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Extremely low birth weight (ELBW;1000 g) survivors are exposed to significant perinatal adversity. In many cases, mothers of these infants receive antenatal corticosteroids (ACS), which reduce offspring neonatal mortality but may have lasting neuropsychiatric effects. However, the long-term neurophysiological effects of being born at ELBW and exposed to ACS are unknown.We compared resting frontal electroencephalogram (EEG) alpha asymmetry in ELBW survivors (n = 51), some of whom were exposed to antenatal corticosteroids (ELBW-S; n = 23) versus non-exposed (ELBW-NS; n = 28), and normal birth weight controls (NBW; n = 66) in adulthood (mELBW survivors exhibited greater relative right frontal EEG alpha (11.5 to 13.5 Hz) asymmetry at rest relative to NBW controls. A linear relation was observed between increased exposure to perinatal adversity (NBW vs. ELBW-NS vs. ELBW-S) and greater relative right frontal asymmetry. Relative right frontal asymmetry was also linked to contemporaneous psychopathology in all individuals.In the fourth decade of life, exposure to perinatal adversity was associated with patterns of frontal brain activity that reflect risk for psychopathology. Exposure to additional physiological stresses such as antenatal corticosteroids may amplify these effects.The mental health of ELBW survivors, particularly those exposed to antenatal corticosteroids, should be monitored into adulthood.

Frontal resting electroencephalogram (EEG) asymmetry is an important physiological indicator of emotion regulation, positive/negative emotion, and approach/withdrawal tendencies. The present study examined the relationship of parent-child frontal resting EEG asymmetry patterns and explored the potential moderating role of emotional parenting on such a relationship. We recorded the frontal resting EEG asymmetry of thirty-nine children (M age = 8.87 years) and their primary caregivers (M age = 39.41 years) and coded their emotional parenting behaviors (psychological control and psychological unavailability) based on behavioral observations. The results indicated that there was not a direct association between parent-child frontal resting EEG asymmetry but that the relationship was moderated by parental psychological control. Specifically, the resting frontal EEG asymmetry of the parents was negatively associated with the EEG asymmetry of their children only under higher levels of parental psychological control. However, psychological unavailability did not exhibit a moderating effect. Accordingly, our findings highlight the critical but differential role of emotional parenting behaviors with respect to the association between the frontal resting EEG asymmetry of parents and their children.

Heightened sensitivity to losses, known as loss aversion, is a putative avoidance behaviour, which commonly influences decision-making, particularly in economic scenarios where participants have a 50/50 chance of winning or losing money. Evidence from neuropsychology, EEG and TMS research suggests individual differences in loss aversion may be explained by neural differences in the lateralisation of the right hemisphere. 40 healthy participants underwent an EEG recording during resting state and subsequently performed a behavioural loss aversion task, in which they had an equal chance of winning or losing money. EEG asymmetry in the alpha band at central and posterior sites was associated with individual differences in behavioural loss aversion. This asymmetry was driven by a combination of increased activation in the right hemisphere and decreased activation in the left hemisphere and the site of this asymmetry differed for females and males. These findings are discussed in relation to behavioural avoidance.

Objective Young children with congenital visual impairment (VI) are at increased risk of behavioral vulnerabilities. Studies on ‘at risk’ populations suggest that frontal EEG asymmetry may be associated with behavioral risk. We investigated frontal asymmetry at 1 year (Time 1), behavior at 2 years (Time 2) and their longitudinal associations within a sample of infants with VI. Frontal asymmetry in the VI sample at 1 year was also compared cross-sectionally to an age-matched typically sighted (TS) group. Methods At Time 1, 22 infants with VI and 10 TS infants underwent 128-channel EEG recording. Frontal asymmetry ratios were calculated from power spectral density values in the alpha frequency band. At Time 2, Achenbach Child Behavior Checklist data was obtained for the VI sample. Results 63.6% of the VI sample and 50% of the TS sample showed left frontal asymmetry; no significant difference in frontal asymmetry was found between the two groups. 22.7% of the VI sample had subclinical to clinical range ‘internalizing’ behavior difficulties. Greater left frontal asymmetry at one year was significantly associated with greater emotionally reactive scores at two years within the VI sample ( r = 0.50, p = 0.02). Conclusions Left frontal asymmetry correlates with later behavior risk within this vulnerable population. Significance These findings make an important first contribution regarding the utility of frontal EEG asymmetry as a method to investigate risk in infants with VI.

