1
|
Nielsen SS, Christensen JR, Søndergaard J, Surrow S, Enemark Larsen A, Skou ST, Simonÿ C. "It has changed my picture of myself": how did females living with chronic pain perceive the impact of the standard pain rehabilitation, including the occupational therapy lifestyle intervention REVEAL(OT)? Disabil Rehabil 2024; 46:2777-2788. [PMID: 37410586 DOI: 10.1080/09638288.2023.2230127] [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: 11/28/2022] [Revised: 06/21/2023] [Accepted: 06/23/2023] [Indexed: 07/08/2023]
Abstract
PURPOSE This study investigated patient perceptions of multidisciplinary chronic pain rehabilitation, including the occupational therapy lifestyle management program REVEAL(OT), on everyday life with chronic pain. METHODS Individual interviews were conducted using video conferencing after completing multidisciplinary chronic pain rehabilitation. The interviews followed a semi-structured interview guide and investigated patient experiences with occupational therapy-supported health behavior transformation. The interviews were transcribed verbatim and analyzed iteratively using an inductive semantic data-driven approach inspired by Braun & Clarke's methodology. RESULTS Five females, 34 to 58 years old, revealed three common themes: To discover oneself anew; Increased energy and calmness; and Look into the future. The themes reflected transformations towards a healthier lifestyle through enhanced self-control, developing meaningful and secure everyday activities, and gaining reaffirmed dignity. The study also identified the participants' need for professional assistance to cope with the pain after discharge. CONCLUSIONS Chronic pain rehabilitation that included an occupational therapy intervention supported health behavior transformation and chronic pain self-management in females, where meaningful daily occupations and physical activity played an important role. Individually tailored support, also available after chronic pain rehabilitation, would benefit the transformation process towards improved pain coping in females.Implications for rehabilitationPersonal gains for health and well-being may develop over a shorter or longer time after chronic pain rehabilitation.Targeting daily occupations and physical activity during chronic pain rehabilitation appears meaningful for females living with chronic pain.Progression from an individual to group approach can be relevant in planning chronic pain rehabilitation, but the individual capacities shall be considered.Male perspectives on chronic pain rehabilitation that includes focus on daily occupations and lifestyle need further investigation.
Collapse
Affiliation(s)
- Svetlana Solgaard Nielsen
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Slagelse Hospital, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Jeanette Reffstrup Christensen
- User Perspectives and Community-based Interventions, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Jens Søndergaard
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Signe Surrow
- Center for Rehabilitation and Emergency Care Bystaevneparken, Copenhagen Municipality, Copenhagen, Denmark
| | - Anette Enemark Larsen
- Department of Therapy and Midwifery Studies, Faculty of Health Sciences, University College Copenhagen, Copenhagen, Denmark
| | - Søren T Skou
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Slagelse Hospital, Denmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Charlotte Simonÿ
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Naestved-Slagelse-Ringsted Hospitals, Slagelse Hospital, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
2
|
Treufeldt H, Burton C. Stigmatisation in medical encounters for persistent physical symptoms/functional disorders: Scoping review and thematic synthesis. PATIENT EDUCATION AND COUNSELING 2024; 123:108198. [PMID: 38367305 DOI: 10.1016/j.pec.2024.108198] [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: 08/07/2023] [Revised: 01/31/2024] [Accepted: 02/05/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVE To conduct a scoping review of stigma in medical encounters for persistent physical symptoms and functional disorders (PPS/FD). Stigma is a social attribute that links a person to an undesirable characteristic. It has been extensively studied in relation to mental illness but less so in relation to PPS/FD. METHODS We followed PRISMA-ScR reporting guidelines for scoping reviews. Searches for were designed using the SPIDER tool. We used descriptive and thematic analysis. RESULTS The searches identified 68 articles, of which 32 were eligible for inclusion. 31 out of the 32 studies used a qualitative methodology. 8 studies used an explicit definition of stigma, of which 6 used the Goffman (1963) definition. Only 2 studies directly examined clinical consultations, the remainder relied on recalled accounts by patients or professionals. Descriptive analysis identified the focus of the studies included: patient-physician interaction (n = 13); health care professionals' perceptions (n = 7); experiences of illness/stigma (n = 6); broader meaning of illness (n = 3); and patients' experiences of stigma in health care consultations (n = 3). CONCLUSION Patients experience stigmatisation in consultations for a wide range of PPS/FD. This suggests the presence of structural stigmatisation. PRACTICE IMPLICATIONS There is a need for effective stigma reduction strategies in consultations about persistent physical symptoms.
Collapse
Affiliation(s)
- Hõbe Treufeldt
- Division of Population Health, University of Sheffield, Samuel Fox House, Northern General Hospital, Sheffield S5 7AU, UK.
| | - Christopher Burton
- Division of Population Health, University of Sheffield, Samuel Fox House, Northern General Hospital, Sheffield S5 7AU, UK
| |
Collapse
|
3
|
Hickling LM, Allani S, Cella M, Scott W. A systematic review with meta-analyses of the association between stigma and chronic pain outcomes. Pain 2024:00006396-990000000-00605. [PMID: 38776178 DOI: 10.1097/j.pain.0000000000003243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 12/22/2023] [Indexed: 05/24/2024]
Abstract
ABSTRACT Stigma is common in people experiencing chronic pain and there are indications that it may adversely affect pain outcomes. However, to date, there is no systematic review exploring the impact of stigma on chronic pain-related outcomes. This systematic review and meta-analysis aimed to examine the association between stigma and key chronic pain outcomes and differences in stigma between pain conditions. Seven databases were searched for studies reporting a measure of association between stigma and at least one pain outcome in adults with chronic pain. Studies were screened by 2 independent researchers. Nineteen studies met eligibility criteria and data were extracted, quality-assessed, and narratively synthesised and meta-analysed where possible. Meta-analyses of bivariate cross-sectional correlations demonstrated significant positive correlations between stigma and pain intensity, disability, and depression, with small to moderate effects. Data from 2 prospective studies and those only reporting multivariate analyses that were not included in meta-analyses further supported these findings. There was some evidence that individuals who experience pain conditions with less clear pathophysiology may report greater stigma, although more research is needed. The review highlights that there is a growing number of studies on stigma in the pain field showing an adverse association between stigma and chronic pain outcomes.
Collapse
Affiliation(s)
- Lauren M Hickling
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Selsebil Allani
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, London, United Kingdom
| | - Matteo Cella
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, London, United Kingdom
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Whitney Scott
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, London, United Kingdom
- INPUT Pain Management Unit, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| |
Collapse
|
4
|
Bauer M, Krigers A, Schoen V, Thomé C, Freyschlag CF. Clinical Depression and Anxiety Are Relieved by Microvascular Decompression in Patients with Trigeminal Neuralgia-A Prospective Patient-Reported Outcome Study. J Clin Med 2024; 13:2329. [PMID: 38673601 PMCID: PMC11051355 DOI: 10.3390/jcm13082329] [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: 03/22/2024] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Objective: Patients with idiopathic trigeminal neuralgia (TN) live in constant fear of triggering shock-like pain episodes, which may cause symptoms of depression and a reduction in quality of life. Microvascular decompressive surgery has been demonstrated to achieve satisfactory and stable results. With this study, we wanted to investigate prevalence and risk factors for depression and perceived stress in correlation with symptom relief after surgical treatment. Methods: In this prospective study, patients undergoing microvascular decompression (MVD) for TN were included. The Barrow Neurological Institute Pain Score (BNI), Beck Depression Inventory (BDI), Chronic Pain Acceptance Questionnaire (CPAQ), Perceived Stress Questionnaire (PSQ) and McGill questionnaire were used to evaluate depression, stress and anxiety disorders before and 3 months after MVD. Results: A total of 35 patients (16 male (46%)) with a mean age of 55.4 (SD 15) years were included in this study. The BDI revealed that 24 (68.8%) patients harbored mild-to-extreme depression preoperatively (2.4 ± 1.4), which improved to 1.2 (±0.6, p < 0.0001). Pain acceptance also changed from 64 (±11.3) to 67.7 (±9.3, p = 0.006). Perceived stress decreased from 46.9 (±21.9) to 19.6 (±18.6) (p < 0.0001) postoperatively, and pain decreased from 31.0 (±11.7) to 9.4 (±12.9, p < 0.0001). Microvascular decompression reduced the mean BNI pain score significantly from 4.6 to 1.8 postoperatively (p < 0.00001). Conclusions: Depression and perceived stress are prevalent in patients with idiopathic TN. Adequate treatment not only provides a high rate of satisfaction through pain relief, but also leads to immediate and significant improvements in depression and stress. Thus, in patients with TN who do not reach an adequate and timely pain reduction through medical management and develop signs of depression, early treatment with microvascular decompression should be considered.
