Environmental and psychopathological predictors of clinical high-risk of psychosis in adolescence

OBJECTIVES

Clinical high-risk of psychosis (CHRp) samples can be heterogeneous, consisting essentially of people with not only psychotic-like experiences but also nonspecific symptoms that may reflect common mental disorders such as depression, anxiety, or substance abuse pathologies. Few studies have attempted to analyze and understand psychosis risk in relation to both environmental (ER) and psychopathological risk (PsR) factors. This study aimed to determine the clinical risk of psychosis in adolescents.

METHODS

A representative sample of 1824 Spanish adolescents from the general population was evaluated using different scales to thoroughly examine the possible interaction of CHRp with various ER and PsR factors. Partial correlations were calculated to assess the relationships between the variables. A series of hierarchical linear regression models were then used to obtain a CHRp predictor model.

RESULTS

The CHRp predictor model indicated that PsR was the most significant determining factor, explaining 22% of the total associated variance of CHRp. However, the ER factor also emerged as a significant predictor of high-risk psychosis (accounting for 9% of the variance).

CONCLUSIONS

A predictive model for CHRp in adolescents was found, in which common psychological problems were presented as more determinant risk factors than ER disruptors. Furthermore, certain transdiagnostic processes, such as psychological inflexibility, may play a central role in the development of mental health problems, including psychosis. Specifying the mechanisms underlying the emergence of CHRp in adolescence is the key to optimizing the focus of preventive therapeutic interventions in these early stages.

Traumatic stress symptoms in civilians after the 2020 Nagorno-Karabakh war: The protective role of self-compassion and emotional intelligence

Exposure to war is linked to negative mental health outcomes. Self-compassion and emotional intelligence may foster post-war adjustment processes differently depending on the time since the event happened. This study examines post-traumatic stress symptoms (PTSS) in civilians exposed to the 2020 Nagorno-Karabakh war shortly after and 6 months post-conflict, while investigating self-compassion and emotional intelligence's protective role. War-exposed civilians self-reported on PTSS, self-compassion, and trait emotional intelligence at two phases. Results showed greater PTSS shortly after war relative to 6 months later. Lower self-compassion scores were related to more PTSS at the first phase, whereas lower emotional intelligence was associated with more symptoms 6 months later. These data show how war-exposed Armenians coped, highlighting individual characteristics' effects, and suggest varying resource utilization during post-war adjustment. Specifically, self-compassion may be a protective factor shortly after war, whereas emotional intelligence may protect individuals against having adverse health outcomes later on.

Academic stress, mindfulness-related skills and mental health in international university students

This study investigated the relationships between academic stress, mindfulness-related constructs (ie, mindfulness, self-compassion and psychological flexibility) and anxiety and depressive symptoms in a sample of 190 international university students. Participants filled in an online questionnaire. Multiple Regression Analyses showed that anxiety and depressive symptoms were significantly related to higher levels of perceived academic stress, and to lower levels of acting with (mindful) awareness, lower self-compassion and lower psychological flexibility. None of the mindfulness-related constructs was found to moderate the relationship between perceived academic stress and anxiety and depressive symptoms. The results provide possible targets for mental health interventions in international university students. Especially the training of mindfulness-related skills could be a promising path.

Effects of a mindfulness-based interventions on stress, burnout in nurses: a systematic review and meta-analysis

Background

Stress in the healthcare environment causes negative effects in nurses such as burnout, anxiety, and depression. The COVID-19 pandemic has resulted in increased pressure on medical staff globally, highlighting the potential benefits of mindfulness-based interventions in reducing nurses' stress levels. Despite numerous studies exploring the effect of mindfulness-based training on nurses, the results remain inconclusive.

Objective

To systematically evaluate the impact of mindfulness training on nurse's performance and increase the certainty of existing evidence.

Methods

This study searched various databases, including EBSCO, Embase, Web of Science, PubMed, ProQuest, Scopus, Cochrane Online Library, Wanfang, SinoMed, CNKI, and VIP, for randomized controlled trials on the impact of mindfulness-based interventions for nurses up until 02 December 2022. Two investigators independently screened and extracted data from the articles, while also assessing the risk of bias. The data was analyzed using RevMan 5.4 software.

