The EUROHIS-QOL 8-item index: psychometric results of a cross-cultural field study

A randomized feasibility study of a positive psychology journaling intervention to support recovery from substance-use disorders

BACKGROUND

Individuals in early recovery face significant biopsychosocial stressors causing a preponderance of negative affect. Novel interventions are needed to improve mood and well-being to support recovery. Positive Recovery Journaling (PRJ) combines elements of positive psychology, behavioral activation, and journaling to emphasize what is going right and to encourage small, positive steps that align with an individual's values to make life in recovery more rewarding and therefore more reinforcing. Our objective was to determine PRJ's feasibility, acceptability, and impact on a set of strengths-based, multidimensional aspects of recovery, including satisfaction with life, happiness with recovery, and commitment to sobriety.

METHODS

The study randomized adults in substance-use disorder treatment (N = 81) to PRJ or control. Those in PRJ were asked to practice PRJ daily and complete online surveys for four weeks; those in the control group completed online surveys for four weeks. We used multi-level modelling to determine intercept and slope for feasibility and acceptability outcomes as well as to compare differences in recovery indicators between treatment and control at baseline and Weeks 2, 4, and 8. We conducted intention-to-treat and per-protocol analyses for each recovery indicator.

RESULTS

Participants were 53 % female, and 26 % Black, Indigenous, People of Color (BIPOC) and mean age of 39 years. PRJ participants attended 71 % of groups and completed 56 % of the daily PRJ entries. Treatment and control groups rated their study tasks (PRJ for the treatment group, surveys for the control group) as equally easy; however, the PRJ group rated PRJ as significantly more satisfying, helpful, and pleasant. Treatment and control were not significantly different on any recovery indicator. In post hoc analyses, we found that for those with <90 days sobriety at baseline (51 %), PRJ had a statistically significant beneficial effect for satisfaction with life, happiness with recovery, and numerous secondary recovery indicators.

DISCUSSION

Results suggest a positive impact of PRJ on numerous recovery indices for those in earliest recovery. Integrating PRJ into support services among those with <90 days sobriety could reinforce what is going well in recovery to encourage its continued maintenance and thereby improve treatment outcomes.

ICD-11 and DSM-5-TR prolonged grief symptoms and quality of life: A criterion validity test

OBJECTIVE

Two similar but distinct versions of prolonged grief disorder (PGD) have recently been included in the International Classification of Diseases eleventh edition (ICD-11) and the Diagnostic and Statistical Manual of Mental Disorders - fifth edition, Text-Revision (DSM-5-TR). This study provides a criterion validity test of both new criteria sets of PGD, by examining concurrent and longitudinal associations of ICD-11 and DSM-5-TR prolonged grief symptoms with quality of life (QOL).

METHODS

Bereaved adults completed a survey assessing ICD-11 and DSM-5-TR prolonged grief symptoms, depressive symptoms, insomnia symptoms and QOL at baseline and 6-month follow-up.

RESULTS

Both ICD-11 and DSM-5-TR prolonged grief symptoms related negatively to QOL concurrently, while controlling for insomnia and depressive symptoms. ICD-11 prolonged grief symptoms, but not DSM-5-TR prolonged grief symptoms, predicted QOL at 6-month follow-up, while controlling for baseline QOL and insomnia and depression symptoms.

CONCLUSIONS

Results provide consistent evidence for the criterion validity of ICD-11 PGD, but mixed evidence for the criterion validity of DSM-5-TR PGD. Study results can help guide attempts to optimize and harmonize future PGD criteria.

Predictors of alcohol and other drug treatment completion among young people accessing residential and community-based treatment: A retrospective analysis of routinely collected service data

BACKGROUND AND AIMS

Young people accessing alcohol and other drug (AOD) treatment experience high rates of treatment disengagement, contributing to poorer outcomes. To improve outcomes, it is important to identify factors associated with treatment retention. This study measured the relationships between client characteristics, treatment characteristics, clinical severity measures and completion of treatment among young people.

DESIGN, SETTING AND PARTICIPANTS

This study was a retrospective analysis of routinely collected data set in residential- and community-based AOD services in New South Wales, Australia. Routinely collected data from the Network of Alcohol and Other Drug Agencies' (NADA) database were used. Included individuals were aged 10-24 years and accessed treatment between 2012 and 2023 (n = 17 474).

MEASUREMENTS

Variables included client-related characteristics, service characteristics and baseline measures of clinical severity [Kessler-10 (K10), EUROHIS-QoL, severity of dependence scale (SDS)]. Multivariable binary logistic regression models assessed the relationships between these characteristics and treatment completion.

FINDINGS

Rates of treatment completion were highest among adolescents in community-based treatment (57%) and lowest among young adults in residential treatment (35%). Polysubstance use was negatively associated with treatment completion among adolescents [adjusted odds ratio (adjOR) = 0.71, P < 0.001] and adults (adjOR = 0.70, P < 0.001) in community-based treatment, and adolescents in residential treatment (adjOR = 0.62, P = 0.006), as was housing insecurity (adolescents in community treatment, adjOR = 0.61, P = 0.001; adults in community treatment, adjOR = 0.77, P = 0.002; adolescents in residential treatment, adjOR = 0.42, P = 0.005). Attending youth-specific services was associated with higher treatment completion rates among adults in community-based (adjOR = 1.81, P < 0.001) and residential treatment (adjOR = 1.72, P < 0.001). Varying correlates of treatment completion were identified throughout treatment groups, reflecting the differences in population and/or needs across contexts.

CONCLUSIONS

In New South Wales, Australia, fewer than half of young people accessing alcohol and other drug treatment between 2012 and 2023 completed treatment, and completion rates were lower among those facing barriers such as polysubstance use and housing insecurity.

Sexual minority disparities in psychosocial functioning following substance use recovery among a representative sample of US adults

Purpose

Sexual minority (SM; e.g., gay, lesbian, bisexual) individuals are disproportionately impacted by alcohol and other drug (AOD) use disorders and psychosocial factors that can exacerbate AOD use disorders and hinder recovery. This study examines SM sub-group differences (monosexual [gay/lesbian] versus bisexual) regarding adaptation to recovery measured by indices of psychosocial functioning. Identifying differential needs of gay/lesbian versus bisexual individuals could improve services to better meet the needs of SM individuals in recovery.

Methods

Using data from the National Recovery Study, a nationally representative cross-sectional sample of US adults who reported resolving an AOD problem (N = 2,002), we compared heterosexual to monosexual and bisexual SM individuals on socio-demographic characteristics, AOD use and treatment, and psychosocial variables.

Results

Bisexual individuals were significantly younger than heterosexual individuals (p = .002 and p ≤ 0.001 among men and women, respectively) and reported significantly fewer years since AOD problem resolution compared to heterosexual individuals (p = .004 and p = .003 among men and women, respectively). Most notably, bisexual individuals, but not gay/lesbian individuals, reported significantly lower quality of life (QOL), happiness, self-esteem, and significantly higher distress compared to heterosexual individuals.

Conclusion

Bisexual, but not monosexual, SM individuals in recovery from an AOD use disorder, were younger and reported worse psychosocial functioning than heterosexual individuals. Findings highlight significant differences between monosexual versus bisexual identified individuals with a notable disadvantage experienced by bisexual individuals. More needs to be learned about the challenges faced by bisexual individuals in recovery to better address their needs and support long-term AOD recovery.

SMART Family and Friends: Feasibility and outcomes of a video-conference delivered intervention for families impacted by another's methamphetamine use

INTRODUCTION

Families affected by another's substance use, including methamphetamine, experience harms to their mental and physical health. Yet, research has paid little attention to support and service needs of this population. This pilot study examines the feasibility and outcomes of SMART Family and Friends, a video-conference-delivered mutual-support group targeting families affected by another's methamphetamine use.

METHODS

Recruitment for this study occurred between March-October 2021 via the SMART Recovery Australia website. Participants were English-speaking Australian residents, ≥18 years, affected by another's methamphetamine use, interested in participating in a manualised eight-module group delivered via video-conferencing. Feasibility was evaluated by attendance rates, participant satisfaction, fidelity ratings, and semi-structured interviews. Measures of distress, quality of life, and family functioning assessed outcomes at baseline and one-month post-treatment conclusion.

RESULTS

Forty-three participants commenced SMART Family and Friends groups. 84 % (n = 36) completed ≥4 modules, 67 % (n = 29) completed ≥6, and 42 % (n = 18) completed all 8 modules. Participant satisfaction (M = 4.32, SD = 0.66, out of 5) and facilitator fidelity (>94 % for all modules) were high. A within-group analysis, without comparison condition demonstrated significant improvements in psychological distress (d = 0.38), family impact (d = 0.64), family strain symptoms (d = 0.48), and total family burden (d = 0.69) post-treatment. Qualitative findings illustrated the benefits and challenges of the video-conference-delivered group, as well as recommendations for improvement.

CONCLUSIONS

Results provide initial support for the feasibility and positive outcomes of the SMART Family and Friends program. These findings demonstrate the successful provision of a mutual-support group for affected families delivered via video-conferencing, and merit further sufficiently powered randomised-control-trials to evaluate efficacy.

An internet-based cognitive behavioural intervention for adults with depression in Arabic-speaking countries: A randomized controlled trial

Internet-based interventions have proven to be effective for the treatment of depression in different samples, but evidence from the Middle East and North Africa (MENA) region is scarce. The aim of this study was to investigate the acceptance and efficacy of an internet-based cognitive behavioural writing intervention for Arabic-speaking participants with depression living in the MENA region. A total of 259 participants (167 female, age in years: M = 25.58, SD = 6.39) with depressive symptoms indicative of clinical relevance were randomly allocated to a treatment group (TG; nTG = 128) or a waitlist control group (WG; nWG = 131). The TG received an internet-based intervention over a 6-week period. The primary outcome was depressive symptoms, and secondary outcomes were anxiety and quality of life (QoL). T-tests with change scores from pre- to post-treatment were used for data analyses. Intention-to-treat (ITT) as well as completer analyses were calculated. The ITT analysis revealed significant differences between the TG and WG in depression (T257 = -4.89, p < 0.001, d = 0.70) and QoL (T257 = 3.39, p < 0.001, d = 0.47). Significant differences regarding anxiety symptoms (T257 = 3.25, p < 0.05, d = 0.53) were identified for the completer sample. The general dropout rate was 39.9%. The results indicate the feasibility and efficacy of an internet-based cognitive behavioural writing intervention in adults from Arabic-speaking countries. The development and implementation of such interventions can be used to improve access to psychological help and adequate treatment.