Collapse
Affiliation(s)
| | | | | | | | - Christian F. Freyschlag
- Department of Neurosurgery, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; (M.B.)
| |
Collapse
|
5
|
Young BE, Goodmann DR, Hamlin E, Tabaczyk O, Dunn LB, Muñoz RF, Leykin Y. Is it worth it? Greater risk aversion with lower life satisfaction among depressed individuals. PSYCHOL HEALTH MED 2024; 29:732-742. [PMID: 38525913 PMCID: PMC10963881 DOI: 10.1080/13548506.2023.2211805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 05/02/2023] [Indexed: 03/26/2024]
Abstract
Decisions of individuals with depression are often risk-averse. Risk-aversion may also extend to decisions regarding treatment, which may cause individuals to forgo or delay treatment. It is also well established that depression is associated with lower satisfaction with life. However, whether life satisfaction is associated with risk aversion for individuals with depression is not yet known. Three groups of participants (Depressed: n = 61; Chronic pain: n = 61; Comorbid depression and pain: n = 58) completed a clinical interview and several self-report questionnaires, including the Satisfaction with Life Scale (SWLS). Participants also completed two utility elicitation tasks: time trade-off (TTO), which measures utilities of health states without implied risks, and standard gamble (SG), which measures utilities of health states in the presence of risk (presented in this study as a hypothetical clinical trial described as having both potential harms and benefits). Risk aversion is defined as the difference in the utility ratings generated via SG and via TTO. For both TTO and SG, individuals evaluated their own depression or pain. When perfect health was used as a hypothetical benefit in TTO and SG tasks, satisfaction with life was not associated with risk preferences, for either depressed participants or participants with chronic pain (all ps ns). However, for participants with depression, when the hypothetical benefit was a more ecologically valid 'mild' depression in TTO and SG tasks, lower satisfaction with life was associated with greater risk aversion (p < .005; p < .03). For depressed individuals, therefore, lower satisfaction with life may be associated with risk aversion regarding treatments when benefits are seen as minor, which may result in treatment avoidance and, consequently, further worsening of both symptoms and life satisfaction.
Collapse
Affiliation(s)
| | | | | | | | | | - Ricardo F. Muñoz
- Palo Alto University
- University of California, San Francisco
- Institute for International Internet Interventions for Health
| | - Yan Leykin
- Palo Alto University
- University of California, San Francisco
| |
Collapse
|
6
|
Connoy L, Solomon M, Longo R, Sud A, Katz J, Dale C, Stanley M, Webster F. Attending to Marginalization in The Chronic Pain Literature: A Scoping Review. Can J Pain 2024; 8:2335500. [PMID: 38831969 PMCID: PMC11146439 DOI: 10.1080/24740527.2024.2335500] [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: 11/30/2023] [Accepted: 03/22/2024] [Indexed: 06/05/2024]
Abstract
Background There has been a recent and, for many within the chronic pain space, long-overdue increase in literature that focuses on equity, diversity, inclusion, and decolonization (EDI-D) to understand chronic pain among people who are historically and structurally marginalized. Aims In light of this growing attention in chronic pain research, we undertook a scoping review of studies that focus on people living with chronic pain and marginalization to map how these studies were carried out, how marginalization was conceptualized and operationalized by researchers, and identify suggestions for moving forward with marginalization and EDI-D in mind to better support people living with chronic pain. Methods We conducted this scoping review using critical analysis in a manner that aligns with dominant scoping review frameworks and recent developments made to scoping review methodology as well as reporting guidelines. Results Drawing on 67 studies, we begin with a descriptive review of the literature followed by a critical review that aims to identify fissures within the field through the following themes: (1) varying considerations of sociopolitical and socioeconomic contexts, (2) conceptual conflations between sex and gender, and (3) differing approaches to how people living with chronic pain and marginalization are described. Conclusion By identifying strengths and limitations in the research literature, we aim to highlight opportunities for researchers to contribute to a more comprehensive understanding of marginalization in chronic pain experiences.
Collapse
Affiliation(s)
- Laura Connoy
- Arthur and Sonia Labatt Family School of Nursing, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Michelle Solomon
- Arthur and Sonia Labatt Family School of Nursing, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Riana Longo
- Arthur and Sonia Labatt Family School of Nursing, Faculty of Health Sciences, Western University, London, Ontario, Canada
| | - Abhimanyu Sud
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Joel Katz
- Department of Psychology, Faculty of Health, York University, Toronto, Ontario, Canada
- Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Craig Dale
- Lawrence Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Tory Trauma Program, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Meagan Stanley
- Western Libraries, Western University, London, Ontario, Canada
| | - Fiona Webster
- Arthur and Sonia Labatt Family School of Nursing, Faculty of Health Sciences, Western University, London, Ontario, Canada
| |
Collapse
|
7
|
Coady A, Godard R, Holtzman S. Understanding the link between pain invalidation and depressive symptoms: The role of shame and social support in people with chronic pain. J Health Psychol 2024; 29:52-64. [PMID: 37565664 PMCID: PMC10757395 DOI: 10.1177/13591053231191919] [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] [Indexed: 08/12/2023] Open
Abstract
Pain invalidation (e.g., having pain discounted) is a risk factor for depression among people with chronic pain, but the mechanisms remain unclear. Shame is a common, yet understudied, aspect of the pain experience. This study investigated whether pain-related shame helps explain the relationship between pain discounting and heightened depressive symptoms. The secondary aim was to examine whether social support can protect against the harmful effects of discounting. Patients with chronic pain (N = 305) were recruited from outpatient pain clinics. Participants completed an online cross-sectional survey and data were analyzed using moderated mediation analysis. Greater discounting was associated with greater depressive symptoms, and pain-related shame significantly mediated this relationship. Perceived social support attenuated the relationship between discounting and depressive symptoms. Greater attention towards pain-related shame as a treatment target is needed. Individual- and system-level interventions are required to address pain invalidation and bolster support for this population.
Collapse
|
8
|
Ee JS, Hing MS, Dogbey GY, Cook MA, Agnello RN, Skelly SK, Frost LS. Association Between Clinical Depression, Anxiety, and Chronic Pain in the Active Duty Army Personnel. Mil Med 2023; 188:311-315. [PMID: 37948263 DOI: 10.1093/milmed/usad126] [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: 11/29/2022] [Revised: 02/13/2023] [Accepted: 04/27/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Chronic pain is highly prevalent among soldiers leading to costly impacts on disability and readiness. Depression and anxiety (D&A) are frequently comorbid with chronic pain, but previous studies tend to focus on reporting the odds of co-occurrence. The aim of this study was to examine the association of properly diagnosed D&A disorders on chronic pain indicators among active duty soldiers. MATERIALS AND METHODS Data were drawn from the intake assessments of 203 soldiers seen at an Interdisciplinary Pain Management Center. The Diagnostic and Statistical Manual of Mental Disorders-5 diagnostic criteria and the D&A subscales of the Patient Health Questionnaire were used to identify patients who met criteria for clinical depression or anxiety. Of the 203 patients, 129 met neither depression nor anxiety criteria (No D&A), 12 met clinical depression criteria only, 16 met clinical anxiety only, and 46 showed coexisting D&A disorders. The D&A and No D&A groups were compared using validated measures to assess the pain intensity rating and pain effect on well-being, physical functioning, and catastrophizing tendency. Data were analyzed using descriptive statistics and independent samples t-test analyses. RESULTS Significant differences were found between the D&A and No D&A groups on all pain-related measures (all Ps < .001). Patients in the D&A group reported higher average intensity of pain (6.11 versus 5.05) and greater effect of pain on activity (6.91 versus 5.37), sleep (7.20 versus 4.90), emotional state (7.74 versus 4.47), and stress (8.13 versus 4.78). Depression and anxiety patients also reported higher pain-catastrophizing tendency (38.56 versus 18.50) and greater physical disability (18.20 versus 12.22). CONCLUSIONS Soldiers who have chronic pain with coexisting D&A disorders experience a greater degree of perceived negative impacts. Consequently, attentiveness to proper diagnosis and treatment of coexisting clinical mood disorders is an essential step in fully addressing chronic pain management.
