Psychiatric illness in general practice. A detailed study using a new method of case identification

Predictive Role of Perceived Social Support and Psychological Distress on Caregiver Burden in Parents of Children With Cancer

OBJECTIVES

This study aimed to explore the predictors of caregiver burden among parents of children with cancer.

METHODS

A descriptive correlational study was conducted on 254 parents of children with cancer in the oncology department of Baghaei 2 Hospital in Ahvaz, Iran from September 2022 to July 2023. The study's data was collected through the demographic information questionnaire, the caregiver burden scale (CBS), the perceived social support (PSS), and the General Health Questionnaire (GHQ). Data were analyzed using an independent t-test, 1-way ANOVA, Pearson's correlation coefficient, and multiple linear regression in SPSS-22.

RESULTS

Parents experienced a moderate level of CBS (54.74 ± 10.17), PSS (41.52 ± 12.94), and GHQ (18.95 ± 4.47). Regression models showed that PSS (β = -0.381, P < .001), GH (β = 0.199, P < .001), caregiving responsibilities for others (β = 0.195, P < .001), satisfaction with income (β = -0.151, P = .005), and hospitalization number (β = 0.142, P = .007) were significantly associated with the CB of parents of children with cancer. These variables accounted for 32% of the variance in CB.

CONCLUSION

This study demonstrated various degrees of CB among parents of children with cancer. A better understanding of the predictive factors of CB is needed to provide suitable interventions such as caregiving skills, and coping strategies to alleviate CB among parents and subsequently improve the quality of caregiving.

IMPLICATION FOR NURSING PRACTICE

Pediatric oncology nurses should adopt a holistic approach that addresses both the emotional and social needs of parents, in addition to the medical needs of the child. Developing support programs tailored to parents' experiences, educating them on managing caregiving challenges, and facilitating effective communication regarding treatment processes can help alleviate parental CB.

Effectiveness of a Food Education Program for healthcare workers: a pilot study in a Total Worker Health© approach

Introduction

Obesity has been identified as a crucial cause of non-communicable diseases, especially for healthcare workers who often take a brief lunch break with high energy and micro- and macronutrients deficient food.

Methods

Our study aims to investigate the clinical and economic effectiveness of the "Food Education Program" (FEP) among healthcare workers having weight problems. Four questionnaires were administered before and after FEP to explore the risk of psychological injury ("Psychological Injury Risk Indicator"), mental and general health status ("Goldberg's General Health Questionnaire-12" and "Short Form-36 health survey") and eating behavior ("Eating Attitudes Test"). The Return on Investment (ROI) was calculated on the base of absenteeism reduction in the 1-year period after FEP.

Results

Fifty-one participants (78.4% females, mean age: 52.04 ± 8.94) were included in the study. They were mainly nurses (56.9%). 54.9% were obese and 43.1% overweight. The success rate was 32.1%; the reduction in BMI was more evident in the overweight participants than the obese subjects. A significant reduction of waist-to-hip ratio, glycosylated hemoglobin, total and LDL cholesterol, and an increase in vitamin D was observed (p-value: 0.047, 0.002, <0.001, 0.001, and 0.03). Scores on general health significantly improved (p-value <0.001 and 0.011). A mean per capita reduction of 3.70 days was observed in 1-year period after the intervention, with a ROI of 6.97.

Conclusion

Food Education Program represents a successful program to improve psychophysical wellbeing of healthcare workers through healthy nutritional plans, also having a notable positive impact on the organization, including its financial accounts.

Do mental and physical health trajectories change around transitions into sandwich care? Results from the UK household longitudinal study

OBJECTIVES

Sandwich carers provide care to ageing parents or older relatives while simultaneously raising dependent children. There has been little focus on how mental and physical health trajectories change around becoming a sandwich carer - a gap this study aims to fill.

STUDY DESIGN

Prospective longitudinal study.

METHODS

We used 10 waves of data from the UK Household Longitudinal Study (2009-2020) - a high-quality longitudinal data. Sandwich carers were parents who lived with children under age 16 and took up unpaid care of a family member in the older generation. Sandwich carers were matched with parents who did not take up any adult care (i.e., non-sandwiched parents) with similar characteristics. We then employed piecewise growth curve modelling to model the trajectories in mental and physical health before, during and after becoming a sandwich carer and comparing these with non-sandwiched parents.