Asymmetry in cortical activity was tested for short- and long-term stability during the first year of life. Infants (N = 129) completed a total of four laboratory visits: two visits occurred about 1 week apart when infants were 6 months old, and two visits occurred about 1 week apart when infants were 12 months of age. At each laboratory visit, EEG readings were taken during five 1-min, neutral baselines as well as during a negative and a positive emotion-eliciting task. The stability of hemispheric asymmetry was assessed at midfrontal (F3/4, F7/8) and parietal (P3/4) electrode sites. Asymmetry in baseline and fear-eliciting episodes showed moderate short-term stability. Long-term stability was apparent when assessments were composited at 6 months and 12 months. Frontal asymmetry was greater than parietal asymmetry for baseline recordings. There was minimal evidence for stability in asymmetry during positive emotion tasks. Results are discussed with regard to the collection and interpretation of alpha asymmetry measures during infancy.

Repetitive transcranial magnetic stimulation (rTMS) is an effective treatment for depressive disorder, with outcomes approaching 45–55% response and 30–40% remission. Eligible predictors of treatment outcome, however, are still lacking. Few studies have investigated quantitative electroencephalography (QEEG) parameters as predictors of rTMS treatment outcome and none of them have addressed the source localization techniques to predict the response to low-frequency rTMS (LF rTMS). We investigated electrophysiological differences based on scalp EEG data and inverse solution method, exact low-resolution brain electromagnetic tomography (eLORETA), between responders and non-responders to LF rTMS in resting brain activity recorded prior to the treatment. Twenty-five unmedicated depressive patients (mean age of 45.7 years, 20 females) received a 4-week treatment of LF rTMS (1 Hz; 20 sessions per 600 pulses; 100% of the motor threshold) over the right dorsolateral prefrontal cortex. Comparisons between responders (≥50% reduction in Montgomery-Åsberg Depression Rating Scale score) and non-responders were made at baseline for measures of eLORETA current density, spectral absolute power, and inter-hemispheric and intra-hemispheric EEG asymmetry. Responders were found to have lower current source densities in the alpha-2 and beta-1 frequency bands bilaterally (with predominance on the left side) in the inferior, medial, and middle frontal gyrus, precentral gyrus, cingulate gyrus, anterior cingulate, and insula. The most pronounced difference was found in the left middle frontal gyrus for alpha-2 and beta-1 bands (p < 0.05). Using a spectral absolute power analysis, we found a negative correlation between the absolute power in beta and theta frequency bands on the left frontal electrode F7 and the change in depressive symptomatology. None of the selected asymmetries significantly differentiated responders from non-responders in any frequency band. Pre-treatment reduction of alpha-2 and beta-1 sources, but not QEEG asymmetry, was found in patients with major depressive disorder who responded to LF rTMS treatment. Prospective trials with larger groups of subjects are needed to further validate these findings.

Asymmetric patterns of frontal brain electrical activity reflect approach and avoidance tendencies, with stability of relative right activation associated with withdrawal emotions/motivation and left hemisphere activation linked with approach and positive affect. However, considerable shifts in approach/avoidance-related lateralization have been reported for children not targeted because of extreme temperament. In this study, dynamic effects of frontal electroencephalogram (EEG) power within and across hemispheres were examined throughout early childhood. Specifically, EEG indicators at 5, 10, 24, 36, 48, and 72 months-of-age (n = 410) were analyzed via a hybrid of difference score and panel design models, with baseline measures and subsequent time-to-time differences modeled as potentially influencing all subsequent amounts of time-to-time change (i.e., predictively saturated). Infant sex was considered as a moderator of dynamic developmental effects, with temperament attributes measured at 5 months examined as predictors of EEG hemisphere development. Overall, change in left and right frontal EEG power predicted declining subsequent change in the same hemisphere, with effects on the opposing neurobehavioral system enhancing later growth. Infant sex moderated the pattern of within and across-hemisphere effects, wherein for girls more prominent left hemisphere influences on the right hemisphere EEG changes were noted and right hemisphere effects were more salient for boys. Largely similar patterns of temperament prediction were observed for the left and the right EEG power changes, with limited sex differences in links between temperament and growth parameters. Results were interpreted in the context of comparable analyses using parietal power values, which provided evidence for unique frontal effects.

