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Cikrikcili U, Altıntaş H. Comparison of death anxiety symptoms between generalized anxiety disorder and somatization disorder in geriatric patients attending a psychiatric outpatient clinic for the first time. J Psychiatr Res 2024; 176:93-97. [PMID: 38850583 DOI: 10.1016/j.jpsychires.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 04/24/2024] [Accepted: 05/03/2024] [Indexed: 06/10/2024]
Abstract
Somatic complaints are among the important complaints frequently seen in Generalized Anxiety Disorder (GAD) and Somatic Symptom Disorder (SSD). Death anxiety has also increased significantly with the Covid-19 pandemic, especially in the elderly population. In this study, we compared the difference of the death anxiety level among patients with GAD, SSD and healthy controls. This cross-sectional study which was carried out in Artvin State Hospital's Psychiatric Outpatient Clinic included 59 participants (GAD = 21, SSD = 18, HC = 20). Three groups were subjected to detailed psychiatric examination by the same psychiatrist. Subsequently, anxiety, somatic symptoms and death anxiety were assessed using standardized tools (GAD-7, Templer Death Anxiety Scale, Somatic Symptom Scale). The GAD-7 Scale mean of the GAD group was significantly higher than SSD (p = 0.001) and Healthy Control (HC) (p = 0.001) groups. Death anxiety and Somatic Symptom levels in GAD and SSD groups were significantly higher than in healthy controls. (GAD, p = 0.001; SSD, p = 0.001) with no significant difference between GAD and SSD groups (p = 1). Healthy controls exhibited significantly lower scores in the three scales mean scores compared to the SSD and GAD groups (p = 0.001). Irrespective of specific psychiatric diagnoses, these findings highlight elevated death anxiety in the elderly, underscoring the need for tailored mental health interventions.
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Affiliation(s)
- Ugur Cikrikcili
- Otto von Guericke University Institue of Cognitive Neuruology and Dementia Research, Magdeburg, Germany; Deutsche Zentrum Für Neurodegenerative Erkrankungen (DZNE), Magdeburg, Germany.
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2
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Phongsaphakjarukorn N, Kanlayanaphotporn R, Jensen MP, Janwantanakul P. Responsiveness and clinically important differences of the PROMIS short form-depression 8a, anxiety 8a, and PASS-20 in individuals with chronic low back pain. Pain Rep 2024; 9:e1170. [PMID: 38910868 PMCID: PMC11191038 DOI: 10.1097/pr9.0000000000001170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/30/2024] [Accepted: 05/14/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction Depression and anxiety are the most commonly reported mental health conditions. The Patient-Reported Outcomes Measurement Information System Short Form v1.0-Depression 8a (PROMIS-D-8a), Anxiety 8a (PROMIS-Anx8a), and Pain Anxiety Symptoms Scale-20 (PASS-20) measures were designed to assess depression, general anxiety, and pain-related anxiety, respectively. Objectives To examine the responsiveness and estimate the clinically important differences (CIDs) of the Thai version of these measures in individuals with chronic low back pain (CLBP). Methods The study sample comprised 144 participants with CLBP. Responsiveness was evaluated by calculating the change scores, effect sizes (ESs), standardized response means (SRMs), area under the curve (AUC), and correlations between the change scores and associated Global Perceived Effect (GPE). We also estimated CIDs by the difference in mean change score between improved and unchanged groups and standard error of measurement (SEM) for each measure. Results Statistically significant differences in the mean change scores, ESs, and SRMs supported the responsiveness of all measures. The AUCs achieved acceptable discriminatory ability (0.71-0.72) for moderate improvement but not for any improvement (0.65-0.68). The correlations between GPE and change scores on all measures were low (r ranging 0.28-0.33). The estimated CIDs for the PROMIS-D-8a, PROMIS-Anx8a, and PASS-20 were 3.64, 4.20, and 8.80, respectively. Conclusion The PROMIS-D-8a, PROMIS-Anx8a, and PASS-20 measures were sensitive for detecting clinical changes over time in individuals with CLBP. The CID values can be used as reference points for assessing meaningful improvements in the domains assessed by these scales in clinical and research practice.
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Affiliation(s)
| | - Rotsalai Kanlayanaphotporn
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Mark P. Jensen
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Prawit Janwantanakul
- Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
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3
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Emmerich OLM, Wagner B, Heinrichs N, van Noort BM. Lifetime victimization experiences, depressiveness, suicidality, and feelings of loneliness in youth in care. CHILD ABUSE & NEGLECT 2024; 154:106870. [PMID: 38823332 DOI: 10.1016/j.chiabu.2024.106870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 05/14/2024] [Accepted: 05/23/2024] [Indexed: 06/03/2024]
Abstract
BACKGROUND Research has demonstrated the damaging effects of poly-victimization on the mental health of children and adolescents. However, few studies have been conducted in high-risk youth in care (Y-IC) samples. OBJECTIVE The study examines the frequency of lifetime victimization and the association of poly-victimization and victimization types on depressiveness, suicidality, and feelings of loneliness among Y-IC. PARTICIPANTS AND SETTING 164 participants aged 14 and 21 years (M = 17.39, SD = 1.95), who live in family-based care or residential care. METHODS The Juvenile Victimization Questionnaire (JVQ) was used to assess lifetime victimization. The Patient Health Questionnaire (PHQ-9), and the Loneliness Scale-SOEP (LS-S) to measure depressiveness, suicidality, and loneliness. Hierarchical regression models were calculated. RESULTS Participants reported on average 12.66 (SD = 6.58) victimization experiences. The female and diverse gender groups reported higher rates of victimization, loneliness, depressiveness, and suicidality than the males. Participants in residential care reported more victimizations and stronger feelings of loneliness than those in family-based care. Poly-victimization was not associated with any of these internalizing symptoms but peer victimization was significantly associated with depressiveness (β = 0.23, p = .002) and loneliness (β = 0.22, p = .006), sexual victimization with depressiveness (β = 0.22, p = .004). CONCLUSION Y-IC show high levels of victimization and internalizing symptoms, with higher burden on girls and youth living in residential care. Findings underscore the relevance of social exclusion experiences among peers within Y-IC. Interventions should address multiple forms of victimization, with a special focus on sexual and peer victimization.
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Affiliation(s)
| | - Birgit Wagner
- Medical School Berlin, Rüdesheimer Straße 50, 14197 Berlin, Germany.
| | - Nina Heinrichs
- Universität Bielefeld, Universitätsstraße 25, 33615 Bielefeld, Germany.
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Holtan KH, Halvari AEM, Olafsen AH, Øvergård KI, Halvari H. The role of leadership in nurses' wellbeing and performance: A cross-sectional survey using a dual motivational pathway model. J Adv Nurs 2024; 80:3211-3225. [PMID: 38318886 DOI: 10.1111/jan.16084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 11/30/2023] [Accepted: 01/21/2024] [Indexed: 02/07/2024]
Abstract
AIM To examine the positive motivational paths from perceived autonomy-supportive leadership, and the negative motivational paths from perceived controlling leadership to satisfaction and frustration of basic psychological needs, work motivation, work performance, work engagement and somatic symptom burden among nurses using Self-Determination Theory. DESIGN The study used a cross-sectional design mapping nurses' perceptions of the various study variables through a survey. METHODS Nurses working in the municipal healthcare in Norway were recruited through an electronic questionnaire sent out via a link to their emails between 29th of August and 29th of September 2020. Of them, 219 nurses completed the questionnaire. Study hypotheses were tested using structural equation modelling. RESULTS Higher levels of perceived autonomy-supportive leadership were associated with reduced levels of somatic symptom burden and increased levels of work performance and work engagement through the satisfaction of basic psychological needs and autonomous motivation, specifically identified regulation and intrinsic motivation. Perceptions of controlling leadership were associated with heightened levels of somatic symptom burden through basic psychological need frustration, amotivation and introjected motivation, along with lower levels of work engagement through need frustration and amotivation. CONCLUSION This study underscores the positive motivational paths of perceived autonomy-supportive leadership on nurses' work performance and wellbeing through the facilitation of basic psychological need satisfaction and autonomous motivation. Conversely, the study highlights negative motivational paths of perceived controlling leadership on reduced work engagement and heightened ill-being through the basic psychological need frustration, controlled motivation and amotivation. IMPACT This study provides insights and actionable recommendations for nurses and their leaders, emphasizing the significance of understanding the adverse impact associated with perceived controlling leadership. The findings underscore the importance of addressing these issues to mitigate detrimental effects on motivation and overall work functioning. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution.
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Affiliation(s)
| | - Anne Elisabeth Münster Halvari
- Department of Health, Social and Welfare Studies, University of South-Eastern Norway, Borre, Norway
- Oral Health Centre of Expertise in Eastern Norway, Oslo, Norway
| | - Anja Hagen Olafsen
- School of Business, University of South-Eastern Norway, Honefoss, Norway
| | - Kjell Ivar Øvergård
- Department of Health, Social and Welfare Studies, University of South-Eastern Norway, Borre, Norway
| | - Hallgeir Halvari
- School of Business, University of South-Eastern Norway, Honefoss, Norway
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Khazanov GK, Wolk CB, Lorenc E, Candon M, Pieri MF, Oslin DW, Press MJ, Anderson E, Famiglio E, Jager-Hyman S. Change in suicidal ideation, depression, and anxiety following collaborative care in the community. BMC PRIMARY CARE 2024; 25:241. [PMID: 38970006 PMCID: PMC11225270 DOI: 10.1186/s12875-024-02494-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 06/26/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND The Collaborative Care Model (CoCM) increases access to mental health treatment and improves outcomes among patients with mild to moderate psychopathology; however, it is unclear how effective CoCM is for patients with elevated suicide risk. METHODS We examined data from the Penn Integrated Care program, a CoCM program including an intake and referral management center plus traditional CoCM services implemented in primary care clinics within a large, diverse academic medical system. In this community setting, we examined: (1) characteristics of patients with and without suicidal ideation who initiated CoCM, (2) changes in suicidal ideation (Patient Health Questionnaire-9 [PHQ-9] item 9), depression (PHQ-9 total scores), and anxiety (Generalized Anxiety Disorder Scale-7 scores) from the first to last CoCM visit overall and across demographic subgroups, and (3) the relationship between amount of CoCM services provided and degree of symptom reduction. RESULTS From 2018 to 2022, 3,487 patients were referred to CoCM, initiated treatment for at least 15 days, and had completed symptom measures at the first and last visit. Patients were 74% female, 45% Black/African American, and 45% White. The percentage of patients reporting suicidal ideation declined 11%-7% from the first to last visit. Suicidal ideation severity typically improved, and very rarely worsened, during CoCM. Depression and anxiety declined significantly among patients with and without suicidal ideation and across demographic subgroups; however, the magnitude of these declines differed across race, ethnicity, and age. Patients with suicidal ideation at the start of CoCM had higher depression scores than patients without suicidal ideation at the start and end of treatment. Longer CoCM episodes were associated with greater reductions in depression severity. CONCLUSIONS Suicidal ideation, depression, and anxiety declined following CoCM among individuals with suicidal ideation in a community setting. Findings are consistent with emerging evidence from clinical trials suggesting CoCM's potential for increasing access to mental healthcare and improving outcomes among patients at risk for suicide.
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Affiliation(s)
- Gabriela Kattan Khazanov
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Center of Excellence for Substance Addiction Treatment and Education, Corporal Michael J. Crescenz VA Medical Center, 3900 Woodland Avenue, Philadelphia, PA, 19104, USA.
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
| | - Courtney Benjamin Wolk
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Emily Lorenc
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Molly Candon
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Matteo F Pieri
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- School of Medicine and Health Sciences, The George Washington University, Washington, DC, USA
| | - David W Oslin
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Mental Illness Research Education and Clinical Center, Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA, USA
| | - Matthew J Press
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA
| | - Eleanor Anderson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Emilie Famiglio
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Shari Jager-Hyman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Kaur N, Vetter C, Konrad M, Kostev K. Investigation of the Association between Sleep Disorders with Subsequent Depression in Children and Adolescents-A Retrospective Cohort Study with 62,796 Patients. CHILDREN (BASEL, SWITZERLAND) 2024; 11:758. [PMID: 39062208 PMCID: PMC11275199 DOI: 10.3390/children11070758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Revised: 06/08/2024] [Accepted: 06/20/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Poor quality of sleep is a widespread issue in modern society, and even children are being diagnosed with sleep disorders nowadays. Sleep disruption in children can lead to poor mental health in the long term. The present study aimed to evaluate the association between sleep disorders and subsequent depression in children and adolescents. METHODS This retrospective cohort study used electronic medical records from the IQVIATM Disease Analyzer database. It included children and adolescents aged 6-16 with an initial diagnosis of a sleep disorder and age- and gender-matched patients without sleep disorders treated by one of 274 office-based pediatricians in Germany between January 2010 and December 2022. The five-year cumulative incidence of depression in the cohorts with and without sleep disorders was studied with Kaplan-Meier curves using the log-rank test. Multivariable Cox regression analyses were used to assess the association between sleep disorders and depression. RESULTS The present study included 10,466 children and adolescents with and 52,330 without sleep disorder diagnosis (mean age 10 ± 3 years, 48% female). Within five years after the index date, 5% of sleep disorder patients and 2% of the matched non-sleep disorder cohort had been diagnosed with depression. A strong and significant association was observed between sleep disorders and subsequent depression (HR: 2.34; 95% CI: 2.09-2.63). This association was stronger in adolescents (HR: 3.78; 95% CI: 3.13-4.56) than in children. Upon the exclusion of depression diagnoses in the first year after the index date, the association between sleep disorders and depression remained strong and significant (HR: 1.92; 95% CI: 1.68-2.19). CONCLUSIONS This study indicates a strong and significant association between sleep disorders and depression.