RESULTS

Among parents, the uptake of caring for a family member was associated with a deterioration in mental health, especially for those who spent more than 20 h per week caring for a family member. The deterioration persisted for several years. Those who cared intensively also experienced greater physical health declines during the transition. We did not see evidence of gender difference in the above associations.

CONCLUSIONS

It is essential for society to recognise the unique needs and challenges of sandwich carers and provide them with the necessary support systems, resources, and community networks to ensure their health is maintained. Targeted support is required for sandwich carers who care intensively.

Structural and functional social support in UK military veterans during the COVID-19 pandemic and associations with mental health and wellbeing: a cross-sectional study

BACKGROUND

The coronavirus disease (COVID-19) pandemic led to the implementation of social distancing laws in the UK. This had several negative consequences on health, wellbeing and social functioning within the general population. Military veterans may have had unique experiences of social isolation during this time. This study examined the level of, and relationship between, structural and functional social support, and its association with mental health and wellbeing in a sample of UK veterans during the COVID-19 pandemic.

METHODS

Throughout the first summer of the pandemic (June-September 2020), an additional wave of cross-sectional data was collected from UK Armed Forces personnel who had left regular military service and were participating in a longitudinal cohort study. In total, 1562 participants (44.04% response rate) completed a series of online questionnaires measuring sociodemographic characteristics, COVID-19 experiences and psychosocial health and wellbeing. Multivariable logistic and ordinal regression analyses were conducted.

RESULTS

For structural social support, 86.76% were in a relationship and 88.96% lived with others. For functional social support, one-quarter reported feelings of loneliness (27.42%) and low levels of perceived social support (28.14%). Structural support was associated with functional support. Being single, living alone and experiencing loneliness were associated with worse mental health and wellbeing, while living with other adults and reporting high levels of perceived social support were associated with better mental health and wellbeing.

CONCLUSIONS

This study has enhanced our understanding of social support among veterans and its implications for health and wellbeing. This knowledge is essential for advising the development of psychosocial interventions and policies to improve the psychological wellbeing of veterans in future pandemics and more broadly in their daily lives.

The Prevalence and Correlates of Internet Addiction in India as Assessed by Young's Internet Addiction Test: A Systematic Review and Meta-analysis

Background

Earlier research on internet addiction (IA) in the adult population in India has concentrated on isolated prevalence surveys conducted nationwide. A systematic grasp of pooled prevalence necessitates a meta-level evaluation of all prior literature. This study aims to investigate the prevalence of IA and its correlates among adults in India.

Methods

We searched EBSCOhost, PubMed, PsycInfo, PsycArticles, and ProQuest for the studies published from 1990 to 2022 and included studies using Young's Internet Addiction Test criteria (age range 18-40 years). The authors obtained a total of 358 non-duplicate records after a thorough search, and they found 10 pertinent epidemiological studies involving 12,286 adults.

Results

The pooled prevalence for mild, moderate, severe, and any level of IA was 36.33% (95% confidence interval [CI]: 30.72%-42.13%), 18.04% (95% CI: 13.49%-23.08%), 0.88% (95% CI:0.50%-1.36%), and 58.34% (95% CI:49.34%-67.07%), respectively. The review of correlates suggested psychosocial factors like male gender, single-parent families, co-morbidities like depression, stress, anxiety, interpersonal issues, andmediating factors like loneliness.

Conclusions

Based on the synthesis of findings, this review underlines the common factors of IA and emphasizes the significance of psycho-social factors in IA; thus, to promote healthy use of technology and to manage IA, a multi-modal psychotherapeutic intervention module for mental health practitioners needs to be developed in line with this review.

Attitudes, Knowledge and Clinical Practice of Health Professionals towards Psychological Disorders in Cancer Patients: An Observational Study

BACKGROUND

The suffering associated with a cancer diagnosis can find different channels to express itself: sleep disorders, psychiatric disorders, sexuality. These are not always analyzed by health professionals, but they have an impact on the patient's quality of life and on the outcome of the disease.

METHODS

An observational study was conducted in order to investigate attitudes, knowledge and clinical practice towards psychological symptoms in cancer patients.