Objective: Asymmetry is a subtle but pervasive aspect of the human brain, and it may be altered in several psychiatric conditions. MRI studies have shown subtle differences of brain anatomy between people with major depressive disorder and healthy control subjects, but few studies have specifically examined brain anatomical asymmetry in relation to this disorder, and results from those studies have remained inconclusive. At the functional level, some electroencephalography studies have indicated left fronto-cortical hypoactivity and right parietal hypoactivity in depressive disorders, so aspects of lateralized anatomy may also be affected. The authors used pooled individual-level data from data sets collected around the world to investigate differences in laterality in measures of cortical thickness, cortical surface area, and subcortical volume between individuals with major depression and healthy control subjects.Methods: The authors investigated differences in the laterality of thickness and surface area measures of 34 cerebral cortical regions in 2,256 individuals with major depression and 3,504 control subjects from 31 separate data sets, and they investigated volume asymmetries of eight subcortical structures in 2,540 individuals with major depression and 4,230 control subjects from 32 data sets. T-1-weighted MRI data were processedwith a single protocol using FreeSurfer and the Desikan-Killiany atlas. The large sample size provided 80% power to detect effects of the order of Cohen's d=0.1.Results: The largest effect size (Cohen's d) of major depression diagnosis was 0.085 for the thickness asymmetry of the superior temporal cortex, which was not significant after adjustment for multiple testing. Asymmetry measures were not significantly associated with medication use, acute compared with remitted status, first episode compared with recurrent status, or age at onset.Conclusions: Altered brain macro-anatomical asymmetry may be of little relevance to major depression etiology in most cases.

Background Antidepressant discontinuation is associated with a high risk of relapse. Robust predictors of relapse risk after antidepressant discontinuation could support clinical decision-making and possibly help reduce long-term prescriptions. Here, we examined whether frontal EEG asymmetry in the alpha band evoked by sad movies might index relapse risk after antidepressant discontinuation. Methods We recruited 35 healthy control subjects and 47 individuals who had achieved stable remission from Major Depressive Disorder while taking antidepressants, and were now intent on discontinuing them. Participants were tested prior to discontinuation and followed up for 6 months after discontinuation to ascertain relapses. All participants underwent EEG recording while viewing sad and neutral movie clips. We compared frontal asymmetry in alpha band power (8-13 Hz) at electrodes F5/F6 during neutral movies vs sad movies. Results Patients with remitted MDD did not differ in sadness-induced frontal asymmetry from healthy controls at electrodes F5/6. However, those who went on to relapse (n=14) after discontinuation did differ significantly from those who remained stable (n=33) over the observation period (p=0.004, Cohen's d'=0.93). Simple thresholding of the F5/6 asymmetry could be used to predict relapse with an accuracy of 83% (AUC 0.71). Conclusions EEG signals from a pair of frontal electrodes during the viewing of sad movies prospectively distinguished those who would and would not go on to relapse after antidepressant discontinuation. This simple procedure has potential to be translated for clinical use and warrants further investigation.