Collapse
Affiliation(s)
- Juliana S Ee
- Womack Army Medical Center, Department of Family Medicine, Fort Bragg, NC 28310, USA
| | - Matthew S Hing
- Womack Army Medical Center, Department of Family Medicine, Fort Bragg, NC 28310, USA
| | - Godwin Y Dogbey
- Department of Research and Medical Education, Campbell University, Jerry M. Wallace School of Osteopathic Medicine, Lillington, NC 27546, USA
| | - Marc A Cook
- Department of Primary Care, Weed Army Community Hospital, Fort Irwin, CA 92310, USA
| | - Robert N Agnello
- Department of Family Medicine, Campbell University, Jerry M. Wallace School of Osteopathic Medicine, Lillington, NC 27546, USA
| | - Stephanie K Skelly
- Womack Army Medical Center, Department of Family Medicine, Fort Bragg, NC 28310, USA
| | - Landon S Frost
- Womack Army Medical Center, Department of Family Medicine, Fort Bragg, NC 28310, USA
| |
Collapse
|
9
|
Roicke A, Esser P, Hornemann B, Ernst J. [Pain-related stigma in patients with breast, colon, prostate or lung cancer : Results of a bicentric register-based cross-sectional study]. Schmerz 2023:10.1007/s00482-023-00752-3. [PMID: 37710022 DOI: 10.1007/s00482-023-00752-3] [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: 06/21/2022] [Revised: 04/22/2023] [Accepted: 06/20/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Studies on cancer patients show a moderately high relevance of perceived stigmatization. However, no studies have explored the perceived stigmatization in relation to cancer-associated pain. In this work, we analysed the relationship between pain and perceived stigmatization across a large sample of four major cancer entities. METHODS Quantitative data of 858 patients (45.6% women, mean age 60.7 years) with breast, bowel, lung and prostate cancer were evaluated in a register-based, bicentric study. Perceived stigmatization was measured using the social impact cale (SIS-D), including a total score and four subscales. Pain was assessed with the brief pain inventory (BPI). The data were analysed using correlation und multiple regression with various sociodemographic and medical predictors. RESULTS Of all 858 cancer patients, those with lung and breast cancer were characterized by the greatest pain. The intensity of the pain was a predictor of the perceived stigma in patients with breast and colorectal cancer. In addition, younger age was also a predictor for perceived stigmatization. A good quality of life resulted as a protective factor. The final models showed a high goodness of the fit (corr. R2 > 0.35), except for the lung cancer patients. CONCLUSIONS Our findings support the assumption that the experience of pain can have an impact on the perceived stigmatization of cancer patients. Depression might influence the perceived stigmatization. Therefore, this group of patients should receive special attention and psycho-oncological care in clinical practice. Further research on the course and mechanisms of action of pain-related perceived stigmatization is also required.
Collapse
Affiliation(s)
- A Roicke
- Abteilung Medizinische Psychologie und Medizinische Soziologie, Universitätsklinikum Leipzig AöR, Philipp-Rosenthal-Str. 55, Haus W, 04103, Leipzig, Deutschland.
| | - P Esser
- Abteilung Medizinische Psychologie und Medizinische Soziologie, Universitätsklinikum Leipzig AöR, Philipp-Rosenthal-Str. 55, Haus W, 04103, Leipzig, Deutschland
| | - B Hornemann
- Universitäts KrebsCentrum (UCC), Psychoonkologie, Universitätsklinikum Carl Gustav Carus, Dresden, Deutschland
| | - J Ernst
- Abteilung Medizinische Psychologie und Medizinische Soziologie, Universitätsklinikum Leipzig AöR, Philipp-Rosenthal-Str. 55, Haus W, 04103, Leipzig, Deutschland
| |
Collapse
|
10
|
Mei Y, Yang X, Gui J, Li Y, Zhang X, Wang Y, Chen W, Chen M, Liu C, Zhang L. The relationship between psychological resilience and depression among the diabetes patients under the background of "dynamic zero COVID-19": the mediating role of stigma and the moderating role of medication burden. Front Public Health 2023; 11:1124570. [PMID: 37680269 PMCID: PMC10481163 DOI: 10.3389/fpubh.2023.1124570] [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: 12/15/2022] [Accepted: 08/11/2023] [Indexed: 09/09/2023] Open
Abstract
Objective Depression in diabetes patients is caused by their own disease or the surrounding social environment. How to cope with changes in mentality and adjust psychological stress responses, especially under China's dynamic zero COVID-19 policy, is worth further discussion. The researchers constructed a moderated mediation model to test the effect of psychological resilience during dynamic zero COVID-19 on depression in diabetes patients and the mediating role of stigma and the moderating effect of medication burden. Method From June to September, 2022, data were collected in Jinghu District, Wuhu City, Anhui Province, by multi-stage stratified sampling. Firstly, we selected a tertiary hospital randomly in Jinghu District. Secondly, departments are randomly chosen from the hospital. Finally, we set up survey points in each department and randomly select diabetes patients. In addition, we used the Connor-Davidson Elasticity Scale (CD-RISC) to measure psychological resilience of patients, and used the Stigma Scale for Chronic Illness (SSCI) to measure stigma, medication burden was measured by the Diabetes Treatment Burden Scale (DTBQ), and depression was assessed by the Patient Health Questionnaire-9 (PHQ-9). We used SPSS (version 23.0) and PROCESS (version 4.1) for data analysis. Results (1) Psychological resilience was negatively correlated with stigma, medication burden, and depression. Stigma was positively associated with medication burden and depression. Medication burden and depression are positively correlated, (2) The mediation analysis showed that psychological resilience had a direct predictive effect on depression, and stigma partially mediated the relationship, and (3) Medication burden moderates the direct pathway by which psychological resilience predicts depression; Medication burden moderates the first half of "psychological resilience → stigma → depression." Conclusion Under the mediating effect of stigma, psychological resilience can improve depression. Medication burden has a moderating effect on the relationship between psychological resilience and depression, and it also has a moderating effect on the relationship between psychological resilience and stigma. These results facilitate the understanding of the relationship mechanisms between psychological resilience and depression.
Collapse
Affiliation(s)
- Yujin Mei
- School of Nursing, Wannan Medical College, Higher Education Park, Wuhu City, Anhui Province, China
| | - Xue Yang
- School of Nursing, Wannan Medical College, Higher Education Park, Wuhu City, Anhui Province, China
| | - JiaoFeng Gui
- School of Nursing, Wannan Medical College, Higher Education Park, Wuhu City, Anhui Province, China
| | - YuQing Li
- School of Nursing, Wannan Medical College, Higher Education Park, Wuhu City, Anhui Province, China
| | - XiaoYun Zhang
- School of Nursing, Wannan Medical College, Higher Education Park, Wuhu City, Anhui Province, China
| | - Ying Wang
- School of Nursing, Wannan Medical College, Higher Education Park, Wuhu City, Anhui Province, China
| | - Wenyue Chen
- School of Nursing, Wannan Medical College, Higher Education Park, Wuhu City, Anhui Province, China
| | - Mingjia Chen
- School of Nursing, Wannan Medical College, Higher Education Park, Wuhu City, Anhui Province, China
| | - Changjun Liu
- School of Marxism, Jinzhou Medical University, Jinzhou City, Liaoning Province, China
| | - Lin Zhang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, Higher Education Park, Wuhu City, Anhui Province, China
| |
Collapse
|
11
|
Roberts-West L, Gravatt A, Guest N, Hunt A, Siddique L, Serbic D. A Comparison of Social Exclusion Towards People with Depression or Chronic Back Pain. Br J Pain 2023; 17:267-280. [PMID: 37342396 PMCID: PMC10278445 DOI: 10.1177/20494637221148337] [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] [Indexed: 09/20/2023] Open
Abstract
Objectives Research comparing mental and physical health stigma is scarce. The aim of this study was to compare social exclusion towards hypothetical males and females with depression or chronic back pain. Furthermore, the study investigated whether social exclusion is associated with participant's empathy and personality traits, while controlling for their sex, age and personal exposure to mental/physical chronic health conditions. Design This study employed a cross-sectional questionnaire design. Methods Participants (N = 253) completed an online vignette-based questionnaire and were randomly allocated to either a depression or chronic back pain study condition. Measures of social exclusion through respondents' willingness to interact with hypothetical individuals, empathy and the Big Five personality traits were completed. Results Willingness to interact scores did not significantly differ depending on the diagnosis or sex of the hypothetical person in the vignette. For depression, higher levels of conscientiousness significantly predicted less willingness to interact. Whilst being a female participant and having higher empathy significantly predicted greater willingness to interact. For chronic back pain, higher empathy significantly predicted greater willingness to interact, with no significant predictors found from the Big Five personality traits. Conclusion Findings indicate that females and males with depression or chronic back pain face similar levels of social exclusion, with empathy being a core variable driving social exclusion behaviours. These findings enhance our understanding of potential variables driving social exclusion, in-turn informing campaign development to reduce public stigma towards depression and chronic back pain.
Collapse
Affiliation(s)
- Lucy Roberts-West
- Department of Psychology, Royal Holloway University of London, Egham, SRY, UK
| | - Amy Gravatt
- Department of Psychology, Royal Holloway University of London, Egham, SRY, UK
| | - Natasha Guest
- Department of Psychology, Royal Holloway University of London, Egham, SRY, UK
| | - Ashley Hunt
- Department of Psychology, Royal Holloway University of London, Egham, SRY, UK
| | - Laraib Siddique
- Department of Psychology, Royal Holloway University of London, Egham, SRY, UK
| | - Danijela Serbic
- Department of Psychology, Royal Holloway University of London, Egham, SRY, UK
| |
Collapse
|
12
|
Chala MB, Donnelly C, Ghahari S, Wondie Y, Abebe A, Miller J. An Interpretative Phenomenological Analysis of Living with Chronic Low Back Pain in Ethiopia. J Pain Res 2022; 15:4031-4045. [PMID: 36575721 PMCID: PMC9790163 DOI: 10.2147/jpr.s389827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 12/06/2022] [Indexed: 12/29/2022] Open
Abstract
Background People with chronic low back pain experience myriads of problems from living with their condition. This study aimed to explore the lived experience of people with chronic low back pain in Ethiopia. Design This is a qualitative semi-structured study design which used an interpretative phenomenological analysis approach for data analysis. Participants Fifteen adults (10 women and 5 men) with chronic low back pain (duration ≥ 3 months) with age ranging from 19 to 66 years old were interviewed. Setting Participants were recruited from the outpatient departments of the University of Gondar hospital in Gondar, Ethiopia. Methods Data was collected through an in-depth semi-structured interview. Interviews were audio-recorded and transcribed verbatim. Data were analyzed through an iterative process, beginning with a line-by-line coding to identify the lived experience of chronic low back pain. Findings Five main themes related to the lived experience of people with chronic low back pain emerged: 1) CLBP impacts life on a day-to-day basis, 2) The invisibility of pain results in misunderstanding, misjudgment, and loneliness, 3) The cause of pain is a mystery, 4) The search for the cure is a quest, 5) Each person has their ways of managing, coping, and living with pain. Conclusion The findings from this study improve our understanding of the experience of people with chronic low back pain and its impact on their day-to-day life in Ethiopia. The findings from this study could inform the development of culturally centered chronic low back pain interventions such as self-management programs in the Ethiopian context.
