hormone synthesized primarily by the pineal gland, regulates many brain functions, including circadian rhythms, pain, sleep, and mood. Selective pharmacological melatonin agonist ramelteon has been clinically used to treat mood and sleep disorders. Posttraumatic stress disorder (PTSD) is a psychiatric condition associated with severe trauma; it is generally triggered by traumatic events, which lead to severe anxiety and uncontrollable trauma recall. We recently reported that repeated social defeat stress (RSDS) may induce robust anxiety-like behaviors and social avoidance in mice. In the present study, we investigated whether melatonin receptor activation by melatonin and ramelteon regulates RSDS-induced behavioral changes. Melatonin treatment improved social avoidance and anxiety-like behaviors in RSDS mice. Moreover, treatment of the non-selective MT 1 /MT 2 receptor agonist, ramelteon, markedly ameliorated RSDS-induced social avoidance and anxiety-like behaviors. Moreover, activating melatonin receptors also balanced the expression of monoamine oxidases, glucocorticoid receptors, and endogenous antioxidants in the hippocampus. Taken together, our findings indicate that the activation of both melatonin and ramelteon regulates RSDS-induced anxiety-like behaviors and PTSD symptoms. The current study also showed that the regulatory effects of neuroendocrine mechanisms and cognitive behaviors on melatonin receptor activation in repeated social defeat stress., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024. Published by Elsevier Inc.)

Social avoidance refers to the tendency to be alone and non-participating to social interactions, which is considered to hamper health interpersonal relationship. However, the neural underpinnings of social and emotional interactions among social avoidant individuals have not been fully studied. In the present study, we used EEG hyperscanning technology to investigate the brain activity and its synchronization of 25 socially avoidant dyads and 28 comparison dyads during an emotional communication task. The emotional communication task consisted of the emotional processing stage and emotional interaction stage. Event-related potentials (ERPs) of the senders during the emotional processing stage and the interbrain synchrony (IBS) of the dyads during the emotional interaction stage were analyzed. Results showed that (1) socially avoidant group showed higher beta, theta and gamma IBS in the negative condition than in the positive and neutral condition; (2) in positive condition, the N1 and LPP amplitudes during the emotional processing stage of socially avoidant individuals were negatively correlated with the IBS within dyads during the emotional communication stage. The findings suggest that the dysfunctional emotional interaction of social avoidant individuals may be attributed to the negative impact of emotional stimuli processing during emotional communication., Competing Interests: The authors declare no conflict of interest., (© 2024 The Authors. Published by Elsevier B.V.)

Social avoidance refers to active non-participation in social activities, which is detrimental to healthy interpersonal interaction for emerging adults. Social rejection is a kind of negative social evaluation from others making people feel social pain. However, how socially avoidant emerging adults process social feedback information after experiencing social rejection has received less attention. The current study aimed to explore the differences in social interaction feedback processing after social rejection between a socially avoidant group ( n = 16) and a comparison group ( n = 16) in a human-to-human interaction context. Computer game tasks with two types of interaction (cooperation and competition) were used to record the event-related potentials when receiving social interaction feedback in two conditions (social rejection and control condition). The results showed that (1) the socially avoidant group had lower reward positivity amplitudes than the comparison group when receiving social feedback; (2) the socially avoidant group presented larger P300 amplitudes in the social rejection condition than in the control condition, but the comparison group did not; and (3) social rejection evoked more negative N1 amplitudes in the socially avoidant and comparison groups. The findings suggest that socially avoidant emerging adults may have flaws in reward sensitivity during interpersonal interaction, and they might also exert more attentional and emotional resources to social feedback after social rejection.

Solitude behaviors encompass four types: positive solitude, eccentricity, social avoidance, and loneliness. These four types of solitude behaviors are not entirely independent but can co-occur within individuals. Thus, the purpose of this study was to explore latent classes of solitude behaviors, their developmental patterns, and relevant influencing factors among college students. The Solitude Behavior Scale-Short Version was administered to a sample of college students. A total of 417 Chinese students completed a three-time longitudinal paper questionnaire. The data analysis was performed using Mplus 8.0 and SPSS 26.0. Harman's single-factor test, latent class analysis (LCA), and latent transition analysis (LTA) were employed for subsequent analysis. The results revealed three classes: low solitude, moderate solitude, and high solitude, which exhibited temporal changes. Social avoidance and loneliness could facilitate transitions between high solitude and moderate solitude. Females and first-grade students exhibited higher transition probabilities than males and students not in the first grade. The incidence of moderate solitude in the not-first-grade group was significantly higher than that in the first-grade group. Finally, this study offers new insights into the dynamics of solitude behaviors and their association with gender and age.

Purpose: We aim to explore the relationship between overparenting and social avoidance among emerging adults, and the mediating effects of peer attachment and gender differences., Participants and Methods: A total of 1161 Chinese college students completed the questionnaire. The structural equation model was established to validate the main effect model and the mediation model., Results: The results found that both paternal and maternal overparenting positively predicted social avoidance among emerging adults. Both attachment avoidance and attachment anxiety played a significant mediating role in the relationship between paternal overparenting and social avoidance. Attachment anxiety played a significant mediating role in the relationship between maternal overparenting and social avoidance, while, the mediating effect of attachment avoidance was not significant. In addition, gender differences were found in the mediating effects of peer attachment. The mediating effect of attachment anxiety in males' families had an opposite-gender matching effect, while in females' families, the mediating effect of attachment avoidance had an opposite-gender matching effect., Conclusion: This study contributes to the understanding of the effects of overparenting on emerging adults, enriching empirical research in related fields., Competing Interests: The authors declare that the research was conducted without any commercial or financial relationships that may be construed as a potential conflict of interest., (© 2024 Chen et al.)

The objective of the study is to explore the influence of self-esteem on the happiness levels of college students and the mediating roles of social avoidance and loneliness. 1021 college students between 18 and 24 years of age completed the Self-esteem Scale, General Well-being Scale, Social Avoidance and Distress Scale, UCLA Loneliness Scale and Interpersonal Trust Scale.And descriptive statistical analysis and correlation analysis, structural equation model analysis were conducted. The result turns out that Self-esteem negatively predicted the happiness levels of college students. Self-esteem indirectly predicted happiness through three paths: mediating the roles of social avoidance, mediating the roles of loneliness and the chain-mediated roles of social avoidance and loneliness in college students.Interpersonal Trust moderated the relationship between loneliness and happiness.The higher the self-esteem levels of the college students, the less happiness they experienced.

Objectives: Psychological issues among adolescents represent a prevalent challenge in today's society. The purpose of this study is to explore the associations among moderate-to-vigorous physical activity, self-disclosure, social anxiety, and social avoidance in adolescents. Methods: This study collected cross-sectional data from 427 students in eight provincial key junior and senior high schools in the central China region of three provinces using snowball sampling and convenience sampling from July to August 2023. A structural equation model was employed to investigate the relationship between moderate-to-vigorous physical activity and social avoidance among adolescents. Results: The findings indicate that moderate-to-vigorous physical activity is negatively correlated with social anxiety (standardized coefficient = -0.219, p < 0.001) and positively correlated with self-disclosure (standardized coefficient = 0.454, p < 0.001). Social anxiety is negatively correlated with self-disclosure (standardized coefficient = -0.220, p < 0.001). Social avoidance is positively correlated with social anxiety (standardized coefficient = 0.461, p < 0.001) and negatively correlated with self-disclosure (standardized coefficient = -0.331, p < 0.001). Conclusions: The chain-mediated dual-path model between moderate-to-vigorous physical activity and social avoidance is facilitated by social anxiety and self-disclosure. In other words, adolescents who engage in more moderate to high-intensity physical activities exhibit lower levels of social anxiety, and those who have a stronger inclination for self-disclosure tend to demonstrate lower levels of social avoidance. In light of these findings, it is recommended that the government, society, schools, and families collaborate synergistically to promote the holistic well-being of adolescents and advance the development of a healthier China.