Lateralized asymmetrical activity in the alpha frequency band over the frontal cortex (i.e., frontal alpha asymmetry [FAA]) is robustly related to motivation and emotion. For example, left FAA is related to approach-motivation, positive emotions, and successful emotion regulation whereas right FAA is associated with avoidance-motivation, negative emotions, and poor emotion regulation. This work has been conducted primarily in undergraduates and young adults despite the important of emotion regulation to healthy aging. The current study examined age-related differences in the relationships between emotion regulation strategy usage and resting frontal EEG asymmetry in a sample of middle-aged to older adults. We found that aging was associated with greater right FAA among both those who habitually used maladaptive emotion regulation strategies (i.e., high suppression/low reappraisal) and those who habitually used adaptive emotion regulation strategies (i.e., low suppression/high reappraisal). However, a slopes difference test revealed that aging was more strongly associated with right FAA among those who habitually used maladaptive (vs. adaptive) emotion regulation strategies. These results suggest that the negative consequences of habitually using maladaptive emotion regulation strategies may be more harmful in older adults. This may explain why some researchers have observed that older adults tend to use maladaptive emotion regulation strategies less often. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Although resting right frontal electroencephalogram (EEG) asymmetry has been linked to avoidance and withdrawal-related behaviors such as shyness in previous cross-sectional studies, relatively little research has examined the influence of frontal brain electrical activity on the development of shyness in children using a prospective, longitudinal study design. Here, we tested whether resting frontal EEG asymmetry predicted the trajectory of children’s shyness across five assessments. Children were enrolled in the study during the summer prior to grade 1 (N = 37; Mage = 6.39 years, S.D. = 0.15 years), at which time resting frontal EEG activity and maternal report of children’s shyness were collected. Mothers then reported on their child’s shyness over another four follow-up assessments, spanning 2 years (winter of grade 1, summer prior to grade 2 entry, winter of grade 2, and summer prior to grade 3). Growth curve analysis revealed that children displaying greater relative right frontal EEG activity had lower levels of shyness relative to children exhibiting greater relative left frontal EEG activity at study enrollment (i.e., age 6), but displayed statistically significant linear increases in shyness across time, with the highest levels of shyness by the summer prior to grade 3 (i.e., age 8). There was, however, no relation between left frontal EEG asymmetry and change in shyness across time. These preliminary findings suggest that right frontal EEG asymmetry may reflect a biological diathesis for the growth of shyness during the early school years.

Background Frontal alpha asymmetry (FAA) has frequently been reported as potential discriminator between depressed and healthy individuals, although contradicting results have been published. The aim of the current study was to provide an up to date meta-analysis on the diagnostic value of FAA in major depressive disorder (MDD) and to further investigate discrepancies in a large cross-sectional dataset. Methods SCOPUS database was searched through February 2017. Studies were included if the article reported on both MDD and controls, provided an FAA measure involving EEG electrodes F3/F4, and provided data regarding potential covariates. Hedges' d was calculated from FAA means and standard deviations (SDs). Potential covariates, such as age and gender, were explored. Post hoc analysis was performed to elucidate interindividual differences that could explain interstudy discrepancies. Results 16 studies were included (MDD: n = 1883, controls: n = 2161). After resolving significant heterogeneity by excluding studies, a non-significant Grand Mean effect size (ES) was obtained (d = − 0.007;CI = [− 0.090]–[0.075]). Crosssectional analyses showed a significant three-way interaction for Gender × Age × Depression severity in the depressed group, which was prospectively replicated in an independent sample. Conclusions The main result was a non-significant, negligible ES, demonstrating limited diagnostic value of FAA in MDD. The high degree of heterogeneity across studies indicates covariate influence, as was confirmed by crosssectional analyses, suggesting future studies should address this Gender × Age × Depression severity interaction. Upcoming studies should focus more on prognostic and research domain usages of FAA rather than a pure diagnostic tool., Highlights • The validity of FAA as diagnostic biomarker for depression should be questioned. • A reversed direction of FAA is found in older-aged severely depressed men and women. • Caution is advised regarding EEG recording and processing characteristics.

Frontal electroencephalographic (EEG) alpha asymmetry is widely researched in studies of emotion, motivation, and psychopathology, yet it is a metric that has been quantified and analyzed using diverse procedures, and diversity in procedures muddles cross-study interpretation. The aim of this article is to provide an updated tutorial for EEG alpha asymmetry recording, processing, analysis, and interpretation, with an eye towards improving consistency of results across studies. First, a brief background in alpha asymmetry findings is provided. Then, some guidelines for recording, processing, and analyzing alpha asymmetry are presented with an emphasis on the creation of asymmetry scores, referencing choices, and artifact removal. Processing steps are explained in detail, and references to MATLAB-based toolboxes that are helpful for creating and investigating alpha asymmetry are noted. Then, conceptual challenges and interpretative issues are reviewed, including a discussion of alpha asymmetry as a mediator/moderator of emotion and psychopathology. Finally, the effects of two automated component-based artifact correction algorithms—MARA and ADJUST—on frontal alpha asymmetry are evaluated.