Collapse
Affiliation(s)
- Mulugeta Bayisa Chala
- Department of Physiotherapy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada,Correspondence: Mulugeta Bayisa Chala, Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada, Tel +1-613-328-3604, Email
| | - Catherine Donnelly
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada
| | - Setareh Ghahari
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada
| | - Yemataw Wondie
- Department of Psychology, College of Social Sciences and Humanities, University of Gondar, Gondar, Ethiopia
| | - Abey Abebe
- Department of Physiotherapy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia,School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada
| | - Jordan Miller
- School of Rehabilitation Therapy, Queen’s University, Kingston, ON, Canada
| |
Collapse
|
13
|
Abstract
Stigma is defined by the World Health Organization (WHO) as "a mark of shame, disgrace or disapproval that results in an individual being rejected, discriminated against and excluded from participating in a number of different areas of society". Extensive literature searches have documented stigma in the context of health. Among the physical health conditions that are associated with stigma, chronic pain deserves particular attention. Stigma experienced by individuals with chronic pain affects their entire life. Literature identifies multiple dimensions or types of stigma, including public stigma, structural stigma and internalized stigma. Recent literature supports the biopsychosocial model of pain, according to which biological, psychological and sociocultural variables interact in a dynamic manner to shape an individual's response to chronic pain. Chronic pain affects a higher proportion of women than men around the world. There is an inadequate education of health care professionals regarding pain assessment and their insecurity to manage patients with chronic pain. A first-line intervention strategy could be to promote pain education and to expand knowledge and assessment of chronic pain, as recently highlighted for headache disorders, paradigmatically for resistant or refractory migraine, whose diagnosis, without an adequate education to understand the possible fluctuations of the disease, may have profound psychological implications with the idea of insolvability and contribute to stigmatizing the patient.
Collapse
|
14
|
He S, Ke XJ, Wu Y, Kong XY, Wang Y, Sun HQ, Xia DZ, Chen GH. The stigma of patients with chronic insomnia: a clinical study. BMC Psychiatry 2022; 22:449. [PMID: 35790932 PMCID: PMC9254637 DOI: 10.1186/s12888-022-04091-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 06/24/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The objective of this study was to explore the stigma and related influencing factors in individuals with chronic insomnia disorder (CID). METHODS A total of 70 CID patients and 70 healthy controls (CON) were enrolled in the study. All subjects completed the assessments of sleep, emotion, and cognition. Their stigma and life quality were measured using the Chronic Stigma Scale and the 36-Item Short-Form Health Survey (SF-36). RESULTS The ratio of individuals with stigma was significantly different between CID and CON groups (C2 = 35.6, p < 0.001). Compared with the CON group, the CID group had higher scores for total stigma (U = 662.0, p < 0.001), internalized stigma (U = 593.0, p < 0.001), enacted stigma (U = 1568.0, p < 0.001), PSQI (U = 2485.0, p < 0.001) and HAMD-17 (U = 69.5, p < 0.001) as well as lower scores for MoCA-C (U = 3997.5, p < 0.001) and most items of SF-36. Partial correlation analysis showed that different items of the Chronic Stigma Scale were positively correlated with illness duration, PSQI and HAMD-17 scores, while negatively correlated with one or more items of the SF-36. Multivariate regression analysis showed that illness duration and the Mental Health domain of the SF-36 were independent risk factors for one or more items of stigma in CID patients. CONCLUSION Patients with CID have an increased risk of stigma. Moreover, illness duration and Mental Health may be primary factors related to stigma.
Collapse
Affiliation(s)
- Shuo He
- grid.186775.a0000 0000 9490 772XDepartment of Neurology (Sleep Disorders), The Affiliated Chaohu Hospital of Anhui Medical University, Hefei, 238000 Chaohu China
| | - Xue-Jia Ke
- grid.477985.00000 0004 1757 6137Department of Geriatrics, Hefei First People’s Hospital, Hefei, 230092 China
| | - Yan Wu
- grid.186775.a0000 0000 9490 772XDepartment of Neurology (Sleep Disorders), The Affiliated Chaohu Hospital of Anhui Medical University, Hefei, 238000 Chaohu China
| | - Xiao-Yi Kong
- grid.186775.a0000 0000 9490 772XDepartment of Neurology (Sleep Disorders), The Affiliated Chaohu Hospital of Anhui Medical University, Hefei, 238000 Chaohu China
| | - Yun Wang
- grid.186775.a0000 0000 9490 772XDepartment of Neurology (Sleep Disorders), The Affiliated Chaohu Hospital of Anhui Medical University, Hefei, 238000 Chaohu China
| | - Hui-Qin Sun
- Department of Neurology (Sleep Disorders), The Affiliated Chaohu Hospital of Anhui Medical University, Hefei, 238000, Chaohu, China.
| | - Deng-Zhi Xia
- Department of Outpatient, The Affiliated Chaohu Hospital of Anhui Medical University, Hefei, 238000, Chaohu, China.
| | - Gui-Hai Chen
- Department of Neurology (Sleep Disorders), The Affiliated Chaohu Hospital of Anhui Medical University, Hefei, 238000, Chaohu, China.
| |
Collapse
|
15
|
The Determinants and Effects of Chronic Pain Stigma: A Mixed Methods Study and the Development of a Model. THE JOURNAL OF PAIN 2022; 23:1749-1764. [PMID: 35700874 DOI: 10.1016/j.jpain.2022.05.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/12/2022] [Accepted: 05/18/2022] [Indexed: 11/22/2022]
Abstract
People with chronic pain report experiencing stigma, but few studies have explored this in detail. This mixed-methods study aimed to investigate factors that contribute to chronic pain stigma, the effects of stigma, and to explore the stigma experiences of people with chronic pain. Participants were 215 adults with chronic pain who completed questionnaires assessing chronic pain stigma, opioid use, mental health conditions, pain, depression, disability and social support, and 179 also answered open-ended questions about stigma experiences. Linear regression and path analysis showed that greater stigma was experienced by those who used more opioids, had a mental health condition, viewed their pain as organic, and were unemployed. Stigma was associated with greater disability, depression and lower social support. Qualitative results supported quantitative findings, with 3 themes: 1. "Faking It": Others disbelieve pain and attribute it to drug seeking, laziness, or mental health problems, 2. A spectrum of stigma: Experiences of stigma vary from none to widespread, and 3. "I hide it well": Concealing pain and avoiding stigmatizing situations lead to isolation & disability. This study demonstrates the negative influence of stigma and presents a novel integrated model of chronic pain stigma which may be used to develop interventions.
Collapse
|
16
|
Bettlach CR, Gibson E, Daines JM, Payne ER, Vuong LN, Merrill CM, Pet MA. The stigma of digital amputation: a survey of amputees with analysis of risk factors. J Hand Surg Eur Vol 2022; 47:461-468. [PMID: 34496665 DOI: 10.1177/17531934211044642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to quantify the stigma associated with digital amputation and examine factors associated with it. One hundred and sixty-four digital amputees completed the Neurological Quality of Life-Stigma questionnaire and a battery of Patient-Reported Outcome Measurement Information System instruments. Multivariable analysis examined factors associated with stigma experience. The mean observed stigma score of 47 (SD 8, range 36-64) was similar to the mean value of the normal population. Younger age, a worker's compensation claim and depression were each independently associated with a more severe experience of stigma after digital amputation. Socioeconomic variables, anatomical details and mechanism of injury were not independently associated with stigma. Digital amputation is not highly stigmatizing overall. Surgeons should consider referring at-risk patients to a mental health provider for support during the coping and adjustment process after amputation.Level of evidence: III.