Social avoidance and distress are the primary aspects of social anxiety. Nonautistic people with high levels of autistic traits are more likely to exhibit social avoidance and distress. However, research has yet to reveal how autistic traits induce social avoidance and distress. To fill this gap, the present study recruited 708 participants to complete the 25-item Autism Spectrum Quotient, Social Avoidance and Distress Scale, Chinese Perceived Stress Scale, and Interpersonal Alienation Subscale. The results indicated that autistic traits significantly predicted social avoidance and distress in nonautistic people. In addition, autistic traits induced social avoidance and distress through perceived stress and interpersonal alienation, respectively. Importantly, perceived stress and interpersonal alienation (including the subdimensions of interpersonal alienation: sense of loneliness, sense of social isolation, and alienation between family members) partially mediated the relationships between autistic traits and social avoidance and distress. Overall, autistic traits predict social avoidance and distress via perceived stress and interpersonal alienation. This finding extends the hypothetical model of clinical anxiety in autism spectrum disorders. Furthermore, reducing perceived stress and interpersonal alienation in nonautistic people with high levels of autistic traits may be a valid intervention method to prevent and eliminate their social avoidance and distress., (© 2023 Scandinavian Psychological Associations and John Wiley & Sons Ltd.)

Psoriasis is an autoimmune skin disease that often co-occurs with psychological morbidities such as anxiety and depression, and psychosocial issues also lead psoriasis patients to avoid other people. However, the precise mechanism underlying the comorbidity of psoriasis and anxiety is unknown. Also, whether the social avoidance phenomenon seen in human patients also exists in psoriasis-like animal models remains unknown. In the present study, anxiety-like behaviours and social avoidance-like behaviours were observed in an imiquimod-induced psoriasis-like C57-BL6 mouse model along with typical psoriasis-like dermatitis and itch-like behaviours. The 11.7T resting-state functional magnetic resonance imaging showed differences in brain regions between the model and control group, and voxel-based morphometry showed that the grey matter volume changed in the basal forebrain region, anterior commissure intrabulbar and striatum in the psoriasis-like mice. Seed-based resting state functional connectivity analysis revealed connectivity changes in the amygdala, periaqueductal gray, raphe nuclei and lateral septum. We conclude that the imiquimod-induced psoriasis-like C57-BL6 mouse model is well suited for mechanistic studies and for performing preclinical therapeutic trials for treating anxiety and pathological social avoidance in psoriasis patients., (© 2023 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective: A high symptom burden systemic inflammatory disorder, endometriosis typically entails both medical management and self-management strategies. The COVID-19 pandemic in Australia precipitated changes to healthcare provision, societal restrictions, and negative psychosocial outcomes particularly for those managing chronic illnesses (e.g., endometriosis). This study's objective was to address the following questions: "How have endometriosis self-management strategies changed since the outbreak of COVID-19, and what are the consequences of these changes?", Methods: In total, 21 respondents residing in Australia during the COVID-19 pandemic participated in a semi-structured interview following completion of an online survey advertised by Endometriosis Australia. In the survey, respondents provided demographic and clinical information, and psychological distress was assessed. Interviews were conducted online and recorded for transcribing. Transcribed data were thematically analyzed using the template method., Results: Qualitative analysis identified five themes: i) Maintaining Relationships with Health Professionals, ii) Altered Information Seeking Strategies, iii) More Autonomous Decision Making, iv) Diminished Self-Care and Behaviour Change, and v) Shifted Priorities. Respondents reported disruptions to, and uncertainties within, the healthcare system that precipitated adverse effects upon their ability to manage endometriosis and mental health., Conclusions: These findings suggest that for many, COVID-19-related disruptions to the healthcare system and social isolation adversely impacted their endometriosis self-management. Targeted interventions are needed to address the consequences of these, including providing reliable information to support informed decision-making regarding endometriosis self-management, and assisting with mental health challenges arising from COVID-19-related social isolation., Competing Interests: Declaration of Competing Interest The authors have no competing interests to report., (Copyright © 2023. Published by Elsevier Inc.)

Background: People with essential tremor (ET) can be subject to stigma, and some adopt avoidance behaviors. Characteristics associated with ET stigma and the relationship between perceived stigma and social dysfunction have not been studied., Objectives: To discern predictors of perceived stigma and social dysfunction in ET, and to identify potentially treatable psychological factors associated with social dysfunction., Methods: We surveyed ET patients ( n  = 158) on recalled stigma incidents and social dysfunction related to tremor, as well as clinical and demographic characteristics including tremor severity, and psychological constructs including anxiety, depression, mindfulness, resilience, and narcissism., Results: Worse tremor severity (Standardized beta [SB] 1.4, P  < 0.001) especially among younger participants (interaction of age and tremor severity SB -0.9, P  < 0.001) and presence of vocal tremor (SB 0.7, P  = 0.002) predict perceived stigma. 53/157 (33.8%) participants met criteria for social dysfunction, employing maladaptive avoidance strategies. Scores for perceived stigma (Odds Ratio [OR] 1.2, P  = 0.002), depression (OR 1.5, P  = 0.004) and stigma psychological distress (OR 1.2, P  = 0.001) as well as sex (OR 4.3 for females, P  = 0.045) predicted social dysfunction., Conclusions: Depression and stigma psychological distress contribute to social dysfunction related to ET stigma. Treating these psychological factors may mitigate social avoidance behaviors prevalent among susceptible individuals: those who most perceive ET stigma, i.e. relatively younger patients with worse tremor or with vocal tremor, and in particular females who are more prone to social dysfunction than males with the same degree of perceived stigma., (© 2023 The Authors. Movement Disorders Clinical Practice published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.)

Objectives: This study aimed to explore the moderating role of teacher-child relationships in the relations between social avoidance and social adjustment (i.e., prosocial behavior, peer exclusion, and anxious-fearful behavior) in Chinese migrant preschoolers., Methods: Participants were 148 migrant children aged 4-6 years (82 boys, M age = 6.67) attending kindergartens in Shanghai, People's Republic of China. Mothers reported children's social avoidance, and teachers rated teacher-child relationships and children's social adjustment.SD = 6.67) attending kindergartens in Shanghai, People's Republic of China. Mothers reported children's social avoidance, and teachers rated teacher-child relationships and children's social adjustment., Results: Results indicated that social avoidance was positively related to peer exclusion and negatively related to prosocial behavior. Teacher-child relationships moderated those associations. Specifically, teacher-child closeness buffered the relationship between social avoidance and peer exclusion, whereas teacher-child conflict exacerbated the relations between social avoidance and peer exclusion and anxious-fearful behavior., Conclusion: The current finding informs us of the importance of improving teacher-child closeness and reducing teacher-child conflict to buffer the negative adjustment among socially avoidant young children who migrated from rural-to-urban China. The findings also highlight the importance of considering the meaning and implication of social avoidance for migrant preschoolers in Chinese culture., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Zhu, Yin, Li, Dong, Zou and Li.)

