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Wickens N, McGivern L, de Gouveia Belinelo P, Milroy H, Martin L, Wood F, Bullman I, Janse van Rensburg E, Woolard A. A wellbeing program to promote mental health in paediatric burn patients: Study protocol. PLoS One 2024; 19:e0294237. [PMID: 38359022 PMCID: PMC10868872 DOI: 10.1371/journal.pone.0294237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 10/27/2023] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND One of the most traumatic injuries a child can experience is a severe burn. Despite improvements in medical treatments which have led to better physical outcomes and reduced mortality rates for paediatric burns patients, the psychological impact associated with experiencing such a traumatic injury has mostly been overlooked. This is concerning given the high incidence of psychopathology amongst paediatric burn survivors. OBJECTIVES This project will aim to pilot test and evaluate a co-designed trauma-focused intervention to support resilience and promote positive mental health in children and adolescents who have sustained an acute burn injury. Our first objective is to collect pilot data to evaluate the efficacy of the intervention and to inform the design of future trauma-focussed interventions. Our second objective is to collect pilot data to determine the appropriateness of the developed intervention by investigating the changes in mental health indicators pre- and post-intervention. This will inform the design of future interventions. METHODS This pilot intervention study will recruit 40 children aged between 6-17 years who have sustained an acute burn injury and their respective caregivers. These participants will have attended the Stan Perron Centre of Excellence for Childhood Burns at Perth Children's Hospital. Participants will attend a 45-minute weekly or fortnightly session for six weeks that involves building skills around information gathering, managing reactions (behaviours and thoughts), identifying, and bolstering coping skills, problem solving and preventing setbacks. The potential effects and feasibility of our intervention will be assessed through a range of age-appropriate screening measures which will assess social behaviours, personal qualities, mental health and/or resilience. Assessments will be administered at baseline, immediately post-intervention, at 6- and 12-months post-intervention. CONCLUSION The results of this study will lay the foundation for an evidence-based, trauma-informed approach to clinical care for paediatric burn survivors and their families in Western Australia. This will have important implications for the design of future support offered to children with and beyond burn injuries, and other medical trauma populations.
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Affiliation(s)
- Nicole Wickens
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, Western Australia, Australia
| | - Lisa McGivern
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, Western Australia, Australia
- The University of Western Australia, Crawley, Western Australia, Australia
| | | | - Helen Milroy
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, Western Australia, Australia
- The University of Western Australia, Crawley, Western Australia, Australia
| | - Lisa Martin
- Burn Injury Research Unit, The University of Western Australia, Crawley, Western Australia, Australia
- Burn Service of Western Australia, Perth Children’s Hospital, Nedlands, Western Australia, Australia
| | - Fiona Wood
- Burn Injury Research Unit, The University of Western Australia, Crawley, Western Australia, Australia
- Burn Service of Western Australia, Perth Children’s Hospital, Nedlands, Western Australia, Australia
| | - Indijah Bullman
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, Western Australia, Australia
| | - Elmie Janse van Rensburg
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, Western Australia, Australia
- The University of Western Australia, Crawley, Western Australia, Australia
| | - Alix Woolard
- Telethon Kids Institute, Perth Children’s Hospital, Nedlands, Western Australia, Australia
- The University of Western Australia, Crawley, Western Australia, Australia
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Bøhle K, Otterholt E, Bjørkly SK. A Prospective Biopsychosocial Repeated Measures Study of Stress and Dropout from Substance Addiction Treatment. Subst Abuse Rehabil 2023; 14:61-75. [PMID: 37465017 PMCID: PMC10351681 DOI: 10.2147/sar.s376389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 05/02/2023] [Indexed: 07/20/2023] Open
Abstract
Introduction This prospective, repeated-measures observational study tested biopsychosocial variables as risk factors for dropping out of inpatient substance addiction treatment. Substance use disorder (SUD) is viewed as a chronic relapsing disease caused by an interaction between biological, psychological, and social factors. However, there is a lack of prospective studies that combine biopsychosocial variables when assessing dropout. The aims of this study were to investigate whether there was 1) An association between biopsychosocial factors and dropping out of inpatient substance addiction treatment, 2) An interaction with SUD diagnosis and cortisol, and 3) Different dropout rates between short-term and long-term institutions. Materials and Methods Patients (n = 173) were recruited from two inpatient treatment centers in Norway between 2018 and 2021. The following biopsychosocial variables were measured at four timepoints: ward atmosphere (Ward Atmosphere Scale, WAS), psychological distress (Hopkins Symptom Checklist 10, HSCL-10), motivation (M-scale of the Circumstances, Motivation, Readiness, and Suitability questionnaire), and concentration of salivary cortisol (CORT- nmol/L). Cortisol levels were measured for two consecutive days at each timepoint and calculated by two cortisol indices, daytime cortisol slope (DCS) and area under the curve with respect to the ground (AUCG). A multivariate logistic regression analysis was performed to find an association between dropout rates and the biopsychosocial variables. Results The results suggest a lower dropout odds for patients with high motivation (OR = 0.76, p = 0.022) and patients admitted to short-term treatment (OR = 0.06, p = 0.005). An interaction with stimulant SUD and DCS (OR = 13.74, p = 0.024) also revealed higher dropout odds. No statistical significance was found for psychological distress, WAS, and cortisol AUCG. Conclusion The results support monitoring motivation during treatment and further investigating biopsychosocial variables when assessing dropout risk together with SUD diagnosis.