Internet-Based Cognitive Behavioural Treatments for Obsessive-Compulsive Disorder: A Systematic Review and Meta-Analysis

Obsessive-compulsive disorder (OCD) is a common mental health condition characterized by distressing, intrusive thoughts (obsessions) and repetitive behaviours (compulsions) aimed at reducing anxiety. Internet-based cognitive behavioural therapy (ICBT) has emerged as an effective treatment modality for various mental health disorders. This meta-analysis evaluates the efficacy of guided self-help ICBT (GSH ICBT) and unguided self-help ICBT (SH ICBT) against active and passive control conditions in adults with OCD. A comprehensive systematic literature search yielded 12 randomized controlled trials (RCTs) comprising 15 comparison arms (N = 1416) that met the inclusion criteria. Results indicate that GSH ICBT significantly reduced OCD symptomatology posttreatment compared to active controls (g = 0.378, k = 9), with no significant effects maintained at follow-up (g = 0.153, k = 4). GSH ICBT was also found to be as effective as active CBT interventions in reducing comorbid anxiety and depression symptoms posttreatment (g = 0.278, k = 6) and at follow-up (g = 0.124, k = 4). However, improvements in quality of life were not significant posttreatment (g = 0.115, k = 4) nor at follow-up (g = 0.179, k = 3). Combined GSH and SH ICBT demonstrated large effects on reducing OCD symptoms (g = 0.754, k = 6), medium effects on comorbid symptoms (g = 0.547, k = 6) and small effects on quality of life (g = 0.227, k = 2) when compared to inactive controls. No significant differences were found between GSH and SH ICBT in all measured outcomes posttreatment (OCD: g = 0.098, k = 3; AD: g = 0.070, k = 3; QoL: g = -0.030, k = 1) and at follow-up (OCD: g = 0.265, k = 2; AD: g = 0.084, k = 2; QoL: g = 0.00, k = 1). Sample size was identified as a significant moderator of treatment effects. This paper further explores clinical significance, treatment adherence, therapist time investment and moderator influences of the ICBT. The limitations of the study and recommendations for future research are thoroughly discussed.

Evaluation of the internet-based intervention "Selfapy" in participants with unipolar depression and the impact on quality of life: a randomized, parallel group study

PURPOSE

Depressive disorders cause a major burden of disease worldwide and often lead to a loss of social functioning. Patients suffering from depressive disorders report a lower quality of life (QOL) than people without a history of mental health issues. Internet-based interventions (IBIs) based on cognitive behavioral therapy (CBT) are effective in reducing symptom severity but data on their impact on quality of life in clinically depressed patients so far is scarce.

METHODS

Selfapy is a CBT-based IBI for depressive disorders. 401 participants (332 female, mean age 37 (SD = 11) with a diagnosis of major depressive disorder (MDD) or dysthymia were enrolled in a randomized, parallel, three-arm trial comparing a therapist-guided Selfapy intervention with an unguided Selfapy intervention and a waiting list control. QOL was measured using the WHOQOL-BREF at baseline, post-treatment (12 weeks) and at 24-week follow-up. The effects of the interventions on QOL were calculated using linear mixed effects models.

RESULTS

At post-treatment (12 weeks) the guided and unguided intervention groups reported an increase in QOL on physical and psychological health domains compared to controls (significant group*time interaction). The gain in QOL was maintained over the follow-up period only for psychological health. QOL decreased in the social relationships and environment domains over the course of treatment and during the follow-up treatment for all participants. There were no differences between the guided and the unguided intervention.

CONCLUSION

Selfapy proved to positively affect psychological and physical QOL in a sample of participants suffering from depressive disorders and can therefore be considered an effective and highly scalable therapeutic tool. The pattern of results might partly be attributable to effects of the COVID-19 pandemic and public health measures that coincided with the trial.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS): DRKS00017191. Registered June 14th, 2019, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00017191 .

Development and validation of a brain fog scale for coeliac disease

BACKGROUND

Brain fog is a subjective cognitive impairment commonly reported in coeliac disease. A standardised tool to define and assess it is an important unmet need.

AIMS

To develop a patient-informed tool to assess brain fog in coeliac disease to support clinical care, research and drug development.

METHODS

A pilot online study defined patient descriptors of brain fog. A second study evaluated the factor structure and performance of the scale across two-time points ('Now' and in the 'Past week'). One month later, participants were invited to repeat the study with two online cognitive processing tests, the Stroop task and the trail making test.

RESULTS

Among adults with treated coeliac disease, 37 (91.9% F) participated in the pilot study and 510 (88.8% F) in the second study of whom 99 repeated the study 1 month later with 51 completing cognitive testing. The most common brain fog descriptors were 'difficulty focusing', 'difficulty thinking' and 'difficulty finding the right words and communicating'. The 12-item scale reflects 'cognitive impairment' and 'somatic and affective experience' and demonstrates strong psychometric properties. It tracked with patients report of brain fog being present or absent across two-time points. It did not significantly correlate with the cognitive tests.

CONCLUSION

The brain fog assessment and severity scale is the first patient-informed clinical outcomes assessment tool measuring brain fog in coeliac disease. It is brief and validated for two time-based formats. Further research coupling it with biomarker discovery is needed to confirm its validity as a predictor of cognitive performance.

Camouflaging in Autism: Age Effects and Cross-Cultural Validation of the Camouflaging Autistic Traits Questionnaire (CAT-Q)

Given that camouflaging has been suggested to contribute to delayed diagnosis and mental health problems among autistic people, validated measures of the construct are needed. This study describes the psychometric evaluation of the Swedish adaptation of the self-reported Camouflaging Autistic Traits Questionnaire (CAT-Q) in autistic (n = 100) and general population (n = 539) samples aged 10 to 83 years. Analyses indicated good-to-excellent internal consistency and test-retest reliability. Construct validity was supported by autistic participants scoring higher than non-autistic, and autistic females scoring higher than autistic males on the measure. Also as expected, camouflaging was associated with theoretically linked traits, including autistic behaviors and depressive symptoms. On the other hand, the factor structure of the original CAT-Q did not provide a good fit in the Swedish data set, and validity issues were found, particularly in children younger than 15 years, warranting further investigation of the construct validity of the scale. Different age trajectories were observed, where camouflaging behaviors decreased during adulthood in non-autistic people but remained at an elevated level among autistic people.

Learning with conviction: Exploring the relationship between criminal legal system involvement and substance use and recovery outcomes for students in collegiate recovery programs

This study examines the association of criminal legal system involvement and age with substance use and academic related outcomes among students involved in collegiate recovery programs in the US. We examined 435 students in collegiate recovery using a national survey of college students. We computed differences between non-system-involved, system-involved with no incarceration history, and formerly incarcerated participants on relevant substance use and recovery-related outcomes. The results provide evidence that there are significant differences between those system-involved and those who are not. Specifically, we found significant differences across the outcomes of recovery capital, quality of life, hours worked per week, and substance use disorder symptoms, but after controlling for relevant covariates, only the differences between hours worked (non-system involved and system involved < formerly incarcerated) and substance use disorder symptoms (non-system involved < system involved and formerly incarcerated) remained significant. The study contributes to the literature by demonstrating that nearly half of the collegiate students in recovery in this sample have legal system-involvement and a third have been incarcerated. Further, interventions for collegiate recovery programs may need to be adjusted to account for legal system involvement among their members.

Commentary on the Revision of SAMHSA's National Outcome Measures (NOMs) for Discretionary Programs

Data collection is an integral part of government agencies like the Substance Abuse and Mental Health Administration (SAMHSA), for reporting program outcomes and accountability. SAMHSA-funded community behavioral health programs have been evaluated by the National Outcome Measures (NOMs) since 2007. NOMs collects data on important aspects of client health including but not limited to mental health symptoms, functioning, and social connectedness through interviews with clients. Since its inception, NOMs has gone through a number of revisions. The most recent revision in 2021 has significant implications for program evaluation and research. This commentary provides an overview of the history of the NOMs followed by a review and critique of the recent changes with a particular attention to revisions in how responses are recorded. Implications of the NOMs are discussed with respect to its utility in evaluation, practice, and research.

Psychometric properties of the World Health Organization WHOQOL-AGE Scale in Singapore

WHOQOL-AGE is a promising quality of life (QOL) tool that has not been fully validated in Asia. The present study aimed to verify its factor structure and psychometric properties among community-dwelling older adults in Singapore. This study was cross-sectional and used data (N = 593) from the Community Health and Intergenerational study that interviewed older adults between 2018 and 2021. Confirmatory factor analysis (CFA) was used to examine the factor structure of the WHOQOL-AGE, and Cronbach's alpha coefficients were employed to examine internal consistency. Spearman's rho correlations coefficients between WHOQOL-AGE and other related scales (Satisfaction with Life and the Friendship) examined convergent validity. A Pearson's correlation coefficient between WHOQOL-AGE and compassion scale examined discriminant validity. An independent t test was used to demonstrate known-groups validity, examining differences in QOL scores between individuals with and without chronic medical conditions. Findings supported a bifactor model with more satisfactory goodness-of-fit indices than the original two-factor model and the two-correlated factor model. WHOQOL-AGE showed adequate internal consistency (Cronbach's alpha coefficients > .70). Good convergent validity was demonstrated by moderate-to-large correlations between WHOQOL-AGE and satisfaction with life (rs = .54) as well as social connectedness (rs = .33). Discriminant validity was shown by low correlations between WHOQOL-AGE and compassion (r = .19). Findings also indicated good known-groups validity (p < 0.01). The WHOQOL-AGE showed promising psychometric properties using an Asian convenience sample and can be useful in large-scale studies or busy clinical settings.

Dementia Screening in Rural Kenya: The Prevalence and Impact of Screening Positive for Dementia

INTRODUCTION

In Kenya, there is a lack of data on the number of people with dementia. In this article, we aim to estimate the number of community-dwelling older adults (aged 60 years and above) that are potentially living with dementia in rural Kenya.