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Affiliation(s)
- Nimran Kaur
- Epidemiology, IQVIA, Bangalore 560 103, India
| | - Céline Vetter
- Epidemiology, IQVIA, 60549 Frankfurt am Main, Germany
| | - Marcel Konrad
- Health & Social, FOM University of Applied Sciences for Economics and Management, 60486 Frankfurt am Main, Germany
| | - Karel Kostev
- Epidemiology, IQVIA, 60549 Frankfurt am Main, Germany
- University Clinic, Philipps-University, 35043 Marburg, Germany
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Löwe B, Toussaint A, Rosmalen JGM, Huang WL, Burton C, Weigel A, Levenson JL, Henningsen P. Persistent physical symptoms: definition, genesis, and management. Lancet 2024; 403:2649-2662. [PMID: 38879263 DOI: 10.1016/s0140-6736(24)00623-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/30/2024] [Accepted: 03/22/2024] [Indexed: 08/29/2024]
Abstract
Persistent physical symptoms (synonymous with persistent somatic symptoms) is an umbrella term for distressing somatic complaints that last several months or more, regardless of their cause. These symptoms are associated with substantial disability and represent a major burden for patients, health-care professionals, and society. Persistent physical symptoms can follow infections, injuries, medical diseases, stressful life events, or arise de novo. As symptoms persist, their link to clearly identifiable pathophysiology often weakens, making diagnosis and treatment challenging. Multiple biological and psychosocial risk factors and mechanisms contribute to the persistence of somatic symptoms, including persistent inflammation; epigenetic profiles; immune, metabolic and microbiome dysregulation; early adverse life experiences; depression; illness-related anxiety; dysfunctional symptom expectations; symptom focusing; symptom learning; and avoidance behaviours, with many factors being common across symptoms and diagnoses. Basic care consists of addressing underlying pathophysiology and using person-centred communication techniques with validation, appropriate reassurance, and biopsychosocial explanation. If basic care is insufficient, targeted psychological and pharmacological interventions can be beneficial. A better understanding of the multifactorial persistence of somatic symptoms should lead to more specific, personalised, and mechanism-based treatment, and a reduction in the stigma patients commonly face.
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Affiliation(s)
- Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, Centre for Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
| | - Anne Toussaint
- Department of Psychosomatic Medicine and Psychotherapy, Centre for Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Judith G M Rosmalen
- Department of Psychiatry, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands; Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, Groningen, Netherlands
| | - Wei-Lieh Huang
- Department of Psychiatry, National Taiwan University Hospital Yunlin Branch, Douliu City, Taiwan; Department of Psychiatry, College of Medicine, National Taiwan University, Taipei City, Taiwan
| | - Christopher Burton
- School of Medicine and Population Health, University of Sheffield, Sheffield, UK
| | - Angelika Weigel
- Department of Psychosomatic Medicine and Psychotherapy, Centre for Internal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - James L Levenson
- Department of Psychiatry, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Peter Henningsen
- Department of Psychosomatic Medicine and Psychotherapy, Technical University Munich, Munich, Germany
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Lapi F, Castellini G, Ricca V, Cricelli I, Marconi E, Cricelli C. Development and validation of a prediction score to assess the risk of depression in primary care. J Affect Disord 2024; 355:363-370. [PMID: 38552914 DOI: 10.1016/j.jad.2024.03.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/07/2024]
Abstract
BACKGROUND Major depression is the most frequent psychiatric disorder and primary care is a crucial setting for its early recognition. This study aimed to develop and validate the DEP-HScore as a tool to predict depression risk in primary care and increase awareness and investigation of this condition among General Practitioners (GPs). METHODS The DEP-HScore was developed using data from the Italian Health Search Database (HSD). A cohort of 903,748 patients aged 18 years or older was selected and followed until the occurrence of depression, death or end of data availability (December 2019). Demographics, somatic signs/symptoms and psychiatric/medical comorbidities were entered in a multivariate Cox regression to predict the occurrence of depression. The coefficients formed the DEP-HScore for individual patients. Explained variance (pseudo-R2), discrimination (AUC) and calibration (slope estimating predicted-observed risk relationship) assessed the prediction accuracy. RESULTS The DEP-HScore explained 18.1 % of the variation in occurrence of depression and the discrimination value was equal to 67 %. With an event horizon of three months, the slope and intercept were not significantly different from the ideal calibration. LIMITATIONS The DEP-HScore has not been tested in other settings. Furthermore, the model was characterized by limited calibration performance when the risk of depression was estimated at the 1-year follow-up. CONCLUSIONS The DEP-HScore is reliable tool that could be implemented in primary care settings to evaluate the risk of depression, thus enabling prompt and suitable investigations to verify the presence of this condition.
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Affiliation(s)
- Francesco Lapi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy.
| | - Giovanni Castellini
- Psychiatric Unit, Department of Health Sciences, University of Florence, Italy
| | - Valdo Ricca
- Psychiatric Unit, Department of Health Sciences, University of Florence, Italy
| | | | - Ettore Marconi
- Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy
| | - Claudio Cricelli
- Italian College of General Practitioners and Primary Care, Florence, Italy
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Jankowsky K, Krakau L, Schroeders U, Zwerenz R, Beutel ME. Predicting treatment response using machine learning: A registered report. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2024; 63:137-155. [PMID: 38111213 DOI: 10.1111/bjc.12452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 11/27/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVE Previous research on psychotherapy treatment response has mainly focused on outpatients or clinical trial data which may have low ecological validity regarding naturalistic inpatient samples. To reduce treatment failures by proactively screening for patients at risk of low treatment response, gain more knowledge about risk factors and to evaluate treatments, accurate insights about predictors of treatment response in naturalistic inpatient samples are needed. METHODS We compared the performance of different machine learning algorithms in predicting treatment response, operationalized as a substantial reduction in symptom severity as expressed in the Patient Health Questionnaire Anxiety and Depression Scale. To achieve this goal, we used different sets of variables-(a) demographics, (b) physical indicators, (c) psychological indicators and (d) treatment-related variables-in a naturalistic inpatient sample (N = 723) to specify their joint and unique contribution to treatment success. RESULTS There was a strong link between symptom severity at baseline and post-treatment (R2 = .32). When using all available variables, both machine learning algorithms outperformed the linear regressions and led to an increment in predictive performance of R2 = .12. Treatment-related variables were the most predictive, followed psychological indicators. Physical indicators and demographics were negligible. CONCLUSIONS Treatment response in naturalistic inpatient settings can be predicted to a considerable degree by using baseline indicators. Regularization via machine learning algorithms leads to higher predictive performances as opposed to including nonlinear and interaction effects. Heterogenous aspects of mental health have incremental predictive value and should be considered as prognostic markers when modelling treatment processes.
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Affiliation(s)
| | - Lina Krakau
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | | | - Rüdiger Zwerenz
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
| | - Manfred E Beutel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz, Mainz, Germany
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Smakowski A, Hüsing P, Völcker S, Löwe B, Rosmalen JGM, Shedden-Mora M, Toussaint A. Psychological risk factors of somatic symptom disorder: A systematic review and meta-analysis of cross-sectional and longitudinal studies. J Psychosom Res 2024; 181:111608. [PMID: 38365462 DOI: 10.1016/j.jpsychores.2024.111608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 02/07/2024] [Accepted: 02/10/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVE Current diagnostic concepts of somatic symptom disorder (SSD) in DSM-5 and bodily distress disorder (BDD) in ICD-11 require certain psychological criteria, but researchers have called for further specification. Therefore, in a first step, this systematic review and meta-analysis aimed to summarize the current evidence on psychological factors associated with SSD/BDD and/or disorder-relevant clinical outcomes such as symptom severity and impairment. METHODS Psychological factors were systematically searched using Pubmed, Cochrane Library and Psycinfo via EBSCO. Studies providing original data in English or German, after 2009 were included. Cross-sectional, cohort and case-control studies investigating at least one psychological factor in individuals with SSD/BDD in the context of disorder-relevant outcomes were included. RESULTS Forty-three eligible studies (n = 3760 patients) in SSD (none in BDD) provided data on at least one psychological factor, 37 in case-control format, 10 cross-sectional and 5 longitudinal. Meta-analyses of the case-control studies found patients with SSD to be more impaired by depression (SMD = 1.80), anxiety (SMD = 1.55), health anxiety (SMD = 1.31) and alexithymia (SMD = 1.39), compared to healthy controls. Longitudinal results are scarce, mixed, and require refining, individual studies suggest self-concept of bodily weakness, anxiety and depression to be predictive for persistent SSD and physical functioning. CONCLUSION This review provides a detailed overview of the current evidence of psychological factors in relation to SSD/BDD. Future studies on SSD and BDD should include under-studied psychological factors, such as negative affect, fear avoidance, or emotion regulation. More longitudinal studies are needed to assess the predictive value of these factors.
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Affiliation(s)
- Abigail Smakowski
- University Medical Center Hamburg-Eppendorf, Department of Psychosomatic Medicine and Psychotherapy, Hamburg, Germany.
| | - Paul Hüsing
- University Medical Center Hamburg-Eppendorf, Department of Psychosomatic Medicine and Psychotherapy, Hamburg, Germany
| | - Sophia Völcker
- Medical School Hamburg, Department of Psychology, Hamburg, Germany
| | - Bernd Löwe
- University Medical Center Hamburg-Eppendorf, Department of Psychosomatic Medicine and Psychotherapy, Hamburg, Germany
| | - Judith G M Rosmalen
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), Netherlands
| | - Meike Shedden-Mora
- University Medical Center Hamburg-Eppendorf, Department of Psychosomatic Medicine and Psychotherapy, Hamburg, Germany; Medical School Hamburg, Department of Psychology, Hamburg, Germany
| | - Anne Toussaint
- University Medical Center Hamburg-Eppendorf, Department of Psychosomatic Medicine and Psychotherapy, Hamburg, Germany.
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11
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Gibson KA, Kaplan RM, Pincus T, Li T, Luta G. PROMIS-29 in rheumatoid arthritis patients who screen positive or negative for fibromyalgia on MDHAQ FAST4 (fibromyalgia assessment screening tool) or 2011 fibromyalgia criteria. Semin Arthritis Rheum 2024; 66:152361. [PMID: 38360468 DOI: 10.1016/j.semarthrit.2024.152361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 12/11/2023] [Accepted: 01/03/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND PROMIS-29 T-scores query health-related quality of life (HRQL) in 7 domains, physical function, pain, fatigue, anxiety, depression, sleep quality, and social participation, to establish population norms. An MDHAQ (multidimensional health assessment questionnaire) scores these 7 domains and includes medical information such as a FAST4 (fibromyalgia assessment screening tool) index. We analyzed PROMIS-29 T-scores in rheumatoid arthritis (RA) patients vs population norms and for positive vs negative fibromyalgia (FM) screens and compared PROMIS-29 T-scores to MDHAQ scores to assess HRQL. METHODS A cross-sectional study was performed at one routine visit of 213 RA patients, who completed MDHAQ, PROMIS-29, and reference 2011 FM Criteria. PROMIS-29 T-scores were compared in RA vs population norms and in FM+ vs FM- RA patients, based on MDHAQ/FAST4 and reference criteria. Possible associations between PROMIS-29 T-scores and corresponding MDHAQ scores were analyzed using Spearman correlations and multiple regressions. RESULTS Median PROMIS-29 T-scores indicated clinically and statistically significantly poorer status in 26-29% FM+ vs FM- RA patients, with larger differences than in RA patients vs population norms for 6/7 domains. MDHAQ scores were correlated significantly with each of 7 corresponding PROMIS-29 domains (|rho|≥0.62, p<0.001). Linear regressions explained 55-73% of PROMIS-29 T-score variation by MDHAQ scores and 56%-70% of MDHAQ score variation by PROMIS-29 T-scores. CONCLUSIONS Scores for 7 PROMIS-29 domains and MDHAQ were highly correlated. The MDHAQ is effective to assess HRQL and offers incremental medical information, including FAST4 screening. The results indicate the importance of assessing comorbidities such as fibromyalgia screening in interpreting PROMIS-29 T-scores.
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Affiliation(s)
- Kathryn A Gibson
- Department of Rheumatology, Liverpool Hospital, Ingham Research Institute, University of New South Wales, Sydney, NSW, 2170, Australia
| | - Robert M Kaplan
- Clinical Excellence Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, 94305
| | - Theodore Pincus
- Division of Rheumatology, Department of Internal Medicine, Rush University School of Medicine, Chicago, Ill, 60612, USA.
| | - Tengfei Li
- Department of Biostatistics, Bioinformatics & Biomathematics, Georgetown University, Washington, DC, 20057, USA
| | - George Luta
- Department of Biostatistics, Bioinformatics & Biomathematics, Georgetown University, Washington, DC, 20057, USA; Clinical Research Unit, The Parker Institute, Copenhagen University Hospital, Frederiksberg, DK-2000, Denmark
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12
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Lee D, Kim SJ, Cheon J, Jung YC, Kang JI. Changes in interoceptive accuracy related to emotional interference in somatic symptom disorder. BMC Psychol 2024; 12:279. [PMID: 38755731 PMCID: PMC11100134 DOI: 10.1186/s40359-024-01778-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 05/09/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVE The somatic symptom disorder (SSD) is characterized by one or more distressing or disabling somatic symptoms accompanied by an excessive amount of time, energy and emotion related to the symptoms. These manifestations of SSD have been linked to alterations in perception and appraisal of bodily signals. We hypothesized that SSD patients would exhibit changes in interoceptive accuracy (IA), particularly when emotional processing is involved. METHODS Twenty-three patients with SSD and 20 healthy controls were recruited. IA was assessed using the heartbeat perception task. The task was performed in the absence of stimuli as well as in the presence of emotional interference, i.e., photographs of faces with an emotional expression. IA were examined for correlation with measures related to their somatic symptoms, including resting-state heart rate variability (HRV). RESULTS There was no significant difference in the absolute values of IA between patients with SSD and healthy controls, regardless of the condition. However, the degree of difference in IA without emotional interference and with neutral facial interference was greater in patients with SSD than in healthy controls (p = 0.039). The IA of patients with SSD also showed a significant correlation with low-frequency HRV (p = 0.004) and high-frequency HRV (p = 0.007). CONCLUSION SSD patients showed more significant changes in IA when neutral facial interference was given. These results suggest that bodily awareness is more affected by emotionally ambiguous stimuli in SSD patients than in healthy controls.
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Affiliation(s)
- Deokjong Lee
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, 03722, South Korea
- Yonsei Empathy Psychiatry Clinic, Seoul, 07008, South Korea
| | - Se Joo Kim
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, 03722, South Korea
- Department of Psychiatry, Yonsei University College of Medicine, Yonsei-ro 50-1, Seodaemun-gu, Seoul, 03722, South Korea
| | - Jooah Cheon
- Department of Medicine, Yonsei University Graduate School, Seoul, 03722, South Korea
| | - Young-Chul Jung
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, 03722, South Korea
- Department of Psychiatry, Yonsei University College of Medicine, Yonsei-ro 50-1, Seodaemun-gu, Seoul, 03722, South Korea
| | - Jee In Kang
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, 03722, South Korea.
- Department of Psychiatry, Yonsei University College of Medicine, Yonsei-ro 50-1, Seodaemun-gu, Seoul, 03722, South Korea.
