Large-Scale Online stimulus Norming and Surveys about Perceptions in Healthcare

疼痛可以通过支持患者-提供者关系的人际过程以及与治疗环境相关的背景因素来调节。例如，安慰剂效应反映了社会背景对缓解疼痛的积极影响，而疼痛的健康差异则受到疼痛评估及其治疗中的刻板印象和不公平的影响。在这个项目中，我们调查了美国医疗保健的大规模规范和信念，以及在治疗环境中对人和其他视觉线索的看法如何影响对治疗期间疼痛和其他人感受到的疼痛的预期。该项目使用在线调查方法来衡量大规模规范的信念和期望，从地理，种族和社会经济多样化的美国人口。该项目的目的是调查可能增强或减少临床疼痛的医疗保健信念，这些信念可用于设计实验室研究，以测试操纵这些信念是否有利于疼痛结局。 在过去的一年里，我们在《情感科学》杂志上发表了一篇关于这个项目的文章（Dildine，Amir，Parsons，Atlas，2023）。 先前的研究表明，相对于白色演员，当看到黑人演员的脸时，白色人需要更强烈的表情才能将一张脸标记为痛苦。只不过这些面孔身份不同，都是演员，而且都是男性。因此，我们进行了一项研究，在这项研究中，我们操纵了相同的面部肌肉运动（根据疼痛表达文献确定的动作单位），但将这些动作叠加在不同的身份上。因此，表情是相同的，只是他们被强加的脸不同。我们还决定不仅按种族测量疼痛判断的潜在差异，而且按性别测量，因为女性患者和研究参与者的疼痛耐受性较低，并且与男性患者相比，女性患者和研究参与者接受疼痛治疗的可能性较低，这与黑人和白色个体之间的差异（无论性别如何）相似。我们在2019年至2020年期间完成了三项研究，其中包括一段种族动荡时期，这段时期导致人们对美国种族差异的认识有所提高。在最初的手稿提交之后，我们完成了评论者建议的另外两项研究，将疼痛与基本情绪进行了比较，并测试了我们的计算机产生的刺激是否在个体中普遍存在。我们没有观察到一致的性别或种族偏见的疼痛评估研究的基础上荟萃分析。 然而，我们的第五项研究表明，与其他基本情绪相比，疼痛的评估不那么准确，并且无论情绪如何，相对于白色个体，个体将较低的强度归因于黑色，并且对女性面孔的信心较低，即使面孔显示相同的表情，无论种族或性别如何。事实上，我们没有在所有研究中观察到一致的疼痛评估结果，这可能反映了2020年年中种族差异的变化背景和意识，但也强调了疼痛评估可能比基本情绪评估更受背景影响。 此外，我们还完成了与Joyce Chung博士（OD，前NIMH）的合作工作，该工作测量了COVID-19大流行对身心健康的影响。我们已经使用自然语言处理来评估心理健康与自由回答项目中语言使用之间的关联，并将我们的工作发表在医学互联网研究杂志-心理健康（Weger等人，2022年）。 我们还提交了一篇关于期望和担忧与报告症状之间关系的论文（Akintola等人，已提交），并正在准备提交另外三份手稿。另外还提交了几份关于大流行病期间心理健康问题的合作文件，目前正在审查之中。

Pain can be modulated by interpersonal processes that support the patient-provider relationship, and contextual factors related to the treatment environment. For example, placebo effects reflect the positive influence of social contexts on pain relief, whereas health disparities in pain are subject to stereotypes and inequities in pain assessment and its treatment. In this project, we investigate large-scale norms and beliefs about healthcare in America, and how perceptions of people and other visual cues in the treatment environment influence expectations about pain during treatment and about the pain other people feel. This project uses online survey methodologies to measure large scale normed beliefs and expectations from a geographically, ethnically, and socioeconomically diverse population of Americans. The purpose of this project is to investigate healthcare beliefs that may enhance or diminish pain in the clinic, which can be used to design studies in the laboratory to test if manipulating these beliefs can be advantageous for pain outcomes. In the past year, we published one article from this project in the journal Affective Science (Dildine, Amir, Parsons, Atlas, 2023). Prior research suggests White individuals need stronger expressions before labeling a face as in pain when viewing the face of a Black actor relative to a White actor. However, these faces differed in identity, were actors, and were all male. We therefore ran a study in which we manipulated the same facial muscle movements (with action units determined based on the pain expression literature) but superimposed these on different identities. Therefore the expressions were identical, it was just the face they were imposed on that differed. We also decided to not only measure potential differences in pain judgments by race, but also by sex, since female patients and research participants have lower pain tolerance and are less likely to be treated for pain than male patients, similar to the disparities between Black and White individuals regardless of sex. We completed three studies over the course of 2019-2020, including a period of racial unrest that led to increased awareness of racial disparities in the US. Following initial manuscript submission, we completed two additional studies suggested by reviewers that compared pain with basic emotions and tested whether findings from our computer generated stimuli generalized across individuals. We did not observe consistent gender or racial biases in pain assessment across studies based on meta-analysis. However, our fifth study demonstrated that pain was less accurately assessed than other basic emotions, and that regardless of emotion, individuals attributed lower intensity to Black, relative to White, individuals, and had lower confidence for female faces, even though faces displayed the same expressions regardless of race or gender. The fact that we did not observe consistent findings in pain assessment across the studies may reflect the changing context and awareness of racial disparities in the middle of 2020, but also highlights that pain assessment may be more subject to context than assessment of basic emotion. In addition, we also completed collaborative work with Dr. Joyce Chung (OD, formerly NIMH) that measures the impact of the covid-19 pandemic on mental and physical health. We have used natural language processing to evaluate the association between mental health and language use in a free response item and published our work in the Journal of Medical Internet Research - Mental Health (Weger et al., 2022). We also submitted one paper on the association between expectations and worries and reported symptoms (Akintola et al., Submitted) and are preparing three additional manuscripts for submission. Several additional collaborative papers on the mental health during the pandemic have been submitted and are currently under review.