Social stressors negatively impact social function, and this is mediated by the amygdala across species. Social defeat stress is an ethologically relevant social stressor in adult male rats that increases social avoidance, anhedonia, and anxiety-like behaviors. While amygdala manipulations can mitigate the negative effects of social stressors, the impact of social defeat on the basomedial subregion of the amygdala is relatively unclear. Understanding the role of the basomedial amygdala may be especially important, as prior work has demonstrated that it drives physiological responses to stress, including heart-rate related responses to social novelty. In the present study, we quantified the impact of social defeat on social behavior and basomedial amygdala neuronal responses using anesthetized in vivo extracellular electrophysiology in adult male Sprague Dawley rats. Socially defeated rats displayed increased social avoidance behavior towards novel Sprague Dawley conspecifics and reduced time initiating social interactions relative to controls. This effect was most pronounced in rats that displayed defensive, boxing behavior during social defeat sessions. We next found that socially defeated rats showed lower overall basomedial amygdala firing and altered the distribution of neuronal responses relative to the control condition. We separated neurons into low and high Hz firing groups, and neuronal firing was reduced in both low and high Hz groups but in a slightly different manner. This work demonstrates that basomedial amygdala activity is sensitive to social stress, displaying a distinct pattern of social stress-driven activity relative to other amygdala subregions., Competing Interests: Conflict of Interest The authors declare no competing financial interests., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Depression, anxiety, and stress are the main issues that affect the mental health of individuals. Solitude behavior, fear of missing out, and mental health are all closely related., Objective: This study was intended to investigate the relationship between solitude behavior, fear of missing out, and mental health., Methods: Short Form of Solitude Behavior Scale, Fear of Missing Out scale, and Depression Anxiety Stress Scale-21 were employed in this study to investigate 616 college students. The collected data were analyzed using SPSS 26.0 for basic data organization, and Mplus 8.3 was used to complete the analysis of the mediation model., Results: (1) Positive solitude was positively associated with eccentricity and negatively related to loneliness; social avoidance positively correlated with eccentricity and loneliness. (2) Social avoidance and loneliness affected mental health through the mediating effect of fear of missing out, whereas positive solitude and eccentricity did not affect mental health through fear of missing out. Moreover, the results still held in the model with depression, anxiety, and stress as dependent variables., Conclusion: The roles of different solitude behavior in the relationship between fear of missing out and mental health differed. Social avoidance and loneliness as not self-determined solitude could activate the fear of missing out, which could affect mental health., (© 2023. The Author(s).)

Introduction: Mobile phone addiction has a negative impact on the physical and mental health of college students, which has attracted extensive attention from scholars., Methods: In this study, we investigated the mechanism of the influence of self-esteem on mobile phone addiction among 694 college students using the Self-Esteem Scale, the Mobile Phone. Addiction Scale, the Peer Relationship Scale and the Social Avoidance and Distress Scale., Results: The results showed that (1) self-esteem significantly and negatively predicted mobile phone addiction; (2) self-esteem influenced mobile phone addiction through the mediating effect of social avoidance; (3) self-esteem influenced mobile phone addiction through the mediating effect of peer relationships; and (4) social avoidance and peer relationships played a chain mediating role in the influence of self-esteem on mobile phone addiction., Discussion: These findings can help researchers and educators better understand the underlying mechanisms of the relationship between self-esteem and mobile phone addiction and to provide practical and effective operational suggestions for the prevention and intervention of mobile phone addiction among college students., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Chen, Shen, Lv, Wang and Zhu.)

Individuals who are socially avoidant actively remove themselves from opportunities for social interaction and have a strong desire for solitude. Although social avoidance is associated with a host of adjustment difficulties, its neural substrates remain under-explored. To address this gap, we conducted an exploratory study to compare electroencephalography (EEG) frontal alpha asymmetry (FAA) scores during processing emotional facial stimuli in socially avoidant and non-withdrawn comparison individuals. From an original sample of N = 384 undergraduate students, 25 avoidant and 27 comparison individuals were identified. For this subset of participants, EEG modulations and self-reported experience ratings during a picture processing task were assessed. Among the results, the socially avoidant group's ratings of positive stimuli were significantly lower than the non-withdrawn comparison group. The socially avoidant group also had significantly lower FAA scores in response to positive stimuli than the comparison group. Further, asymmetry scores of the comparison group in the positive conditions were higher than in the negative and neutral conditions. However, there were no significant differences between these three conditions in the socially avoidant group. Our results suggest that socially avoidant individuals may eschew interpersonal relationships because of a relatively greater right hemisphere cortical activity, which may contribute to a withdrawal motivation when confronted with negative emotional stimuli in social contexts., Competing Interests: Declarations of interest None., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Objective: Prolonged social withdrawal (PSW) or hikikomori and problematic internet use (PIU) have attracted the attention of mental health experts worldwide. The scientific literature suggests a complex relationship between these conditions and psychotic-like experiences (PLEs) or disorders. In the present cross-sectional study, we tested the role of PIU symptoms as a moderator of the relationship between symptoms of PSW and PLEs in a sample of 238 Italian emerging adults., Method: Data was collected using the 25-item Hikikomori Questionnaire, the Internet Disorder Scale, the Brief Prodromal Questionnaire, and the Brief Symptom Inventory. In addition, lifetime psychological disorders and drug and alcohol use during the last month were explored. No participant reported a lifetime episode of schizophrenia or other psychotic disorder., Results: Symptoms of PSW and PIU were significantly associated with PLEs total distress and PLEs total number of symptoms endorsed, after adjustment for age and symptoms of depression and anxiety. Further, PIU symptoms moderated the relationship between symptoms of PSW and PLEs total distress (b= 2.745, s.e.= 1.089, p= 0.012). However, PIU symptoms did not moderate the relationship between PSW and PLEs total symptoms (b= 0.615, s.e.= 0.349, p= 0.078). This study is limited because the participants were most likely university students and because of the cross-sectional design., Conclusions: Findings from this study partially support the role of high symptoms of PIU as a risk factor in the relationship between symptoms of PSW and PLEs. Future longitudinal research is needed to confirm our findings examining the temporal relationship between PSW, PIU, and PLEs using both dimensional and categorical approaches., Competing Interests: Competing interests: None., (© 2023 Giovanni Fioriti Editore s.r.l.)