METHODS

Recruitment of older adults occurred through adopting a convenience approach based on the catchment areas served by ten trained community health workers. Screening was conducted using the Brief Community Screening Instrument for Dementia (CSI-D), in which prevalence ratios were reported. Regression analyses were run to understand the association between screening outcome and wellbeing, social isolation, and employment status (adjusted for age, sex, literacy, geography, and social status).

RESULTS

Of the 3,546 older adults who were screened for dementia, 652 screened positive (PR = 0.18, 95% CIs: 0.17-0.20). Back estimating screen positives based on established sensitivity and specificity of the tool against a gold standard (clinical diagnosis), yielded a prevalence of 9.4% (0.09, 95% CIs: 0.08-0.11). Screening positive for dementia was associated with poorer quality of life (B = -0.17, p < 0.001) and loneliness (B = 0.28, p < 0.001).

CONCLUSION

There are potentially 258,000 older adults living with dementia in Kenya, who likely have poorer outcomes. We need to encourage a timely diagnosis and develop better ways to support people living with dementia in Kenya and other resource-limited settings.

Social cognition abilities in patients with primary and secondary chronic pain

Previous evidence suggested that chronic pain is characterized by cognitive deficits, particularly in the social cognition domain. Recently, a new chronic pain classification has been proposed distinguishing chronic primary pain (CPP), in which pain is the primary cause of patients' disease, and chronic secondary pain (CSP), in which pain is secondary to an underlying illness. The present study aimed at investigating social cognition profiles in the two disorders. We included 38 CPP, 43 CSP patients, and 41 healthy controls (HC). Social cognition was assessed with the Ekman-60 faces test (Ekman-60F) and the Story-Based Empathy Task (SET), whereas global cognitive functioning was measured with the Montreal Cognitive Assessment (MoCA). Pain and mood symptoms, coping strategies, and alexithymia were also evaluated. Correlations among clinical pain-related measures, cognitive performance, and psychopathological features were investigated. Results suggested that CSP patients were impaired compared to CPP and HC in social cognition abilities, while CPP and HC performance was not statistically different. Pain intensity and illness duration did not correlate with cognitive performance or psychopathological measures. These findings confirmed the presence of social cognition deficits in chronic pain patients, suggesting for the first time that such impairment mainly affects CSP patients, but not CPP. We also highlighted the importance of measuring global cognitive functioning when targeting chronic pain disorders. Future research should further investigate the cognitive and psychopathological profile of CPP and CSP patients to clarify whether present findings can be generalized as disorder characteristics.

Changes in some health and lifestyle behaviours are significantly associated with changes in gambling behaviours: Findings from a longitudinal New Zealand population study

Although a large number of studies have investigated associations between risky gambling behaviours and health, lifestyle and social factors, research has not focused on changes in these factors and associations with changes in gambling risk level. This study utilised existing data from the four waves of the longitudinal New Zealand National Gambling Study to examine associations between changes in substance use, mental and physical health, and quality of life and deprivation with changes in gambling risk level over time. A Markov chain transition model was used to perform these analyses using data from participants who had completed all four waves (11,080 data transitions). Although changes in various covariates were associated with changes in all gambling risk levels, the highest number of significant factors was for transitioning into risky gambling from non-problematic gambling, including development, or continuation, of several negative health and lifestyle factors that may possibly be alleviated by transitioning out of risky gambling. These findings highlight the importance of screening for gambling behaviours when assisting people with substance use, health issues, or social situations or conditions in order to provide appropriate and effective social, health and treatment supports for people whose gambling behaviour increases over time.

Psychometric evaluation of the WHOQOL-BREF and its shorter versions for general Thai population: confirmatory factor analysis and Rasch analysis

PURPOSE

Rasch analysis was employed to validate the World Health Organization Quality of Life-BREF (WHOQOL-BREF) and its existing shorter versions in the general Thai population.

METHODS

1200 respondents were randomly selected to complete the questionnaire. Confirmatory factor analysis (CFA) was employed to test the structure of the WHOQOL-BREF and its shorter versions with the random sub-sample of 900 respondents, while Rasch analysis was performed with a random sub-sample of 300 respondents.

RESULTS

The CFA confirmed the factor structure of WHOQOL-BREF and its shorter versions. The Rasch analysis revealed that the WHOQOL-BREF, when a four-domain structure was tested using a subtest approach, achieved acceptable model fit to the Rasch model and met the expectations of unidimensionality with high reliability (PSI = 0.87). Individual domain models were also unidimensional, but reliability of the 3-item social domain was inadequate. While the 8-item EUROHIS-QOL-8 and 5-item WHOQOL-5 achieved an overall acceptable fit and met the expectations of unidimensionality, the reliability of the WHOQOL-5 was below the acceptable threshold (PSI = 0.66). Reliability of the EUROHIS-QOL-8 was satisfactory (PSI = 0.79).

CONCLUSIONS

The WHOQOL-BREF is a valid instrument for use in the Thai general population, both as a total score as well as individual subscales. Rasch analysis also supports the use of EUROHIS-QOL-8, but the WHOQOL-5 lacks good reliability. While the reliability of the EUROHIS-QOL-8 is sufficiently high for between-group analysis, the Thai WHOQOL-BREF total score can also be used for within-participant analyses. Rasch investigation with a more varied health conditions of general Thai samples or patient groups is encouraged for future studies.

Post-migration stress, quality of life, and mental health among accompanied and unaccompanied young refugees in Germany: How do adolescents feel after fleeing?

This study examines the impact of post-migration living difficulties (PMLDs) and quality of life (QoL) on the mental health of 55 young refugees who arrived in Germany either accompanied or unaccompanied. The results reveal that nearly 62% of the participants exhibited clinically significant symptoms of depression or post-traumatic stress disorder. Regression analyses indicate that psychopathology was associated with being unaccompanied and experiencing lower QoL, while QoL was associated with higher economic status and lower PMLDs. Mediation analysis further demonstrates that higher economic status and reduced PMLDs were associated with higher QoL, which, in turn, correlated with lower levels of psychopathology. These findings emphasise the importance of considering PMLDs and QoL, as well as economic status and being accompanied/unaccompanied, in the assessment and treatment of young refugees in the host country.

Patterns of posttraumatic stress symptoms, their predictors, and comorbid mental health symptoms in traumatized Arabic-speaking people: A latent class analysis

Many people from the Middle East and North Africa (MENA) have experienced traumatic events due to human rights abuses, violence, and conflict in the region, with potential psychological consequences including symptoms of posttraumatic stress and comorbid mental health problems. Yet, little is known about how different posttraumatic stress symptoms unfold in Arabic-speaking people who have experienced diverse traumatic events. This study examined latent classes based on posttraumatic stress symptoms, differences across classes concerning comorbid mental health symptoms and quality of life, and several predictors, including sociodemographic characteristics, social support, and trauma-related characteristics. Participants were 5,140 traumatized Arabic-speaking individuals who had registered for an online intervention. Latent class analysis was conducted to identify distinct classes based on DSM-5 posttraumatic stress symptoms. Multinomial logistic regression was used to analyze predictors of class membership. Differences between classes in severity of posttraumatic stress, depressive, anxiety, and somatoform symptoms, as well as quality of life were examined. Five different latent classes were identified: a general high posttraumatic stress symptom class (43.8%), a high posttraumatic stress symptom-low avoidance class (12.8%), a mixed posttraumatic stress symptom class (20.9%), a high dysphoric-low reexperiencing/avoidance class (14%), and a general low posttraumatic stress symptom class (8.4%). The classes differed in severity of posttraumatic stress, depressive, anxiety and somatoform symptoms, and quality of life. Consistent significant predictors of class membership were gender, social support, cumulative trauma exposure, sexual violence and direct exposure during the most distressing trauma, as well as time since the most distressing trauma. Distinct symptom classes with quantitative and qualitative differences can emerge following exposure to trauma among help-seeking Arabic-speaking people from the MENA region, with gender, social support, and trauma-related characteristics predicting symptom presentation. The results have implications for identifying distressed people and enhancing interventions based on an individual's symptom presentation.

Stigma, depression and quality of life among people affected by neglected tropical diseases in Nepal

BACKGROUND

Stigma and poor mental health are important factors influencing the quality of life (QOL) of people with neglected tropical diseases (NTDs). This study examines the relationship between stigma, depression and QOL among people affected by leprosy and lymphatic filariasis (LF) in Nepal.

METHODS

A cross-sectional community-based survey was conducted among 102 NTD-affected persons (70 leprosy and 32 LF) using interview-administered questionnaires measuring the level of stigma (5-QSI-AP), symptoms of depression (PHQ-9) and QOL (WHOQOL-8). Three different regression models were developed, each using the ordinary least squares and Poisson regression to evaluate the association between stigma and QOL, depression and QOL, and stigma and depression.

RESULTS

The mean scores were 21.8±4.4 for QOL, 6.6±5.6 for depression and 3.0±2.8 for stigma. Almost 17% reported the prevalence of depression symptoms. Both stigma (β=-0.65, p<0.001) and depression (β=-0.32, p<0.001) were associated with lower scores for QOL, while there was a significant positive relationship between stigma and depression (β=0.92, p<0.001). Similar results were obtained from the Poisson regression models.

CONCLUSIONS

The study showed a considerable burden of depression, stigma and poor QOL among study participants with leprosy and LF in Nepal. A holistic package of care that addresses the physical, mental and psychological well-being of people with NTD is required.

CONTEXTE

La stigmatisation et la mauvaise santé mentale sont des facteurs importants qui influencent la qualité de vie des personnes atteintes de maladies tropicales négligées (MTN). Cette étude examine la relation entre la stigmatisation, la dépression et la qualité de vie chez les personnes atteintes de lèpre et de filariose lymphatique au Népal.