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13
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Gebreegziabher ZA, Eristu R, Molla A. Determinants of adolescents' depression, anxiety, and somatic symptoms in Northwest Ethiopia: A non-recursive structural equation modeling. PLoS One 2024; 19:e0281571. [PMID: 38598540 PMCID: PMC11006201 DOI: 10.1371/journal.pone.0281571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 01/16/2024] [Indexed: 04/12/2024] Open
Abstract
INTRODUCTION In low and middle-income countries, adolescent mental health is not only a major public health challenge but also a development concern. Depression and anxiety are the most common mental health disorders and somatic symptoms often co-exist with them. Adolescents with common mental health problems are associated with an increased risk of suicide, future unemployment, and poor quality of life. However, little is known about the mental health of adolescents in Ethiopia. Thus, this study aimed to assess the determinants of depression, anxiety, and somatic symptoms among adolescents in Northwest Ethiopia, in 2022. METHODS An institution-based cross-sectional study was conducted from June 8 to 24, 2022. Two-stage stratified random sampling was used to select 1407 adolescents in Northwest Ethiopia. Structured and standardized self-administered questionnaires were used to collect the data. Non-recursive structural equation modeling was employed to assess the direct, indirect, and total effects of predictors. Adjusted regression coefficients and corresponding 95% confidence intervals were used to interpret the strength of the association. RESULTS The prevalence of depression, anxiety, and somatic symptoms were 28.21% (95% CI: 25.8, 31%), 25.05% (95%CI: 22.8, 27.5), and 25.24(95% CI: 23, 27.6%) respectively. Alcohol use had a significant positive effect on depression [β = 0.14, 95% CI: 0.073, 0.201], anxiety [β = 0.11, 95% CI: 0.041, 0.188], and somatic symptoms [β = 0.12, 95% CI: 0.062, 0.211]. Stress had a significant positive effect on depression [β = 0.76, 95% CI: 0.642, 0.900], anxiety [β = 1.10, 95% CI: 0.955, 1.264], and somatic symptoms [β = 086, 95% C: 0.700, 1.025]. Depression had a direct positive effect on anxiety [β = 0.74, 95% CI: 0.508, 1.010]. CONCLUSION In this study, the prevalence of depression, anxiety, and somatic symptoms was moderate. Alcohol use and stress were significantly related to depression, anxiety, and somatic symptoms. The bidirectional relationship between anxiety and depression was significant. Therefore, public health interventions should focus on the bidirectional relationship between depression and anxiety, as well as on identified factors to reduce the burden of mental illness in adolescents.
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Affiliation(s)
- Zenebe Abebe Gebreegziabher
- Department of Epidemiology and Biostatistics, School of Public Health, Asrat Woldeyes Health Science Campus, Debre Berhan University, Debre Berhan, Ethiopia
| | - Rediet Eristu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ayenew Molla
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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14
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Hsiao YY, Elliott TR, Jaramillo J, Douglas ME, Powers MB, Warren AM. The Fatigue and Altered Cognition Scale among SARS-CoV-2 Survivors: Psychometric Properties and Item Correlations with Depression and Anxiety Symptoms. J Clin Med 2024; 13:2186. [PMID: 38673462 PMCID: PMC11050894 DOI: 10.3390/jcm13082186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/17/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
Background/Objectives: This study examined the psychometric properties of the Fatigue and Altered Cognition Scale (FACs) among adult COVID-19 survivors and its unique ability to assess symptomology not accounted for by measures of depression and anxiety. Methods: COVID-19 survivors completed an online survey that included the FACs, a measure of brain fog and central fatigue with 20 items rated on a digital-analog scale. Useable data from 559 participants were analyzed to test the two-factor structure of the FACs, test for measurement invariance by sex and device was used to complete the survey (hand-held, computer), and item correlations with symptoms of depression and anxiety were examined. Results: The two-factor structure of the FACs replicated, supporting the separate assessments of brain fog and fatigue, χ2(164) = 1028.363, p < 0.001, CFI = 0.934, TLI = 0.923, RMSEA = 0.097, SRMR = 0.053. The FACs exhibited invariance at the scalar level, indicating item and factor integrity regardless of sex and device type. Using a correlation > 0.70 as a criterion (i.e., indicating more than 50% shared variance between two items), items on the FACs (assessing fatigue and lack of energy) were highly correlated with feeling tired or having little energy on the depression measure. No other items correlated with any anxiety symptom larger than 0.70. Conclusions: The FACs appears to be a psychometrically sound and efficient measure for use with COVID-19 survivors, assessing symptoms of brain fog and central fatigue that are not attributable to symptoms assessed by established measures of depression and anxiety.
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Affiliation(s)
- Yu-Yu Hsiao
- Department of Individual, Family and Community Education, University of New Mexico, Albuquerque, NM 87131, USA; (Y.-Y.H.); (J.J.)
| | - Timothy R. Elliott
- Department of Educational Psychology, Texas A&M University, College Station, TX 77843, USA
| | - Julie Jaramillo
- Department of Individual, Family and Community Education, University of New Mexico, Albuquerque, NM 87131, USA; (Y.-Y.H.); (J.J.)
| | - Megan E. Douglas
- Baylor Scott & White Research Institute, Dallas, TX 75246, USA; (M.E.D.); (M.B.P.); (A.M.W.)
| | - Mark B. Powers
- Baylor Scott & White Research Institute, Dallas, TX 75246, USA; (M.E.D.); (M.B.P.); (A.M.W.)
| | - Ann Marie Warren
- Baylor Scott & White Research Institute, Dallas, TX 75246, USA; (M.E.D.); (M.B.P.); (A.M.W.)
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15
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Kostova Z, Matanova VL. Transgenerational trauma and attachment. Front Psychol 2024; 15:1362561. [PMID: 38650899 PMCID: PMC11033415 DOI: 10.3389/fpsyg.2024.1362561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 03/25/2024] [Indexed: 04/25/2024] Open
Abstract
An integrative approach is presented to understand the transmission mechanisms of attachment trauma and the quality of the internal working model through manifestations of bodily symptoms concerning physical and mental health. A case of dissociative symptomatology is described in a woman whose ancestors experienced individual and collective trauma related to the political regime. The approach allows for an analytical view beyond the standard complaints of anxiety, depression, post-traumatic symptoms, eating disorders, etc. A brief description of the transgenerational transmission of trauma is presented.
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Affiliation(s)
| | - Vanya L. Matanova
- Institute of Mental Health and Development (Bulgaria), Sofia, Bulgaria
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16
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Müller-Tasch T, Löwe B, Frankenstein L, Frey N, Haass M, Friederich HC. Somatic symptom profile in patients with chronic heart failure with and without depressive comorbidity. Front Psychiatry 2024; 15:1356497. [PMID: 38566960 PMCID: PMC10985237 DOI: 10.3389/fpsyt.2024.1356497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 03/08/2024] [Indexed: 04/04/2024] Open
Abstract
Background Patients with chronic heart failure (CHF) frequently suffer from depressive comorbidity. CHF and depressive comorbidity can cause somatic symptoms. The correct attribution of somatic symptoms is important. Thus, we aimed to assess potential differences in somatic symptom severity between CHF patients with and without depressive comorbidity. Methods We evaluated depressive comorbidity using the Patient Health Questionnaire-9 (PHQ-9), somatic symptom severity with the Patient Health Questionnaire-15 (PHQ-15), and sociodemographic and medical variables in 308 CHF outpatients. To compare somatic symptom severity between CHF patients with and without depressive comorbidity, we conducted item-level analyses of covariance. Results Of the 308 participating patients, 93 (30.3%) met the PHQ-9 criteria for depressive comorbidity. These patients did not differ from those without depressive comorbidity with regard to age, sex, left ventricular function, and multimorbidity. Patients with depressive comorbidity scored significantly higher on ten out of thirteen PHQ-15 items than patients without depressive comorbidity. The largest effect sizes (0.71-0.80) were shown for symptoms of headache, chest pain, shortness of breath, and palpitations, and the latter three were potentially attributable to heart failure. Conclusions Among patients with CHF, somatic symptoms are more pronounced in those with depressive comorbidity than those without depressive comorbidity. This finding is especially true for cardiac symptoms independent of CHF severity. The potential interpretation of somatic symptoms as correlates of depressive comorbidity must be recognized in clinical practice.
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Affiliation(s)
- Thomas Müller-Tasch
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum am Weissenhof, Weinsberg, Germany
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Lutz Frankenstein
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Norbert Frey
- Department of Cardiology, University of Heidelberg, Heidelberg, Germany
| | - Markus Haass
- Department of Cardiology, Theresien Hospital Mannheim, Mannheim, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, University of Heidelberg, Heidelberg, Germany
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17
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Chaabouni A, Houwen J, Grewer G, Liebau M, Akkermans R, van Boven K, Walraven I, Schers H, Olde Hartman T. The burden of persistent symptom diagnoses in primary care patients: a cross-sectional study. Scand J Prim Health Care 2024; 42:112-122. [PMID: 38189313 PMCID: PMC10851811 DOI: 10.1080/02813432.2023.2293930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 12/06/2023] [Indexed: 01/09/2024] Open
Abstract
INTRODUCTION The burden of symptoms is a subjective experience of distress. Little is known on the burden of feeling unwell in patients with persistent symptom diagnoses. The aim of this study was to assess the burden in primary care patients with persistent symptom diagnoses compared to other primary care patients. METHODS A cross-sectional study was performed in which an online survey was sent to random samples of 889 patients with persistent symptom diagnoses (>1 year) and 443 other primary care patients after a transactional identification in a Dutch primary care data registry. Validated questionnaires were used to assess the severity of symptoms (PHQ-15), Symptom Intensity and Symptom Interference questionnaires, depression (PHQ-9), anxiety (GAD-7), quality of life (SF-12 and EQ-5D-5L)) and social functioning (SPF-ILs). RESULTS Overall, 243 patients completed the survey: 178 (73.3%) patients in the persistent symptom diagnoses group and 65 (26.7%) patients in the control group. In the persistent group, 65 (36.5%) patients did not have persistent symptom(s) anymore according to the survey response. Patients who still had persistent symptom diagnoses (n = 113, 63.5%) reported significantly more severe somatic symptoms (mean difference = 3.6, [95% CI: 0.24, 4.41]), depression (mean difference = 3.0 [95% CI: 1.24, 3.61]) and anxiety (mean difference = 2.3 [95% CI: 0.28, 3.10]) and significantly lower physical functioning (mean difference = - 6.8 [95% CI: -8.96, -3.92]). CONCLUSION Patients with persistent symptom diagnoses suffer from high levels of symptoms burden. The burden in patient with persistent symptoms should not be underestimated as awareness of this burden may enhance person-centered care.
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Affiliation(s)
- Asma Chaabouni
- Department of Primary and Community care, Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Juul Houwen
- Department of Primary and Community care, Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Georg Grewer
- USUMA Markt- und Sozialforschung GmbH, Berlin, Germany
| | - Martin Liebau
- USUMA Markt- und Sozialforschung GmbH, Berlin, Germany
| | - Reinier Akkermans
- Department of Primary and Community care, Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
- Scientific Institute for Quality of Healthcare, Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Kees van Boven
- Department of Primary and Community care, Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Iris Walraven
- Department for Health Evidence, Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Henk Schers
- Department of Primary and Community care, Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Tim Olde Hartman
- Department of Primary and Community care, Radboud Institute of Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
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18
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Rask MT, Frostholm L, Hansen SH, Petersen MW, Ørnbøl E, Rosendal M. Self-help interventions for persistent physical symptoms: a systematic review of behaviour change components and their potential effects. Health Psychol Rev 2024; 18:75-116. [PMID: 36651573 DOI: 10.1080/17437199.2022.2163917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/22/2022] [Indexed: 01/19/2023]
Abstract
Persistent physical symptoms (PPS) remain a challenge in the healthcare system due to time-constrained consultations, uncertainty and limited specialised care capacity. Self-help interventions may be a cost-effective way to widen the access to treatment. As a foundation for future interventions, we aimed to describe intervention components and their potential effects in self-help interventions for PPS. A systematic literature search was made in PubMed, EMBASE, PsycINFO and CENTRAL. Fifty-one randomised controlled trials were included. Interventions were coded for effect on outcomes (standardised mean difference ≥0.2) related to symptom burden, anxiety, depression, quality of life, healthcare utilisation and sickness absence. The Behaviour Change Technique (BCT) Taxonomy v1 was used to code intervention components. An index of potential was calculated for each BCT within an outcome category. Each BCT was assessed as 'potentially effective' or 'not effective' based on a two-sided test for binomial random variables. Sixteen BCTs showed potential effect as treatment components. These BCTs represented the themes: goals and planning, feedback and monitoring, shaping knowledge, natural consequences, comparison of behaviour, associations, repetition and substitution, regulation, antecedents and identity. The results suggest that specific BCTs should be included in new PPS self-help interventions aiming to improve the patients' physical and mental health.
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Affiliation(s)
- Mette Trøllund Rask
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus N, Denmark
| | - Lisbeth Frostholm
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus N, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Sofie Høeg Hansen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus N, Denmark
| | - Marie Weinreich Petersen
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus N, Denmark
| | - Eva Ørnbøl
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus N, Denmark
| | - Marianne Rosendal
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus N, Denmark
- Research Unit for General Practice, Aarhus C, Denmark
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19
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Barbek R, Toussaint A, Löwe B, von dem Knesebeck O. Intersectional inequalities in somatic symptom severity in the adult population in Germany found within the SOMA.SOC study. Sci Rep 2024; 14:3820. [PMID: 38360818 PMCID: PMC10869707 DOI: 10.1038/s41598-024-54042-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/07/2024] [Indexed: 02/17/2024] Open
Abstract
Somatic symptoms are common in a wide range of medical conditions. In severe cases, they are associated with high individual and economic burden. To explore social inequalities in somatic symptom severity (SSS) and to identify social groups with highest SSS, we applied an intersectional research approach. Analyses are based on cross-sectional data of the adult population living in Germany (N = 2413). SSS was assessed with the Somatic Symptom Scale-8. A multiple linear regression model with three-way interaction of gender, income and history of migration and post-hoc pairwise comparison of estimated marginal means was conducted. Analyses revealed intersectional inequalities in SSS along the axis of gender, income, and history of migration. Highest SSS was found in males with low income whose parent(s) immigrated, females with low income who immigrated themselves, and females with low income and no history of migration. Intersectional approaches contribute to a more comprehensive understanding of health disparities. To reduce disparities in SSS, proportionate universal interventions combining universal screening and targeted treatment seem promising.