Collapse
Affiliation(s)
- Carrie Roth Bettlach
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, MO, USA
| | - Ella Gibson
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, MO, USA
| | - John M Daines
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, MO, USA
| | - Emma R Payne
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, MO, USA
| | - Linh N Vuong
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, MO, USA
| | - Corinne M Merrill
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, MO, USA
| | - Mitchell A Pet
- Division of Plastic and Reconstructive Surgery, Department of Surgery, School of Medicine, Washington University, St. Louis, MO, USA
| |
Collapse
|
17
|
Disparities in telehealth utilization in patients with pain during COVID-19. Pain Rep 2022; 7:e1001. [PMID: 35450155 PMCID: PMC9015206 DOI: 10.1097/pr9.0000000000001001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/13/2022] [Accepted: 02/20/2022] [Indexed: 11/26/2022] Open
|
18
|
Li C, Hu M, Yang T, Shao X, Zheng D. Correlates of stigma for poststroke patients: A meta-analysis. J Clin Nurs 2022; 32:1952-1962. [PMID: 35181955 DOI: 10.1111/jocn.16250] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/27/2021] [Accepted: 01/24/2022] [Indexed: 11/27/2022]
Abstract
AIMS A meta-analysis was carried out to review and identify correlates of stigma in poststroke patients. BACKGROUND Patients suffer from impaired physical functions and sequelae of stroke. Stroke-related stigma hinders the recovery process and produces poorer clinical outcomes of stroke, leading to compromised quality of life. DESIGN A systematic review and meta-analysis was reported by following PRISMA 2020 guidelines. REVIEW METHODS Nine databases were searched from their inception to May 2021 to identify studies focused on the relationships among demographics, disease-related factors, psychosocial factors and poststroke stigma. Included studies were assessed by using the Agency for Healthcare Research and Quality (AHRQ) scale. The statistical software R studios were used to perform statistical analysis. RESULTS Nineteen studies were included in the meta-analysis. Four demographic factors (age, caregiver, residence, monthly income), seven stroke-related characteristics (type of stroke, mRS, ADLs, stroke duration, recurrence, sequelae, chronic disease comorbidity) and three psychosocial factors (depression, social support, quality of life) showed significant associations with stroke-related stigma. CONCLUSIONS The results of our study can serve as a foundation for designing interventions to reduce stigma and improve the overall quality of life of poststroke patients and may produce positive clinical outcomes. Healthcare professionals should be aware of stroke patients who are characterised by correlates of stigma. Relevance to clinical practice Poststroke patients showed a moderate-to-high level of stigma, and this issue warrants more attention. This review provides a preliminary foundation for healthcare professionals to develop interventions to address stroke-related stigma by focusing on demographic, disease-related and psychosocial factors. Additionally, stigma identification should be a part of clinical nursing evaluation. The involvement of clinical and community nursing is very important to screen stroke-related stigma and pay attention to this population.
Collapse
Affiliation(s)
- Chen Li
- Neurology Department, The First Affiliated Hospital of Jinan University, Guang Dong, Guangzhou, China
| | - Mingyue Hu
- Department of Nursing, XiangYa School of Medicine, Central South University, Changsha, China
| | - Tao Yang
- Neurosurgery Department, The First Affiliated Hospital of Jinan University, Guang Dong, Guangzhou, China
| | - Xinmei Shao
- Neurology Department, The First Affiliated Hospital of Jinan University, Guang Dong, Guangzhou, China
| | - Dongxiang Zheng
- Neurology Department, The First Affiliated Hospital of Jinan University, Guang Dong, Guangzhou, China
| |
Collapse
|
19
|
Altered effective connectivity within the cingulo-frontal-parietal cognitive attention networks in chronic low back pain: a dynamic causal modeling study. Brain Imaging Behav 2022; 16:1516-1527. [PMID: 35080703 DOI: 10.1007/s11682-021-00623-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2021] [Indexed: 11/02/2022]
Abstract
Dysfunction of the cingulo-frontal-parietal (CFP) cognitive attention network has been associated with the pathophysiology of chronic low back pain (cLBP). However, the direction of information processing within this network remains largely unknown. We aimed to study the effective connectivity among the CFP regions in 36 cLBP patients and 36 healthy controls by dynamic causal modeling (DCM). Both the resting-state and task-related (Multi-Source Interference Task, MSIT) functional magnetic resonance imaging (fMRI) data were collected and analyzed. The relationship between the effective connectivity of the CFP regions and clinical measures was also examined. Our results suggested that cLBP had significantly altered resting-state effective connectivity of the prefrontal cortex (PFC)-to-mid-cingulate cortex (MCC) (increased) and MCC-to-left superior parietal cortex (LPC) (decreased) pathways as compared with healthy controls. MSIT-related DCM suggested that the interference task could significantly increase the effective connectivity of the right superior parietal cortex (RPC)-to-PFC and RPC-to-MCC pathways in cLBP than that in healthy controls. The control task could significantly decrease the effective connectivity of the MCC-to-LPC and MCC-to-RPC pathways in cLBP than that in healthy controls. The endogenous connectivity of the PFC-to-RPC pathway in cLBP was significantly lower than that in healthy controls. No significant correlations were found between the effective connectivity within CFP networks and pain/depression scores in patients with cLBP. In summary, our findings suggested altered effective connectivity in multiple pathways within the CFP network in both resting-state and performing attention-demanding tasks in patients with cLBP, which extends our understanding of attention dysfunction in patients with cLBP.
Collapse
|
20
|
Yang YC, Cai GQ, Yang QC, Li B, Ge QM, Li QY, Shi WQ, Min YL, Liang RB, Shao Y. Brain Functional Connectivity Changes in Patients with Acute Eye Pain: A Resting-State Functional Magnetic Resonance Imaging (fMRI) Study. Med Sci Monit 2021; 27:e930588. [PMID: 34388144 PMCID: PMC8369943 DOI: 10.12659/msm.930588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background By using functional magnetic resonance imaging (fMRI), we aimed to study the changes in potential brain function network activity in patients with acute eye pain. Also, by using the voxel-wise degree centrality (DC) method, we aimed to explore the relationship between spontaneous brain activity and the clinical features of patients with acute eye pain. Material/Methods A total of 15 patients with acute eye pain (5 women and 10 men; EP group) and 15 healthy controls (5 women and 10 men; HC group), were scanned by fMRI. The DC method was used to evaluate changes in spontaneous brain activity. Receiver operating characteristic (ROC) curves were analyzed, and Pearson correlation analysis was used to study the relationship between DC values and clinical manifestations in different regions of brain. Results The area of the left limbic lobe showed a reduction in DC value in patients in the EP group. DC values were elevated in the left cerebellum posterior lobe, left inferior parietal lobule, left inferior temporal gyrus, left precuneus, and right cerebellum posterior lobe in the EP group. The visual analog scale value of the eyes in the EP group was negatively correlated with the left limbic lobe signal value and positively correlated with the left inferior parietal lobule signal value. Further, the scores of the hospital anxiety and depression scale and DC value of the left limbic lobe were negatively correlated. Conclusions Compared with the HC group, patients with acute eye pain had abnormal patterns of intrinsic brain activity in different brain regions, which may help reveal the potential neural mechanisms involved in eye pain.
Collapse
Affiliation(s)
- Yan-Chang Yang
- Department of Anesthesiology, Nanchang University, Nanchang, Jiangxi, China (mainland)
| | - Guo-Qian Cai
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, Jiangxi, China (mainland)
| | - Qi-Chen Yang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China (mainland)
| | - Biao Li
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, Jiangxi, China (mainland)
| | - Qian-Min Ge
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, Jiangxi, China (mainland)
| | - Qiu-Yu Li
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, Jiangxi, China (mainland)
| | - Wen-Qing Shi
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, Jiangxi, China (mainland)
| | - You-Lan Min
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, Jiangxi, China (mainland)
| | - Rong-Bin Liang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center,, Nanchang, Jiangxi, China (mainland)
| | - Yi Shao
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center,, Nanchang, Jiangxi, China (mainland)
| |
Collapse
|
21
|
Yu BCL, Chio FHN, Mak WWS, Corrigan PW, Chan KKY. Internalization process of stigma of people with mental illness across cultures: A meta-analytic structural equation modeling approach. Clin Psychol Rev 2021; 87:102029. [PMID: 34058604 DOI: 10.1016/j.cpr.2021.102029] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/11/2021] [Accepted: 04/13/2021] [Indexed: 12/24/2022]
Abstract
This meta-analytic study synthesized findings from 108 independent data sets across 22 cultures to investigate whether the stigma internalization model (the internalization of experienced stigma and perceived stigma to self-stigma) is associated with well-being and recovery of people with mental illness. We also examined the moderating role of collectivism in the internalization process. Results of the meta-analytic structural equation modeling suggested that self-stigma is a significant mediator in the relationships between experienced stigma and perceived stigma with well-being and recovery variables (indirect effects = 0.02 to -0.16). Experienced and perceived stigma had significant direct effects on well-being and recovery variables (Bs = 0.07 to -0.21, p < 0.05), suggesting that both external (e.g., public stigma) and internal (i.e., self-stigma) influences of stigma work concurrently to affect recovery and well-being of people with mental illness. The results of the mixed effect three-level meta-analytic models showed that collectivism significantly moderated the relationship between experienced and perceived stigma with self-stigma (Bs = 0.06 to 0.11, p < 0.05). This implied that the more collectivistic a culture is, the stronger the correlation between experienced and perceived stigma with self-stigma. Implications to stigma reduction approaches were discussed.