MÉTHODES UTILISÉES

Une enquête communautaire transversale a été menée auprès de 102 personnes atteintes de MTN (70 de la lèpre et 32 de la filariose lymphatique) à l'aide de questionnaires administrés par entretien mesurant le niveau de stigmatisation (5-QSI-AP), les symptômes de dépression (PHQ-9) et la qualité de vie (WHOQOL-8). Trois modèles de régression différents ont été développés, chacun utilisant les moindres carrés ordinaires et la régression de Poisson pour évaluer l'association entre : (i) la stigmatisation et la QV; (ii) la dépression et la QV; et (iii) la stigmatisation et la dépression.

RÉSULTATS

Les scores moyens étaient de 21,8±4,4 pour la QV, 6,6±5,6 pour la dépression, et 3,0±2,8 pour la stigmatisation. Près de 17% des personnes interrogées ont signalé la prévalence de symptômes dépressifs. La stigmatisation (β = -0,65, p<0 001) et la dépression (β = -0,32, p<0 001) ont été associées à des scores plus faibles pour la qualité de vie, tandis qu'il existait une relation positive significative entre la stigmatisation et la dépression (β = 0,92, p<0 001). Des résultats similaires ont été obtenus à partir des modèles de régression de Poisson.

CONCLUSIONS

L'étude a montré une incidence importante de dépression, de stigmatisation et d'une mauvaise qualité de vie parmi les participants atteints de lèpre et de FL au Népal. Il convient donc de mettre en place un ensemble de soins holistiques pour ces patients qui prendrait en compte le bien-être physique, mental et psychologique des personnes atteintes de MTN.

ANTECEDENTES

La estigmatización y la mala salud mental son factores importantes que influyen en la calidad de vida de las personas con enfermedades tropicales desatendidas. las personas con enfermedades tropicales desatendidas (ETD). Este estudio examina la relación entre el estigma, la depresión y la CdV entre las personas afectadas por lepra y lepra y la filariasis linfática en Nepal.

MÉTODOS

Se realizó una encuesta comunitaria transversal entre 102 personas afectadas por ETD (70 de lepra y 32 de filariasis linfática) utilizando cuestionarios entrevistas para medir el nivel de estigma (5-QSI-AP), los síntomas de depresión (PHQ- 9) y la CdV (OMS- 9). 9) y la calidad de vida (WHOQOL-8). Se desarrollaron tres modelos de regresión diferentes regresión de Poisson para evaluar la asociación entre: (i) el estigma y (ii) la depresión. entre: (i) estigma y CdV; (ii) depresión y CdV; y (iii) estigma y depresión.

RESULTADOS

Las puntuaciones medias fueron 21,8±4,4 para la CdV, 6,6±5,6 para la depresión y 3,0±2,8 para el estigma. Casi el 17% informó de la prevalencia de síntomas de depresión. Tanto el estigma (β = -0,65, p<0 001), como la depresión (β = -0,32, p<0 001) se asociaron con puntuaciones más bajas para la CdV, mientras que hubo una relación positiva significativa entre el estigma y la depresión (β = 0,92, p<0 001). Se obtuvieron resultados similares en los modelos de regresión de Poisson.

CONCLUSIONES

El estudio mostró una carga considerable de depresión, estigma y mala CdV entre los participantes del estudio con lepra y FL en Nepal. Se requiere un paquete holístico de atención que aborde el bienestar físico, mental y psicológico de las personas con ETD.

Exposure Versus Cognitive Restructuring Techniques in Brief Internet-Based Cognitive Behavioral Treatment for Arabic-Speaking People With Posttraumatic Stress Disorder: Randomized Clinical Trial

BACKGROUND

Cognitive behavioral interventions delivered via the internet are demonstrably efficacious treatment options for posttraumatic stress disorder (PTSD) in underserved, Arabic-speaking populations. However, the role of specific treatment components remains unclear, particularly in conflict-affected areas of the Middle East and North Africa.

OBJECTIVE

This study aims to evaluate 2 brief internet-based treatments in terms of efficacy, including change in PTSD symptom severity during treatment. Both treatments were developed in line with Interapy, an internet-based, therapist-assisted cognitive behavioral therapy protocol for PTSD and adapted to the specific research question. The first treatment comprised self-confrontation and social sharing (exposure treatment; 6 sessions); the second comprised cognitive restructuring and social sharing (cognitive restructuring treatment; 6 sessions). The 2 treatments were compared with each other and with a waitlist control group.

METHODS

In total, 365 Arabic-speaking participants from the Middle East and North Africa (mean age 25.49, SD 6.68 y) with PTSD were allocated to cognitive restructuring treatment (n=118, 32.3%), exposure treatment (n=122, 33.4%), or a waitlist control group (n=125, 34.2%) between February 2021 and December 2022. PTSD symptom severity, posttraumatic maladaptive cognitions, anxiety, depressive and somatoform symptom severity, and quality of life were assessed via self-report at baseline and after treatment or waiting time. PTSD symptom severity was also measured throughout treatment or waiting time. Treatment satisfaction was assessed after treatment completion. Treatment use and satisfaction were compared between the 2 treatment conditions using appropriate statistical tests (eg, chi-square and Welch tests). Multiple imputation was performed to address missing data and evaluate treatment-associated changes. These changes were analyzed using multigroup change modeling in the completer and intention-to-treat samples.

RESULTS

Overall, 200 (N=240, 83.3%) participants started any of the treatments, of whom 123 (61.5%) completed the treatment. Treatment condition was not significantly associated with the proportion of participants who started versus did not start treatment (P=.20) or with treatment completion versus treatment dropout (P=.71). High treatment satisfaction was reported, with no significant differences between the treatment conditions (P=.48). In both treatment conditions, PTSD, anxiety, depressive and somatoform symptom severity, and posttraumatic maladaptive cognitions decreased, and quality of life improved significantly from baseline to the posttreatment time point (P≤.001 in all cases). Compared with the baseline assessment, overall PTSD symptom severity decreased significantly after 4 sessions in both treatment conditions (P<.001). Moreover, both treatment conditions were significantly superior to the waitlist control group regarding overall PTSD symptom severity (P<.001) and most other comorbid mental health symptoms (P<.001 to P=.03). Differences between the 2 conditions in the magnitude of change for all outcome measures were nonsignificant.

CONCLUSIONS

Internet-based cognitive behavioral treatments for PTSD focusing primarily on either self-confrontation or cognitive restructuring are applicable and efficacious for Arabic-speaking participants.

TRIAL REGISTRATION

German Clinical Trials Register DRKS00010245; https://drks.de/search/de/trial/DRKS00010245.

Internalized Weight Stigma and Weight Discrimination: Associations with Quality of Life and Psychosocial Impairment in a Sample Living with Food Insecurity

Research suggests that experiencing weight discrimination is associated with a lower quality of life and poor psychological and physical health. However, much of the existing weight discrimination literature has neglected under-represented groups. Little is known about how the experience of weight discrimination affects quality of life and eating/weight-related psychosocial impairment in those living with food insecurity. The present study investigated the associations of weight discrimination and eating/weight-related psychosocial impairment and quality of life. We examined internalized weight stigma and several psychological indicators as potential mediators. Participants (N = 1085) who were recruited from a local food bank completed a questionnaire assessing food insecurity, weight discrimination, internalized weight stigma, eating disorder pathology, anxiety, depression, eating/weight-related psychosocial impairment, and quality of life. Overall, almost one in four participants reported experiencing weight discrimination. Our serial mediation models indicated that increased experiences of weight discrimination were associated with greater internalized weight stigma and psychopathology, which were in turn associated with lower quality of life and greater eating/weight-related psychosocial impairment. Thus, experiencing weight discrimination may negatively impact quality of life and eating/weight-related psychosocial impairment through its effect on mental health. It is imperative to address the negative effects of the widespread discrimination of people based on their weight.

Exploring the Impact of Covid-19-Related Perceptions on Psychological Distress and Quality of Life in an International Gastrointestinal Cohort Over Time Guided by the Common Sense Model

The aim of this longitudinal study was to examine changes in COVID-19 and illness-related perceptions, gastrointestinal symptoms, coping, catastrophising, psychological distress, and QoL during the COVID-19 pandemic. A total of 831 adults with a gastrointestinal condition completed an online questionnaire at baseline (May-October 2020). Of those, 270 (32.5%) participants (85.2% female, mean age = 47.3 years) provided follow-up data (March-May 2021). Repeated-measures multiple analysis of variance and a cross-lagged panel model were used to test the study hypotheses. Gastrointestinal symptoms and COVID-19 perceptions at follow-up were strongly predicted by their baseline values, while illness perceptions were predicted by baseline gastrointestinal symptoms. Cross-lagged relationships indicated a reciprocal relationship between gastrointestinal symptoms and psychological distress. Moreover, gastrointestinal symptoms had substantial predictive utility, strongly predicting future gastrointestinal symptoms, and to a lesser extent, more negative illness perceptions, greater psychological distress, and greater use of adaptive coping strategies across time.

A UK national study of prevalence and correlates of adopting or not adopting a recovery identity among individuals who have overcome a drug or alcohol problem

BACKGROUND

The concept of recovery has increasingly become an organizing paradigm in the addiction field in the past 20 years, but definitions of the term vary amongst interested groups (e.g. researchers, clinicians, policy makers or people with lived experience). Although professional groups have started to form a consensus, people with lived experience of alcohol or drug (AOD) problems use the term in a different way, leading to confusion in policy making in the UK. Greater knowledge about the prevalence and correlates of adopting a recovery identity amongst those who have overcome an AOD problem would inform clinical, public health, and policy communication efforts.

METHODS

We conducted a cross-sectional nationally representative survey of individuals resolving a significant AOD problem (n = 1,373). Weighted analyses estimated prevalence and tested correlates of label adoption. Qualitative analyses summarized reasons for adopting or not adopting a recovery identity.

RESULTS

The proportion of individuals currently identifying as being in recovery was 52.4%, never in recovery 28.6%, and no longer in recovery 19.0%. Predictors of identifying as being in recovery included current abstinence from AOD, formal treatment, recovery support service or mutual-help participation, and history of being diagnosed with AOD or other psychiatric disorders. Qualitative analyses found themes around not adopting a recovery identity related to low AOD problem severity, viewing the problem as resolved, or having little difficulty in stopping.