Background: Reducing the rate and impact of problematic smartphone use (PSU) among deaf and hard-of-hearing (DHH) students has become a social issue. Research has suggested that perceived discrimination is associated with PSU, although the underlying mechanism of this association for DHH students is not clear., Aims: This study explored the mediating roles of sense of security and social avoidance in the association between perceived discrimination and PSU among Chinese DHH students., Method: Five hundred and seventy DHH students, selected through simple random sampling, participated in an online survey, which included measurements of perceived discrimination, sense of security, social avoidance, and PSU. The results were analyzed with SPSS 25.0 and Mplus 7.0., Results: (1) Perceived discrimination, sense of security, and social avoidance were significantly associated with PSU among DHH students; (2) sense of security and social avoidance played mediating roles separately in the association between perceived discrimination and PSU; (3) sense of security and social avoidance played serial mediating roles in the relationship between perceived discrimination and PSU., Conclusions: The findings suggest that discriminatory experiences of DHH students are related to a relatively low sense of security and high social avoidance, which may lead to PSU. The results have important implications for the prevention of and intervention for PSU among DHH students., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Inflammation can have social consequences, which may be relevant to inflammation's link with depression. The current study tests whether a typhoid vaccine increases feelings of social disconnection and avoidance behavior., Method: In two full-day visits at least three weeks apart, 172 postmenopausal breast cancer survivors (Stage I-IIIA) each received a typhoid capsular polysaccharide vaccination and a saline placebo injection in a random sequence. Blood was drawn prior to the injection, as well as every 90 min thereafter for 8 h to assess the inflammatory response (interleukin-6, IL-6; interleukin-1 receptor antagonist, IL-1Ra). At both visits, women completed the Social Connection Scale at 0 and 8.5 h post-vaccination as well as implicit and explicit social avoidance tasks at 7 h post-vaccination., Results: The typhoid vaccine triggered rises in both inflammatory markers (ps < 0.01), but it did not impact feelings of social connection (p = .32), or performance on the implicit (p = .34) or explicit tasks (p = .37). Inflammatory rises did not predict feelings of social connection (ps > 0.64) or performance on explicit (ps > 0.73) or implicit (ps > 0.88) social avoidance tasks., Conclusion: Milder inflammatory stimuli may not affect social processes. Higher levels of inflammation or, relatedly, more sickness symptoms may be necessary to recapitulate prior findings of social avoidance., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Inc. All rights reserved.)

The present study explored the moderating role of household chaos and gender in the relation between social avoidance and social adjustment among Chinese preschool migrant children. Participants were 148 children (82 boys, M age = 62.63 months, SD = 0.05) from two kindergartens, Shanghai, People's Republic of China. Multi-source assessments included: (1) mother ratings of children's social avoidance; (2) mother ratings of families' household chaos; (3) teacher ratings of children's prosocial behavior, peer exclusion, interpersonal skills, and internalizing problems. Results showed that social avoidance significantly predicted peer exclusion among Chinese migrant preschoolers. Moreover, household chaos moderated the relationship between social avoidance and social adjustment. Specifically, at higher levels of household chaos, social avoidance was negatively associated with interpersonal skills. In contrast, social avoidance was not associated with interpersonal skills at a lower level of household chaos. In addition, social avoidance was positively associated with peer exclusion among boys but not girls. The current findings inform us of the importance of reducing household chaos to buffer the negative adjustment among socially avoidant young children who migrated from rural to urban China. The findings also highlight the need to pay particular attention to migrant socially avoidant boys' development in early childhood and the importance of considering the meaning and implication of social avoidance for migrant preschoolers in Chinese culture.

The excitatory neurons of the medial prefrontal cortex (mPFC) respond to social stimuli. However, little is known about how the neural activity is altered during social avoidance, and whether it could act as a target of low-intensity focused ultrasound stimulation (LIFUS) to rescue social deficits. The present study aimed to investigate the mechanisms of neuronal activities and inflammatory responses underlying the effect of LIFUS on social avoidance. We found that chronic LIFUS stimulation can effectively improve social avoidance in the defeated mice. Calcium imaging recordings by fiber photometry in the defeated mice showed inhibited ensemble activity during social behaviors. LIFUS instantaneously triggered the mPFC neuronal activities, and chronic LIFUS significantly enhanced their neuronal excitation related to social interactions. We further found that the excessive activation of microglial cells and the overexpression of the inflammation signaling, i.e. Toll-like receptors(TLR4)/nuclear factor-kappaB(NF-КB), in mPFC were significantly inhibited by LIFUS. These results suggest that the LIFUS may inhibit social avoidance behavior by reducing activation of the inflammatory response, increasing neuronal excitation, and protecting the integrity of the neuronal structure in the mPFC. Our findings raised the possibility of LIFUS being applied as novel neuromodulation for social avoidance treatment in neuropsychiatric diseases., (© The Author(s) 2022. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Social avoidance has been found to be related to negative social adjustment, yet evidence of the relationship between social avoidance and social adjustment is very limited in suburban preschoolers in China. Moreover, the underlying mechanisms that help to explain the associations between social avoidance and socio-emotional adjustment remain poorly considered. The goal of the present study was to examine the moderating effect of marital conflict in the link between social avoidance and indices of socio-emotional functioning among young children in mainland China. Participants were N = 256 children aged from 49 to 72 months (125 boys, 131 girls, M age  = 59.06 months, SD  = 6.58) attending preschools/kindergartens in suburban areas of Shanghai, People's Republic of China. Multi-source assessments were employed, with mothers reporting marital conflict as well as rating their children's social withdrawal (i.e., social avoidance, shyness, unsociability), and teachers assessing indices of children's socio-emotional functioning at school (i.e., anxious-fearful behavior, peer exclusion, and loneliness). Children were asked about their loneliness. Among the results, social avoidance was positively associated with anxious-fearful behavior, peer exclusion, and loneliness (marginal significance). Moreover, as hypothesized, marital conflict was found to exacerbate the relations between social avoidance and peer exclusion, and loneliness. Results are discussed in terms of the etiology and implications of social avoidance among young children in mainland China., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Zhu, Liu, Shu, Xiang, Jiang and Li.)

Background: We aimed to investigate the effects of aerobic-anaerobic exercise on social avoidance, positive and negative emotions, and self-awareness in obese women as well as provide some basis for guiding them to increase their physical exercise and promote physical and mental health., Methods: Sixty obese women (body mass index≥23 kg/m 2 ) who volunteered to participate in the experiment were selected in Tianjin, China in 2022, and divided into control group and observation group with 30 people in each group. The control group received normal physical training, whereas the observation group received a uniform diet and an aerobic-anaerobic exercise intervention based on normal physical training that lasted for 12 weeks. The changes in the two groups before and after the intervention were compared., Results: After intervention, the body fat rate and fat weight of obese women in the observation group were significantly decreased, the lean body weight and muscle weight were significantly increased, and the improvement of body composition index was better than those in the control group was ( P <0.05). The obese women in the observation group showed lower scores in negative affect and higher scores in positive affect ( P <0.05). The obese women in the observation group showed higher scores in comfort, health assessment, satisfaction of body parts, overweight, gregariousness, anxiety, physical appearance and properties, intelligence, school situation, and behavior, while the observation group received lower scores in social avoidance and social distress., Conclusion: Aerobic-anaerobic exercise has a better role in strengthening the physical exercise and physical and mental development of obese women., Competing Interests: Conflict of interest The authors declare that there is no conflict of interests., (Copyright © 2022 Wang et al. Published by Tehran University of Medical Sciences.)

Background: Social avoidance plays an important role in influencing quality of life among patients with breast cancer. Social avoidance behaviors change with treatment periods. However, the trajectory patterns and the predictive factors have not been fully studied., Objective: This study examined the growth trajectory of social avoidance and its predictors in patients with breast cancer., Materials and Methods: A total of 176 patients with breast cancer in a university hospital in Shaanxi Province, China, were followed up four times over 6 months following surgery, and data from the final 144 patients were analyzed. The growth mixed model (GMM) was used to identify the trajectory categories, and the predictive factors of the trajectory types were analyzed by logistic regression., Results: The best-fit growth mixture modeling revealed three class models: persistent high social avoidance group (Class 1), social avoidance increased first and then decreased group (Class 2), and no social avoidance group (Class 3), accounting for 13.89, 31.94, and 54.17% of patients, respectively. Single-factor analysis showed that family income per capita, residence, and temperament type were related to the social avoidance trajectory. Logistic regression analysis showed that only temperament type was an independent predictor of the social avoidance trajectory, and patients with melancholia were more likely to have persistent high social avoidance., Conclusion: Our study proved the heterogeneity of social avoidance behaviors and the influencing effect of temperament type on the development of social avoidance behaviors in Chinese patients with breast cancer. Health professionals should pay more attention to patients who are at higher risk of developing a persistent social avoidance pattern and provide target interventions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 He, Wu, Yang, He, Yan, Lin, Du, He, Wu and Cao.)