RESULTS

A total of 132 clinicians from all Italian regions responded. In total, 99.2% (n = 131) considered the figure of the psychologist useful in the oncology field and recommended him/her in clinical practice (n = 115; 87.7%), especially in the terminal phase of the illness (58.6%; n = 99). Despite the importance given to the figure of the psychologist, psychiatric disorders are not diagnosed. Only 20.0% (n = 26) identified depressive disorder as accurate and only 33.9% (n = 43) identified demoralization syndrome as accurate.

CONCLUSIONS

Results prove the need for training on psychological disorders in oncology and the emotional repercussions of cancer illness.

Mode of birth and long-term maternal mental health: A follow-up study in the Danish National Birth Cohort

BACKGROUND

Cesarean birth has been associated with increased risks of short-term mental health problems. Little is known about whether these associations persist in the long term. This study aimed to estimate the associations between mode of birth and maternal mental health in midlife while considering mental health before and during pregnancy.

METHODS

Cohort study among mothers in the Danish National Birth Cohort. Birth mode for each woman's entire reproductive history was obtained from Danish national registries. Symptoms of depression and stress in midlife were self-reported using validated scales. Log binomial regression was used to calculate risk ratios (RR) with 95% confidence intervals (CI) for the association between birth mode and depressive symptoms. Linear regression was used to calculate mean difference in stress score by birth mode.

RESULTS

Among 42,872 women, 15.5% reported depressive symptoms at follow-up, where they were, on average, 43.9 years and 11.2 years after their last birth. Compared with women who only ever had spontaneous vaginal births, women who only had cesarean births, or had both cesarean and vaginal births with the last birth by cesarean, reported slightly more symptoms of depression (RR 1.10, 95% CI 1.01;1.20) and stress (mean difference 0.68 on a 100-point scale, 95% CI 0.10;1.26).

CONCLUSION

Whether due to the birth experience or underlying factors, depression and stress in midlife were more frequent in women with only cesarean births or whose last birth was by cesarean compared with women with vaginal births.

Potential suicide risk among the college student population: machine learning approaches for identifying predictors and different students' risk profiles

BACKGROUND

Suicide is one of the leading causes of death among young people and university students. Research has identified numerous socio-demographic, relational, and clinical factors as potential predictors of suicide risk, and machine learning techniques have emerged as promising ways to improve risk assessment.

OBJECTIVE

This cross-sectional observational study aimed at identifying predictors and college student profiles associated with suicide risk through a machine learning approach.

METHODS

A total of 3102 students were surveyed regarding potential suicide risk, socio-demographic characteristics, academic career, and physical/mental health and well-being. The classification tree technique and the multiple correspondence analysis were applied to define students' profiles in terms of suicide risk and to detect the main predictors of such a risk.

RESULTS

Among the participating students, 7% showed high potential suicide risk and 3.8% had a history of suicide attempts. Psychological distress and use of alcohol/substance were prominent predictors of suicide risk contributing to define the profile of high risk of suicide: students with significant psychological distress, and with medium/high-risk use of alcohol and psychoactive substances. Conversely, low psychological distress and low-risk use of alcohol and substances, together with religious practice, represented the profile of students with low risk of suicide.

CONCLUSIONS

Machine learning techniques could hold promise for assessing suicide risk in college students, potentially leading to the development of more effective prevention programs. These programs should address both risk and protective factors and be tailored to students' needs and to the different categories of risk.

The impact of psoriasis on wellbeing and clinical outcomes in juvenile psoriatic arthritis

OBJECTIVES

Juvenile PsA (JPsA) has varied clinical features that are distinctive from other JIA categories. This study investigates whether such features impact patient-reported and clinical outcomes.

METHODS

Children and young people (CYP) were selected if recruited to the Childhood Arthritis Prospective Study, a UK multicentre JIA inception cohort, between January 2001 and March 2018. At diagnosis, patient/parent-reported outcomes (as age-appropriate) included the parental global assessment (10 cm visual analogue scale), functional ability (Childhood Health Assessment Questionnaire (CHAQ)), pain (10 cm visual analogue scale), health-related quality of life (Child Health Questionnaire PF50 psychosocial score), mood/depressive symptoms (Moods and Feelings Questionnaire) and parent psychosocial health (General Health Questionnaire 30). Three-year outcome trajectories have previously been defined using active joint counts, physician and parent global assessments (PGA and PaGA, respectively). Patient-reported outcomes and outcome trajectories were compared in (i) CYP with JPsA vs other JIA categories and (ii) CYP within JPsA, with and without psoriasis via multivariable linear regression.