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Affiliation(s)
- Kari Bøhle
- Faculty of Health and Social Science, Molde University College, Molde, Norway
- Clinic of Mental Health and Addiction, Møre and Romsdal Hospital Trust, Molde, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Eli Otterholt
- Faculty of Health and Social Science, Molde University College, Molde, Norway
- Clinic of Mental Health and Addiction, Møre and Romsdal Hospital Trust, Molde, Norway
| | - Stål Kapstø Bjørkly
- Faculty of Health and Social Science, Molde University College, Molde, Norway
- Regional Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital, Oslo, Norway
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Roberts RL, Garland EL. Association between opioid use disorder and blunted heart rate variability among opioid-treated chronic pain patients. Addict Biol 2022; 27:e13230. [PMID: 36301218 PMCID: PMC10234179 DOI: 10.1111/adb.13230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 08/14/2022] [Accepted: 08/21/2022] [Indexed: 01/24/2023]
Abstract
Given the severity of the ongoing opioid epidemic, it is essential to understand the mechanisms of risk for development and maintenance of opioid use disorder (OUD). The aim of the current large-scale psychophysiological investigation was to test whether patients with OUD had lower resting-state high-frequency heart rate variability (HF-HRV) than those without OUD, controlling for sociodemographic and clinical confounds. Additionally, we tested whether HF-HRV was associated with opioid craving in this population. Participants in this cross-sectional study were 490 chronic pain patients (50.4% female) treated with long-term opioid therapy. OUD diagnosis was determined by psychiatric interview. HF-HRV was measured at resting baseline. We computed the association between OUD and resting-state HF-HRV, controlling for age, gender, race, pain severity, emotional distress and opioid dose. Opioid craving was measured with visual analogue scales to assess whether HF-HRV was associated with craving. Results showed that resting HF-HRV was significantly lower for patients with OUD than for those without OUD (p < 0.001, d = 0.36), indicating deficits in autonomic flexibility. OUD diagnosis (p = 0.002) and OUD severity (p = 0.03) were associated with lower HF-HRV in regression models accounting for a range of confounders. Additionally, lower HF-HRV was significantly (but weakly) correlated with heightened opioid craving (r = -0.166, p < 0.001). Overall, findings suggest that resting-state HF-HRV may serve as a valid biomarker of addiction among people on long-term opioid therapy.