A serious form of social withdrawal, initially described within Japan as hikikomori, has received increasing attention from the international scientific community during the last decade. The 25-item Hikikomori Questionnaire (HQ-25) was initially developed and validated in Japan. To date, data on its psychometric properties in other populations where cases of hikikomori have been described are still scarce. Thus, the aims of this study were to (1) translate, adapt, and validate the Italian version of the HQ-25 analyzing its psychometric properties; and (2) verify the association between hikikomori and personality functioning, social support, and problematic Internet use. A sample of 372 Italian adults aged 18 to 50 years completed the HQ-25 and measures of psychoticism, personality dysfunction, social support, and problematic Internet use were employed to test the convergent validity of the HQ-25. The data showed a satisfactory fit for a three-factor model, significantly better than a one-factor model. The three factors (socialization, isolation, and emotional support, as in the original study on the HQ-25) correlated positively with psychoticism, personality dysfunction, and problematic Internet use, and correlated negatively with social support. A lifetime history of hikikomori was present in 1.1% of the sample ( n = 4). This is the first study to use the Italian validated version of the HQ-25 with an adult population. The findings from this study provide evidence of the satisfactory psychometric properties of the Italian version of the HQ-25 and support further investigation of the HQ-25 as an instrument to help screen for and investigate the presence of hikikomori.

Exposure to psychosocial stress is a risk factor for human diseases such as depression. Social defeat stress (SDS) is a well-known rodent model of human psychosocial stress, and animals exposed to SDS show social avoidance behavior. Fish oil, which is rich in docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA), is expected to decrease the risk of depressive disorders. In this study, we determined whether fish oil affects the social behavior of SDS-exposed mice and measured serotonin levels and expression of genes related to tryptophan (TRP) metabolism in the hippocampus. The experimental animals were fed a diet containing fish oil during SDS exposure. For the fish oil treatment, experimental mice were fed a diet containing fish oil at low (L-FO), middle (M-FO), and high (H-FO) concentrations. The control group was supplemented with an equivalent amount of canola oil (no fish oil: N-FO). After the SDS protocol, we performed a social interaction test and assessed the sociality of experimental mice. In the N-FO group, SDS-exposed mice showed negative social interactions compared with non-stressed mice. The L-FO and H-FO groups showed negative social interactions after SDS exposure; however, the M-FO group did not exhibit negative social behavior. The serotonin levels of SDS-exposed mice were lower than those of non-stressed mice in the N-FO group. In contrast with these results in the N-FO group, there was no difference in serotonin levels between SDS-exposed and non-stressed mice in the FO groups. In addition, the expression of genes related to TRP metabolism in SDS-exposed mice increased in the N-FO group, but not in the FO group. These results suggest that fish oil improves the psychosocial behavioral disorders caused by SDS. This improvement could be explained by the increase in serotonin synthesis in the hippocampus., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Most preclinical research on the effects of stress has been done on male subjects, even though women are more prone than men to experience stress-related problems. Chronic social defeat stress (CSDS) is a rodent model of psychosocial stress. However, this model has been challenged in female mouse studies since neither male nor female resident mice attack intruder females. A female-to-female CSDS model is needed to investigate the physiological and behavioral aspects., Methods: The intruders were either male or female C57BL/6J mice, whereas the residents were male or ovariectomized (OVX) female CD-1 mice. The CD-1 aggressor mice had direct physical contact with the C57BL/6J mice for 10 min before initiating sensory contact with them for 24 h. Jump escape and freezing were evaluated during the social defeat of days 1 and 12. Experimental C57BL/6J mice underwent a social interaction test after suffering social defeat for 12 days., Results: We found that the number of attack bites and attack latency had a significant negative correlation during the selection of aggressors. In the single-housed OVX mice, 34% of mice met the criterion of the selection of aggressors. However, single-housed OVX mice did not show sustained aggressive behavior (eg, attack bites) through the 12-day CSDS. As a result, we did not find susceptible mice during the social interaction test. In contrast, during the selection of aggressors, 42% of OVX mice housed with partners satisfied the criterion and displayed consistently aggressive behavior. CSDS produced susceptible (50%) and resilient (50%) phenotypes during the social interaction test. Notably, male and OVX female CD-1 mice housed with partners had similar amounts of attack bites and attack rates over the 12-day CSDS. Finally, we found that chronically socially defeated male and female mice displayed different coping behaviors (eg, active vs passive) with social defeat., Conclusions: Our study demonstrates that OVX CD-1 mice housed with mates exhibited territorial aggression toward female intruders, producing susceptibility and resilience to social avoidance. Additionally, socially defeated male and female mice displayed different behavioral susceptibility to social defeat., (© The Author(s) 2022.)

Resilience, the ability to overcome stressful conditions, is found in most mammals and varies significantly among individuals. A lack of resilience can lead to the development of neuropsychiatric and sleep disorders, often within the same individual. Despite extensive research into the brain mechanisms causing maladaptive behavioral-responses to stress, it is not clear why some individuals exhibit resilience. To examine if sleep has a determinative role in maladaptive behavioral-response to social stress, we investigated individual variations in resilience using a social-defeat model for male mice. Our results reveal a direct, causal relationship between sleep amount and resilience-demonstrating that sleep increases after social-defeat stress only occur in resilient mice. Further, we found that within the prefrontal cortex, a regulator of maladaptive responses to stress, pre-existing differences in sleep regulation predict resilience. Overall, these results demonstrate that increased NREM sleep, mediated cortically, is an active response to social-defeat stress that plays a determinative role in promoting resilience. They also show that differences in resilience are strongly correlated with inter-individual variability in sleep regulation., Competing Interests: BB, CD, EA, DL, CG, ZQ, AB, HJ, HB, SS, TS, MB, KP, JE No competing interests declared

Background: Previous research has shown that metabotropic glutamate receptor-5 (mGluR5) signaling is significantly involved in social avoidance. We investigated the relationship between levels of social avoidance and mGluR5 availability in drug-naïve young patients with major depressive disorder (MDD)., Methods: Twenty non-smoking patients and eighteen matched non-smoking healthy controls underwent [ 11 C]ABP688 positron emission tomography (PET) and magnetic resonance imaging scans. The binding potential (BP ND ) of [ 11 C]ABP688 was obtained using the simplified reference tissue model. Patients' level of social avoidance was assessed using the Social Avoidance and Distress Scale (SADS). For [ 11 C]ABP688 BP ND , the region-of-interest (ROI)-based between-group comparisons and correlations with SADS scores were investigated. The frontal cortices were chosen as a priori ROIs based on previous PET investigations in MDD, and on literature underscoring the importance of the frontal cortex in social avoidance., Results: Independent samples t -tests revealed no significant differences in [ 11 C]ABP688 BP ND in the frontal cortices between the MDD patient group as a whole and healthy controls. One-way analysis of variance with post-hoc tests revealed significantly lower BP ND in the bilateral superior frontal cortex (SFC) and left middle frontal cortex (MFC) in MDD patients with low levels of social avoidance (L-SADS) than in healthy controls. The L-SADS patients also had significantly lower BP ND in the medial part of the right SFC than both MDD patients with high levels of social avoidance (H-SADS) and healthy controls. The L-SADS patients also showed significantly lower BP ND in the orbital parts of the SFC, MFC, and inferior frontal cortex than H-SADS patients. No significant group differences were found between H-SADS patients and healthy controls. The ROI-based correlation analysis revealed significant positive correlations between social avoidance levels and frontal [ 11 C]ABP688 BP ND in the entire patients., Conclusion: Our exploratory study shows significant differences in frontal mGluR5 availability depending on the level of social avoidance in drug-naïve non-smoking MDD patients, suggesting that social avoidance should be considered as one of the clinical factors involved in mGluR5 signaling changes in depression., Competing Interests: The authors declare no conflicts of interest or financial disclosures for this work., (© 2022 Kim et al.)