Results

This review identified 15 studies out of the 2,171 records retrieved, consisting of a total of 1,165 participants who were randomized. Post-intervention analysis provided very-low certainty evidence of moderate effectiveness of mindfulness-based training in reducing stress [standardized mean difference (SMD) = -0.81; 95% confidence interval (CI) = -1.11 to -0.52], with no significant effect on anxiety (SMD = -0.30; 95% CI = -0.72 to 0.13) or depression (SMD = -0.24; 95% CI = -0.55 to 0.07). However, the training was effective in reducing burnout, as demonstrated by the lower scores for emotional exhaustion (SMD = -4.27; 95% CI = -5.94 to -2.59) and depersonalization (SMD = -2.89; 95% CI = -4.24 to -1.54) and higher scores for personal accomplishment (SMD = 2.81; 95% CI = 0.12 to 5.50). There was a sustained improvement in stress levels in the short-term (≤3 months), with delayed benefits for burnout. However, only two studies were available for later follow-ups, and there was no significant evidence of long-term effects.

Conclusion

Mindfulness-based training may be a viable intervention for improving the psychological wellbeing of nurses, including reducing stress, burnout.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023387081.

Investigating the associations between cognitive appraisals, emotion regulation and symptoms of posttraumatic stress disorder among Asian American and European American trauma survivors

This study investigated whether the associations between emotion regulation and cognitive appraisals and symptoms of posttraumatic stress disorder (PTSD) differ between Asian American and European American trauma survivors. Asian American (n = 103) and European American (n = 104) trauma survivors were recruited through mTurk and completed an on-line questionnaire assessing cognitive appraisals, emotion regulation and PTSD symptomatology. The European American group reported greater trauma-specific rumination, psychological inflexibility, seeking out others for comfort, and negative self-appraisals than the Asian American group. The Asian American group reported greater secondary control appraisals and cultural beliefs about adversity than the European American group. Second, cultural group moderated the associations between (a) brooding rumination, (b) fatalism, (c) self-blame, and (d) negative communal self-appraisals and PTSD symptoms. These associations were larger for the European American group than the Asian American group. Third, there was an indirect pathway from self-construal (independent and interdependent) to PTSD symptoms through certain emotion regulation approaches and cognitive appraisals. Additionally, cultural group was found to moderate several of these indirect effects. These findings highlight the importance of considering cultural background and cultural values in understanding the processes involved in PTSD. Further research in this area is needed.

Early Maladaptive Schemas and Self-Stigma in People with Physical Disabilities: The Role of Self-Compassion and Psychological Flexibility

Self-stigmatizing thoughts may be rooted in one's core beliefs, and in turn be associated with early maladaptive schemas (EMS). Psychological flexibility, an ability to distance and accept one's thoughts, is reported to diminish EMS's effect on well-being, while self-compassion, a mindful attitude towards one's suffering, often reduces self-stigma. The objective of this study was to examine associations between EMS, self-stigma, psychological flexibility and self-compassion in individuals with disabilities, as they are at higher risk of experiencing self-stigma. Participants were 238 persons with disabilities. The Self-Stigma Scale, Young's Schemas Questionnaire, the Self-Compassion Scale Short and the Acceptance and Action-II Questionnaire were used. Hierarchical regression and mediation analysis were used to establish (1) predictors and (2) potential mediators of self-stigma in people with disabilities. Hierarchical regression showed that EMS alone accounted for 39% of the variance explained by self-stigma, and with the addition of psychological flexibility-an additional 2% was explained. Parallel mediation analyses indicated that psychological flexibility partially mediated the relationship between EMS domains and self-stigma. It appears that psychological rigidity is related to self-stigma and should be addressed in treatment through evidence-based approaches such as Schema Therapy and Acceptance and Commitment Therapy to enhance individuals' healthy life patterns, flexibility and self-compassion.

Quality of life in adults with autism spectrum disorder: influence of age, sex, and a controlled, randomized mindfulness-based stress reduction pilot intervention

PURPOSE

Adults with autism spectrum disorder (ASD) consistently report worse functional health and well-being, compared to neurotypical (NT) peers. In a series of studies, we aimed to elucidated the effects of sex, age, and their interaction on health-related quality of life (HRQoL) and evaluated the effectiveness of mindfulness-based stress reduction (MBSR) for improving health-, disability-, and autism-related QoL, with possible sex and age outcome moderators, in adults with ASD.

METHODS

Study 1 used the 36-Item Short Form Survey to compare mental and physical HRQoL composite scores in adults with ASD (n = 67) and matched NT adults (n = 66). Study 2 was a randomized pilot evaluation of the effect of MBSR, compared to an active control intervention with social support and relaxation education (support/education; n = 56), on the World Health Organization QoL BREF, Disability, and Autism-Specific scales in adults with ASD.

RESULTS

In Study 1, we replicated findings that mental HRQoL is worse in both men and women with ASD, compared to NT counterparts, but physical HRQoL is only worse in women with ASD. We present novel findings that older age is associated with better mental HRQoL in women with ASD only. In Study 2, MBSR improved disability-related QoL in adults with ASD over and above the support/education intervention, but both interventions improved mental HRQoL. Lastly, both interventions were more effective for HRQoL improvements in women with ASD.