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Affiliation(s)
- R Lynae Roberts
- Center on Mindfulness and Integrative Health Intervention Development (C-MIIND), University of Utah, Salt Lake City, Utah, USA
- College of Social Work, University of Utah, Salt Lake City, Utah, USA
| | - Eric L Garland
- Center on Mindfulness and Integrative Health Intervention Development (C-MIIND), University of Utah, Salt Lake City, Utah, USA
- College of Social Work, University of Utah, Salt Lake City, Utah, USA
- Veterans Health Care Administration VISN 19 Whole Health, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
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Bøhle K, Otterholt E, Bjørkly S. Is There an Association Between Salivary Cortisol and Dropping Out of Inpatient Substance Addiction Treatments? A Prospective Repeated Measures Study. Subst Abuse 2022; 16:11782218221106797. [PMID: 35800884 PMCID: PMC9253992 DOI: 10.1177/11782218221106797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 05/21/2022] [Indexed: 11/15/2022]
Abstract
Several studies have found an association between salivary cortisol levels and
dropping out of inpatient substance addiction treatment programs. The results
are mixed due to variations in the study design and the lack of standardized
routines for cortisol assessment. The aim of this study was to investigate
whether there was (1) an association between salivary cortisol levels and
dropping out from inpatient substance addiction treatments; (2) higher
predictive validity for dropout in one of the cortisol indexes: Area Under the
Curve with respect to ground (AUCG) or Daily Cortisol Slope (DCS);
(3) an interaction effect with time for each cortisol index; and (4) different
dropout rates for sex and patients in short-term versus long-term treatment
programs. This was a prospective, repeated-measures observational study.
Patients (n = 173) were recruited from 2 inpatient facilities in the central
region of Norway between 2018 and 2021. Salivary cortisol was measured 4 times
during the treatment period, with 8 samples collected over 2 consecutive days at
each time point. Cortisol levels were calculated using the cortisol indices
AUCG and DCS. Dropout was used as the outcome measure at each
time point. Associations were calculated using a logistic linear regression. The
results suggest a main effect of AUCG, whereby higher levels reduce
dropout risk (OR = 0.92, P = .047). An interaction with time in
treatment also revealed a higher dropout risk (OR = 1.09,
P = .044) during week 4 of the treatment, depending on the
AUCG. These results support using AUCG as the
recommended index when assessing cortisol, and that the relationship between
cortisol levels and length of treatment should be further investigated.
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Affiliation(s)
- Kari Bøhle
- Faculty of Health and Social Sciences, Molde University College, Clinic of Mental Health and Addiction, Møre and Romsdal Hospital Trust, Molde, Norway
| | - Eli Otterholt
- Clinic of Mental Health and Addiction, Møre and Romsdal Hospital Trust, Faculty of Health and Social Sciences, Molde University College, Molde, Norway
| | - Stål Bjørkly
- Faculty of Health and Social Sciences, Molde University College, Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital, Molde, Norway
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Elkana O, Adelson M, Sason A, Doniger GM, Peles E. Improvement in Cognitive Performance after One Year of Methadone Maintenance Treatment. Psychiatry Res 2020; 294:113526. [PMID: 33126016 DOI: 10.1016/j.psychres.2020.113526] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/17/2020] [Indexed: 11/29/2022]
Abstract
Individuals with substance use disorders are known to suffer from stress, poor sleep, and cognitive impairment. We investigated whether individuals with opioid use disorder would improve cognitive performance following a year of methadone maintenance treatment (MMT). Perceived Stress Scale (PSS), the Pittsburgh Sleep Quality Index (PSQI), and a standardized computerized cognitive battery were administered at admission (T0) to 29 patients, and repeatedly following one year of MMT (T1) by 19 patients. Admission measures did not differ between those who studied once or twice. Patients who perceived very high stress levels (PSS ≥24) at T0 (11, 37.9%) had lower computerized global cognitive scores (67.6±16.2 vs. 90.9±12.5 p≤0.0005). At T1, PSS and PSQI scores improved significantly among 11 patients with no substance abuse, but worsened among 8 with substance abuse (PSS p(interaction)=0.009, p(groups)=0.005, PSQI p(interaction)=0.01, p(groups)=0.04). Global cognitive score improved at T1 for the entire sample (81.8±20.1 to 89.2±13.8, p=0.05). Differentiation by high stress at T0 or by substance abuse at T1 subgroups showed that improvement was observed by those with very low cognitive scores at T0. Patients with poor cognition may improve following one year of MMT, due to stress and substance abuse reduction. Interventions for stress reduction are recommended.
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Affiliation(s)
- Odelia Elkana
- Behavioral Sciences, Academic College of Tel Aviv, Yaffo, Israel
| | - Miriam Adelson
- Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research, Tel Aviv Sourasky Medical Center, Israel
| | - Anat Sason
- Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research, Tel Aviv Sourasky Medical Center, Israel
| | - Glen M Doniger
- Department of Clinical Research, NeuroTrax Corporation, Modiin, Israel
| | - Einat Peles
- Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse, Treatment and Research, Tel Aviv Sourasky Medical Center, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
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