Asymmetry in frontal alpha activation (FAA) has been associated with specific behavior patterns. Greater activation in the left frontal cortex is related to "approach" motivation, while greater activation in the right cortex is associated with "withdrawal" motivation. Moreover, resting FAA is stable over time among adults. This stability has not been demonstrated among adolescents, and the correspondence between resting FAA and personality has been inconsistently observed. The present study examined stability of FAA and the association between resting FAA and behavioral activation among adolescents. At baseline and 4 months, 99 adolescents completed a resting electroencephalogram (EEG) and a pencil-and-paper measure of personality (BIS/BAS). FAA showed good stability over time (Intra-class correlation coefficient=0.65, p

Nature environments have significant benefits for human psychological functioning, in both the cognitive and emotional domains. These positive effects have been found primarily with questionnaires, performance measures, and transient physiological measures. This study explores the long-term relationships between degree of nature exposure and physiological states. With a publically available dataset, multiple hierarchical regressions were conducted testing the relationship between reported nature exposure and two physiological measures of cognition and emotion, including alpha band EEG asymmetry and degree of eyeblink startle reflex (EBR). A significant relationship was found with nature exposure and these measures, suggesting that nature has enduring positive effects for human functioning via measured physiology.

Mindfulness is defined as nonjudgmental attention to experiences in the present moment. Frontal EEG asymmetry can be considered as a biological indicator of affective style. Up to date, most studies examined how mindfulness training influenced frontal EEG asymmetry at resting baseline; however, few studies investigated how mindfulness training influenced frontal EEG asymmetry during emotional challenge. The present study examined simultaneously how mindfulness training influenced frontal EEG asymmetries at resting baseline and during emotional challenge in non-clinical population. In order to test the effect of mindfulness training, the present study tested the mindfulness-based cognitive therapy (MBCT) group (n = 16) and the waitlist control (WC) group (n = 20) at baseline, 4 weeks, and 8 weeks. A testing phase (baseline, 4 weeks, and 8 weeks) × time point (the first sad film phase, relaxation phase, the second sad film phase, and the meditation intervention phase) × group (MBCT and WC), ANOVA was conducted for the tasking EEG data. The results showed that there was significant testing phase × group interactive effect for frontal EEG asymmetry during emotional challenge. Further analysis showed that frontal EEG asymmetry scores at 8 weeks were lower than at baseline and 4 weeks for the MBCT group but not significant differences for the WC group. However, mindfulness training did not influence frontal EEG asymmetry at resting baseline. Therefore, it is concluded that 8 weeks of mindfulness training can enhance left frontal EEG asymmetry during emotional challenge. These results indicated that frontal EEG asymmetry during emotional challenge may be an index of affective style.

Cerebral hemispheres, although similar, are neither completely symmetrical in structure nor equivalent in function. EEG asymmetry studies have been directed more to frequency than to amplitude analysis. Objective Better definition of normal amplitude asymmetry values on the classical EEG frequency bands. Results EEG amplitude asymmetry index (AAI) is physiologically low in normal adults, differences usually lesser than 7%. Conclusion Persistent or intermittent amplitude asymmetry regional differences higher than 7% may be suggestive of pathology after adequate correlation with clinical data and EEG classical visual analysis. RESUMO Os hemisférios cerebrais não são simétricos em morfologia ou funções. Tradicionalmente, os estudos de assimetria do EEG focaram mais na análise de frequências do que na de amplitudes. Objetivo Contribuir para melhor definição dos valores normais de assimetria de amplitudes nas faixas de frequência clássicas do EEG. Resultados O índice de assimetria de amplitudes é fisiologicamente baixo em adultos, usualmente menor do que 7%. Conclusão Se adequadamente correlacionadas aos dados clínicos e à análise visual do EEG, assimetrias persistentes ou intermitentes de amplitude acima de 7% podem ser sugestivas de patologia.

It is well accepted that parent-child interactions are bidirectional by nature, yet not much is known about the psychophysiological activity underlying these interactions. This study examined, during a parent-child interaction, how a child's negativity statistically predicted maternal frontal electroencephalograph (EEG) asymmetry and how a mother's negativity statistically predicted child frontal EEG asymmetry. Thirty-four mother-child dyads participated in the study. Maternal and child behaviors and physiology were measured during a puzzle task. Results indicated that mothers whose children exhibited more challenging behaviors during the dyadic interaction displayed more right (relative to left) asymmetry, as did children whose mothers were high in negativity during the interaction. These findings suggest that mothers and children react to each other's signals not only behaviorally but also physiologically.