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Affiliation(s)
- Rieke Barbek
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany.
| | - Anne Toussaint
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
| | - Olaf von dem Knesebeck
- Institute of Medical Sociology, University Medical Center Hamburg-Eppendorf, 20246, Hamburg, Germany
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20
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Liao J, Rosenheck R, Sun B, Liu J, Shen Y, Yuan S, Ma Y, Zhang J, Zhang R, Zheng L, Chen H, Feng H, He H. Prevalence and correlates of suicide risk among non-psychiatric inpatients in a general hospital in China. J Affect Disord 2024; 347:509-514. [PMID: 38036048 DOI: 10.1016/j.jad.2023.11.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 09/25/2023] [Accepted: 11/18/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE This study aims to investigate the suicide risk and mental health status of non-psychiatric inpatients in general hospital and explore the risk factors of suicide. METHODS A prospective study was conducted at a tertiary general hospital in Guangzhou, Guangdong Province, China. On-line assessment of mental health status and suicide was completed at admission and discharge. We assessed depression, anxiety, insomnia and suicide of inpatients and binary logistics regression was used to examine the risk factors of suicide. RESULTS From April 1, 2021 and January 31, 2022, 3685 inpatients were included. The detection rates of depression, anxiety and insomnia were 14.6 %, 9.0 % and 17.8 %, respectively. There were 2.7 % of inpatients at suicide risk. Binary logistics regression demonstrated that the inpatients with anxiety were at higher risk of suicide. LIMITATIONS (1) Single-center study limits the generalization of conclusion, (2) low response rate at discharge. CONCLUSIONS The comorbidity of physical illnesses and mental health problems, including depression, anxiety, insomnia, and suicide among non-psychiatric patients in general hospital was common. An assessment of anxiety may help identify individuals at high suicide risk. Medical staff in general hospitals should be trained to improve their ability to identify mental disorders and high-risk individuals for suicide, provide timely interventions and effectively reduce the suicide risk of patients.
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Affiliation(s)
- Jiayi Liao
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Robert Rosenheck
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Bin Sun
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Jingwen Liu
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Yizhong Shen
- The Third People's Hospital of Zhuhai, Zhuhai, China
| | - Shuai Yuan
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Yarong Ma
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Jie Zhang
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China
| | - Rong Zhang
- Guangdong Second Rongjun Hospital, Foshan, China
| | - Lijiao Zheng
- Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Hanwei Chen
- Guangzhou Panyu Central Hospital, Guangzhou, China
| | - Huiqiang Feng
- Health Commission of Guangdong Province, Guangzhou, China
| | - Hongbo He
- The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou, China; Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou, China.
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21
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Badinlou F, Rahimian F, Hedman-Lagerlöf M, Lundgren T, Abzhandadze T, Jansson-Fröjmark M. Trajectories of mental health outcomes following COVID-19 infection: a prospective longitudinal study. BMC Public Health 2024; 24:452. [PMID: 38350959 PMCID: PMC10863235 DOI: 10.1186/s12889-024-17997-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/05/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has triggered a global mental health crisis. Yet, we know little about the lasting effects of COVID-19 infection on mental health. This prospective longitudinal study aimed to investigate the trajectories of mental health changes in individuals infected with COVID-19 and to identify potential predictors that may influence these changes. METHODS A web-survey that targeted individuals that had been infected with COVID-19 was used at three time-points: T0 (baseline), T1 (six months), and T2 (twelve months). The survey included demographics, questions related to COVID-19 status, previous psychiatric diagnosis, post-COVID impairments, fatigue, and standardized measures of depression, anxiety, insomnia. Linear mixed models were used to examine changes in depression, anxiety, and insomnia over time and identify factors that impacted trajectories of mental health outcomes. RESULTS A total of 236 individuals completed assessments and was included in the longitudinal sample. The participants' age ranged between 19 and 81 years old (M = 48.71, SD = 10.74). The results revealed notable changes in mental health outcomes over time. The trajectory of depression showed significant improvement over time while the trends in anxiety and insomnia did not exhibit significant changes over time. Younger participants and individuals who experienced severe COVID-19 infection in the acute phase were identified as high-risk groups with worst mental ill-health. The main predictors of the changes in the mental health outcomes were fatigue and post-COVID impairments. CONCLUSIONS The findings of our study suggest that mental health outcomes following COVID-19 infection exhibit a dynamic pattern over time. The study provides valuable insights into the mental health trajectory following COVID-19 infection, emphasizing the need for ongoing assessment, support, and interventions tailored to the evolving mental health needs of this population.
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Affiliation(s)
- Farzaneh Badinlou
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, and Stockholm Health Care Services, Region of Stockholm, Stockholm, Sweden.
- Medical Unit, Medical Psychology, Women's Health and Allied Health Professional Theme, Karolinska University Hospital, Stockholm, Sweden.
| | - Fatemeh Rahimian
- RISE Research Institutes of Sweden, Department of Computer Science, Stockholm, Sweden
| | - Maria Hedman-Lagerlöf
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, and Stockholm Health Care Services, Region of Stockholm, Stockholm, Sweden
| | - Tobias Lundgren
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, and Stockholm Health Care Services, Region of Stockholm, Stockholm, Sweden
| | - Tamar Abzhandadze
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Markus Jansson-Fröjmark
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, and Stockholm Health Care Services, Region of Stockholm, Stockholm, Sweden
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Knopp M, Burghardt J, Oppenauer C, Meyer B, Moritz S, Sprung M. Affective and cognitive Theory of Mind in patients with alcohol use disorder: Associations with symptoms of depression, anxiety, and somatization. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 157:209227. [PMID: 37992810 DOI: 10.1016/j.josat.2023.209227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 08/23/2023] [Accepted: 11/14/2023] [Indexed: 11/24/2023]
Abstract
INTRODUCTION Theory of Mind (ToM) is the ability to ascribe thoughts (cognitive ToM) and feelings (affective ToM) to others. Ample evidence exists for impairments of affective and cognitive ToM in individuals with alcohol use disorder (AUD); however, evidence regarding changes of these impairments during AUD treatment and their possible relationship to comorbid symptoms is ambiguous. The current study analyzed changes in ToM during treatment and tested associations with comorbid symptoms of depression, anxiety, somatization, and social functioning. METHODS We analyzed data from 175 individuals with AUD. The study assessed ToM and comorbid symptoms of depression, anxiety, somatization, and social functioning at the time of admission and at the time of discharge from an approximately 60 days long abstinence-oriented inpatient treatment. We assessed affective and cognitive ToM using the Movie for the Assessment of Social Cognition, a measure with high ecological validity. RESULTS All symptoms, total and cognitive ToM improved following treatment; however, affective ToM did not improve. Moreover, cognitive ToM at the beginning of treatment was associated with improved symptoms of depression and somatization, while affective ToM was not. CONCLUSIONS Our study shows improvements in total and cognitive ToM as well as symptoms of depression, anxiety, somatization, and social functioning following long-term treatment. Furthermore, cognitive ToM was related to improvements in comorbid symptoms. This finding suggests that ToM may be an important treatment target in patients with AUD.
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Affiliation(s)
- Magdalena Knopp
- Karl Landsteiner University of Health Sciences, Division of Clinical Psychology, Dr.-Karl-Dorrek-Straße 30, 3500 Krems an der Donau, Austria; Ludwig-Maximilians-Universität München, Faculty of Psychology and Educational Sciences, Department of Psychology, Leopoldstraße 13, 80802 München, Germany.
| | - Juliane Burghardt
- Karl Landsteiner University of Health Sciences, Division of Clinical Psychology, Dr.-Karl-Dorrek-Straße 30, 3500 Krems an der Donau, Austria
| | - Claudia Oppenauer
- Karl Landsteiner University of Health Sciences, Division of Clinical Psychology, Dr.-Karl-Dorrek-Straße 30, 3500 Krems an der Donau, Austria
| | - Bernhard Meyer
- Karl Landsteiner University of Health Sciences, Division of Clinical Psychology, Dr.-Karl-Dorrek-Straße 30, 3500 Krems an der Donau, Austria
| | - Steffen Moritz
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistrasse 52, 20246 Hamburg, Germany
| | - Manuel Sprung
- Karl Landsteiner University of Health Sciences, Division of Clinical Psychology, Dr.-Karl-Dorrek-Straße 30, 3500 Krems an der Donau, Austria; Ludwig-Maximilians-Universität München, Faculty of Psychology and Educational Sciences, Department of Psychology, Leopoldstraße 13, 80802 München, Germany; University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistrasse 52, 20246 Hamburg, Germany; Psychiatric Rehabilitation Clinic Gars am Kamp, Psychosomatisches Zentrum Waldviertel, Kremserstraße 656, 3571 Gars am Kamp, Austria
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23
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Banerjee K, Sahoo H, Govil D. Financial stress, health and malnourishment among older adults in India. BMC Geriatr 2023; 23:861. [PMID: 38102552 PMCID: PMC10724991 DOI: 10.1186/s12877-023-04532-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 11/29/2023] [Indexed: 12/17/2023] Open
Abstract
As India's elderly population grows rapidly, there is a demand for robust policy tools for geriatric health management. This study focuses on unveiling the impact of financial stress and insecurity in diverse economic sectors on adult malnutrition in India. Further, we explore the connections of adult malnourishment with mental and physical health outcomes. Analysis has been done using data of 59,764 respondents aged 45 years and above from the Longitudinal Ageing Study in India (LASI- Wave I) (2017-19). A modified Malnutrition Universal Screening Tool (MUST) has been used to assess the risk of adult malnutrition. It categorizes malnutrition into Low Risk, High Risk Group 1 (HRG1-undernourished), and High Risk Group 2 (HRG2-over-nourished). Approximately 26% of adults were classified in HRG1, characterized by low body mass index, recent hospital admissions, and affiliation with food-insecure households. Around 25% adults belonged to HRG2 characterized by high body mass index and waist-to-hip ratio. The relative risk ratios from the multinomial logit generalized structural equation model indicate that the risk of being in HRG1 was 20-40% higher among respondents not presently working or receiving pension benefits, as well as those involved in agricultural work. The risk of being in HRG2 doubles if the respondent was diagnosed with some chronic disease during the last 12 months. A higher composite cognition score reduces the risk of being in HRG1 by 4%, while it increases the risk of being in HRG2 by 3%. Additionally, experiencing episodic depression raises the risk of being in HRG1 by 10%. Financial insecurity, particularly in the informal and agricultural sectors, coupled with poor mental health, hinders positive nutritional outcomes. Extending universal pro-poor policies to fortify food security in resource poor households and integrating mental health variables in nutrition policies can be beneficial to address adult malnourishment in India.
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Affiliation(s)
- Kajori Banerjee
- Department of Quantitative Techniques, Anil Surendra Modi School of Commerce (ASMSOC), SVKM's Narsee Monjee Institute of Management Studies (NMIMS) Deemed-to-University, Mumbai, Maharashtra, 400056, India.
| | - Harihar Sahoo
- Department of Family & Generations, International Institute for Population Sciences (IIPS), Mumbai, Maharashtra, 400088, India
| | - Dipti Govil
- Department of Family & Generations, International Institute for Population Sciences (IIPS), Mumbai, Maharashtra, 400088, India
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Kalde J, Atik E, Stricker J, Schückes M, Neudeck P, Pittig A, Pietrowsky R. Enhancing the effectiveness of CBT for patients with unipolar depression by integrating digital interventions into treatment: A pilot randomized controlled trial. Psychother Res 2023:1-16. [PMID: 37922395 DOI: 10.1080/10503307.2023.2277866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2023] Open
Abstract
OBJECTIVE Blended cognitive behavioral therapy (bCBT) combines face-to-face therapy with digital elements, such as digital health apps. This pilot study aimed to explore the effectiveness and safety of a novel bCBT application for treating unipolar depression in adults combined with cognitive behavioral therapy (CBT) compared to CBT alone in routine care. METHODS Patients (N = 82) were randomly assigned to bCBT (n = 42) or CBT (n = 40) over 12 weeks. bCBT consisted of weekly CBT sessions accompanied by the elona therapy depression module (a bCBT application for unipolar depression) for use between sessions. Standard CBT consisted of weekly CBT sessions. Outcomes (6,12 weeks) were analyzed with linear mixed models. RESULTS Improvements in depressive symptoms (BDI-II, PHQ-9) were descriptively larger for the bCBT group. Yet, this difference did not reach statistical significance. bCBT was superior to standard CBT in secondary outcome measures of psychological health (d = .50) and generalized anxiety symptoms (d = -.45). In other secondary outcomes (BAI, PSWQ, GSE, WHOQOL-BREF), improvements were descriptively larger for bCBT compared to CBT. CONCLUSION This pilot study provided preliminary evidence that bCBT might be advantageous in comparison to CBT alone in the treatment of depression, but larger RCTs of the bCBT application are needed.
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Affiliation(s)
- Jan Kalde
- Department of Experimental Psychology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Ece Atik
- Elona Health GmbH, Düsseldorf, Germany
- Translational Psychotherapy, Georg-Elias-Mueller-Institute of Psychology, University of Goettingen, Göttingen, Germany
| | - Johannes Stricker
- Department of Experimental Psychology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | | | - Peter Neudeck
- Elona Health GmbH, Düsseldorf, Germany
- Department of Clinical Psychology, Technical University Chemnitz, Chemnitz, Germany
| | - Andre Pittig
- Translational Psychotherapy, Georg-Elias-Mueller-Institute of Psychology, University of Goettingen, Göttingen, Germany
| | - Reinhard Pietrowsky
- Department of Experimental Psychology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
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25
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Halliburton AE, Hill MB, Hightower JM, Harrison TL, LaFever CR. Mental health during COVID-19: College students' need for structure. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2023:1-8. [PMID: 37910659 DOI: 10.1080/07448481.2023.2277195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 10/22/2023] [Indexed: 11/03/2023]
Abstract
Objective: College students made the unprecedented shift to remote learning during the COVID-19 pandemic, potentially contributing to escalating anxiety, depression, and suicide. This loss of structure may be a driving factor in students' distress. We examined the relationship between students' mental health, perceived need for structure, and five stressors related to COVID-19. Participants: Students (N = 1319, 76.3% female, 79.8% White) at a southeastern university responded to a survey in spring 2020. Methods: Participants answered questions about global anxiety and depression, suicide, perceived need for structure, and COVID-19 related stressors. Results: Participants reported increased anxiety and depression and elevated suicidality compared to previous studies of student mental health. Findings indicated that the stressors and lack of structure added unique variance toward predicting anxiety and depression. Conclusions: As COVID-19's consequences persist, counseling centers and other stakeholders are urged to work together in providing support for students' mental wellness and stress management.