RESULTS

There were no significant differences in patient-reported outcomes at diagnosis between CYP with JPsA and non-JPsA. Within JPsA, those with psoriasis had more depressive symptoms (coefficient = 9.8; 95% CI: 0.5, 19.0) than those without psoriasis at diagnosis. CYP with JPsA had 2.3 times the odds of persistent high PaGA than other ILAR categories, despite improving joint counts and PGA (95% CI: 1.2, 4.6).

CONCLUSION

CYP with psoriasis at JPsA diagnosis report worse mood, supporting a greater disease impact in those with both skin and joint involvement. Multidisciplinary care with added focus to support wellbeing in children with JPsA plus psoriasis may help improve these outcomes.

Suicidal Behavior and Its Association With Psychological Distress, Coping Mechanisms, and Resilience: A Cross-Sectional Study

Introduction Recent literature reveals that psychological factors such as resilience and coping mechanisms can act as buffers against suicide risk. Indian literature on the interplay between psychological risk and protective factors of suicidal behavior is scarce. Methods A cross-sectional descriptive study was done among suicide attempters in a tertiary care hospital in Southern India. A semi-structured proforma was used to obtain sociodemographic data and suicide attempt characteristics. Suicide intent, lethality, stressful life events, perceived stress, subjective distress, coping strategies, and resilience were recorded using standard rating scales. Inferential analyses were carried out with p≤ 0.05 set as statistical significance. Results Pesticide poisoning (46.7%) was the most common mode of suicide attempt. Significant gender differences emerged in the mode of suicide attempt, coping strategies, and resilience. Depression (48.7%) was the most common psychiatric comorbidity. Increased perceived stress was associated with the presence of psychiatric comorbidity, past history of suicide attempts, and high-intent suicide attempts. Maladaptive coping strategies were associated with substance abuse and a history of past suicide attempts. Low resilience levels were associated with hanging attempts, psychiatric or substance use disorder comorbidity, past history of suicide attempts, high-intent suicide attempts, and less lethal suicide attempts. Conclusion Perceived stress levels, coping strategies, and resilience have significant relationships with suicidal behavior and act as avenues for suicide prevention efforts.

The Interplay of Sleep Quality, Mental Health, and Sociodemographic and Clinical Factors among Italian College Freshmen

Background/Objectives: Sleep and mental health are closely linked, with sleep deprivation increasing the risk of mental health problems in college students. This study aimed to analyze the role of sleep in the mental health status of a sample of Italian freshmen, considering various mental health outcomes and potential interactions between sleep and other relevant factors, such as sociodemographic characteristics, academic experiences, and mental health history. Methods: All freshmen from a medium-sized Italian university were invited to participate in a multidimensional online survey (n = 3756). Sleep quality was assessed through questions on average hours of sleep per night and on satisfaction of perceived sleep quality. Mental health outcomes included psychophysical well-being, psychological distress, substance use, and problematic internet use. Statistical analysis involved multivariate analysis of variance, followed by pairwise comparisons. Results: The sample (n = 721) exhibited low levels of well-being and a high prevalence of psychological distress (52.1%). Approximately one-third of students (n = 258) were dissatisfied with their sleep quality, and one-fourth (n = 186) reported inadequate sleep (less than 7 h per night). More specifically, 24.4% of students slept on average six hours per night, and 1.4% slept five hours or less. Satisfaction with perceived sleep quality significantly influenced well-being, psychological distress, and cannabis use (ηp2 = 0.02). Interaction effects were observed between satisfaction with sleep quality and drop-out intentions (ηp2 = 0.01), as well as between satisfaction with sleep quality and history of mental health diagnosis (ηp2 = 0.02), both of which were significant for psychological distress and cannabis use. Conclusions: This study highlights the influence of perceived sleep quality on academic distress among college freshmen, particularly those with higher intentions of leaving university and with a history of mental health diagnosis.