Backgrounds: The neural circuit mechanisms underlying depression remain unclear. Recently optogenetics has gradually gained recognition as a novel technique to regulate the activity of neurons with light stimulation. Scientists are now transferring their focus to the function of brain regions and neural circuits in the pathogenic progress of depression. Deciphering the circuitry mechanism of depressive-like behaviors may help us better understand the symptomatology of depression. However, few studies have summarized current progress on optogenetic researches into the neural circuit mechanisms of depressive-like behaviors., Aims: This review aimed to introduce fundamental characteristics and methodologies of optogenetics, as well as how this technique achieves specific neuronal control with spatial and temporal accuracy. We mainly summarized recent progress in neural circuit discoveries in depressive-like behaviors using optogenetics and exhibited the potential of optogenetics as a tool to investigate the mechanism and possible optimization underlying antidepressant treatment such as ketamine and deep brain stimulation., Methods: A systematic review of the literature published in English mainly from 2010 to the present in databases was performed. The selected literature is then categorized and summarized according to their neural circuits and depressive-like behaviors., Conclusions: Many important discoveries have been made utilizing optogenetics. These findings support optogenetics as a powerful and potential tool for studying depression. And our comprehension to the etiology of depression and other psychiatric disorders will also be more thorough with this rapidly developing technique in the near future., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Lin, Du, Xia, Xie, Xiao and Wang.)

Hikikomori is a form of social withdrawal that is commonly described as having an onset during adolescence, a life stage when other psychiatric problems can also emerge. This study aimed to adapt the 25-item Hikikomori Questionnaire (HQ-25) for the Italian adolescent population, examining its psychometric properties; associations between hikikomori and psychoticism, depression, anxiety, problematic internet use (PIU), psychotic-like experiences (PLEs), to confirm convergent validity of the HQ-25; and the interaction effect between symptoms of hikikomori and PIU in predicting PLEs. Two-hundred and twenty-one adolescents participated in the study. Measures included the HQ-25, the Psychoticism subscale of the Personality Inventory for the Diagnostic and Statistical Manual of Mental Disorders, the Depression and Anxiety subscales of the Brief Symptom Inventory, the Internet Disorder Scale, and the Brief Prodromal Questionnaire. Data showed a satisfactory fit for a three-factor model for the HQ-25 that is consistent with the original study on the HQ-25. Three factors (socialization, isolation, and emotional support) were associated with psychopathology measures. Six participants reported lifetime history of hikikomori. Symptoms of hikikomori and PIU did not interact in predicting PLEs. This is the first study to validate the HQ-25 in a population of adolescents. Findings provide initial evidence of the adequate psychometric properties of the Italian version of the HQ-25 for adolescents.

Social anxiety disorder (SAD) is a highly prevalent and comorbid anxiety disorder with rather unclear underlying mechanisms. Here, we aimed to characterize neurobiological changes occurring in mice expressing symptoms of social fear and to identify possible therapeutic targets for SAD. Social fear was induced via social fear conditioning (SFC), a validated animal model of SAD. We assessed the expression levels of the immediate early genes (IEGs) cFos, Fosl2 and Arc as markers of neuronal activity and the expression levels of several genes of the GABAergic, serotoninergic, oxytocinergic, vasopressinergic and neuropeptide Y (NPY)-ergic systems in brain regions involved in social behavior or fear-related behavior in SFC+ and SFC- mice 2 h after exposure to a conspecific. SFC+ mice showed a decreased number and density of cFos-positive cells and decreased expression levels of IEGs in the dorsal hippocampus. SFC+ mice also showed alterations in the expression of NPY and serotonin system-related genes in the paraventricular nucleus of the hypothalamus, basolateral amygdala, septum and dorsal raphe nucleus, but not in the dorsal hippocampus. Our results describe neuronal alterations occurring during the expression of social fear and identify the NPY and serotonergic systems as possible targets in the treatment of SAD.

Relative to other motivations of social withdrawal (i.e., shyness, unsociability), social avoidance is understudied. Furthermore, the relation between social avoidance and externalizing problems seldom has been investigated despite reasons to expect an association. We examined the association between social avoidance and externalizing problems using a sample of early adolescents in the United States using parents' reports (N = 294; 54.1% boys; M age = 12.43 years). Supporting our hypotheses, structural equation models indicated that social avoidance positively predicted concurrent externalizing problems, controlling for shyness, unsociability, and internalizing problems (including depression and anxiety). Findings highlight that socially avoidant adolescents' behaviors may include avoiding others as well as acting out. Longitudinal work is needed to examine the potential bidirectional relations between social avoidance and externalizing problems., (© 2021 Society for Research on Adolescence.)

Objective: Here, we investigated the relationship between social avoidance and depression in college students, explored the mediating roles of loneliness and trust, and the regulatory role of self-esteem, to provide a theoretical intervention approach based on internal mechanisms., Methods: Using a simple random overall sampling method, 1,021 college students were investigated using self-rating depression, social avoidance and distress, loneliness, interpersonal trust and self-esteem scales., Results: There was a significant positive correlation between social avoidance and depression. Loneliness and interpersonal trust played chain-mediating roles between social avoidance and depression. The influence of social avoidance on interpersonal trust was regulated by self-esteem. Specifically, the social avoidance level of the low self-esteem group was more likely to be affected by interpersonal trust issues., Conclusion: Social avoidance not only directly affects college students' depression, it also has indirect effects through interpersonal trust and loneliness. Thus, interpersonal trust and loneliness have chain-mediating effects between social avoidance and depression in college students, and self-esteem regulates the mediation process., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Yuan, Jiang, Wen, Han, Wu, Wang, Ye, Hu, Jeong and Xiang.)