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Affiliation(s)
- Amanda E Halliburton
- Department of Psychological Science, University of North Georgia, Dahlonega, Georgia, USA
| | - Michele B Hill
- Department of Psychological Science, University of North Georgia, Dahlonega, Georgia, USA
| | - Jennifer M Hightower
- Department of Educational and Developmental Science, University of South Carolina, Columbia, South Carolina, USA
| | - Tyler L Harrison
- Department of Psychological Science, University of North Georgia, Dahlonega, Georgia, USA
| | - Christopher R LaFever
- Department of Educational Psychology and Learning Systems, Florida State University, Tallahassee, Florida, USA
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26
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Krempel L, Stricker J, Martin A. Heart Rate Variability, Autonomic Reactivity, and Emotion Regulation during Sadness Induction in Somatic Symptom Disorder. Int J Behav Med 2023:10.1007/s12529-023-10238-2. [PMID: 37907817 DOI: 10.1007/s12529-023-10238-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND Preliminary evidence suggests altered heart rate variability (HRV) and impaired emotion regulation (ER) in somatic symptom disorder (SSD). Moreover, HRV can be considered an index of ER. Yet, to date, research on HRV and emotional reactivity in SSD is scarce and findings are inconsistent. Thus, this study aimed to examine ER differences, HRV at rest, and in response to emotion induction in persons with SSD compared to controls. METHODS The sample comprised 44 persons with SSD (DSM-5; 79.5% female, Mage = 45.7, SD = 14.7) and 41 persons without SSD (non-SSD; 78% female, Mage = 44.2, SD = 14.7). We assessed the participants' somatic symptom severity, ER, and control variables (e.g., depressive symptoms). Frequency and time domain HRV by ECG and subjective emotional states were measured at rest, under sadness induction, and during recovery periods. We evaluated baseline between-group differences with t-tests, and HRV and emotional reactivity and recovery with repeated measures ANOVAs. RESULTS We found no significant differences in resting state HRV between persons with and without SSD. Regarding reactivity and recovery, SSD group showed lower reactivity in SDNN (standard deviation of NN interval) than non-SSD group. Moreover, SSD group reported more maladaptive ER techniques (e.g. rumination) and a higher effort to regulate their emotions during the experiment than non-SSD group. CONCLUSIONS The study indicated impaired ER in persons with SSD. This finding showed more clearly in self-report than in HRV. Further research on HRV reactivity including tasks evoking other negative emotions in persons with SSD is required.
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Affiliation(s)
- Laura Krempel
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, School of Human and Social Sciences, University of Wuppertal, Gaußstraße 20, Wuppertal, 42119, Germany.
| | - Johannes Stricker
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, School of Human and Social Sciences, University of Wuppertal, Gaußstraße 20, Wuppertal, 42119, Germany
| | - Alexandra Martin
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, School of Human and Social Sciences, University of Wuppertal, Gaußstraße 20, Wuppertal, 42119, Germany
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27
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Krefting F, Hölsken S, Benson S, Schedlowski M, Sondermann W. How familiar are German dermatologists with placebo and nocebo effects and to what extent are these targeted in clinical practice: A survey within the dermatological community. J Eur Acad Dermatol Venereol 2023; 37:2133-2141. [PMID: 37322597 DOI: 10.1111/jdv.19258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 05/03/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND Every medical treatment inevitably comprises not only physiological, but also psychological components, reflected by placebo and nocebo effects, which significantly affect treatment outcome. However, the extent of knowledge on the mechanisms steering placebo and nocebo effects in the dermatological community in Germany is currently unclear. OBJECTIVES To assess the state of knowledge about placebo and nocebo effects in the German dermatological community, to evaluate whether this knowledge is already being used in clinical practice, and to investigate whether German dermatologists are interested in learning more about the topic. METHODS German Dermatologists, the majority working in their own practice, were asked to fill in an online survey addressing the knowledge about placebo and nocebo effects and the feasibility of special techniques to enhance placebo and minimize nocebo effects within the clinical routine. RESULTS N = 154 complete (79%) or partial (21%) responses to the survey were recorded in the online database and included in the analysis. All participants reported to know what the placebo effect is and 59.7% (74/124) indicated that they already had experience with prescribing or recommending a treatment without active substances. In contrast, only 62.0% (80/129) stated to know what the nocebo effect is. Participants showed a rather superficial knowledge regarding placebo and nocebo mechanisms. The majority of participants (76.7%, 99/129) expressed their willingness to be further educated about the underlying mechanisms mediating placebo and nocebo effects and the possible application in clinical practice. CONCLUSIONS The current survey offers a so far unique insight into the state of knowledge of German dermatologists on placebo and nocebo effects. The results indicate a need for education about this topic. Encouragingly, however, German dermatologists considered communication strategies to maximize placebo and reduce nocebo effects and expressed motivation to be trained to implement these strategies in everyday clinical practice.
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Affiliation(s)
- Frederik Krefting
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Stefanie Hölsken
- Center of Translational Neuro- and Behavioral Sciences (C-TNBS), Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Sven Benson
- Center of Translational Neuro- and Behavioral Sciences (C-TNBS), Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Center of Translational Neuro- and Behavioral Sciences (C-TNBS), Institute of Medical Education, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Manfred Schedlowski
- Center of Translational Neuro- and Behavioral Sciences (C-TNBS), Institute of Medical Psychology and Behavioral Immunobiology, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Wiebke Sondermann
- Department of Dermatology, Venereology and Allergology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
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28
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Hennemann S, Killikelly C, Hyland P, Maercker A, Witthöft M. Somatic symptom distress and ICD-11 prolonged grief in a large intercultural sample. Eur J Psychotraumatol 2023; 14:2254584. [PMID: 37767693 PMCID: PMC10540649 DOI: 10.1080/20008066.2023.2254584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 07/12/2023] [Indexed: 09/29/2023] Open
Abstract
Background: Grief is a multi-faceted experience including emotional, social, and physical reactions. Research in ICD-11 prolonged grief disorder (PGD) in different cultural contexts has revealed different or potentially missing grief symptoms that may be relevant.Objective: This study thus aimed to explore the prevalence of somatic symptom distress and its associations with grief and negative affect in a culturally diverse sample of bereaved individuals with symptoms of PGD.Methods: Based on cross-sectional survey data from the Measurement and Assessment of Grief (MAGIC) project, this study included 1337 participants (mean age 23.79 yrs, 76.1% female) from three regions (USA: 62.3%, Turkey/Iran: 24.2%, Cyprus/Greece: 13.5%), who experienced a loss of a significant other. Associations between somatic symptom distress (Somatic Symptom Scale, SSS-8), symptoms of PGD (International Prolonged Grief Disorder Scale, IPGDS-33), anxiety (Generalized Anxiety Disorder Questionnaire, GAD-7), depression (Patient Health Questionnaire, PHQ-9) as well as demographic and loss related characteristics were investigated. Three hundred and thirteen participants (23.4%) scored above the proposed cut-off for clinically severe PGD.Results: 'High' or 'very high' levels of somatic symptom distress were more frequent in a possible PGD group (58.2%), than in a non-PGD group (22.4%), p < .001, as divided per cut-off in the IPGDS. In a multiple regression analysis, PGD symptoms were significantly but weakly associated with somatic symptom distress (β = 0.08, p < .001) beyond demographics, loss-related variables, and negative affect. Negative affect (anxiety and depression) mediated the relationship of PGD symptoms with somatic symptom distress and the indirect effect explained 58% of the variance.Conclusions: High levels of somatic symptom distress can be observed in a substantial proportion of bereaved across cultures. Our findings suggest that PGD is related to somatic symptom distress partly and indirectly through facets of negative affect.
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Affiliation(s)
- Severin Hennemann
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Clare Killikelly
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland
| | - Andreas Maercker
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Johannes Gutenberg University Mainz, Mainz, Germany
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Perros P, Nagy EV, Papini E, Van Der Feltz-Cornelis CM, Weetman AP, Hay HA, Abad-Madroñero J, Tallett AJ, Bilas M, Lakwijk P, Poots AJ, Hegedüs L. Hypothyroidism and Somatization: Results from E-Mode Patient Self-Assessment of Thyroid Therapy, a Cross-Sectional, International Online Patient Survey. Thyroid 2023; 33:927-939. [PMID: 37134204 DOI: 10.1089/thy.2022.0641] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Background: Between 10% and 15% of hypothyroid patients experience persistent symptoms despite achieving biochemical euthyroidism. Unexplained persistent symptoms can be a sign of somatization. This is associated with distress and high health care resource use and can be classified as somatic symptom disorder (SSD). Prevalence rates for SSD differ depending on classification criteria and how they are ascertained, varying between 4% and 25%. As this has not been studied in hypothyroid patients before, the aim of this study was to document somatization in people with hypothyroidism and to explore associations with other patient characteristics and outcomes. Methods: Online, multinational cross-sectional survey of individuals with self-reported, treated hypothyroidism, which included the validated Patient Health Questionnaire-15 (PHQ-15) for assessment of somatization. Chi-squared tests with the Bonferroni correction were used to explore outcomes for respondents with a PHQ-15 score ≥10 (probable somatic symptom disorder [pSSD]) versus a PHQ-15 score <10 (absence of SSD). Results: A total of 3915 responses were received, 3516 of which contained the valid PHQ-15 data (89.8%). The median score was 11.3 (range 0-30 [confidence interval 10.9-11.3]). The prevalence of pSSD was 58.6%. Associations were found between pSSD and young age (p < 0.001), women (p < 0.001), not working (p < 0.001), having below average household income (p < 0.001), being treated with levothyroxine (LT4) (rather than combination of LT4 and L-triiodothyronine [LT3], LT3 alone, or desiccated thyroid extract) (p < 0.001), expression of the view that the thyroid medication taken did not control the symptoms of hypothyroidism well (p < 0.001), and with number of comorbidities (p < 0.001). pSSD was associated with respondent attribution of most PHQ-15 symptoms to the hypothyroidism or its treatment (p < 0.001), dissatisfaction with care and treatment of hypothyroidism (p < 0.001), a negative impact of hypothyroidism on daily living (p < 0.001), and with anxiety and low mood/depression (p < 0.001). Conclusions: This study demonstrates a high prevalence of pSSD among people with hypothyroidism and associations between pSSD and negative patient outcomes, including a tendency to attribute persistent symptoms to hypothyroidism or its treatment. SSD may be an important determinant of dissatisfaction with treatment and care among some hypothyroid patients.
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Affiliation(s)
- Petros Perros
- Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Endre Vezekenyi Nagy
- Division of Endocrinology, Department of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Enrico Papini
- Department of Endocrinology and Metabolism, Regina Apostolorum Hospital, Albano, Rome, Italy
| | - Christina Maria Van Der Feltz-Cornelis
- Department of Health Sciences, HYMS, University of York, York, United Kingdom
- Institute of Health Informatics, University College London, London, United Kingdom
| | | | | | | | | | - Megan Bilas
- Picker Institute Europe, Oxford, United Kingdom
| | - Peter Lakwijk
- Thyroid Federation International, Transpolispark, Hoofddorp, The Netherlands
| | | | - Laszlo Hegedüs
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
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Delle Donne V, Massaroni V, Borghetti A, Ciccullo A, Dusina A, Lombardi F, Steiner RJ, Iannone V, Salvo PF, Di Giambenedetto S. Characteristics of mental health interventions in a cohort of Italian PLWH over the last five years: impact of HIV disease and outbreak of COVID-19 pandemic. PSYCHOL HEALTH MED 2023; 28:2562-2578. [PMID: 37287347 DOI: 10.1080/13548506.2023.2221447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 05/30/2023] [Indexed: 06/09/2023]
Abstract
Evidence accumulated during past years confirm that people living with HIV (PLWH) still have to deal with comorbidities and chronic complications that can increase physical and psychological issues and can affect daily functioning, quality of life and mental health. Moreover, during the COVID-19 pandemic PLWH proved to be a population at increased risk of psychological distress. We explored the ongoing issues and the characteristics of the mental health interventions for which a cohort of Italian PLWH interacted with a psychologist over the past five years. We analysed a dataset that included 61 PLWH who underwent a psychological intervention between 2018 and 2022. We compared different frequencies in characteristics of mental health interventions according to different demographic and clinical variables, psychopathological symptoms and time of the request for intervention. We showed that psychopathological symptoms most frequently reported by patients were anxiety (55.7%), and depression (49.2%). Furthermore, we reported that most our patients undertook occasional psychological support meetings (31%), sought an intervention after the outbreak of the COVID-19 pandemic (62.3%) and complained about disclosure issues (48.5%). Disclosure issues were mainly reported by younger PLWH (p = 0.002) with a shorter disease (p = 0.031) and treatment history (p = 0.032), and higher interpersonal sensitivity (p = 0.042). It seems fundamental to integrate psychological interventions into the care of PLWH, to give particular attention to PLWH with risky demographic, clinical and mental health factors and to pay special attention to emergency conditions (such as the COVID-19 pandemic) and the most widespread issues to create ad hoc interventions.
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Affiliation(s)
- Valentina Delle Donne
- Infectious Diseases Institute, Department of Safety and Bioethics, Catholic University of Sacred Heart, Rome, Italy
| | - Valentina Massaroni
- Infectious Diseases Institute, Department of Safety and Bioethics, Catholic University of Sacred Heart, Rome, Italy
| | - Alberto Borghetti
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Arturo Ciccullo
- UOC Infectious Diseases, Ospedale S. Salvatore, L'Aquila, Italy
| | - Alex Dusina
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Francesca Lombardi
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rebecca Jo Steiner
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Valentina Iannone
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | - Simona Di Giambenedetto
- Infectious Diseases Institute, Department of Safety and Bioethics, Catholic University of Sacred Heart, Rome, Italy
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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31
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Mund M, Uhlenbusch N, Rillig F, Weiler-Normann C, Herget T, Kubisch C, Löwe B, Schramm C. Psychological distress of adult patients consulting a center for rare and undiagnosed diseases: a cross-sectional study. Orphanet J Rare Dis 2023; 18:82. [PMID: 37060005 PMCID: PMC10103043 DOI: 10.1186/s13023-023-02669-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 03/11/2023] [Indexed: 04/16/2023] Open
Abstract
BACKGROUND Centers for rare diseases serve as contact points for patients with complex, often undiagnosed complaints and persistent somatic symptoms of heterogeneous origin. Little is known about psychological distress of patients consulting these centers. OBJECTIVES To better understand psychological distress of adult patients presenting at a center for rare diseases by determining the proportion of patients screening positive for depressive, anxiety, and somatic symptom disorders (SSD) and to identify factors associated with increased psychopathology. METHODS Cross-sectional data from the routine care registry of the Martin Zeitz Center for Rare Diseases (MZCSE) at the University Medical Center Hamburg-Eppendorf in Germany was retrieved and analyzed. We included all adult patients presenting between October 01,2020 and September 30,2021, who gave written informed consent. MEASURES Sociodemographic variables, medical history and healthcare utilization, as well as validated measures to screen for a depressive disorder (PHQ-8), an anxiety disorder (GAD-7), and SSD (PHQ-15, SSD-12). RESULTS N = 167 patients were included (age 44.5 ± 14.3 years, 64.7% female). A total of 40.7% of the patients screened positive for a depressive disorder (PHQ-8 ≥ 10), 27.5% for an anxiety disorder (GAD-7 ≥ 10) and 45.0% screened positive for SSD (PHQ-15 ≥ 9 & SSD-12 ≥ 23). Factors associated with increased psychopathology included the number of symptoms, the number of different specialties consulted before and past psychotherapy. CONCLUSIONS Patients presenting at centers for rare diseases are likely to experience high rates of psychological distress. Systematically screening patients with rare and undiagnosed diseases for mental disorders can help to detect those at risk at an early stage and initiate adequate psychological care.