CONCLUSIONS

Despite increasing use of the recovery label and concept in clinical and policy contexts, many resolving AOD problems do not identify in this manner. These are most likely to be individuals with less significant histories of impairment secondary to AOD and who have not engaged with formal or informal treatment systems. The understanding of the term recovery in this UK population did not completely align with abstinence from alcohol or drugs.

Association between food insecurity and quality of life among older adults (60+) in six low and middle-income countries

Food insecurity is a key social determinant of health and nutrition. However, very few studies have examined the association of food insecurity and quality of life outcomes among older adults in low and middle-income settings. In this study, we examine the association of food insecurity with self-rated poor quality of life, low life satisfaction, and WHO quality of life (WHOQol). Nationally representative data from WHO's Study on global AGEing and adult health (SAGE) consisting of 20,026 older adults were analyzed. The association of food insecurity with self-rated poor quality of life and low life satisfaction was assessed using bivariate and multivariate logistic regression analysis. Multivariate linear regression models examine the association between food insecurity and WHOQol score. Pooled data analysis of six countries showed older adults with severe food insecurity were two times more likely to report poor quality of life (OR = 2.49, CI 2.10, 2.96; p < 0.001) and low life satisfaction (OR = 2.36, CI 1.94, 2.87; p < 0.001), respectively. Similarly, older adults with severe food insecurity had 3.60 (CI-4.25, -2.95; p < 0.001) points lower WHO-QoL score than those who are food secure. These results show that the association of food insecurity is statistically significant with all three outcomes of quality of life in all six countries adjusting for sociodemographic and health measures. Public health and social security interventions are important to prevent food insecurity to promote overall wellbeing of the growing older population in low and middle-income countries.

The multicultural conceptualisation of well-being : The role of culture and circumstance in operationalising well-being in South Africa: A mixed-methods approach

BACKGROUND

Exploring and understanding indicators of better life outcomes have remained popular among social and health researchers. However, the subjective approach to measuring well-being has raised questions on the appropriateness of standard measures of well-being in multicultural settings. The current study examines generalised well-being and its dependence on the implicit understanding of individual culture and circumstances.

METHODS

A mixed-method approach with a cross-sectional design and focus group discussions was adopted. Fifteen focus group discussions with 66 participants were conducted in four provinces of South Africa. Descriptive statistics, correlations, regression analysis and analysis of variance were computed for quantitative data. The focus group discussions were analysed using a content analysis approach. The recorded focus group discussions were transcribed using the intelligent verbatim technique. Data analysis was done stepwise using open, axial, and selective coding techniques.

RESULTS

Quantitative analysis showed a strong and significant association between quality of life and income and a moderate association with educational attainment. The open coding technique for qualitative data confirmed 11 different subconstructs of well-being, mentioned 403 times during the 15 focus group discussions. Furthermore, well-being indicators varied based on participants' racial identity.

CONCLUSIONS

The findings confirm personal circumstance and culture as significant for interpreting results from well-being research. Furthermore, it supports Maslow's Hierarchy of Needs, highlighting the movement from deficiency needs to growth needs after deficiency needs are met. Research must adopt a more sociological approach to improve the accuracy and implementibility of findings when using standardised measures of well-being.

Examining the factor structure and validity of the WHOQOL-AGE among the oldest-old Chinese in Singapore

Objectives

A short measure of quality of life in old age is essential. The present study examined the factor structure and validity of the 13-item WHOQOL-AGE among the oldest-old.

Methods

Data came from 1,000 Chinese aged ≥85 years in Singapore. Exploratory and confirmatory factor analyzes were conducted on the WHOQOL-AGE. Regression examined the demographic, social and health correlates of the identified factors.

Results

Factor analyzes suggested a bifactor model of the WHOQOL-AGE, which comprised three specific factors, namely "health," "environment" and "mastery," in addition to the general factor ("overall"). Partial scalar invariance (concerning only one item) and scalar invariance were established across gender and education level respectively, generally supporting the measurement invariance of this model. Regression results demonstrated known-groups validity. Health correlates were more predictive of "health" than "environment" and "mastery," with more basic and instrumental activities of daily living, lower depressive symptomatology and fewer falls positively relating to "health." Strength of social network and social engagement (social correlates) positively related to "environment" and "mastery" but not "health."

Conclusion

The WHOQOL-AGE exhibits a bifactor structure and known-groups validity among the oldest-old Chinese in Singapore. It seems useful to capture different facets of quality of life in the concerned population.

Exploring the structure and psychometric properties of the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) in a representative adult population sample

This article reports the psychometric properties of both full and the abbreviated (Short) Warwick-Edinburgh Mental Well-being Scales (WEMWBS; SWEMWBS) in the Finnish general population. A large cross-sectional dataset (N = 5,335) was collected as part of the nationally representative FinHealth Study in 2017. Exploratory and confirmatory factor analyses of the data evaluated one-, two-, three-, and bi-factorial solutions with a split-half approach. McDonald's omega was used to assess internal consistency and convergent validity was evaluated using four established mental health and well-being scales (BDI-6, GHQ-12, MHI-5, EUROHIS-QOL8). Contrary to previous findings, our results supported a three-factor model of the full scale with separate, yet highly correlated, mental, social, and eudemonic well-being factors. For the SWEMWBS, the bi-factor model showed the best fit, with a strong general mental well-being factor and a weaker specific eudemonic well-being factor. In this sampling context, the social aspect of mental well-being may be considered a separable construct from other mental well-being dimensions and the shorter 7-item version might thus be a preferable option when assessing overall mental well-being.

Who affiliates with SMART recovery? A comparison of individuals attending SMART recovery, alcoholics anonymous, both, or neither

BACKGROUND

Mutual-help organizations (MHOs) play a crucial role for many individuals with alcohol use disorder (AUD) or other substance use disorders in achieving stable remission. While there is now substantial research characterizing who uses 12-step MHOs, very little is known about who becomes affiliated with newer and rapidly growing MHOs, such as Self-Management and Recovery Training ("SMART" Recovery). More research could inform knowledge regarding who may be best engaged by these differing pathways.

METHODS

We conducted a cross-sectional analysis of participants (N = 361) with AUD recruited mostly from the community who were starting a new recovery attempt and self-selected into one of four different recovery paths: (1) SMART Recovery ("SMART-only"; n = 75); (2) Alcoholics Anonymous ("AA-only"; n = 73); (3) Both SMART and AA ("Both"; n = 53); and (4) Neither SMART nor AA ("Neither"; n = 160). We compared the groups on demographics, clinical history, treatment and recovery support service use, and indices of functioning and well-being. We computed descriptives and conducted inferential analyses according to the data structure.

RESULTS

Compared to study participants choosing AA-only or Both, SMART-only participants were more likely to be White, married, have higher income and more education, be full-time employed, and evince a pattern of lower clinical severity characterized by less lifetime and recent treatment and recovery support services usage, lower alcohol use intensity and fewer consequences, and less legal involvement. AUD symptom levels, lifetime psychiatric diagnoses, psychiatric distress, and functioning were similar across MHO-engaged groups.

CONCLUSION

SMART Recovery appears to attract individuals with greater psychosocial stability and economic advantage and less severe histories of alcohol-related impairment and legal involvement. Findings suggest that certain aspects specific to the SMART Recovery group approach, format, and/or contents may appeal to individuals exhibiting this type of profile. As such, SMART appears to provide an additional resource that expands the repertoire of options for individuals with AUD who seek recovery.

Benefits of Fiber-Enriched Foods on Satiety and Parameters of Human Well-Being in Adults with and without Cardiometabolic Risk

Consumption of fiber-rich foods is linked to beneficial effects on chronic diseases and gut health, while implications towards improving satiety and parameters of well-being remain unclear. A randomized placebo-controlled intervention study was conducted to compare the effects of fiber-enriched foods to their non-enriched counterparts in adults over a 12-week period on selected clinical parameters-satiety, quality of life, body sensation, and life satisfaction-subjective health status, and importance of diet for well-being. Quality of life (QOL) differed significantly between intervention and control groups at baseline, throughout, and at the end of the study. No effects on satiety, satisfaction with life, or the importance of diet for well-being could be shown between groups. With higher fiber intake, body sensation ratings increased. A higher BMI was significantly associated with lower-body sensation, subjective health status and quality of life. Fiber-enriched foods do not seem to affect feeling of satiety or parameters of well-being. Larger samples and additional methods are necessary to fully explore the effect of increased fiber intake on patient-related outcomes in more detail.

Feasibility and preliminary results of a call centre delivered continuing care intervention following residential alcohol and other drug treatment

INTRODUCTION

To help reduce relapse rates following alcohol and other drug (AOD) treatment, continuing care interventions have been recommended. Previous continuing care interventions have incorporated telephone and face-to-face sessions to help promote participant engagement. The study was conducted as a randomised controlled feasibility study and examined a call centre delivered continuing care intervention for people leaving residential rehabilitation services.

METHODS

Participants were attending AOD residential treatment services in NSW, Australia (N = 154). Participants were randomised to either 12- or 4-sessions of continuing care. Follow up assessments were completed at 6-months. The primary outcomes were demand and implementation. Secondary outcomes were AOD use, mental health and physical health at 6-months.

RESULTS

Interest in continuing care was high, with 93% of participants approached reporting an interest in being involved. Of the participants who completed the consent and baseline procedures, 29% of people were contacted post residential treatment and randomised. For those people randomised, the average number of sessions completed was 2.78 (SD = 1.65) for the 4-session arm and 4.81 (SD = 4.46) for the 12-session arm. Fidelity to the treatment manual was high. Both treatment arms showed higher complete abstinence at 6-months compared to baseline (12-session OR 28.57 [2.3, 353.8]; 4-session OR 28.11 [3.6, 221.2]).

DISCUSSION AND CONCLUSIONS

A major challenge associated with the call centre approach was re-engaging participants once they left the residential facility and delivering the planned dose of treatment. Further work is required to promote greater uptake of these protocols once people leave residential treatment.

