To clarify and quantify the influence of video game violence (VGV) on aggressive behavior, we conducted a metaanalysis of all prospective studies to date that assessed the relation between exposure to VGV and subsequent overt physical aggression. The search strategy identified 24 studies with over 17,000 participants and time lags ranging from 3 months to 4 years. The samples comprised various nationalities and ethnicities with mean ages from 9 to 19 years. For each study we obtained the standardized regression coefficient for the prospective effect of VGV on subsequent aggression, controlling for baseline aggression. VGV was related to aggression using both fixed [β = 0.113, 95% CI = (0.098, 0.128)] and random effects models [β = 0.106 (0.078, 0.134)]. When all available covariates were included, the size of the effect remained significant for both models [β = 0.080 (0.065, 0.094) and β = 0.078 (0.053, 0.102), respectively]. No evidence of publication bias was found. Ethnicity was a statistically significant moderator for the fixed-effects models (P≤ 0.011) but not for the random-effects models. Stratified analyses indicated the effect was largest among Whites, intermediate among Asians, and nonsignificant among Hispanics. Discussion focuses on the implications of such findings for current debates regarding the effects of violent video games on physical aggression.

Character-based video games do more than allow one to practice various kinds of behaviors in a virtual environment, they allow one to practice being a different kind of person. As such, we propose that games can alter self-perceptions of personal characteristics, attitudes, and values with broad consequences for behavior. In a multiwave, longitudinal study of adolescents, we examined the extent to which play of mature-rated, risk-glorifying (MRRG) games was associated with increases in alcohol use, cigarette smoking, aggression, delinquency, and risky sex as a consequence of its effects on personality, attitudes, and affiliations indicative of increased tolerance of deviance. Participants were selected using random digit dial procedures and followed for four years. Data were analyzed using linear mixed modeling to assess change over time and structural equation modeling with latent variables to test hypothesized mediational processes. Among those who play video games, playing MRRG games was associated with increases in all measures of behavioral deviance. Mediational models support the hypothesis that these effects are in part a consequence of the effects of such gameplay on sensation seeking and rebelliousness, attitudes toward deviant behavior in oneself and others, and affiliation with deviant peers. Effects were similar for males and females, and strongest for those who reported heavy play of mature-rated games and games that involved protagonists who represent non-normative and anti-social values. In sum, the current research supports the perspective that MRRG gameplay can have consequences for deviant behavior broadly defined by affecting the personality, attitudes, and values of the player.

Context Little is known about whether early palliative care (EPC) support for family caregivers (CGs) impacts depressive symptoms and grief after care recipients die. Objectives To assess after-death CG depressive symptom and grief scores for early compared to delayed group CGs. Methods We conducted a randomized controlled trial (RCT) (10/2010-9/2013) of an EPC telehealth intervention for CGs (n=123) initiated at the time of care recipients' advanced cancer diagnosis (early group) or 12 weeks later (delayed group) in a rural comprehensive cancer center, affiliated clinics, and a Veterans Administration medical center. The ENABLE [Educate, Nurture, Advise, Before Life Ends] CG intervention consisted of three weekly sessions, monthly follow-up, and a bereavement call. CGs completed the Center for Epidemiological Study-Depression scale (CESD) and the Prigerson Inventory of Complicated Grief-Short Form (PG13) 8-12 weeks after care recipients' deaths. Crude and covariate-adjusted between-group differences were estimated and tested using general linear models. Results For care recipients who died (n=70), 44 CGs (early: n=19; delayed: n=25) completed after-death questionnaires. Mean depressive symptom scores (CESD) for the early group was 14.6 (standard deviation [SD]=10.7) and for the delayed group was 17.6 (SD=11.8). Mean complicated grief scores (PG13) for the early group was 22.7 (SD=4.9) and for the delayed group was 24.9 (SD=6.9). Adjusted between-group differences were not statistically significant (CESD: d=0.07, P=0.88; PG13: d=-0.21, P=0.51). Conclusion CGs' depressive symptom and complicated grief scores 8-12 weeks after care recipients' deaths were not statistically different based on the timing of EPC support. The impact of timing of CG EPC interventions on CGs bereavement outcomes requires further investigation.

We conducted a randomized controlled trial (RCT) of an early palliative care intervention (ENABLE: Educate, Nurture, Advise, Before Life Ends) for persons with advanced cancer and their family caregivers. Not all patient participants had a caregiver coparticipant; hence, we explored whether there were relationships between patient survival, having an enrolled caregiver, and caregiver outcomes prior to death. One hundred and twenty‐three patient‐caregiver dyads and 84 patients without a caregiver coparticipant participated in the ENABLE early versus delayed (12 weeks later) RCT. We collected caregiver quality‐of‐life (QOL), depression, and burden (objective, stress, and demand) measures every 6 weeks for 24 weeks and every 3 months thereafter until the patient's death or study completion. We conducted survival analyses using log‐rank and Cox proportional hazards models. Patients with a caregiver coparticipant had significantly shorter survival (Wald = 4.31, HR = 1.52, CI: 1.02–2.25, P = 0.04). After including caregiver status, marital status (married/unmarried), their interaction, and relevant covariates, caregiver status (Wald = 6.25, HR = 2.62, CI: 1.23–5.59, P = 0.01), being married (Wald = 8.79, HR = 2.92, CI: 1.44–5.91, P = 0.003), and their interaction (Wald = 5.18, HR = 0.35, CI: 0.14–0.87, P = 0.02) were significant predictors of lower patient survival. Lower survival in patients with a caregiver was significantly related to higher caregiver demand burden (Wald = 4.87, CI: 1.01–1.20, P = 0.03) but not caregiver QOL, depression, and objective and stress burden. Advanced cancer patients with caregivers enrolled in a clinical trial had lower survival than patients without caregivers; however, this mortality risk was mostly attributable to higher survival by unmarried patients without caregivers. Higher caregiver demand burden was also associated with decreased patient survival.

Objective Randomized controlled trials (RCTs) of early palliative care interventions in advanced cancer have positively impacted patient survival, yet the mechanisms remain unknown. This secondary analysis of two RCTs assessed whether an early palliative care intervention moderates the relationship between depressive symptoms and survival. Methods The relationships among mood, survival, and early palliative care intervention were studied among 529 advanced cancer patients who participated in two RCTs. The first (N=322) compared intervention vs. usual care. The second (N=207) compared early vs. delayed intervention (12 weeks after enrollment). The interventions included an in-person consultation, weekly nurse coach-facilitated phone sessions, and monthly follow-up. Mood was measured using the Center for Epidemiologic Studies Depression Scale (CES-D). Cox proportional hazard analyses were used to examine the effects of baseline CES-D scores, the intervention, and their interaction on mortality risk while controlling for demographic variables, cancer site, and illness severity. Results The combined sample was 56% male (mean = 64.7 years). Higher baseline CES-D scores were significantly associated with greater mortality risk (HR = 1.042, 95% CI 1.017 to 1.067, p = .001). However, participants with higher CES-D scores who received the intervention had a lower mortality risk (HR = .963, CI 0.933–0.993, p = .018) even when controlling for demographics, cancer site, and illness-related variables. Conclusions This study is the first to demonstrate that patients with advanced cancer who also have depressive symptoms benefit the most from early palliative care. Future research should be devoted to exploring the mechanisms responsible for these relationships.