Collapse
Affiliation(s)
- Ben C L Yu
- Department of Psychology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| | - Floria H N Chio
- Department of Counselling and Psychology, Hong Kong Shue Yan University, North Point, Hong Kong
| | - Winnie W S Mak
- Department of Psychology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong.
| | - Patrick W Corrigan
- Department of Psychology, Illinois Institute of Technology, Chicago, United States
| | - Kelly K Y Chan
- Department of Psychology, The Chinese University of Hong Kong, Shatin, NT, Hong Kong
| |
Collapse
|
22
|
Konradi A. Stigma and psychological distress among pediatric participants in the FD/MAS Alliance Patient Registry. BMC Pediatr 2021; 21:173. [PMID: 33853566 PMCID: PMC8048182 DOI: 10.1186/s12887-021-02647-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 04/07/2021] [Indexed: 11/26/2022] Open
Abstract
Background Stigma, both enacted and internalized, is part of the illness experience of many chronic conditions / diseases and has been found to increase psychological distress, lower self-esteem, and impact social engagement lowering quality of life (QOL). Stigma among pediatric patients is of particular concern due to its potential impact on identity formation. Using patient data from the online FD/MAS Alliance Patient Registry (FDMASAPR), this study seeks to 1) determine levels of enacted and self-stigma in a pediatric population of fibrous dysplasia (FD) / McCune Albright syndrome (MAS) patients and 2) to explore the relationship between stigma and anxiety and depression. Methods This is a cross sectional analysis of deidentified self-report data from 18 pediatric patients. Key analytic variables include the Neuro-QOL stigma short form, the Hospital Anxiety and Depression Scale (HADS), diagnostic category and craniofacial involvement, and select demographics. Sample means and score distributions are examined. Bivariate relationships between stigma, anxiety and depression and patient’s personal and medical characteristics are established through analysis of variance and correlation. Results Composite stigma levels for FD/MAS pediatric patients were comparable to those of children with multiple sclerosis, epilepsy, and muscular dystrophy. Self-stigma was more frequently reported than enacted/felt stigma, but few patients indicated complete freedom from either type of stigma. Diagnosis was significantly related to self-stigma. Significant bivariate relationships were found between depression and enacted/felt and self-stigma and between anxiety and self-stigma. Conclusions This study establishes the illness experience of pediatric patients with FD / MAS is impacted by stigma and suggests they should be regularly screened for stigma and psychological distress. It supports the integration of clinical psychologists/ therapists in regular patient care, referral of families to advocacy organizations, and indicates that rare disease patient registries can be a useful tool in efforts to improve the QOL of patients.
Collapse
Affiliation(s)
- Amanda Konradi
- Department of Sociology, Loyola University Maryland, 4501 North Charles St., Baltimore, MD, 20210, USA.
| |
Collapse
|
23
|
Sedney CL, Dekeseredy P, Haggerty T. Stigmatizing Diagnoses in Neurosurgery: A Narrative Review. World Neurosurg 2020; 145:25-34. [PMID: 32889195 DOI: 10.1016/j.wneu.2020.08.183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 08/24/2020] [Accepted: 08/25/2020] [Indexed: 11/18/2022]
Abstract
Stigma is defined as a social process resulting in labeling, stereotyping, and separation that cause status loss, disapproval, rejection, exclusion, and discrimination of the labeled individuals. Stigma can be experienced by individuals or groups, can be real or perceived, and can include a wide array of characteristics (e.g., race/ethnicity, gender, and health conditions). It is well documented that stigma for health conditions is a barrier to treatment and leads to worse outcomes for vulnerable people. The purpose of this study is to examine the increasingly mature field of stigma theory and research, and how this relates to the practice of neurosurgery. This review provides an overview of stigma and its application in a neurosurgical setting, including diagnoses treated by neurosurgeons as well as diagnoses with impact on neurosurgical outcomes. Examples of stigmatizing diagnoses of relevance to neurosurgical practice include epilepsy, pain, smoking, obesity, and substance use disorder. This information is useful for the practicing neurosurgeon to understand the origins and higher-order effects of societal perceptions surrounding certain diagnoses, and the subsequent effects on health that those perceptions can create on a systemic level.
Collapse
Affiliation(s)
- Cara L Sedney
- Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA.
| | - Patricia Dekeseredy
- Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA
| | - Treah Haggerty
- Department of Family Medicine, West Virginia University, Morgantown, West Virginia, USA
| |
Collapse
|
24
|
Effect of Acupuncture on Chronic Pain with Depression: A Systematic Review. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:7479459. [PMID: 32714417 PMCID: PMC7334776 DOI: 10.1155/2020/7479459] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 06/10/2020] [Indexed: 01/09/2023]
Abstract
Background Numerous studies suggested that chronic pain and depression were closely related and widespread in the population. When patients have symptoms of chronic pain and depression, the corresponding treatment will become difficult. Acupuncture, a unique therapeutic method of traditional Chinese medicine, has been reported to potentially serve as an alternative treatment for patients with comorbid chronic pain and depression by many research studies. Methods A comprehensive search was conducted through the online database, including the Cochrane Library, PubMed, EMBASE, SinoMed, CNKI, and Wanfang database. Trials were RCTs published in the English or Chinese language, recruiting participants with chronic pain and depression comorbidity. The primary outcomes were the Visual Analogue Scale (VAS) and Hamilton Depression Scale (HAMD). Statistical analyses were conducted using Review Manager 5.3. Each trail was quality appraised with the five-point Jadad Score. Results 7 eligible RCTs involving 535 patients were included. Better therapeutic effect and safety could be observed in the experimental group compared with the control group. There was a significant decrease in the VAS (mean difference (MD) = −0.68 (−1.24, −0.12), P=0.02) and HAMD (MD = −2.18 (−3.09, −1.26), P < 0.00001) scores and the incidence of adverse events between two groups. Conclusion In the treatment of chronic pain with depression, acupuncture could not only get better clinical efficacy, but also have higher security compared with medicine therapy, which can be used in patients with poorer response to the conventional medication or suffering from serious side effects.
Collapse
|
25
|
Buono FD, Savage SR, Cerrito B, O'Connell J, Garakani A, Ackerman S, Cutter CJ. Chronic Pain, Mood Disorders and Substance Use: Outcomes of Interdisciplinary Care in a Residential Psychiatric Hospital. J Pain Res 2020; 13:1515-1523. [PMID: 32612379 PMCID: PMC7322115 DOI: 10.2147/jpr.s250568] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 06/05/2020] [Indexed: 01/10/2023] Open
Abstract
Purpose The objective is to report outcomes of an interdisciplinary group-based residential chronic pain recovery program (CPRC), located in a private non-profit psychiatric hospital. The chronic pain program was aimed at treatment and engagement in self-care of both pain and co-occurring disorders in a residential facility that also offered treatment for specific psychiatric disorders. Patients and Methods A retrospective chart review was conducted that included a convenience sample of 131 patients admitted from March 2012 through August 2017 who completed treatment. An interdisciplinary team of professionals provided psycho-behavioral therapy, movement therapies and medication management. Patients completed a battery of psycho-social and demographic questionnaires on admission and before discharge of the program. Results Significant differences were noted in pain severity, pain interference, depression and anxiety (p<.01) between admission and discharge, and the Chronic Pain Coping Inventory demonstrated significant differences in guarding (p <.001), asking (p =.018), exercise (p <.001), relaxation (p <.001), and pacing (p=.024). Of patients using opioids on admission, at discharge, 37% had tapered and remained off all opioids, 43% were using buprenorphine for opioid use disorder, and 20% continued on analgesic opioids. Conclusion Treatment was associated with reductions in pain severity and interference, in anxiety and in depression as well as improvements in pain coping. Additionally, there was a reduction in reliance on opioids for pain relief.