The effect of internet-delivered cognitive behavioral therapy for depression and anxiety on quality of life: A meta-analysis of randomized controlled trials

Although numerous studies have examined the effects of internet-delivered cognitive behavioral therapy (iCBT) for depression and anxiety on quality of life, no meta-analysis has yet been conducted to integrate the results of these studies. We conducted systematic searches in PubMed, Cochrane, and PsycInfo, which included terms for treatment type, modality of delivery, condition, and main outcome. We included studies that met the following inclusion criteria: (a) randomized controlled trials, (b) patients allocated to some form of the control condition, (c) patients receiving some type of treatment of anxiety and/or depression involving Internet-delivered Cognitive Behavioral Therapy, (d) use of a validated outcome measure assessing the level of quality of life, (e) conducted with adult participants diagnosed with anxiety disorder and/or unipolar depression, (f) papers written in English. We analyzed 40 randomized controlled trials with a total of 4289 participants that met inclusion criteria. The pooled between-group effect size for the quality of life overall score was small (g = 0.35, 95 % CI: 0.26-0.44, p = .0001), favoring iCBT over the control conditions. Regarding the distinct quality of life domains measured by the World Health Organization Quality of Life Assessment, a statistically significant difference between iCBT and control conditions was found only for the physical health domain (g = 0.56, 95 % CI: 0.06-1.07, p = .029), in favor of iCBT. In both cases, heterogeneity was moderate. While the effect on the quality of life is small (the overall quality of life score) to moderate (the physical health domain score), we conclude that iCBT for depression and anxiety may be a promising approach for improving the quality of life of patients.

Health-Related Quality of Life, Stress, Caregiving Burden and Special Needs of Parents Caring for a Short-Statured Child-Review and Recommendations for Future Research

Children with short stature can experience a range of burdens due to their chronic condition. However, little is known about parents' experiences dealing with their child's short stature and the potential caregiving burdens and concerns they may face. We aim to review the literature on health-related quality of life (HRQOL), caregiving burden, and special needs among parents caring for a child with isolated growth hormone deficiency (IGHD) or idiopathic short stature (ISS). Using pre-defined inclusion and exclusion criteria, we systematically searched for literature using PubMed and Web of Science from its inception to December 2022. We identified 15 articles assessing HRQOL, special needs, or caregiving burdens in parents of IGHD/ISS children. The main problems included concerns about the future, organizational issues, side effects from growth hormone treatment, and social stigmatization. Furthermore, two studies assessed parents' special needs to cope with caregiving stress, mainly the dialogue between them and their families or parent support groups. This review outlines parental burdens, needs, and resources when caring for an IGHD/ISS child. Furthermore, it provides information about previously used measures appraising parents' special needs and underlines the need for disease-specific measurements.

Fear of childbirth and its determinants in pregnant women in the third trimester: a cross-sectional study

BACKGROUND

Fear of childbirth (FOC) is a prevalent issue among pregnant women and significantly relates to adverse outcomes for the mother and child. However, it is not clear the prevalence and risk factors of FOC among pregnant women in a region with a moderate level of economic development in China. The aim of this study was to investigate the prevalence and risk factors of FOC among pregnant women in the third trimester of pregnancy in Lianyungang city, Eastern China.

METHODS

A cross-sectional survey was conducted from December 2022 to February 2023 among pregnant women in the third trimester who met the inclusion criteria and visited Lianyungang Maternal and Child Health Hospital in Jiangsu Province, Eastern China. A structured questionnaire including sociodemographic characteristics, clinical characteristics, FOC, family function, doctor-patient communication, social support, general self-efficacy, anxiety, depression, insomnia symptoms, and quality of life was used to collect data. A multiple linear regression model was used to identify predictors of FOC.

RESULTS

This study included 535 pregnant women in the third trimester. The mean score of FOC was 30.67 ± 10.18, and the median score was 29.00. The prevalence of FOC was 56.64%. Multiple linear regression analysis revealed that pregnant women with electronic screen exposure time more than 5 h per day (β = 2.02, 95%CI: 0.50-3.53, P < 0.05), no history of cesarean section (β = 2.66, 95%CI: 0.61-4.71, P < 0.05), likes sour food or hates greasy food (β = 1.75, 95%CI: 0.00-3.50, P < 0.05), anxiety (β = 0.50, 95%CI: 0.21-0.80, P < 0.05) and depression (β = 0.30, 95%CI: 0.04-0.57, P < 0.05) were more likely to have a greater level of FOC than their counterparts. However, a significantly lower level of FOC was observed in pregnant women who were multipara (β=-1.64, 95%CI: -3.27-0.01, P < 0.05), not worrying about delivery without family members (β=-3.75, 95%CI: -5.26-2.25, P < 0.001), had good family function (β=-0.32, 95%CI: -0.64-0.00, P < 0.05) and doctor-patient communication (β=-0.33, 95%CI: -0.64-0.02, P < 0.05).

CONCLUSIONS

The prevalence of FOC was high in Lianyungang city, Eastern China. FOC is influenced by multiple factors. There is an urgent need to develop interventions to reduce the prevalence of FOC in the third trimester of pregnancy, and to pay attention to pregnant women with risk factors for FOC.

Health status and quality of life in comorbid physical multimorbidity and depression among adults aged ⩾50 years from low- and middle-income countries

BACKGROUND

Data on the clinical and functional significance of comorbid depression in physical multimorbidity in middle-aged and older adults and from low- and middle-income countries (LMICs) are lacking.

AIMS

This study aims to determine the association of comorbid depression in physical multimorbidity with health outcomes and quality of life among adults aged ⩾50 years from six LMICs.

METHODS

Cross-sectional, nationally representative data from the Study on Global Ageing and Adult Health were analyzed. DSM-IV Depression was based on past 12-month symptoms. Eleven chronic physical conditions were assessed. Health status was based on scales ranging from 0 (best) to 100 (worse). The quality of life (8-item WHO Quality of Life) scale ranged from 0 (worse) to 100 (best). Multivariable linear regression analyses were conducted.

RESULTS

Data on 34,129 individuals aged ⩾50 years [mean (SD) age 62.4 (16.0) years; 52.1% females] were analyzed. Among people with physical multimorbidity, having comorbid depression was associated with significantly worse health status in terms of sleep/energy (β = 14.71: 95% CI [12.23, 17.20]), self-care (13.23: [8.66, 17.82]), pain/discomfort (13.03: [9.59, 16.47]), mobility (11.06: [6.91, 15.21]), cognition (10.41: [7.31, 13.50]), perceived stress (8.35: [4.71, 11.99]), interpersonal activities (7.81: [3.71, 11.91]), and lower quality of life (-8.81: [-10.74, -6.88]).

CONCLUSIONS

Comorbid depression in physical multimorbidity was associated with lower quality of life and poorer scores in multiple domains of health status. Treatment of depression in people with physical multimorbidity may potentially lead to better clinical outcomes, but future studies are needed to determine the most effective intervention to address this comorbidity in LMICs.

Introduction and behavioral validation of the climate change distress and impairment scale

Governmental agencies and the medical and psychological professions are calling for a greater focus on the negative mental health effects of climate change (CC). As a first step, the field needs measures to distinguish affective/emotional distress due to CC from impairment that requires further scientific and diagnostic attention and that may require treatment in the future. To this end, we constructed the climate change distress and impairment scale, which distinguishes CC distress (spanning anger, anxiety, and sadness) from impairment. In four studies (N = 1699), we developed and validated English and German versions of the scale. Across samples, spanning 2021-2022, CC distress was at least moderate, while we observed general moderate to high levels of distress and low to moderate levels of impairment. In three English-speaking samples, younger individuals and women were most affected by CC distress, whereas this was not the case in a German-speaking sample, suggesting sociopolitical influencing factors. We demonstrate convergent validity with previous measures and discriminant validity for general negative affectivity and depressive and generalized anxiety disorder symptoms, which underlines that CC distress is not in itself pathological. Employing a fully incentivized social dilemma paradigm, we demonstrate that CC distress and (to a lesser degree) CC impairment predict pro-environmental behavior, underscoring them as possible drivers, and targets, of climate-change mitigation efforts.

Depressive Symptoms and Their Impact on Quality of Life in Parkinson's Disease: An Exploratory Network Analysis Approach

The clinical presentation of Parkinson's disease (PD) is often dominated by depressive symptoms, which can significantly impact the patients' quality of life (QoL). However, it is not clear how these depressive symptoms are interconnected, or if some symptoms are more influential in affecting QoL. In the Cohort of Patients with Parkinson's Disease in Spain (COPPADIS) study, 686 patients with PD were analyzed using network analyses. The patients completed the Beck Depression Inventory II (BDI-II) and provided their overall QoL (EUROHIS-QOL) at the beginning of the study. The study used centrality measures such as Expected Influence and Bridge Expected Influence to identify depressive symptoms that had the greatest impact on overall QoL. The results of exploratory network analyses indicate that the BDI-II items related to loss of energy, past failure, and tiredness or fatigue have the greatest impact on overall QoL as measured by the EUROHIS-QOL 8-item index. The loss of energy and tiredness or fatigue BDI-II items are also strongly associated with a number of different EUROHIS-QOL items, according to Bridge Expected Influences. For individuals suffering from PD, network analysis can aid in identifying significant non-motor symptoms that impact their QoL, thus paving the way for potential improvements.

Menopausal symptoms by HIV status and association with health-related quality of life among women in Zimbabwe: a cross-sectional study

BACKGROUND

The scale-up of antiretroviral therapy programmes has resulted in increased life expectancy of people with HIV in Africa. Little is known of the menopausal experiences of African women, including those living with HIV. We aimed to determine the prevalence and severity of self-reported menopause symptoms in women at different stages of menopause transition, by HIV status, and evaluate how symptoms are related to health-related quality of life (HRQoL). We further sought to understand factors associated with menopause symptoms.

METHODS

A cross-sectional study recruited women resident in Harare, Zimbabwe, sampled by age group (40-44/45-49/50-54/55-60 years) and HIV status. Women recruited from public-sector HIV clinics identified two similarly aged female friends (irrespective of HIV status) with phone access. Socio-demographic and medical details were recorded and women staged as pre-, peri- or post-menopause. The Menopausal Rating Scale II (MRS), which classified symptom severity, was compared between those with and without HIV. Linear and logistic regression determined factors associated with menopause symptoms, and associations between symptoms and HRQoL.