CONCLUSION

Findings encourage precision medicine approaches tailored to age and sex groups for best HRQoL outcomes in adults with ASD.

CLINICALTRIALS

gov Identifier: NCT04017793.

Experiential avoidance is associated with medical and mental health diagnoses in a national sample of deployed Gulf War veterans

A substantial minority of deployed Gulf War veterans developed posttraumatic stress disorder (PTSD), depression, and several chronic illnesses. Although military combat and exposure to certain nuclear, biological, and chemical agents (NBCs) increase risk for post-deployment health problems, they do not fully explain many Gulf War veteran health diagnoses and are not viable treatment targets. Experiential avoidance (EA; one's unwillingness to remain in contact with unpleasant internal experiences) is a modifiable psychosocial risk factor associated with PTSD and depression in veterans as well as pain and gastrointestinal diseases in the general population. In this study, we recruited a national sample of deployed Gulf War veterans (N = 454) to test the hypothesis that greater EA would be significantly associated with higher lifetime odds of PTSD, depression, "Gulf War Illness" (GWI/CMI), and other chronic illnesses common in this veteran cohort. Participants completed a self-report battery assessing demographic, military-related, and health-related information. Multivariate analyses showed that after adjusting for age, sex, race, combat exposure, and NBC exposure, worse EA was associated with higher lifetime odds of PTSD, depression GWI/CMI, gastrointestinal problems, irritable bowel syndrome, arthritis, fibromyalgia, and chronic fatigue syndrome (ORs ranged 1.25 to 2.89; effect sizes ranged small to large), but not asthma or chronic obstructive pulmonary disease. Our findings suggest medical and mental health providers alike should assess for EA and potentially target EA as part of a comprehensive, biopsychosocial approach to improving Gulf War veterans' health and wellbeing. Study limitations and future research directions are also discussed.

Psychological Flexibility and Self-Compassion as Predictors of Well-Being: Mediating Role of a Balanced Time Perspective

Measures of psychological flexibility and self-compassion are strongly associated with well-being. The aim of the present study was to test the hypothesis that these relationships are mediated by a balanced time perspective, a proposed ideal way of relating to the past, present, and future that may correspond with an ability to flexibly switch temporal focus. For this purpose, a Polish community sample (N = 421) responded to a web-survey including measures of psychological flexibility (AAQ-II), self-compassion (SCS), two measures of positive aspects of well-being (Satisfaction with Life, Quality of Life), and the Zimbardo Time Perspective Inventory (ZTPI). Structural equation models, involving a measure of deviation from a balanced time perspective (DBTP) as a mediator of relationships between latent-level psychological flexibility, self-compassion and well-being factors, were tested. We examined separate models for psychological flexibility and self-compassion and a model including both constructs. The results for separate models were consistent with partial mediation of relationships with well-being, both for psychological flexibility and self-compassion. Results for the analysis involving both constructs, suggested unique contributions of both to DBTP, which in turn predicted well-being, but the link between psychological flexibility and DBTP appeared to be the strongest. In further analyses, three ZTPI dimensions were identified as most critical, namely Past Positive, Present Fatalistic, and Past Negative, each of which were part of an indirect effect on well-being. Psychological flexibility in particular, showed a strong negative association with a Past Negative orientation. Taken together, the results indicate that time perspective is a factor to understand the links between psychological flexibility/self-compassion and well-being. While the results pertaining to self-compassion were consistent with results of a couple of prior studies, this is, to our knowledge, the first demonstration of a link between psychological flexibility and a balanced time perspective. These findings should be relevant for clinical research and practice.

The effect of mindfulness training on burnout syndrome in nursing: A systematic review and meta-analysis

AIM

To analyse the effect of mindfulness training on levels of burnout among nurses.

BACKGROUND

Burnout syndrome is a common occupational hazard for nursing staff. Mindfulness training has been proposed as a valid intervention for burnout.

DESIGN

Systematic review and meta-analysis.

DATA SOURCES

The CINAHL, LILACS, Medline, ProQuest, PsycINFO, Scielo and Scopus databases were consulted, using the search equation 'Nurs * AND burnout AND mindfulness'. There was no restriction on the year of publication.

REVIEW METHODS

Papers were selected for analysis in accordance with the PRISMA guidelines. The meta-analysis was carried out using Review Manager 5.3 software.