Background: The fact that depression and anxiety are highly prevalent and often co-occur has been well documented. The present study hypothesized that loneliness and interpersonal trust mediate the relationship between depression and social anxiety, with self-esteem playing a moderating role., Methods: 1021 college students completed the interpersonal trust scale (ITS), self-rating depression scale (SDS), UCLA loneliness scale, self-esteem scale (SES), and social avoidance and distress (SAD) scale. And descriptive statistical analysis and correlation analysis, structural equation model analysis were conducted., Results: 1) The correlations between depression, loneliness, interpersonal trust, self-esteem and social avoidance were all statistically significant. 2) Loneliness and interpersonal trust mediated the relationship between depression and social avoidance. 3) Self-esteem moderated the relationship between interpersonal trust and social avoidance. Specifically, compared with individuals who had high self-esteem, social avoidance in those with low self-esteem individuals was more susceptible to the effects of interpersonal trust., Limitations: First, the questionnaire data may be influenced by social approval. Second, most of the participants were college students. Finally, the causal relationship between the variables could not be inferred., Conclusions: The results indicated that loneliness and interpersonal trust played mediating roles between depression and social avoidance, and the relationship between interpersonal trust and social avoidance was moderated by self-esteem. It provides a new way to explain the mechanism of depression, and a new perspective for the clinical intervention of depression, that is, from the perspective of their self-experience and self-esteem., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: Several psychological cofactors of migraine have been identified, but relationships to different headache parameters (e.g., headache frequency vs. headache-related disability) are only incompletely understood., Methods: We cross-sectionally assessed 279 migraine patients at their first presentation at our tertiary headache center. We obtained headache and acute medication frequency, pain intensity, the Migraine Disability Assessment Scale (MIDAS), and the Pain Disability Index (PDI) as headache-related outcomes as well as scores of the Hospital Anxiety and Depression Scale (HADS), the Pain Catastrophizing Scale (PCS), Pain-Related Control Scale (PRCS), and Avoidance Endurance Questionnaire (AEQ) as psychological factors., Results: Linear regression models revealed the highest associations of the psychological factors with the PDI (adjusted R 2  = 0.296, p < 0.001, independent predictors: PCS, AEQ social avoidance, depression) followed by the MIDAS (adjusted R 2  = 0.137, p < 0.001, predictors: depression, AEQ social avoidance) and headache frequency (adjusted R 2  = 0.083, p < 0.001, predictors: depression, AEQ humor/distraction). Principal component analysis corroborated that psychological factors were preferentially associated with the PDI, while the MIDAS loaded together with headache frequency., Conclusion: Our results suggest that psychological factors are more strongly associated with the subjective degree of headache-related disability measured by the PDI than with the days with disability (MIDAS) or the more objective parameter of headache frequency. This once again highlights the need for comprehensive assessment of migraine patients with different headache parameters and the need for considering psychological treatment, especially in patients with high disability., (© 2021. The Author(s).)

Exposure to repeated social stress may cause maladaptive emotional reactions that can be reduced by healthy nutritional supplementation. Histaminergic neurotransmission has a central role in orchestrating specific behavioural responses depending on the homeostatic state of a subject, but it remains to be established if it participates in the protective effects against the insults of chronic stress afforded by a healthy diet. By using C57BL/6J male mice that do not synthesize histamine ( Hdc -/- ) and their wild type ( Hdc ) congeners we evaluated if the histaminergic system participates in the protective action of a diet enriched with polyunsaturated fatty acids and vitamin A on the deleterious effect of chronic stress. Behavioural tests across domains relevant to cognition and anxiety were performed. Hippocampal synaptic plasticity, cytokine expression, hippocampal fatty acids, oxylipins and microbiota composition were also assessed. Chronic stress induced social avoidance, poor recognition memory, affected hippocampal long-term potentiation, changed the microbiota profile, brain cytokines, fatty acid and oxylipins composition of both +/+ ) congeners we evaluated if the histaminergic system participates in the protective action of a diet enriched with polyunsaturated fatty acids and vitamin A on the deleterious effect of chronic stress. Behavioural tests across domains relevant to cognition and anxiety were performed. Hippocampal synaptic plasticity, cytokine expression, hippocampal fatty acids, oxylipins and microbiota composition were also assessed. Chronic stress induced social avoidance, poor recognition memory, affected hippocampal long-term potentiation, changed the microbiota profile, brain cytokines, fatty acid and oxylipins composition of both Hdc -/- and Hdc +/+ mice. Dietary enrichment counteracted stress-induced deficits only in Hdc +/+ mice as histamine deficiency prevented almost all the diet-related beneficial effects. Interpretation : Our results reveal a previously unexplored and novel role for brain histamine as a mediator of many favorable effects of the enriched diet. These data present long-reaching perspectives in the field of nutritional neuropsychopharmacology.

Avoidance of sick individuals is vital to the preservation of one's health and preventing transmission of communicable diseases. To do this successfully, one must identify social cues for sickness, which include sickness behaviors and chemosignals, and use this information to orchestrate social interactions. While many social species are highly capable with this process, the neural mechanisms that provide for social responses to sick individuals are only partially understood. To this end, we used a task in which experimental rats were allowed to investigate two conspecifics, one healthy and one sick. To imitate sickness, one conspecific received the viral mimic Polyinosinic:polycytidylic acid (Poly I:C) and the other saline. In a 5-minute social preference test, experimental male and female adult rats avoided Poly I:C treated adult conspecifics but did not adjust social interaction in response to Poly I:C treated juvenile conspecifics. Seeking a neural locus of this behavior, we inhibited the insular cortex, a region necessary for social behaviors directed toward conspecifics in distress. Insular cortex inactivation via administration of the GABA A agonist muscimol to experimental rats prior to social preference tests eliminated the preference to avoid sick adult conspecifics. These results suggest that some aspect of conspecific illness may be encoded in the insular cortex which is anatomically positioned to coordinate a situationally appropriate social response., (Copyright © 2021 Elsevier B.V. All rights reserved.)

In the phase between ovulation and potential implantation of the egg, and especially during pregnancy, females downregulate their immune system to prevent it from attacking the (future) embryo, which is after all a half-foreign organism. Yet this adaptive mechanism, that is set off by rising progesterone, makes females more vulnerable to pathogens at those critical times. It has been proposed that, to compensate this depression of physiological immunity, progesterone reinforces behavioral immunity-by increasing proneness to disgust and hence active avoidance of infection-but evidence is inconclusive and indirect. Manipulating progesterone directly, a recent, crucial study on female mice's disgust for infected males came up empty handed. Here, reanalyzing these data in a more statistically sensitive manner, we show that progesterone not only raises disgust but does so in a way that is both significant and substantial., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Extant research on the topic of death and dying in modern society frequently includes the observation that death is now rendered invisible, and dying individuals are stigmatized and socially avoided. The current research speculated that lack of contact with a dying individual may promote negative perceptions of the dying, and this may in turn lead to further avoidance of them. Three studies were conducted: The first study examined how frequently the current U.S. participants had social contact with a dying individual; the second study investigated what perceptions they have of the dying, and the third study tested for potential causal links between negative perceptions of the dying and social avoidance of them. The results indicated: Only a small number of the U.S. participants ever had frequent social contact with a dying individual outside their family; they, nevertheless, shared several common negative perceptions of the dying; and those negative perceptions exerted different effects on one's avoidant attitude toward a dying individual-only making males more avoidant, especially in a physically close social relationship. Two concepts, medicalization and masculinism, were suggested as possible explanations for why dying individuals are stigmatized and avoided in modern society.