RESULTS

The 378 women recruited (193[51.1%] with HIV), had a mean (SD) age of 49.3 (5.7) years; 173 (45.8%), 51 (13.5%) and 154 (40.7%) were pre-, peri and post-menopausal respectively. Women with HIV reported more moderate (24.9% vs. 18.1%) and severe (9.7% vs. 2.6%) menopause symptoms than women without HIV. Peri-menopausal women with HIV reported higher MRS scores than those pre- and post-menopausal, whereas in HIV negative women menopausal stage was not associated with MRS score (interaction p-value = 0.014). With increasing severity of menopause symptoms, lower mean HRQoL scores were observed. HIV (OR 2.02[95% CI 1.28, 3.21]), mood disorders (8.80[2.77, 28.0]), ≥ 2 falls/year (4.29[1.18, 15.6]), early menarche (2.33[1.22, 4.48]), alcohol consumption (2.16[1.01, 4.62]), food insecurity (1.93[1.14, 3.26]) and unemployment (1.56[0.99, 2.46]), were all associated with moderate/severe menopause symptoms. No woman reported use of menopausal hormone therapy.

CONCLUSIONS

Menopausal symptoms are common and negatively impact HRQoL. HIV infection is associated with more severe menopause symptoms, as are several modifiable factors, including unemployment, alcohol consumption, and food insecurity. Findings highlight an unmet health need in ageing women in Zimbabwean, especially among those living with HIV.

Characteristics of Students Participating in Collegiate Recovery Programs and the Impact of COVID-19: An Updated National Longitudinal Study

The goals of the present study were to describe the development of the first national longitudinal study of collegiate recovery programs (CRP) students; provide an updated characterization of CRP students' demographics, past problem severity, and current recovery-related functioning; and examine the perceived impact of COVID-19 on CRP students' recovery. Universities and community colleges with CRPs across the United States and Ontario, Canada, were invited to partner on this project. Launched in fall 2020, three cohorts of participants were recruited. All participants who completed the baseline survey (N = 334 from 43 CRPs) were invited to complete follow-up surveys. The sample was composed of mostly undergraduate, White, cisgender women averaging 29 years old at baseline. They reported challenging backgrounds, including high levels of polysubstance use, alcohol/substance problem severity, mental health challenges, and involvement with the criminal legal system. Despite such adversity, they evidenced high levels of recovery-related functioning. Recovery capital and quality of life were high. Students reported an average of nearly four years in recovery, with most having between two and four years of abstinence from their primary substance of choice. COVID-19 represented a substantial source of stress for many, impacting some students' abstinence and recovery-related functioning. Results generally parallel findings from the only other national study of CRP students conducted a decade ago, providing a much-needed update and novel insights into CRP students. Findings can inform our understanding of the CRP student population and can be used to tailor CRP design and service offerings to students' backgrounds and needs.

Patient-Related Predictors for Seeking and Receiving Obesity Surgery

INTRODUCTION

The decision for obesity surgery (OS) is complex and strongly driven by patients' preference. This study aimed to examine patients' preference for OS before and after behavioral weight loss treatment (BWLT), associated patient characteristics, its role in predicting the receipt of OS after BWLT, and potential mediators.

METHODS

Data of N = 431 adults with obesity starting a 1-year routine care obesity BWLT were analyzed. Patients were interviewed before (pre-BWLT) and after BWLT (post-BWLT) regarding their preference for OS, and anthropometric, medical, and psychological data were collected.

RESULTS

Only a minority of patients (11.6%) had an explicit preference for OS pre-BWLT. Post-BWLT, the number of patients preferring OS significantly increased (27.4%). Patients with a constant or emerging preference for OS showed less favorable anthropometric, psychological, and medical characteristics than patients without or with a vanishing preference for OS. Patients' pre-BWLT preference for OS significantly predicted receiving OS post-BWLT. This association was mediated by higher body mass index pre- and post-BWLT, but not by less percentage total body weight loss (%TBWL) through BWLT.

CONCLUSION

Although the preference for OS pre-BWLT predicted the receipt of OS post-BWLT, it was not associated with %TBWL during BWLT. Further prospective studies with multiple assessment time points during BWLT may help understand when and why patients' attitude toward OS changes, and identify possible mediators on the association between the preference and receipt of OS.

Fat talk, old talk, or both? Association of negative body talk with mental health, body dissatisfaction, and quality of life in men and women

BACKGROUND

Little research has investigated the harmful effects of old talk-negative age-related body talk-on mental health and quality of life despite substantial research examining fat talk. Old talk also has only been evaluated in women and in relation to few outcomes. Of note, old talk and fat talk are strongly correlated, suggesting possible overlap in elements that drive negative outcomes. Thus, the primary aim of this study was to investigate the extent that old talk and fat talk contribute to negative mental health and quality of life outcomes when examined in the same model and when interacting with age.

METHODS

Adults (N = 773) ages 18-91 completed an online survey assessing eating disorder pathology, body dissatisfaction, depression, aging anxiety, general anxiety, quality of life, and demographics.

RESULTS

While fat talk and old talk were correlated with almost all outcome variables, fat talk was more commonly significantly associated with poorer outcomes than old talk. Additionally, the relationship between fat talk and old talk with poorer mental health was affected by age in men, but not women.

CONCLUSIONS

Future research is warranted to decipher the individual effects of old talk and fat talk on mental health and quality of life across the adult lifespan.

Psychometric properties of measures designed to assess common mental health problems and wellbeing in adults with intellectual disabilities: a systematic review

BACKGROUND

Multiple measures of mental health problems and mental wellbeing for adults with intellectual disabilities are available, but investigations into their reliability and validity are still in the early stages. The aim of this systematic review was to provide an update to previous evaluations of measures of common mental health problems and wellbeing in adults with mild to moderate intellectual disabilities (ID).

METHODS

A systematic search was performed across three databases (MEDLINE, PsycINFO and SCOPUS). The literature search was limited to the years from 2009 to 2021 and to the original English versions. Ten papers evaluating nine measures were reviewed, and the psychometric properties of these measures were discussed using the Characteristics of Assessment Instructions for Psychiatric Disorders in Persons with Intellectual Developmental Disorders as a framework.

RESULTS

Four measures had at least one rating of 'good' across both dimensions of reliability and at least one dimension of validity and were deemed to have promising psychometric properties: the Clinical Outcomes in Routine Evaluation-Learning Disabilities, Impact of Events Scale-Intellectual Disabilities, Lancaster and Northgate Trauma Scales and Self-Assessment and Intervention (self-report section). Additionally, these measures were developed through consultations with mental health professionals and/or people with IDs and thus were deemed to have good content validity.

CONCLUSIONS

This review informs measurement choice for researchers and clinicians while highlighting a need for continued research efforts into the quality of measures available for people with IDs. The results were limited by incomplete psychometric evaluations of measures available. A paucity of psychometrically robust measures of mental wellbeing was observed.

Psychological sense of community, self-rated health and quality of life among older adults in Puerto Rico two years after Hurricane María

Older adults who experience natural disasters are at risk for immediate and longer-term negative health outcomes and diminished quality of life (QOL), in part due to disruptions to social relationships and protections. We use a risk and resilience framework to examine the protective effects of psychological sense of community (PSOC) on self-rated health (SRH) and QOL for older adults in Puerto Rico 2 years after the devastation of Hurricane María in 2017. Between September 2019 and January 2020, we conducted face-to-face interviews with a nonprobability sample of 154 community-dwelling adults aged 60+ in Puerto Rico. Controlling for covariates, we used multivariate regression to examine the association of PSOC and key social risk factors (mental health, social isolation, and loneliness) with SRH and QOL. Higher levels of PSOC were significantly associated with better SRH and QOL. Regarding risks, worse mental health was significantly associated with lower QOL and SRH, loneliness was significantly related to worse QOL, and social isolation was significantly associated with better SRH and better QOL. PSOC was a protective factor for older adults, suggesting that prevention and intervention efforts should focus on building and sustaining older adults' sense of community in the longer-term wake of natural disasters.

COVID-19 and Its Impact on Healthcare Workers: Understanding Stigma, Stress, and Quality of Life

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has negatively impacted public health systems worldwide and created anxiety and stress among communities, resulting in the stigmatization of patients infected with the virus. Stigmatization of individuals who are sick or thought to be infected has a long history and can lead to discrimination and prejudice. This study aims to evaluate the prevalence of COVID-19-related stigma in Jordan, assess the relationship between stigma and the quality of life (QoL) in healthcare workers, and identify possible measures to decrease stressful events. Understanding the psychological effects of healthcare workers' jobs and reducing their burden is essential to improving medical outcomes and the QoL of patients.

METHODOLOGY

This cross-sectional study was conducted in three primary hospitals in Amman, Jordan, from July to December 2021. Healthcare workers were recruited through convenience sampling and completed a self-administered questionnaire, which included demographic information, a validated COVID-19 stigma questionnaire, work conditions during the pandemic, the Depression, Anxiety and Stress Scale - 21 Items (DASS-21) questionnaire to measure depression, anxiety, and stress, and the EUROHIS-QOL questionnaire to assess the QoL. Data were analyzed using descriptive and inferential statistics, including chi-square tests and post hoc analysis. The study was approved by the institutional review board, and participation was voluntary and confidential.

RESULTS

The study was conducted among 683 healthcare workers in Jordan, with 77.7% based in the capital city, Amman. Most of the participants were between 18 and 30 years of age, and slightly more than half were female. The study found that 38.1% of healthcare workers would not take the COVID-19 vaccine once it became available. More than half (56%) reported experiencing stress, 61% reported anxiety, and 65% reported depression during the pandemic. Internal medicine specialties and frontline nurses reported the highest levels of stress, and healthcare workers with greater exposure to COVID-19 patients reported higher levels of anxiety and stress. Only 3% of participants reported experiencing stigmatization (p=0.043), with low-income participants reporting it more frequently. Stigmatization was significantly correlated with feelings of depression, anxiety, and stress (p<0.001).

CONCLUSION

Healthcare workers' mental well-being has been affected negatively by the COVID-19 pandemic, resulting in depression, anxiety, and stress. Widespread mental surveillance for healthcare workers is crucial to protect healthcare workers from psychological issues and to improve the healthcare service provided to patients. Stigma among healthcare workers can be a major factor that may increase depression, anxiety, and stress.