RESULTS

The sample was of 17 articles including 632 nurses. Mindfulness training reduces levels of burnout, producing lower scores for emotional exhaustion and depersonalization and higher for personal accomplishment. The differences in the means were 1.32 (95% CI: -9.41-6.78), 1.91 (95% CI: -4.50-0.68) and 2.12 (95% CI: -9.91-14.14), respectively, between the intervention and control groups.

CONCLUSION

Mindfulness training reduces the emotional burden and hence levels of burnout, among nurses. However, further randomized clinical trials are required.

Associations Between Difficulties in Emotion Regulation and Post-Traumatic Stress Disorder in Deployed Service Members of the German Armed Forces

BACKGROUND

Experiencing a traumatic event can lead to post-traumatic stress disorder (PTSD), but not every traumatized person develops PTSD. Several protective and risk factors have been identified in civilians and veterans to explain why some individuals develop PTSD and others do not. However, no research has confirmed the relationship between emotion regulation and PTSD in deployed German Armed Forces service members after a foreign assignment. Previous studies have identified some protective factors, such as social support, social acknowledgment, specific personal values, and posttraumatic growth, as well as risk factors, like moral injury and emotion regulation. Thus, the aim of the present study is to confirm the relationship between emotion regulation and PTSD and to test for factors that are associated with higher severity of PTSD symptoms in such a sample.

METHODS

A post-hoc secondary analysis was conducted on data collected in a randomized controlled trial. Participants (N = 72) were male active and former military service members that have returned from deployment and were recruited from the German Armed Forces. These participants were separated into two groups according to PTSD diagnosis based on the results of a structured diagnostic interview. Data from evaluation questionnaires administered upon entry into the study were subjected to a cross-sectional analysis. The measures included the severity of PTSD symptoms, clusters of PTSD symptoms, clinical measures, and several measures assessing PTSD-related constructs. Analyses included the Spearman rank correlation coefficient, X² tests for nominal data, Mann-Whitney U-tests for non-parametric data, and a mediation analysis.

RESULTS

The results of the mediation analysis revealed that difficulties in emotion regulation were significantly associated with the severity of PTSD symptoms, which was mediated by social acknowledgment and experimental avoidance but not by moral injury. The analyses showed that the severity of PTSD symptoms and all clusters of PTSD symptoms were significantly associated with most of the measured constructs in expectable directions. Participants in the PTSD group showed significantly higher mean scores on questionnaires measuring constructs that have been associated with PTSD, like emotion regulation and moral injury. They also showed lower mean scores in questionnaires for social support and social acknowledgment as a victim or survivor than participants in the non-PTSD group.

CONCLUSION

The present results show that difficulties in emotion regulation are directly associated with the severity of PTSD symptoms in service members of the German Armed Forces. This association is mediated by social acknowledgment and experimental avoidance, but not by moral injury. Thus, future studies should investigate these potentially crucial factors for better understanding of the development and maintenance of PTSD in service members of the German Armed Forces after deployment to create possible treatment adaptions.

CLINICAL TRIAL REGISTRATION

Australian Clinical Trials Registry, identifier ACTRN 12616000956404 http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370924.

A Multisite Randomized Controlled Trial of Mindfulness-Based Stress Reduction in the Treatment of Posttraumatic Stress Disorder

Objective:

Posttraumatic stress disorder (PTSD) is often difficult to treat, and many patients do not achieve full remission. Complementary and integrative health approaches, such as mindfulness meditation, are intended to be integrated with evidence‐based treatment. This study examined the efficacy of mindfulness‐based stress reduction (MBSR) in the treatment of PTSD in U.S. military veterans.

Methods:

Veterans with a diagnosis of PTSD (N=214) were randomly assigned to either 90‐minute group MBSR or present‐centered group therapy (PCGT) for eight weeks. Follow‐up assessments were obtained at baseline and weeks 3, 6, 9 (primary endpoint), and 16.

Results:

Both the MBSR and PCGT groups achieved significant improvement in PTSD as measured by the Clinician‐Administered PTSD Scale for DSM‐IV (CAPS‐IV), with no statistically significant differences between groups. However, compared with PCGT, the MBSR group showed a statistically significant improvement in PTSD on the self‐reported PTSD Checklist for DSM‐IV over the nine weeks. This difference was not maintained posttreatment, at week 16. Strengths of the study include its large sample size, multisite design, active control group, single‐blind outcome ratings, fidelity monitoring, large minority representation, and randomized approach. The study was limited by its high attrition rate and low representation of women.

Conclusions:

Both MBSR and PCGT appear to have beneficial effects in treating PTSD in veterans, with greater improvement observed in self‐reported PTSD symptoms in the MBSR group. No differences between groups were observed on the CAPS‐IV scale.