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Affiliation(s)
- Meike Mund
- Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Natalie Uhlenbusch
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246, Germany
| | - Franziska Rillig
- Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christina Weiler-Normann
- Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Theresia Herget
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Kubisch
- Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute of Human Genetics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246, Germany
| | - Christoph Schramm
- Martin Zeitz Center for Rare Diseases, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- 1st Department of Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Hüsing P, Smakowski A, Löwe B, Kleinstäuber M, Toussaint A, Shedden-Mora MC. The framework for systematic reviews on psychological risk factors for persistent somatic symptoms and related syndromes and disorders (PSY-PSS). Front Psychiatry 2023; 14:1142484. [PMID: 37091694 PMCID: PMC10113674 DOI: 10.3389/fpsyt.2023.1142484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/16/2023] [Indexed: 04/25/2023] Open
Abstract
Introduction Numerous psychological factors are believed to play a pivotal role in the development and maintenance of persistent somatic symptoms (PSS) in all fields of medicine. However, very few of these factors have been empirically investigated in relation to PSS. The aim of this study is firstly to propose a framework and define search terms for systematic reviews on the empirical evidence and diagnostic value of psychological risk factors for PSS and PSS-related outcomes (PSY-PSS). Secondly, the application of the framework is illustrated using the example of a systematic review on the relevance of psychological factors in somatic symptom disorders (SSD; DSM-5) and bodily distress disorders (BDD; ICD-11). Methods Following a narrative review approach, two comprehensive lists of search terms to identify studies in (1) relevant patient groups with PSS and (2) relevant psychological factors were generated by reviewing the current literature and employing an iterative process of internal revision and external expert feedback. Results We identified 83 relevant symptoms, syndromes and disorders for which we defined a total of 322 search terms (list 1). We further comprised 120 psychological factors into 42 subcategories and 7 main categories (list 2). The introduced lists can be combined to conduct systematic reviews on one or more specific psychological factors in combination with any symptom, syndrome or disorder of interest. A protocol of the application of this framework in a systematic review and meta-analysis on psychological etiological factors of SSD and BDD is presented following the PRISMA guidelines. Discussion This framework will help to gather systematic evidence on psychological factors in order to improve the understanding of the etiology of PSS, to refine future diagnostic conceptualizations of PPS, and to develop optimized mechanism-based interventions for individuals with PPS and related syndromes and disorders.
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Affiliation(s)
- Paul Hüsing
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Abigail Smakowski
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maria Kleinstäuber
- Department of Psychology, Utah State University, Logan, UT, United States
| | - Anne Toussaint
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Johnson AW, Golzarri Arroyo L, Mahendraker N, Hosty J, Kroenke K. Hospital Opioid Usage and Adverse Events in Patients With End-Stage Liver Disease. J Pain Symptom Manage 2023; 65:326-334.e2. [PMID: 36496114 DOI: 10.1016/j.jpainsymman.2022.11.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 11/21/2022] [Accepted: 11/26/2022] [Indexed: 12/13/2022]
Abstract
CONTEXT Patients with end-stage liver disease (ESLD) commonly experience pain and other symptoms that result in a poor quality of life. Few studies have examined opioid usage, adverse events (AEs), and other outcomes in ESLD patients receiving opioid analgesia. OBJECTIVES This study aimed to compare outcomes in ESLD patients who received opioids to those who did not and to determine risk factors for AEs. METHODS This was a retrospective case-cohort study of 270 hospitalized patients with ESLD that used administrative and clinical data from the electronic medical record. RESULTS Two-thirds of patients with ESLD admitted during the study period received at least one opioid analgesic. Patients who received opioids presented with a greater number of liver related complications and higher rates of anxiety (32% vs. 17%, P= 0.007), had substantially worse initial and average pain scores (both P< 0.001), and received more palliative care consultations. The opioid group had somewhat more respiratory (22.2% vs. 11.1%, P= 0.02) and gastrointestinal (38.5% vs. 25.2%, P= 0.03) AEs, but no increase in CNS adverse events which included hepatic encephalopathy. Anxiety and disease severity (i.e., the number of liver related complications) but not opioid administration were risk factors for the number of AEs. CONCLUSION Opioid administration was not an independent risk factor for the number of AEs in hospitalized patients with ESLD, whereas anxiety and more liver-related complications increased AE risk. Our findings suggest that opioids have an appropriate and reasonably safe role in alleviation of pain in patients with ESLD.
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Affiliation(s)
- Amy W Johnson
- Division of General Internal Medicine and Geriatrics (A.W.J,N.M.,K.K.), Indianapolis.
| | - Lilian Golzarri Arroyo
- Department of Epidemiology and Biostatistics (L.G-A), School of Public Health, Bloomington
| | - Neetu Mahendraker
- Division of General Internal Medicine and Geriatrics (A.W.J,N.M.,K.K.), Indianapolis
| | - Jack Hosty
- Indiana University School of Medicine (J.H.), Indianapolis
| | - Kurt Kroenke
- Division of General Internal Medicine and Geriatrics (A.W.J,N.M.,K.K.), Indianapolis; Regenstrief Institute, Inc. (K.K.), Indianapolis, Indianapolis USA
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Kiviruusu O, Haravuori H, Lindgren M, Therman S, Marttunen M, Suvisaari J, Aalto-Setälä T. Generalized anxiety among Finnish youth from 2013 to 2021-Trend and the impact of COVID-19. J Affect Disord 2023; 330:267-274. [PMID: 36914117 PMCID: PMC10008046 DOI: 10.1016/j.jad.2023.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 03/04/2023] [Accepted: 03/06/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Alarming levels of emotional symptoms among youth were reported during the COVID-19 pandemic. Studies assessing these figures against the pre-pandemic developments are rare. We examined the trend of generalized anxiety (GA) in adolescents in the 2010s and the effect of the COVID-19 pandemic against this trend. METHODS Data from the Finnish School Health Promotion study with 750,000 participants aged 13-20 between 2013 and 2021 was analyzed using GAD-7 to measure self-reported GA (cut-off ≥10). Inquiries were made about remote learning arrangements. Effects of time and COVID-19 were analyzed with logistic regression. RESULTS Among females, an increasing trend in GA between 2013 and 2019 was found (OR per year 1.05), and the prevalence increased from 15.5 % to 19.7 %. Among males, the trend was decreasing (OR = 0.98), with prevalence from 6.0 % to 5.5 %. Increase in GA from 2019 to 2021 was stronger in females (19.7 % to 30.2 %) than males (5.5 % to 7.8 %), while the effect of COVID-19 on GA was equally strong (OR = 1.59 vs. OR = 1.60) against the pre-pandemic trends. Remote learning was associated with elevated levels of GA, especially among those with unmet needs for learning support. LIMITATIONS The design of repeated cross-sectional surveys doesn't allow analyses of within individual changes. CONCLUSIONS Given the pre-pandemic trends of GA, the COVID-19 effect on it appeared equal in both sexes. The increasing pre-pandemic trend among adolescent females and the strong effect of COVID-19 on GA among both sexes warrants constant monitoring of mental health of the youth in the aftermath of the COVID-19 pandemic.
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Affiliation(s)
- Olli Kiviruusu
- Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland.
| | - Henna Haravuori
- Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland; Adolescent Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maija Lindgren
- Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Sebastian Therman
- Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Mauri Marttunen
- Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland; Adolescent Psychiatry, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jaana Suvisaari
- Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Terhi Aalto-Setälä
- Equality Unit, Finnish Institute for Health and Welfare, Helsinki, Finland
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Danson S, Sirois F, Fradley K, Wadsley J, Ray J, Bishop R, Horsman J, Mann C, Chantry-Groves L, Young M, Bentall R. Mental health burden for NHS healthcare staff during the COVID-19 pandemic: First results of a longitudinal survey. Heliyon 2023; 9:e13765. [PMID: 36811018 PMCID: PMC9933547 DOI: 10.1016/j.heliyon.2023.e13765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 02/01/2023] [Accepted: 02/09/2023] [Indexed: 02/17/2023] Open
Abstract
Background The current investigation aimed to assess the mental health burden on healthcare workers during the early stages of the COVID-19 pandemic. Methods A link to an online survey was sent to an estimate of 18,100 employees of Sheffield Teaching Hospitals NHS Foundation Trust (STH) who had access to email. The survey was completed between 2nd and June 12, 2020.1390 healthcare workers (medical, nursing, administrative and other professions) participated in the first survey. Data from a general population sample (n = 2025) was used for comparison. Severity of somatic symptoms was measured by the PHQ-15. Severity and probable diagnosis of depression, anxiety, and PTSD were measured by the PHQ-9, GAD-7, and ITQ. Linear and logistic regressions were performed to determine if population group predicted the severity of mental health outcomes, and probable diagnosis of depression, anxiety, and PTSD. Additionally, ANCOVAs were performed to compare mental health outcomes between occupational roles in HCWs. Analysis was performed using SPSS. Findings Healthcare workers are more likely to experience greater severity of somatic symptoms, as well as severity and probable diagnosis of depression and anxiety, compared to the general population, but not increased traumatic stress symptoms. Scientific and technical, nursing and admin staff were more likely to experience worse mental health outcomes, compared to medical staff. Interpretation The COVID-19 pandemic has led to increased mental health burden in some, but not all healthcare workers during the first acute phase of the pandemic. The findings from the current investigation provide valuable insights into which healthcare workers are particularly vulnerable to developing adverse mental health outcomes during and after a pandemic.
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Affiliation(s)
- Sarah Danson
- Department of Oncology and Metabolism, University of Sheffield, UK,Sheffield Teaching Hospital NHS Trust, UK
| | | | - Kathryn Fradley
- Department of Psychology, Edge Hill University, UK,Corresponding author
| | - Jonathan Wadsley
- Department of Oncology and Metabolism, University of Sheffield, UK,Sheffield Teaching Hospital NHS Trust, UK
| | - Jaydip Ray
- Department of Neuroscience, University of Sheffield, UK,Sheffield Teaching Hospital NHS Trust, UK
| | | | - Janet Horsman
- Department of Nursing and Midwifery, Sheffield Hallam University, UK
| | | | | | - Matthew Young
- Department of Psychology, University of Sheffield, UK
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McGhie-Fraser B, Lucassen P, Ballering A, Abma I, Brouwers E, van Dulmen S, Olde Hartman T. Persistent somatic symptom related stigmatisation by healthcare professionals: A systematic review of questionnaire measurement instruments. J Psychosom Res 2023; 166:111161. [PMID: 36753936 DOI: 10.1016/j.jpsychores.2023.111161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/16/2023] [Accepted: 01/18/2023] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Patients with persistent somatic symptoms (PSS) experience stigmatising attitudes and behaviours by healthcare professionals. While previous research has focussed on individual manifestations of PSS related stigma, less is known about sound ways to measure stigmatisation by healthcare professionals towards patients with PSS. This review aims to assess the quality of questionnaire measurement instruments and make recommendations about their use. METHODS A systematic review using six databases (PubMed, Embase, CINAHL, PsycINFO, Open Grey and EThOS). The search strategy combined three search strings related to healthcare professionals, PSS and stigma. Additional publications were identified by searching bibliographies. Three authors independently extracted the data. Data analysis and synthesis followed COSMIN methodology for reviews of outcome measurement instruments. RESULTS We identified 90 publications that met the inclusion criteria using 62 questionnaire measurement instruments. Stereotypes were explored in 92% of instruments, prejudices in 52% of instruments, and discrimination in 19% of instruments. The development process of the instruments was not rated higher than doubtful. Construct validity, structural validity, internal consistency and reliability were the most commonly investigated measurement properties. Evidence around content validity was inconsistent or indeterminate. CONCLUSION No instrument provided acceptable evidence on all measurement properties. Many instruments were developed for use within a single publication, with little evidence of their development or establishment of content validity. This is problematic because stigma instruments should reflect the challenges that healthcare professionals face when working with patients with PSS. They should also reflect the experiences that patients with PSS have widely reported during clinical encounters.
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Affiliation(s)
- Brodie McGhie-Fraser
- Radboud University Medical Center, Radboud Institute for Health Services Research, Department of Primary and Community Care, Nijmegen, the Netherlands.
| | - Peter Lucassen
- Radboud University Medical Center, Radboud Institute for Health Services Research, Department of Primary and Community Care, Nijmegen, the Netherlands.
| | - Aranka Ballering
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Groningen, the Netherlands.
| | - Inger Abma
- Radboud University Medical Center, Radboud Institute of Health Sciences, IQ Healthcare, Nijmegen, the Netherlands.
| | - Evelien Brouwers
- Tranzo, Scientific Center for Care and Wellbeing, Tilburg University, Tilburg, the Netherlands.
| | - Sandra van Dulmen
- Radboud University Medical Center, Radboud Institute for Health Services Research, Department of Primary and Community Care, Nijmegen, the Netherlands; Nivel (Netherlands Institute for Health Services Research), Utrecht, the Netherlands; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden.
| | - Tim Olde Hartman
- Radboud University Medical Center, Radboud Institute for Health Services Research, Department of Primary and Community Care, Nijmegen, the Netherlands.