Recent research has linked avoidance-oriented motivational states to elevated pro-inflammatory cytokine levels. According to one of many theories regarding the association between avoidance and cytokine levels, because the evolutionarily basic avoidance system may be activated when an organism is threatened or overwhelmed, an associated inflammatory response may be adaptive for dealing with potential injury in such threatening situations. To examine this hypothesis, we tested whether the neural correlate of avoidance motivation associates with baseline levels of the circulating pro-inflammatory cytokine interleukin-6 (IL-6). Controlling for covariates, greater resting neural activity in the right frontal cortex relative to the left frontal cortex-the neural correlate of avoidance motivation-was associated with baseline IL-6. These results thus support the hypothesis that the avoidance motivational system may be closely linked to systemic inflammatory activity.

Previous studies have documented the serotonin transporter linked polymorphic region (5-HTTLPR) as a genetic susceptibility variant that contributes to variability in outcomes related to affective psychopathology, with the short allele associated with negative affectivity and the long allele associated with positive affectivity. In a separate but related line of research, extensive evidence suggests that frontal electroencephalography (EEG) hemispheric asymmetry in the alpha band is also associated with risk for affective psychopathologies, with leftward asymmetry associated with approach-related behavior patterns and rightward frontal EEG asymmetry associated with withdrawn behavioral tendencies. We examined frontal EEG hemispheric asymmetries in relation to 5-HTTLPR genotyping in 70 children between 4 and 6 years of age. Analyses revealed that frontal EEG lateralization interacted with genotype such that children homozygous for the short allele exhibited rightward frontal EEG asymmetries, children who were homozygous for the long allele consistently exhibited a positive pattern of leftward asymmetry, and heterozygotes exhibited equivalent left and right frontal activity. These findings suggest that the 5-HTTLPR short allele may provide a degree of susceptibility for later affective psychopathology in adolescence and adulthood, through mediation of frontal brain activity that is associated with cognitive–behavioral withdrawal tendencies and negative affectivity.

The present study examined the differences in frontal EEG asymmetry during emotion regulation between participants who had different levels of trait mindfulness. EEG recordings were taken from 23 high mindfulness adolescents (Mage = 12.34) and 22 low mindfulness adolescents (Mage = 12.53) during the Reactivity and Regulation-Image Task. The results showed that (1) high mindfulness adolescents had greater left (relative to right) asymmetry than low mindfulness adolescents in down-regulation and up-regulation conditions; however, there was no significant difference in the non-regulation condition; (2) In the up-regulating condition, adolescents showed greater right (relative to left) asymmetry for negative stimuli compared to neutral stimuli; however, there was no significant difference in down-regulation and non-regulation conditions. The results provide neurological evidence that trait mindfulness was highly related to the regulation of emotions and affects how emotions are processed.

Exposure to early adversity is known to shape brain-behavior relations, which in turn can lead to hypersensitivity to threat and an increased risk of developing a range of psychopathologies. To date, much of the work in this area has considered exposure to negative post-natal events (e.g., maltreatment) in shaping these relations in humans. Here we examined the influence of prenatal adversity in the form of a suboptimal intra-uterine environment (i.e., being born at extremely low birth weight; [ELBW i.e.,1000 g]). ELBW babies are the tiniest and most at-risk infants and are known to be at risk for internalizing problems (e.g., depression and anxiety) from childhood through early adulthood. However, we know relatively little about the mechanism(s) underlying this risk. Using the oldest known prospectively followed cohort of ELBW survivors, we examined associations among birth weight status, individual differences in frontal brain electrical activity (EEG) at rest (a marker of affective style) at age 22-26 years, and threat-related biases to angry faces (using the dot probe task) at 30-35 years of age. We found that among ELBW adults, those displaying greater relative right frontal EEG activity at rest exhibited greater vigilance to angry faces than those exhibiting greater relative left frontal EEG activity (n = 34, r = -0.40, p = .02). This pattern was not observed among normal birth weight (NBW) control participants (n = 47, r = .08, p .05). As well, the relation between frontal EEG asymmetry and vigilance to angry faces was stronger for the ELBW group versus the NBW group (z = -2.21, p = .03). These findings suggest that exposure to significant prenatal adversity may have long-term programming effects on biological and cognitive systems associated with emotion regulatory processes in the fourth decade of life. We speculate that these vulnerabilities may contribute to making some ELBW survivors susceptible to psychopathology.