Ketamine is a popular recreational substance of abuse that induces persistent behavioral deficits. Although disrupted oxytocinergic systems have been considered to modulate vulnerability to developing drugs of abuse, the involvement of central oxytocin in behavioral abnormalities caused by chronic ketamine has remained largely unknown. Herein, we aimed to investigate the potential role of oxytocin in the medial prefrontal cortex (mPFC) in social avoidance and cognitive impairment resulting from repeated ketamine administration in mice. We found that ketamine injection (5 mg/kg, i.p.) for 10 days followed by a 6-day withdrawal period induced behavioral disturbances in social interaction and cognitive performance, as well as reduced oxytocin levels both at the periphery and in the mPFC. Repeated ketamine exposure also inhibited mPFC neuronal activity as measured by a decrease in c-fos-positive cells. Furthermore, direct microinjection of oxytocin into the mPFC reversed the social avoidance and cognitive impairment following chronic ketamine exposure. In addition, oxytocin administration normalized ketamine-induced inflammatory cytokines including TNF-α, IL-6, and IL-1β levels. Moreover, the activation of immune markers such as neutrophils and monocytes, by ketamine was restored in oxytocin-treated mice. Finally, the reversal effects of oxytocin on behavioral performance were blocked by pre-infusion of the oxytocin receptor antagonist atosiban into the mPFC. These results demonstrate that enhancing oxytocin signaling in the mPFC is a potential pathway to reverse social avoidance and cognitive impairment caused by ketamine, partly through inhibition of inflammatory stimulation., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Zhu, Ding, Zhang, Wu, Liu, Zhang, Li, Zhou, Tian and Qin.)

This study examined whether older people with epicenter travel experiences in the event of the novel coronavirus disease epidemic suffered from stigmatization, which in turn affected subsequent behavior, including fear of disclosure and social avoidance. A three-wave survey was conducted using a time-lagged design of older people who had travel experiences in Hubei, China on the eve of the outbreak. Results reveal positive associations between stigmatization and stress, social avoidance, and fear of disclosure, in addition to positive associations between stress and social avoidance and fear of disclosure. Findings thus suggest that the effects of stigmatization on social avoidance and fear of disclosure is mediated, in part, by stress. De-stigmatization and psychological supports should be prioritized for epidemic prevention and control among older people in quarantine.

Adolescence is a developmental period when spending time alone becomes particularly important. The aim of this study was to explore adolescents' experiences of solitude, with a focus on the implications of both spending too much time alone-as well as not enough time alone. Participants were N = 869 adolescents (15-19 years of age, M = 16.14, SD = 0.50), who completed a series of self report measures assessing time spent alone, activities while alone, social motivations (shyness, sociability), affect, and the recently introduced construct of aloneliness (i.e., negative feeling that arise from the perception that one is not getting enough time in solitude). Among the results, person-oriented analyses provided evidence of distinct subgroups of socially withdrawn adolescents (e.g., shy-withdrawn, unsociable, socially avoidant) as well as an alonely group (high aloneliness, low time alone). There was also preliminary support for the notion that solitary activity activities that are intrinsically motivated may be particularly effective at satisfying the need for solitude (and thereby reducing feelings of aloneliness). Taken together, these results highlight the importance of considering the implications of getting both too much-as well as not enough solitude for adolescents' well-being.

Individuals experiencing avoidant personality disorder (AvPD) tend to make sense of social interactions via maladaptive self-and other attributions. They also experience difficulties in recognizing emotions. A further feature of AvPD psychopathology is the tendency to resort to maladaptive coping strategies, such as behavioral avoidance and perfectionism. Despite its impact, psychological treatments for AvPD remains poorly investigated. Herein, we describe the first five sessions of Metacognitive Interpersonal Therapy with a 28-year-old woman, whose treatment goal was to reduce social avoidance. We describe how this goal was achieved through a combination of working through the therapeutic relationship, alongside experiential techniques such as guided imagery, rescripting, and bodily work. Through this treatment configuration, the patient was able to increase self-awareness of her own emotions, enabling her to realize that she was guided by rigid schemas; specifically seeing herself as inadequate and others as judgmental. Finally, implications for the treatment of AvPD are discussed., (© 2021 Wiley Periodicals LLC.)

Background: Loneliness and social avoidance are widespread and serious mental health problems. People experiencing loneliness or social avoidance have difficulties maintaining ordinary life activities and often experience profound suffering. How do we as clinicians deal with or help people out of loneliness and social avoidance?, Aims: In this paper, we introduce the issue on loneliness and social avoidance. We do so by first defining loneliness and social avoidance and outlining the impact on mental health issues of these phenomena. Next, we introduce the six papers central to the special issue along with some thoughts on how to understand therapy and treatment of social avoidance., Discussion: We discuss new directions and how to move beyond more conventional therapeutic approaches to these problems., (© 2021 Wiley Periodicals LLC.)

The present study explored the role of emotion regulation and emotion lability/negativity as a moderator in the relation between child social avoidance and social adjustment (i.e., interpersonal skills, asocial behavior, peer exclusion) in Chinese culture. Participants were N = 194 children (102 boys, 92 girls, M = 70.82 months, SD = 5.40) recruited from nine classrooms in two public kindergartens in Shanghai, People's Republic of China. Multi-source assessments were employed with mothers rating children's social avoidance and teachers rating children's emotion regulation, emotion lability/negativity and social adjustment outcomes. The results indicated that the relations between social avoidance and social adjustment difficulties were more negative among children lower in emotion regulation, but not significant for children with higher emotion regulation. In contrast, the relations between social avoidance and social adjustment difficulties were more positive among children higher in emotion lability/negativity, but not significant for children with lower emotion lability/negativity. This study informs us about how emotion regulation and emotion lability/negativity are jointly associated with socially avoidant children's development. As well, the findings highlight the importance of considering the meaning and implication of social avoidance in Chinese culture. age = 70.82 months, SD = 5.40) recruited from nine classrooms in two public kindergartens in Shanghai, People's Republic of China. Multi-source assessments were employed with mothers rating children's social avoidance and teachers rating children's emotion regulation, emotion lability/negativity and social adjustment outcomes. The results indicated that the relations between social avoidance and social adjustment difficulties were more negative among children lower in emotion regulation, but not significant for children with higher emotion regulation. In contrast, the relations between social avoidance and social adjustment difficulties were more positive among children higher in emotion lability/negativity, but not significant for children with lower emotion lability/negativity. This study informs us about how emotion regulation and emotion lability/negativity are jointly associated with socially avoidant children's development. As well, the findings highlight the importance of considering the meaning and implication of social avoidance in Chinese culture., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Zhu, Xiao, Hipson, Yan, Coplan and Li.)

Background: A chronic social defeat stress (CSDS) model has been proposed as relevant to stress-induced behavioral change in humans. In this study, we examined the effect of Korean Red Ginseng (KRG) on CSDS-induced mood disorders and protein expression in an animal model., Methods: To evaluate the effect of KRG on social defeat stress, test mice were exposed in the resident aggressor's home cage compartment for 14 days beginning 1 h after KRG treatment (10, 20, and 40 mg/kg, per oral (p.o.)). After the exposure, behavioral tests to measure anxiety, social interaction, and depression-like behavior were performed. To investigate the underlying mechanism, N-methyl-D-aspartate receptor expression levels in CSDS-induced mice were evaluated using Western blot analysis., Results: CSDS induced anxiety-like behaviors by decreasing central activity in the open-field test and open-arm approach in the elevated plus maze test and led to social avoidance behavior in the social interaction test. CSDS mice showed upregulated NR1, NR2A, and NR2B expression in the hippocampus. KRG 20 and 40 mg/kg ameliorated anxiety-like activities and KRG 20 mg/kg alleviated social avoidance by decreasing time in the corner zone. KRG treatment recovered CSDS-induced NR1, NR2A, and NR2B protein levels in the hippocampus., Conclusion: These results indicate that KRG has a therapeutic effect on CSDS-induced mood disorder by alleviating N-methyl-D-aspartate receptor overexpression in the hippocampus., Competing Interests: The authors have no conflicting interests to disclose., (© 2019 The Korean Society of Ginseng, Published by Elsevier Korea LLC.)