Collapse
Affiliation(s)
- Frank D Buono
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Seddon R Savage
- Department of Anesthesiology, Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | | | | | - Amir Garakani
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA.,Silver Hill Hospital, New Canaan, CT, USA
| | | | - Christopher J Cutter
- Yale Child Study Center, Yale University School of Medicine, Yale University, New Haven, CT, USA
| |
Collapse
|
26
|
Merkin AG, Medvedev ON, Sachdev PS, Tippett L, Krishnamurthi R, Mahon S, Kasabov N, Parmar P, Crawford J, Doborjeh ZG, Doborjeh MG, Kang K, Kochan NA, Bahrami H, Brodaty H, Feigin VL. New avenue for the geriatric depression scale: Rasch transformation enhances reliability of assessment. J Affect Disord 2020; 264:7-14. [PMID: 31846809 DOI: 10.1016/j.jad.2019.11.100] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 10/23/2019] [Accepted: 11/21/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND Depression is a common problem in older adults. The 15-item Geriatric Depression Scale (GDS-15) is a widely used psychometric tool for measuring depression in the elderly, but its psychometric properties have not been yet rigorously investigated. The aim was to evaluate psychometric properties of the GDS-15 and improve precision of the instrument by applying Rasch analysis and deriving conversion tables for transformation of raw scores into interval level data. METHODS The data was extracted from the prospective cohort Sydney Memory and Ageing Study of initially not demented individuals aged 70 years and older. The GDS-15 items scores of 212 participants (47.2% males) were analysed using the dichotomous Rasch model. RESULTS Initially poor reliability of the GDS-15, Person Separation Index (PSI) = 0.68, was improved by combining locally dependent items into seven super-items. These modifications improved reliability of the GDS-15 (PSI = 0.78) and resulted in the best Rasch model fit (χ2(28)=37.72, p = =0.104), strict unidimensionality and scale invariance across personal factors such as gender, diagnostic and language background. LIMITATIONS Presence of participants with cognitive impairment may be a potential limitation. CONCLUSIONS Reliability and psychometric characteristics of the GDS-15 were improved by minor modifications and now satisfy expectations of the unidimensional Rasch model. By using Rasch transformation tables published here psychiatrists, psychologists and researchers can transform GDS raw scores into interval-level data, which improves reliability of the GDS-15 without the need to modify its original response format. These findings increase accuracy of clinical psychometric assessments, leading to more precise diagnosis of depression in the elderly.
Collapse
Affiliation(s)
- Alexander G Merkin
- Faculty of Health & Environmental Sciences, National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand.
| | - Oleg N Medvedev
- University of Waikato, School of Psychology, Hamilton, New Zealand
| | - Perminder S Sachdev
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia
| | | | - Rita Krishnamurthi
- Faculty of Health & Environmental Sciences, National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Susan Mahon
- Faculty of Health & Environmental Sciences, National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Nikola Kasabov
- Faculty of Health & Environmental Sciences, National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Priya Parmar
- Faculty of Health & Environmental Sciences, National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - John Crawford
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Zohreh G Doborjeh
- Faculty of Health & Environmental Sciences, National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Maryam G Doborjeh
- Faculty of Health & Environmental Sciences, National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Kristan Kang
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Nicole A Kochan
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Helena Bahrami
- Faculty of Health & Environmental Sciences, National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| | - Henry Brodaty
- Centre for Healthy Brain Ageing (CHeBA), School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Valery L Feigin
- Faculty of Health & Environmental Sciences, National Institute for Stroke and Applied Neurosciences, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand
| |
Collapse
|
27
|
Modelli A, Candal Setti VP, van de Bilt MT, Gattaz WF, Loch AA, Rössler W. Addressing Mood Disorder Diagnosis' Stigma With an Honest, Open, Proud (HOP)-Based Intervention: A Randomized Controlled Trial. Front Psychiatry 2020; 11:582180. [PMID: 33643079 PMCID: PMC7902913 DOI: 10.3389/fpsyt.2020.582180] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 12/23/2020] [Indexed: 11/21/2022] Open
Abstract
Introduction: The public stigma and self-stigma contribute to the dilemma of disclosing or not one's own mental illness diagnosis. Studies suggest that revealing it diminishes stress, besides helping with self-esteem. Honest, Open, Proud (HOP) is a group program that aids in the process of deciding on it, reducing its impact. Considering the relevance of this issue, the present study aimed to apply a HOP-based intervention in a group of patients diagnosed with mood disorders. Methods: A randomized controlled clinical trial was used, including 61 patients with mood disorders, of whom 31 were diagnosed with depression and 30 were diagnosed with bipolar disorder. They were randomly placed on the intervention (HOP) or the control group (unstructured psychoeducation). The evaluations occurred before (T0) and after (T1) the sessions. We administered eight scales, from which three presented relevant results: Coming Out with Mental Illness Scale (COMIS), Cognitive Appraisal of Stigma as a Stressor (CogApp), and Authenticity Scale. Results: The intervention groups (depression and bipolar) did not present a significant change regarding the decision to disclose their diagnostics. However, the depression group showed a decrease on the perception of stigma as a stressor (T0 = 0.50 vs. T1 = -1.45; p = 0.058). Improvements in post-intervention results were seen for both groups (depression and bipolar) on the Authenticity Scale-self-alienation subscale (T0 = 10.40 vs. T1 = 12.37, p = 0.058). Conclusion: Our HOP-based intervention appeared to be an important program to aid patients in facing stigma stress, showing positive effects, whether helping to diminish stress or to improve self-conscience, both of which have indirect effects on self-stigma. As it is a compact program, it can bring benefits when applying to public health institutions.
Collapse
Affiliation(s)
- Arlete Modelli
- Laboratory of Neuroscience (LIM 27), Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.,Psychology and Neuropsychology Service, Department and Institute of Psychiatry, Universidade de São Paulo Medical School, São Paulo, Brazil
| | - Viviane P Candal Setti
- Laboratory of Neuroscience (LIM 27), Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Martinus Theodorus van de Bilt
- Laboratory of Neuroscience (LIM 27), Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Cientifico e Tecnológico, São Paulo, Brazil
| | - Wagner Farid Gattaz
- Laboratory of Neuroscience (LIM 27), Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Cientifico e Tecnológico, São Paulo, Brazil
| | - Alexandre Andrade Loch
- Laboratory of Neuroscience (LIM 27), Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Cientifico e Tecnológico, São Paulo, Brazil
| | - Wulf Rössler
- Laboratory of Neuroscience (LIM 27), Institute of Psychiatry, University of São Paulo, São Paulo, Brazil.,Instituto Nacional de Biomarcadores em Neuropsiquiatria (INBION), Conselho Nacional de Desenvolvimento Cientifico e Tecnológico, São Paulo, Brazil.,Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.,Department of Psychiatry and Psychotherapy, Charité University of Medicine, Berlin, Germany
| |
Collapse
|
28
|
Gardiner P, Luo M, D’Amico S, Gergen-Barnett K, White LF, Saper R, Mitchell S, Liebschutz JM. Effectiveness of integrative medicine group visits in chronic pain and depressive symptoms: A randomized controlled trial. PLoS One 2019; 14:e0225540. [PMID: 31851666 PMCID: PMC6919581 DOI: 10.1371/journal.pone.0225540] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 11/05/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Current treatment options for chronic pain and depression are largely medication-based, which may cause adverse side effects. Integrative Medical Group Visits (IMGV) combines mindfulness techniques, evidence based integrative medicine, and medical group visits, and is a promising adjunct to medications, especially for diverse underserved patients who have limited access to non-pharmacological therapies. OBJECTIVE Determine the effectiveness of IMGV compared to a Primary Care Provider (PCP) visit in patients with chronic pain and depression. DESIGN 9-week single-blind randomized control trial with a 12-week maintenance phase (intervention-medical groups; control-primary care provider visit). SETTING Academic tertiary safety-net hospital and 2 affiliated federally-qualified community health centers. PARTICIPANTS 159 predominantly low income racially diverse adults with nonspecific chronic pain and depressive symptoms. INTERVENTIONS IMGV intervention- 9 weekly 2.5 hour in person IMGV sessions, 12 weeks on-line platform access followed by a final IMGV at 21 weeks. MEASUREMENTS Data collected at baseline, 9, and 21 weeks included primary outcomes depressive symptoms (Patient Health Questionnaire 9), pain (Brief Pain Inventory). Secondary outcomes included pain medication use and utilization. RESULTS There were no differences in pain or depression at any time point. At 9 weeks, the IMGV group had fewer emergency department visits (RR 0.32, 95% CI: 0.12, 0.83) compared to controls. At 21 weeks, the IMGV group reported reduction in pain medication use (Odds Ratio: 0.42, CI: 0.18-0.98) compared to controls. LIMITATIONS Absence of treatment assignment concealment for patients and disproportionate group attendance in IMGV. CONCLUSION Results demonstrate that low-income racially diverse patients will attend medical group visits that focus on non-pharmacological techniques, however, in the attention to treat analysis there was no difference in average pain levels between the intervention and the control group. TRIAL REGISTRATION clinicaltrials.gov NCT02262377.