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Nickerson A, Hoffman J, Keegan D, Kashyap S, Argadianti R, Tricesaria D, Pestalozzi Z, Nandyatama R, Khakbaz M, Nilasari N, Liddell B. Intolerance of uncertainty, posttraumatic stress, depression, and fears for the future among displaced refugees. J Anxiety Disord 2023; 94:102672. [PMID: 36657336 DOI: 10.1016/j.janxdis.2023.102672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 12/14/2022] [Accepted: 01/12/2023] [Indexed: 01/18/2023]
Abstract
INTRODUCTION The vast majority of the 100 million forcibly displaced persons worldwide live in a state of prolonged uncertainty with limited resettlement prospects and access to resources. Little is known, however, regarding how refugees and asylum-seekers cope with this uncertainty. METHODS In this study, we investigated the longitudinal association between a measure of how people cope with uncertainty (intolerance of uncertainty (IU)), fears for the future, posttraumatic stress disorder (PTSD) symptoms and depression symptoms. A sample of 1,237 refugees displaced in Indonesia completed an online survey in Arabic, Farsi, Dari, Somali or English at two time-points six-months apart. RESULTS Results indicated that greater IU-inhibitory anxiety (IU-IA or impairment related to uncertainty) was associated with subsequent increases in PTSD and depression symptoms and fears for the future. Greater PTSD symptoms and fears for the future were associated with increases in IU-prospective anxiety (IU-PA or distress related to uncertainty), and greater depression symptoms were associated with increases in IU-IA. DISCUSSION These findings provide evidence for the mechanistic role of IU in psychological symptoms amongst displaced refugees. Results underscore the importance of policies to reduce uncertainty in displacement environments, and highlight IU as a potential intervention target to help refugees cope with protracted displacement.
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Affiliation(s)
| | - Joel Hoffman
- School of Psychology, UNSW Sydney, NSW, Australia.
| | - David Keegan
- HOST International, 31 Grose Street, Parramatta, NSW, Australia.
| | | | - Rizka Argadianti
- HOST International, 31 Grose Street, Parramatta, NSW, Australia; SUAKA, Indonesian Civil Society Network for Refugee Rights Protection, Menteng, Jakarta Pusat 10320, Indonesia.
| | - Diah Tricesaria
- HOST International, 31 Grose Street, Parramatta, NSW, Australia.
| | - Zico Pestalozzi
- SUAKA, Indonesian Civil Society Network for Refugee Rights Protection, Menteng, Jakarta Pusat 10320, Indonesia.
| | - Randy Nandyatama
- Department of International Relations, Gadjah Mada University Yogyakarta, Bulaksumur, Yogyakarta 55281, Indonesia.
| | - Mitra Khakbaz
- HOST International, 31 Grose Street, Parramatta, NSW, Australia.
| | - Nindita Nilasari
- Department of International Relations, Gadjah Mada University Yogyakarta, Bulaksumur, Yogyakarta 55281, Indonesia.
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Predictors of Full Recovery in Individuals with Emotional Disorders: One-Year Follow-Up Secondary Analysis of the PsicAP Randomized Controlled Trial. COGNITIVE THERAPY AND RESEARCH 2023. [DOI: 10.1007/s10608-023-10360-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Mason EC, Grierson AB, Sie A, Sharrock MJ, Li I, Chen AZ, Newby JM. Co-occurring insomnia and anxiety: a randomized controlled trial of internet cognitive behavioral therapy for insomnia versus internet cognitive behavioral therapy for anxiety. Sleep 2023; 46:6679359. [PMID: 36041459 DOI: 10.1093/sleep/zsac205] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/27/2022] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Insomnia and anxiety are highly prevalent and frequently co-occur. Given limited therapeutic resources and time constraints, the aim of this study was to compare which treatment-internet cognitive behavioral therapy (CBT) for insomnia or internet CBT for anxiety-leads to the best outcomes in individuals with comorbid insomnia and anxiety. METHODS 120 participants with comorbid insomnia and clinical anxiety (as defined by scores above the clinical cutoff on the insomnia severity index (ISI) and the generalized anxiety disorder 7-item scale (GAD-7)) were randomized to receive internet-based cognitive behavioral therapy (iCBT) for insomnia or iCBT for anxiety. The primary outcome measures were the ISI and the generalized anxiety disorder 7-item scale. Primary outcome measures were assessed before treatment, at mid-treatment, at post-treatment, and 3 months after treatment. Secondary outcome measures assessed depression symptoms, distress, and sleep diary parameters. RESULTS Participants in both groups experienced large reductions in symptoms of insomnia, anxiety, depression, and distress, as well as improvements in sleep efficiency and total sleep time. Improvements were maintained at follow-up. Crucially, at the end of treatment, the insomnia treatment was more effective in reducing symptoms of insomnia than the anxiety treatment, and equally effective in reducing symptoms of anxiety. Treatment gains were maintained at 3-month follow-up, however, there were no differences between groups at that time point. CONCLUSIONS These results suggest that in the common case of a patient presenting with comorbid insomnia and anxiety, treatment for insomnia may be the most efficient treatment strategy. TRIAL REGISTRATION The trial was registered with the Australian and New Zealand Clinical Trials Registry, https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12618001141235. Trial ID: ACTRN12618001141235. Trial name: a comparison of internet-based CBT for insomnia versus internet-based CBT for anxiety in a comorbid sample.
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Affiliation(s)
- Elizabeth C Mason
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW, Australia.,School of Psychology, Faculty of Science, University of New South Wales, Sydney, NSW, Australia
| | - Ashlee B Grierson
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW, Australia
| | - Amanda Sie
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW, Australia
| | - Maria J Sharrock
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW, Australia
| | - Ian Li
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW, Australia
| | - Aileen Z Chen
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney, NSW, Australia
| | - Jill M Newby
- School of Psychology, Faculty of Science, University of New South Wales, Sydney, NSW, Australia.,Black Dog Institute, Randwick, NSW, Australia
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The Effects of Art Therapy on Anxiety and Distress for Korean-Ukrainian Refugee: Quasi-Experimental Design Study. Healthcare (Basel) 2023; 11:healthcare11040466. [PMID: 36833000 PMCID: PMC9956358 DOI: 10.3390/healthcare11040466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/08/2023] Open
Abstract
Since Russia invaded Ukraine in February 2022, there has been an urgent need to provide mental healthcare and share various practices for Ukrainian war refugees. This study urgently focuses on the need for art therapy to support the mental health of Ukrainian refugees, Koryo-saram, who are staying in the Republic of Korea due to the wartime emergency. It also examines the impact of art therapy intervention on anxiety and subjective stress. The single-session art therapy with the 54 Koryo-saram refugees aged 13-68 showed the effectiveness of the art therapy intervention. The results indicate that GAD-7 (t = 3.092, p = 0.003) and SUDs (t = 3.335, p = 0.002) were statistically significant within the intervention group. In addition, satisfaction assessments of the qualitatively analyzed participants showed that Ukrainian Koryo-saram had a positive experience of art therapy. Therefore single-session art therapy in this study demonstrated the efficacy of art therapy for the anxiety and subjective distress of Ukrainian Koryo-saram refugees. This result suggests that the intervention of art therapy as immediate mental healthcare for refugees facing war could benefit the mental health of Koryo-saram refugees.
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Gershoni T, Pud D, Aviram J, Eisenberg E. Wellness of patients with chronic pain is not only about pain intensity. Pain Pract 2023; 23:145-154. [PMID: 36181347 PMCID: PMC10092262 DOI: 10.1111/papr.13168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/07/2022] [Accepted: 09/14/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Attaining good outcomes in the management of chronic pain remains a clinical challenge. This study aimed to investigate the relationships between - and the contribution of - pain and related conditions to the wellness of these patients. DESIGN A secondary analysis of database of patients with chronic pain treated with medical cannabis (MC) to carry out a one-year prospective follow-up study was conducted. Questionnaires were completed before (T0 ), six (T6 ), and twelve (T12 ) months after MC initiation. Data included patients' demographics and questionnaires related to three latent factors: pain intensity measures, related conditions (catastrophizing, sleep disturbance, anxiety, and depression), and wellness parameters (quality-of-life, disability, subjective-health-state). Weighted average of the observed variables (WOBs) were calculated for each latent factor. Longitudinal structural equation modeling (SEM) and mediation analyses were performed to identify predictors and interrelations between the WOBs, respectively. RESULTS Participants included 510 patients. All variables were significantly improved from T0 to T6 and T12 . SEM revealed that related conditions, and to a lesser extent pain, predicted wellness at T0 , T6 , and T12 (related conditions: β0 = 0.55, p < 0.001; β6 = 0.54, p < 0.001; and β12 = 0.51, p < 0.001; pain: β0 = 0.42, p < 0.001; β6 = 0.18, p < 0.001; and β12 = 0.25, p < 0.001). Mediation analyses demonstrated that the effect of WOB-related conditions was greater than WOB-pain on wellness. CONCLUSION Wellness of patients with chronic pain can be determined not only by pain itself but even more so by the severity of related conditions. Thus, considering a broad spectrum of pain measures and related conditions seems relevant for improving the wellness of patients with chronic pain.
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Affiliation(s)
- Tamar Gershoni
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Dorit Pud
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel
| | - Joshua Aviram
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa, Israel.,Faculty of Biology, Technion - Israel Institute of Technology, Haifa, Israel
| | - Elon Eisenberg
- Institute of Pain Medicine, Rambam Health Care Campus, Haifa, Israel.,Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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Quality of life and mood disorders of mild to moderate stroke survivors in the early post-hospital discharge phase: a cross-sectional survey study. BMC Psychol 2023; 11:32. [PMID: 36721206 PMCID: PMC9890754 DOI: 10.1186/s40359-023-01068-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 01/24/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Exploring sociodemographic and disease characteristics that contribute to patient-reported outcomes can inform targeting of strategies to support recovery and adaptation to stroke. This study aimed to examine among a sample of stroke survivors at three months post-hospital discharge: (1) self-reported physical and mental health quality of life scores; (2) self-reported depressive and anxiety symptoms; and (3) sociodemographic and clinical predictors of these outcomes. METHODS This cross-sectional survey study recruited stroke survivors from eight hospitals in one Australian state. Adult survivors recently discharged from hospital stroke wards (within 3 months) were mailed a study information package and invited to complete a pen-and paper survey. Survey items assessed: quality of life (SF12v2), depression (PHQ-9), anxiety (GAD-7) and sociodemographic and clinical characteristics. Predictors were examined using multiple linear regression analysis. RESULTS Of the 1161 eligible patients who were posted a recruitment pack, 401 (35%) returned a completed survey. Participants reported a mean SF-12v2 Physical Composite Score (PCS) quality of life score of 44.09 (SD = 9.57); and a mean SF-12v2 Mental Composite Score (MCS) quality of life score of 46.84 (SD = 10.0). Approximately one third of participants (34%; n = 132) were classified as depressed (PHQ-9 ≥ 10); and 27% (n = 104) were classified as anxious (GAD-7 ≥ 8). Lower PCS was associated with being female, not employed and having a comorbid diagnosis of diabetes and atrial fibrillation. Lower MCS was associated with a history of transient ischemic attack (TIA). Males and those with higher levels of education, had greater odds of having lower depression severity; those with a history of TIA or diabetes had lower odds of having lower depression severity. Males had greater odds of having lower anxiety severity; those with a history of TIA had lower odds of having lower anxiety severity. CONCLUSION Sub-groups of stroke survivors may be at-risk of poorer quality of life and psychological morbidity in the early post-discharge phase. These findings support the role of early identification and prioritisation of at-risk survivors at discharge, as they may require modifications to standard hospital discharge processes tailored to their level of risk.
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Zhao Y, Zhang Y, Teopiz KM, Lui LMW, McIntyre RS, Cao B. Presence of Depression Is Associated with Functional Impairment in Middle-Aged and Elderly Chinese Adults with Vascular Disease/Diabetes Mellitus-A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1602. [PMID: 36674357 PMCID: PMC9864745 DOI: 10.3390/ijerph20021602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/11/2023] [Accepted: 01/12/2023] [Indexed: 06/17/2023]
Abstract
Objectives: The association between chronic diseases and depression has received increasing attention, and are both considered to increase the risk of functional impairment. However, previous research evidence is controversial. Our study aimed to investigate the association between depression, three types of vascular disease (i.e., hypertension, myocardial infarction, stroke), diabetes mellitus, and functional impairment in middle-aged and elderly Chinese people. Methods: We designed a cross sectional study. Data were collected from the China Health and Retirement Longitudinal Study (CHARLS) in 2018. Logistic regression models were used to explore the association between independent variables and functional status. Results: Lower functional status was significantly associated with comorbid depression and vascular disease/diabetes mellitus (Activity of Daily Living/Instrumental Activity of Daily Living: Adjusted OR of Hypertension, Diabetes mellitus, Myocardial infarction, Stroke is 3.86/4.30, 3.80/4.38, 3.60/4.14, 6.62/7.72, respectively; all p < 0.001). Conclusions: Depression is associated with functional decline in middle-aged and elderly Chinese individuals with vascular disease/diabetes mellitus. Identifying mediational factors and preventative strategies to reduce concurrent depression in persons with vascular diseases should be a priority therapeutic vista.
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Affiliation(s)
- Yuxiao Zhao
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing 400715, China
| | - Yueying Zhang
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing 400715, China
| | - Kayla M. Teopiz
- Mood Disorders Psychopharmacology Unit, Toronto, ON M5T 2S8, Canada
| | - Leanna M. W. Lui
- Mood Disorders Psychopharmacology Unit, Toronto, ON M5T 2S8, Canada
| | - Roger S. McIntyre
- Mood Disorders Psychopharmacology Unit, Toronto, ON M5T 2S8, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON M5T 1R8, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Bing Cao
- Key Laboratory of Cognition and Personality, Faculty of Psychology, Ministry of Education, Southwest University, Chongqing 400715, China
- National Demonstration Center for Experimental Psychology Education, Southwest University, Chongqing 400715, China
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Fu Y, Lin Q, Xiang Q, Wen X, Liu L. Comparison of SSS-CN and PHQ-15 in the evaluation of patients with suspected psychological disorders in cardiovascular medicine. Front Psychol 2023; 14:1027253. [PMID: 36936003 PMCID: PMC10019093 DOI: 10.3389/fpsyg.2023.1027253] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
Aims Somatic Symptom Scale-China (SSS-CN) has been applied to assess the presence and severity of somatization symptom disorders (SSD) in Chinese patients. However, there was no study comparing SSS-CN with Patient Health Questionnaire-15 (PHQ-15). The aim of this study was to compare the consistency of the SSS-CN with the PHQ-15 in evaluating SSD in patients with suspected psychological disorders in cardiovascular medicine and to explore the relationship between scores on the two SSD self-rating scales and scores on self-rating scales for anxiety or depression. Methods In this study, 1,324 subjects were enrolled by using a "three-question method." Then, they completed four self-assessment scales, i.e., SSS-CN, PHQ-15, Patient Health Questionnaire-9 (PHQ-9), and General Anxiety Disorder-7 (GAD-7), in turn. The ability of SSS-CN to diagnose SSD was analyzed by the receiver operating characteristic (ROC) curve, and the area under the curve (AUC) value, sensitivity, and specificity were calculated. Reliability analysis was performed with the Kappa statistic to determine consistency between SSS-CN and PHQ-15. The relationship between two qualitative variables was analyzed by Spearman correlation analysis. Results The proportions of SSD evaluated by SSS-CN and PHQ-15 were 83.2 and 87.0%, respectively. SSS-CN score was significantly correlated with PHQ-15 one (r = 0.709, p < 0.001). The AUC of the SSS-CN for the diagnosis of SSD was 0.891, with a high sensitivity and acceptable specificity. There was a moderate agreement between SSS-CN and PHQ-15 in assessing SSD, with a Kappa value of 0.512. Anxiety and/or depression were detected in about 70% of patients with SSD. There was significant correlation between the score of each SSD scale and that of GAD-7 or PHQ-9 (SSS-CN: r = 0.614 or 0.674; PHQ-15: r = 0.444 or 0.582, all p < 0.001). In addition, the SSS-CN score was more closely correlated with the GAD-7 or PHQ-9 score than the PHQ-15 score, and a higher proportion of patients with anxiety or depression was detected in those with moderate and severe SSD evaluated by SSS-CN. Conclusion The SSS-CN could be one of the ideal scales for the rapid screening of patients with suspected psychological disorders in cardiovascular medicine.