Chronic physical conditions, physical multimorbidity, and quality of life among adults aged ≥ 50 years from six low- and middle-income countries

PURPOSE

Multimorbidity (i.e., ≥ 2 chronic conditions) poses a challenge for health systems and governments, globally. Several studies have found inverse associations between multimorbidity and quality of life (QoL). However, there is a paucity of studies from low- and middle-income countries (LMICs), especially among the older population, as well as studies examining mediating factors in this association. Thus, the present study aimed to explore the associations, and mediating factors, between multimorbidity and QoL among older adults in LMICs.

METHODS

Cross-sectional nationally representative data from the Study on Global Ageing and Adult Health were analyzed. A total of 11 chronic conditions were assessed. QoL was assessed with the 8-item WHO QoL instrument (range 0-100) with higher scores representing better QoL. Multivariable linear regression and mediation analyses were conducted to assess associations.

RESULTS

The final sample consisted of 34,129 adults aged ≥ 50 years [mean (SD) age 62.4 (16.0) years; age range 50-114 years; 52.0% females]. Compared to no chronic conditions, 2 (b-coefficient - 5.89; 95% CI - 6.83, - 4.95), 3 (- 8.35; - 9.63, - 7.06), 4 (- 10.87; - 12.37, - 9.36), and ≥ 5 (- 13.48; - 15.91, - 11.06) chronic conditions were significantly associated with lower QoL, dose-dependently. The mediation analysis showed that mobility (47.9%) explained the largest proportion of the association between multimorbidity and QoL, followed by pain/discomfort (43.5%), sleep/energy (35.0%), negative affect (31.9%), cognition (20.2%), self-care (17.0%), and interpersonal activities (12.0%).

CONCLUSION

A greater number of chronic conditions was associated with lower QoL dose-dependently among older adults in LMICs. Public health and medical practitioners should aim to address the identified mediators to improve QoL in patients with multimorbidity.

The effect of volunteer-led activities on the quality of life of volunteers, residents, and employees of a long-term care institution: a cohort study

BACKGROUND

The COVID-19 pandemic primarily impacted long-term care facilities by restricting visiting and circulation of visitors, affecting the quality of life (QoL) of older adults living in these institutions. Volunteer activities, essential for older adults' daily life, were also interrupted and potentially negatively impacted the QoL of older adults, volunteers themselves, and also employees in these institutions. In this context, this study aims to evaluate the impact of the return of volunteer-led activities in a long-term care institution on the QoL of older adult residents, employees, and volunteers.

METHODS

This study used a pre-test and post-test design within the same group. The first round of data collection was conducted before volunteer-led activities returned and the second round after 1 month of return. The instrument used to assess QoL was the EUROHIS-QoL-8 scale. This study was conducted within a nursing home in São Paulo, Brazil, created in 1937 by members of the Israeli community living in Brazil. Volunteer-led activities were part of residents' daily life before the COVID-19 pandemic, when these activities were interrupted for about 20 months. A total of 79 individuals participated in both rounds (pre and post), of which: 29 residents, 27 volunteers, and 23 employees of the long-term care institution.

RESULTS

Using a Wilcoxon signed-rank test, the analyses indicated improvements after the 1 month return in different QoL aspects for the three groups. Volunteers improved their personal relationships (Z - 2.332, p < .05), residents their overall health (Z - 2.409, p < .05) and employees in their overall QoL perception (Z - 2.714, p < .05). Influencing factors for residents were the number of activities (3 or more), gender (male), and education (undergraduate/graduate). For employees, those who assumed additional activities due to the volunteer-led activities interruption had a significant impact on their overall QoL.

CONCLUSIONS

Evidence from this study suggests that volunteers' return positively impacted different QoL aspects for volunteers, residents, and employees.

Long-term quality of life and work ability among severe COVID-19 survivors: A multicenter study

Background

Coronavirus disease 2019 (COVID-19), is known for its variable severity and high infectivity. Though fewer than 15% of infected cases develop severe disease, a major proportion had prolonged stay in the intensive care unit (ICU). Prolonged ICU stay is known to have a long-term impact on behavior and quality of life.⁸ Therefore, it is likely that patients discharged after severe COVID-19 have issues that persist for long term. The current study aimed to assess the long-term impact of severe COVID-19 on the Quality of life (QOL), sleep pattern, behavior, and workability.

Methods

The current multicenter study adopted a cross-sectional design to analyze data from two tertiary care COVID-19 dedicated hospitals. All experimental procedures were approved by the ethics committee of the M.L.B Medical College. Participants were 20–60 age group who had been admitted to the ICU because of severe COVID-19 and had elapsed at least one and a half year since their discharge. After informed written consent the participants were assessed for: EUROHIS-QOL 8-item index; Workability Score; Quality of sleep; The major depression inventory (MDI) questionnaire; Generalized anxiety disorder 7 item scale (GAD-7); Current global health status score: an innovative subjective scale (1−10) to determine the current global health status when 5 is the status before COVID-19.

Findings

491 participants were assessed, the median follow-up time after discharge from the hospital was 561·0 days (range, 548–580 days). The mean duration of ICU stay was 8·72 ± 2·85 days. There was significant reduction in the prevalence of obesity, diabetes, and hypertension as compared with discharge time. The mean of EUROHIS-QOL score, workability score, current global health status score was 3·28 ± 0·98, 6·87 ± 0·85, 4·53 ± 1·36 respectively. The mean MDI and anxiety scores were 4·12 ± 1·45 and 18·63 ± 3·28, respectively.

Interpretation

Severe COVID-19 survivors have new-onset psychological disorders and sleep disturbances. Long term quality of life and work ability remains poor after prolong ICU admission secondary to severe COVID-19.

Mental health outcomes and quality of life of Ukrainian refugees in Germany

The war in Ukraine has generated an increase in the number of refugees. As one of the top recipients of refugees, Germany has introduced policies to ease the integration of Ukrainians. The current study explores mental health outcomes and their association with quality of life among a sample of Ukrainian refugees in Germany. Cross-sectional data were collected from a sample of Ukrainian refugees in Germany (n = 304) using standardised instruments. A t-test was used to check for possible significant differences based on gender. Multiple regression analysis was used to analyse potential associations between general health (GHQ-12) and depressive symptoms and anxiety (PHQ-4), and quality of life (EUROHIS-QOL 8 item). Female participants reported significantly higher psychological distress, depressive symptoms and anxiety. The significant model (p < .001) for the males accounts for 33.6% of the variance in quality of life. General psychological distress (β = - .240) and depressive symptoms and anxiety (β = - .411) are associated with decreased quality of life. For the female sample (p < .001), the model explains 35.7% of the variance in quality of life. General psychological distress (β = - .402) and depressive symptoms and anxiety (β = - .261) are associated with decreased quality of life. The current study provides the first knowledge on the prevalence of mental health problems and their associations with quality of life among Ukrainian refugees. The findings further identify the vulnerability of women refugees to poorer mental health outcomes. The results also confirm that traumatic experiences in the context of war explain a considerable bulk of mental health problems.

Incidence and persistence of psychological distress during the COVID-19 pandemic among individuals with and without disability

OBJECTIVES

We investigated the incidence (becoming distressed at the follow-up) and persistence (distressed at the baseline and the follow-up) of psychological distress among individuals with and without disability in the period from early 2017 (before the COVID-19 pandemic) to late 2020 (the second wave of the pandemic).

METHODS

We analyzed the population-based FinHealth 2017 survey and its follow-up conducted in 2020 (number of individuals who participated in both surveys: n = 4881; age = 18+). Logistic regressions were applied to investigate differences in the incidence and persistence of psychological distress between people with and without disability. We also investigated whether age, quality of life at the baseline, and perceived increase in loneliness during the COVID-19 pandemic moderated the association between disability and the incidence of distress.

RESULTS

The incidence of psychological distress was higher (OR = 3.01, 95% CI:2.09-4.35) for people with disability (18.9%) than among those without (7.4%), being highest (31.5%) among the youngest participants with disability, aged 18 to 39. People with disability who had a poor quality of life at the baseline were particularly prone to become distressed during the follow-up. People who reported perceived increase in loneliness during the pandemic were prone to become distressed at the follow-up regardless of their disability status. The persistence of distress was more common (OR = 6.00, 95% CI:3.53-10.12) among people with disability (65.7%) than among those without (24.9%).

CONCLUSION

The COVID-19 pandemic had more negative mental health effects on people with disability, especially adults with disability who were young and had a low quality of life before the pandemic.

A three step protocol for the development of an innovative footwear (shoe and sensor based insole) to prevent diabetic foot ulceration

Background

The incidence of diabetic foot ulceration (DFU) is increasing worldwide. Therapeutic footwear is usually recommended in clinical practice for preventing foot ulcers in persons with diabetes. The project Science DiabetICC Footwear aims to develop innovative footwear to prevent DFU, specifically a shoe and sensor-based insole, which will allow for monitoring pressure, temperature, and humidity parameters.

Method

This study presents a three-step protocol for the development and evaluation of this therapeutic footwear, specifically: (i) a first observational study will specify the user requirements and contexts of use; (ii) after the design solutions were developed for shoe and insole, the semi-functional prototypes will be evaluated against the initial requirements; (iii) and a pre-clinical study protocol will enable the evaluation of the final functional prototype. The eligible diabetic participants will be involved in each stage of product development. The data will be collected using interviews, clinical evaluation of the foot, 3D foot parameters and plantar pressure evaluation. This three-step protocol was defined according to the national and international legal requirements, ISO norms for medical devices development, and was also reviewed and approved by the Ethics Committee of the Health Sciences Research Unit: Nursing (UICISA: E) of the Nursing School of Coimbra (ESEnfC).

Results

The involvement of end-users (diabetic patients) will enable the definition of user requirements and contexts of use to develop design solutions for the footwear. Those design solutions will be prototyped and evaluated by end-users to achieve the final design for therapeutic footwear. The final functional prototype will be evaluated in pre-clinical studies to ensure that the footwear meets all the requirements to move forward to clinical studies.

Discussion

The three-step study outlined in this protocol will provide the necessary insights during the product development, ensuring this new therapeutic footwear's main functional and ergonomic features for DFU prevention.