Collapse
Affiliation(s)
- Paula Gardiner
- Department of Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Man Luo
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, United States of America
| | - Salvatore D’Amico
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, United States of America
| | - Katherine Gergen-Barnett
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, United States of America
| | - Laura F. White
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Robert Saper
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, United States of America
| | - Suzanne Mitchell
- Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, United States of America
| | - Jane M. Liebschutz
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America
| |
Collapse
|
29
|
Schmid AA, Van Puymbroeck M, Fruhauf CA, Bair MJ, Portz JD. Yoga improves occupational performance, depression, and daily activities for people with chronic pain. Work 2019; 63:181-189. [PMID: 31156199 DOI: 10.3233/wor-192919] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Chronic pain is a complex accumulation of physical, psychological, and social conditions, thus interventions that address pain and promote occupational performance are needed. A holistic intervention, with mind and body components, is likely necessary to best treat the complexities of chronic pain. Thus, we developed and tested a yoga intervention for people with chronic pain. OBJECTIVES In a randomized control trial (RCT), participants with chronic pain were randomized to a yoga intervention or usual care group. Between and within group differences for pre-and post-outcome measure scores were assessed for: occupational performance, completion of activities, and depression. METHODS Pilot RCT with participant allocation to 8 weeks of yoga or usual care. Both groups received ongoing monthly self-management programming. Data were collected before and after the 8-week intervention. Participants were randomized to yoga or usual care after baseline assessments. Demographics were collected and measures included: Canadian Occupational Performance Measure (COPM) to assess occupational performance; the 15-item Frenchay Activities Index (FAI)(activities); and the 9-item Patient Health Questionnaire (PHQ-9) for depression. Independent t-tests were used to assess differences between groups. Paired t-tests were used to assess differences between pre- and post 8-week intervention for both the yoga and the usual care groups. Percent change scores and effect sizes were calculated. RESULTS 83 people were recruited for the study and completed baseline assessments; 44 individuals were randomized to yoga and 39 to the control group. The average age of all participants was 51.4±10.5 years, 68% were female; and 60% had at least some college education. There were no significant differences in demographics or outcome measures between groups at baseline or 8 weeks; however, the study was not powered to see such differences. Individuals randomized to the control group did not significantly improve in any outcome measure over the 8 weeks. There were significant improvements in COPM performance and COPM satisfaction scores for individuals randomized to the yoga group; both scores significantly improved. COPM performance improved by 27% with a moderate to large effect size (3.66±1.85 vs 4.66±1.93, p < 0.001, d = 0.76). COPM satisfaction significantly improved by 78% (2.14±2.31 vs. 3.80±2.50, p < 0.001) and had a large effects size (d = 1.02). FAI scores improved, indicating increased activity or engagement in daily occupation during the 8-week intervention. Scores increased by 5% (38.13±8.48 vs. 39.90±8.57, p = 0.024) with a small effect size (d = 0.37). Depression significantly decreased from 13.21±5.60 to 11.41±5.82, p = 0.041, with a small effect size. CONCLUSION Data from this pilot RCT indicate yoga may be an effective therapeutic intervention with people in chronic pain to improve occupational performance, increase engagement in activities, and decrease depression. Occupational therapy practitioners may consider adding yoga as a treatment intervention to address the needs of people with pain.
Collapse
Affiliation(s)
- Arlene A Schmid
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO, USA
| | - Marieke Van Puymbroeck
- Department of Parks, Clemson University, Recreation and Tourism Management, Clemson, SC, USA
| | - Christine A Fruhauf
- Department of Human Development and Family Studies, Colorado State University, Fort Collins, CO, USA
| | - Matthew J Bair
- Department of Medicine, VA HSR&D Center for Health Information and Communication, Roudebush VA Medical Center, Indiana University School of Medicine, Regenstrief Institute, Inc., Indianapolis, IN, USA
| | | |
Collapse
|
30
|
Depressive symptoms among women with endometriosis: a systematic review and meta-analysis. Am J Obstet Gynecol 2019; 220:230-241. [PMID: 30419199 DOI: 10.1016/j.ajog.2018.11.123] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 10/22/2018] [Accepted: 11/01/2018] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To evaluate whether endometriosis is associated with depressive symptoms, and whether the association is modulated by pelvic pain. DATA SOURCES PubMed, Embase, PsychINFO, and the Cochrane Library, were systematically searched through September 2017. STUDY ELIGIBILITY CRITERIA The following eligibility criteria applied: full-text original article; quantitative data about depressive symptoms or depression; comparison of women with and without endometriosis, or women with endometriosis with and without pelvic pain. Articles reporting duplicated data were excluded. STUDY APPRAISAL AND SYNTHESIS METHODS Two reviewers selected and reviewed the studies. Disagreements were resolved through discussion or a third opinion. Qualitative synthesis was performed through tabulation and assessment using a modified version of the Newcastle-Ottawa Scale. Effect sizes were pooled through meta-analysis, and moderator analyses were performed to identify potential confounders with several variables: region of the sample, method of ascertainment of endometriosis, method of measurement of depression, year of publication, and quality score. RESULTS A meta-analysis of 24 studies (99,614 women) showed higher levels of depression among women with endometriosis compared to controls (standardized mean difference [SMD], 0.22, 95% confidence interval [CI], 0.13-0.32). The heterogeneity in this analysis (I2 = 68%) was not explained by any of the moderating variables. When only healthy controls were considered, a larger endometriosis-depression effect was found (11 studies, SMD, 0.49; 95% CI, 0.24-0.73; I2 = 69%). Endometriosis patients reporting pelvic pain had significantly higher levels of depression compared to those without pain (4 studies; SMD, 1.01; 95% CI, 0.71-1.31; I2 = 0%). No significant difference was found between women with pelvic pain and endometriosis and those with pelvic pain but without endometriosis (11 studies, SMD, -0.11; 95% CI, -0.25 to 0.04; I2 = 0%). CONCLUSION The association between endometriosis and depressive symptoms is largely determined by chronic pain but may also be modulated by individual and context vulnerabilities. Awareness of the complex relationship between endometriosis and depressive symptoms informs tailored care and patient-centered research outcomes.
Collapse
|
31
|
Patterns of concordances in mhGAP-IG screening and DSM-IV/ICD10 diagnoses by trained community service providers in Kenya: a pilot cross-sectional study. Soc Psychiatry Psychiatr Epidemiol 2018; 53:1277-1287. [PMID: 30062482 DOI: 10.1007/s00127-018-1567-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/24/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE The objective of this study was to determine the extent of concordance between positive screens for mental disorders by various trained community-based health workers using the WHO mental health Gap Action Programme Intervention Guide (mhGAP-IG) and independently confirmed DSM-IV/ICD-10 diagnoses. METHODS This was a cross-sectional study conducted in Makueni County, Kenya. 40 nurses/clinical officers, 60 Community Health Workers (CHWs), 51 Faith Healers (FHs), and 59 Traditional Healers (THs) from 20 facilities were trained to screen and refer patients with eight priority mental health conditions using the mhGAP-IG. These referrals, as well as referrals from friends or family members, and self-referrals were assessed using the Mini International Neuropsychiatric Instrument (M.I.N.I.) Plus. Concordance between positive screens and M.I.N.I. Plus diagnoses was investigated. RESULTS 15,078 community members agreed to participate in screening. Of these 12,170 (81%) screened positive for a mental disorder and were referred to their local clinics/hospitals. 8333 (68.5%) of those who were referred went for independent diagnostic assessment at the nearest facility. Positive predictive values varied with different providers and for different conditions. There was over 80% concordance between the initial screen and the M.I.N.I. Plus diagnoses across the different health providers and across all diagnoses. CONCLUSION Both formal and informal mental health providers can be trained to successfully and accurately screen for mental health disorders using the mhGAP-IG symptoms. This suggests that community-based non-specialist providers may play a key role in decreasing the mental health treatment gap. Further policy implications are discussed.
Collapse
|
32
|
Tang LY, Li HJ, Huang X, Bao J, Sethi Z, Ye L, Yuan Q, Zhu PW, Jiang N, Gao GP, Shao Y. Assessment of synchronous neural activities revealed by regional homogeneity in individuals with acute eye pain: a resting-state functional magnetic resonance imaging study. J Pain Res 2018; 11:843-850. [PMID: 29719418 PMCID: PMC5916265 DOI: 10.2147/jpr.s156634] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective Previous neuroimaging studies have demonstrated that pain-related diseases are associated with brain function and anatomical abnormalities, whereas altered synchronous neural activity in acute eye pain (EP) patients has not been investigated. The purpose of this study was to explore whether or not synchronous neural activity changes were measured with the regional homogeneity (ReHo) method in acute EP patients. Methods A total of 20 patients (15 males and 5 females) with EP and 20 healthy controls (HCs) consisting of 15 and 5 age-, sex-, and education-matched males and females, respectively, underwent resting-state functional magnetic resonance imaging. The ReHo method was applied to assess synchronous neural activity changes. Results Compared with HCs, acute EP patients had significantly lower ReHo values in the left precentral/postcentral gyrus (Brodmann area [BA]3/4), right precentral/postcentral gyrus (BA3/4), and left middle frontal gyrus (BA6). In contrast, higher ReHo values in acute EP patients were observed in the left superior frontal gyrus (BA11), right inferior parietal lobule (BA39/40), and left precuneus (BA7). However, no relationship was found between the mean ReHo signal values of the different areas and clinical manifestations, which included both the duration and degree of pain in EP patients. Conclusion Our study highlighted that acute EP patients showed altered synchronous neural activities in many brain regions, including somatosensory regions. These findings might provide useful information for exploration of the neural mechanisms underlying acute EP.
Collapse
Affiliation(s)
- Li-Yuan Tang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Hai-Jun Li
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xin Huang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jing Bao
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zubin Sethi
- The Department of Medicine, University of Miami, Coral Gables, FL, USA
| | - Lei Ye
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Qing Yuan
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Pei-Wen Zhu
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Nan Jiang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Gui-Ping Gao
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yi Shao
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| |
Collapse
|