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Affiliation(s)
- Yan Fu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, Hunan, China
- Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, The Second Xiangya Hospital, Central South University Changsha, Hunan, China
- Cardiovascular Disease Research Center of Hunan Province, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qiuzhen Lin
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, Hunan, China
- Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, The Second Xiangya Hospital, Central South University Changsha, Hunan, China
- Cardiovascular Disease Research Center of Hunan Province, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qunyan Xiang
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, Hunan, China
- Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, The Second Xiangya Hospital, Central South University Changsha, Hunan, China
- Cardiovascular Disease Research Center of Hunan Province, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xingyu Wen
- Xiangya School of Medicine, Central South University, Changsha, Hunan, China
| | - Ling Liu
- Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Research Institute of Blood Lipid and Atherosclerosis, Central South University, Changsha, Hunan, China
- Modern Cardiovascular Disease Clinical Technology Research Center of Hunan Province, The Second Xiangya Hospital, Central South University Changsha, Hunan, China
- Cardiovascular Disease Research Center of Hunan Province, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- *Correspondence: Ling Liu,
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Jobin K, Wang M, du Plessis S, Silverberg ND, Debert CT. The importance of screening for functional neurological disorders in patients with persistent post-concussion symptoms. NeuroRehabilitation 2023; 53:199-208. [PMID: 37638460 DOI: 10.3233/nre-237002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
BACKGROUND Functional neurological disorder (FND) may commonly co-occur with persistent symptoms following a psychological trauma or physical injury such as concussion. OBJECTIVE To explore the occurrence of FND in a population with persistent post-concussion symptoms (PPCS) and the associations between FND and depression as well as anxiety in participants with PPCS. METHODS Sixty-three individuals with PPCS presenting to a specialized brain injury clinic completed the following questionnaires: screening for somatoform disorder conversion disorder subscale (SOM-CD), Rivermead post-concussion symptom questionnaire (RPQ), patient health questionnaire-9 (PHQ-9), and generalized anxiety disorder questionnaire- 7 (GAD-7). Both multiple linear regression and logistic regression were conducted to evaluate the relationship between questionnaires and adjust for covariates. RESULTS We found that total RPQ score (βˆ= 0.27; 95% CI = [0.16, 0.38]), GAD-7 score (βˆ= 0.71; 95% CI = [0.50, 0.92]) and PHQ-9 score (βˆ= 0.54; 95% CI = [0.32, 0.76]) were positively associated with SOM-CD score individually, after consideration of other covariates. Participants meeting the criteria for severe FND symptoms were 4.87 times more likely to have high PPCS symptom burden (95% CI = [1.57, 22.84]), 8.95 times more likely to have severe anxiety (95% CI = [3.31, 35.03]) and 4.11 times more likely to have severe depression symptom burden (95% CI = [1.77, 11.53]). CONCLUSION The findings of this study indicate an association between FND and post-concussion symptoms as well as an association between FND and symptoms of depression and anxiety in patients with PPCS. Patients with PPCS should be screened for FND to provide a more targeted treatment approach that includes somatic-focused interventions.
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Affiliation(s)
- Kaiden Jobin
- Department of Clinical Neurosciences, Cumming School of Medicine, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - Meng Wang
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Sané du Plessis
- Department of Clinical Neurosciences, Cumming School of Medicine, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
| | - Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - Chantel T Debert
- Department of Clinical Neurosciences, Cumming School of Medicine, Faculty of Medicine, University of Calgary, Calgary, AB, Canada
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Assessing Internalizing Symptoms and Their Relation with Levels of Impairment: Evidence-Based Cutoffs for Interpreting Inventory of Depression and Anxiety Symptoms (IDAS-II) Scores. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2023; 45:170-180. [PMID: 36644288 PMCID: PMC9830132 DOI: 10.1007/s10862-022-10008-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 01/12/2023]
Abstract
Tests and scales measuring psychological disorders should provide information about how scores relate to other constructs such as quality of life or functional impairment. Such information is necessary to allow that their scores contribute to clinical decision making. The current study analyzes the clinical utility of the Spanish version of the Inventory for Depression and Anxiety Symptoms (IDAS-II) to discriminate between different levels of functional impairment and identify the IDAS-II scales that contribute most to explaining impairment. The total sample (N = 1390) consists of two subsamples: a community sample of the general population (n = 1072) selected by random sampling; and a sample of patients (n = 318) from public and private mental health services. The Spanish IDAS-II for measuring internalizing symptoms and WHODAS 2.0 for measuring impairment were administered to all participants. All scales show statistically significant higher scores in the patient sample, with Cohen's d effect sizes values greater than 0.30, except for well-being (d = 0.19). The cutoff values and their confidence intervals do not overlap with the means of either the community or patient sample. AUC values for most of the scales are above .70, except for appetite gain, ordering, euphoria, cleaning, and well-being. Multiple linear regression model using IDAS-II scales explain 57.1% of the variance of the WHODAS 2.0 (F 12.1377 = 155.305; p < .001). Cutoff values provided allow us to reliably differentiate between the patients and community samples. Spanish IDAS-II scores show greater sensitivity and specificity in detecting those with greater impairment. General Depression, Lassitude, Panic and Claustrophobia contribute to impairment in a greater extent. Knowledge of which symptoms are most related with impairment, allows healthcare providers to improve treatment planning based on empirical evidence.
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Zhang C, Zhang W. The impact of mental disturbance on second language learning psychology among Chinese undergraduate students: a structural equation modelling analysis. CURRENT PSYCHOLOGY 2022; 42:1-15. [PMID: 36573180 PMCID: PMC9771772 DOI: 10.1007/s12144-022-04145-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 11/01/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
Recent developments in the field of second language acquisition have led to a growing interest in exploring the influential power of domain-general psychological properties in the L2 learning context. Several attempts have been made to elucidate the impact of properties such as boredom, resilience and enjoyment, etc. However, the association between psychopathology and second language learning psychology has received scant attention and has not been closely examined. Hence, the current study aims to explore the impact of mental disturbance on second language learning psychology and delineate the influential trajectory, by referring to the network approach as the theoretical foundation. Participants were 173 Chinese speakers of L2 English. By performing correlation analysis and structural equation modelling analysis, this research revealed that mental disturbance had a significant positive impact on L2 anxiety and a significant negative impact on L2 autonomy and L2 self-efficacy. L2 anxiety and L2 autonomy acted as mediating roles in the impact of mental disturbance on L2 self-efficacy, in which a chain mediation trajectory was detected. An expanded network approach was thus advanced. Pedagogical implication and future research were identified and discussed.
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Affiliation(s)
- Chen Zhang
- Department of English, College of Foreign Languages, Nankai University, No. 94 Weijin Road, 300071 Tianjin, China
| | - Wenzhong Zhang
- Department of English, College of Foreign Languages, Nankai University, No. 94 Weijin Road, 300071 Tianjin, China
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Sacchetto L, Apa E, Ciorba A, Palma S, Caragli V, Gherpelli C, Monzani D, Genovese E, Nocini R. Psychological Profile and Social Behaviors of Patients with Hyperacusis. J Clin Med 2022; 11:jcm11247317. [PMID: 36555934 PMCID: PMC9784993 DOI: 10.3390/jcm11247317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/02/2022] [Accepted: 12/08/2022] [Indexed: 12/13/2022] Open
Abstract
Increased noise sensitivity refers to the abnormal subjective response to external sounds, with a prevalence of between 8% and 15.2% in the adult population as suggested by epidemiological studies. The basic neural mechanism of hyperacusis still remains obscure, so therapies for this often-devastating symptom remain elusive. The aim of this study was to assess psychological profiles in patients with presbycusis without tinnitus in a perspective case-control design. All subjects were initially submitted to audiological evaluation (tympanometry, recordings of the acoustic reflex thresholds, pure tone audiometry) and subsequently were administered the following questionnaires: the hyperacusis questionnaire (HQ), the brief symptom inventory (BSI), and the modified somatic perception questionnaire (MSPQ). Patients with hyperacusis reported a total score and subscales (attentional, social, and emotional) of the HQ significantly higher than controls. They also reported higher scores of the MSPQ and significantly higher mean values with concern to the somatization, obsessive-compulsive, interpersonal sensitivity, depression, and anxiety subscales of the BSI. These results show that psychological distress, as expressed by higher level of somatic attention, somatization, anxiety, and depression, is a significant factor to consider for a complete diagnosis and effective treatment of hyperacusis. For a correct diagnosis of patients seeking help for hyperacusis, their psychological distress should also be assessed, regardless of their hearing abilities. Further studies are required to investigate the pathological mechanisms that are involved in the onset of hyperacusis in patients with normal hearing and those with sensorineural hearing loss.
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Affiliation(s)
- Luca Sacchetto
- Ear Nose and Throat (ENT), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37134 Verona, Italy
| | - Enrico Apa
- Audiology, ENT Department, University of Modena and Reggio Emilia, 41100 Modena, Italy
| | - Andrea Ciorba
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, Via Aldo Moro 8, 44124 Cona, Italy
| | - Silvia Palma
- Audiology, Primary Care Department, Ausl Modena, 41121 Modena, Italy
- Correspondence:
| | - Valeria Caragli
- Audiology, ENT Department, University of Modena and Reggio Emilia, 41100 Modena, Italy
| | - Chiara Gherpelli
- Audiology, ENT Department, University of Modena and Reggio Emilia, 41100 Modena, Italy
| | - Daniele Monzani
- Ear Nose and Throat (ENT), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37134 Verona, Italy
| | - Elisabetta Genovese
- Audiology, ENT Department, University of Modena and Reggio Emilia, 41100 Modena, Italy
| | - Riccardo Nocini
- Ear Nose and Throat (ENT), Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37134 Verona, Italy
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Estlein R, Segel‐Karpas D, Elran‐Barak R. Relational uncertainty, interdependence and psychological distress during COVID‐19: A longitudinal study. Stress Health 2022; 38:1029-1044. [PMID: 35482755 PMCID: PMC9111071 DOI: 10.1002/smi.3155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/07/2022] [Accepted: 04/19/2022] [Indexed: 12/16/2022]
Abstract
Drawing on the relational turbulence theory, this study explored the associations of self, partner and relationship uncertainty, and partner interference and facilitation with psychological distress symptoms during the COVID-19 stay-at-home orders. A longitudinal study of 313 individuals was conducted in Israel at three time points, spanning from the first lockdown (April 2020) and through the alleviation of the severe restrictions (June 2020). Multilevel modelling indicated divergent associations between the different sources of relational uncertainty and interdependence and somatization, depression and anxiety. Further analyses pointed to divergent findings regarding how change in self, partner and relationship uncertainty predicted change in somatization, depression and anxiety over the course of the study, depending on whether the three sources of relational uncertainty were analysed separately or simultaneously in the same model. Change in interference from a partner did not predict changes in psychological distress. Theoretical and practical implications of the findings are discussed.
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Affiliation(s)
- Roi Estlein
- School of Social WorkUniversity of HaifaHaifaIsrael
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50
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Badinlou F, Lundgren T, Jansson-Fröjmark M. Mental health outcomes following COVID-19 infection: impacts of post-COVID impairments and fatigue on depression, anxiety, and insomnia - a web survey in Sweden. BMC Psychiatry 2022; 22:743. [PMID: 36447183 PMCID: PMC9708120 DOI: 10.1186/s12888-022-04405-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/18/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The negative impact of the COVID-19 pandemic on the mental health is now clearly established. However, information on the levels of mental ill health of people infected with COVID-19 and potential correlates of poor mental health is still limited. Therefore, the current study aimed to study indicative of potential mental health problems in individuals with a history of probable or confirmed SARS CoV-2 infection/infections and address the impacts of post-COVID impairments and fatigue following COVID-19 infection/infections on depression, anxiety, and insomnia. METHODS A web-survey including demographics, questions related to COVID-19 status and post-COVID impairments, and standardized measures of depression, anxiety, insomnia, and fatigue was completed by 507 individuals with a history of probable or confirmed SARS CoV-2 infection/infections. RESULTS We found significant rates of significant depression, anxiety, and insomnia in our sample, with more than 70% experiencing levels above the clinical cut offs for at least one psychological health problems. Higher levels of depression, anxiety, and insomnia were associated with the severity of COVID-19 infection in the acute phase, hospitalization because of COVID-19, and higher levels of post-COVID impairments and fatigue. Reduced motivation emerged as the strongest predictor for mental ill health. CONCLUSIONS These findings highlight that individuals infected with COVID-19, especially those who still have experienced post-COVID impairments, are more likely to suffer from mental ill-health and may be more vulnerable for poor mental health outcomes. Therefore, more effective actions are needed to take in order to promote and protect mental health of individuals with a history of COVID-19 infection.
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Affiliation(s)
- Farzaneh Badinlou
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, and Stockholm Health Care Services, Region of Stockholm, Norra Stationsgatan 69, 113 64, Stockholm, Sweden.
| | - Tobias Lundgren
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, and Stockholm Health Care Services, Region of Stockholm, Norra Stationsgatan 69, 113 64, Stockholm, Sweden
| | - Markus Jansson-Fröjmark
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, and Stockholm Health Care Services, Region of Stockholm, Norra Stationsgatan 69, 113 64, Stockholm, Sweden
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