Health factors that influence sustainable behaviour in a single-player resource management game

Encouraging sustainable use of limited natural, social, and economic resources requires understanding the variety of ways in which people think about how resources work and how they adjust their behaviour (or not) as available resources fluctuate. Previous investigations which have focused on understanding how individuals navigate erodible resources, have tended to use group-based, common pool games. However, such social games make it difficult to disentangle whether resource erosion is linked to difficulty navigating the dynamics of the resource or caused by social factors. Here, in two experiments, we recruited 781 participants to play a single-player resource management game in which individuals were invited to harvest monetary rewards from a fully depletable but stochastically replenishing resource over time. We find that the ability to sustain a resource over successive harvesting opportunities (in order to maximize the total harvested rewards) is reliably worse in individuals reporting elevated psychological distress, the often cooccurring hazardous alcohol use, and elevated rates of delay discounting. The associations between resource outcomes, harmful alcohol use, and psychological distress remained substantial even once we had controlled for elevated discounting rates (as a form of impulsivity and a strong risk factor for these health challenges). By contrast, individuals who reported higher levels of financial literacy and general well-being achieved better resource outcomes. Our observations demonstrate that the capacity to respond effectively to the dynamics of a resource are compromised in individuals at risk of psychological and alcohol-related disorders.

Prevalence and sociodemographic determinants of common mental disorders (CMDs) symptoms in a rural adult population of Haryana, North India

Objectives

Common mental disorders (CMDs), including depression, anxiety, and somatoform disorders, affect all stages of life and impact individuals, families, and communities. This study aimed to determine the magnitude of CMDs and their sociodemographic determinants in the adult population of a rural block in North India.

Material and Methods

A cross-sectional, quantitative, community-based study was conducted among adult residents of a rural block in Haryana, North India, using a multistage random sampling technique. The Hindi version of the General Health Questionnaire (GHQ-12), a well-validated tool, was used to screen participants for CMDs. Scores of 4 or above denoted the presence of CMDs. Bivariate analyses were performed to determine the associations between CMDs and sociodemographic characteristics.

Results

Of the 180 residents selected for the study, most were women (60.0%) and aged between 31 and 50 years (52.3%). The prevalence of CMDs symptoms in the study population was 20.0%. The presence of CMDs symptoms was significantly higher among those who were aged 60 years or older [OR=12.33, 95% CI 3.21-47.38], widowed, divorced or separated [OR=7.50, 95% CI 1.09-51.52], illiterate [OR= 6.25, 95% CI 2.84-13.77], had monthly family income below 10,000 INR [OR=3.33, 95% CI 1.54-7.20], had any chronic physical illness [OR=8.28, 95% CI 3.70-18.56] and had a family history of any psychiatric illness [OR=5.56, 95% CI 1.52-19.42].

Conclusion

The burden of CMDs was quite high among adults in rural North India. The presence of CMDs was closely associated with sociodemographic characteristics. Primary care and community-based settings need to screen for, diagnose, and manage CMDs to address this growing problem.

Cohort profile: rationale and design of the Resource Center for Health Science (RECHS) project - a study of health hazards and medical cost burden among the Japanese population

PURPOSE

The increased global burden of non-communicable diseases and mental disorders is an urgent health challenge for countries around the entire world, especially those experiencing super-ageing societies, where over 21% of the population is age 65 years or older. Japan is the world's most rapidly ageing society, and as a result, medical costs are also rising dramatically. With the aims of establishing a foundational framework for future research efforts, primarily focusing on the development of a personal health record (PHR) system, and creating a long-term repository for bioresources integrated with PHRs, this study investigated potential health risks and future healthcare burdens based on a longitudinal analysis of health records.

PARTICIPANTS

The Resource Center for Health Science (RECHS) project is a long-term, prospective biobank project, population and health check-up-based cohort that primarily investigates the associations between lifestyle and environmental factors and some surrogate markers of non-communicable diseases, such as diabetes, hypertension, cardiovascular disease and cancer. Starting in 2010, we initiated an annual cohort study among voluntary participants recruited from health check-up programmes and collected data from the following sources: a self-administered baseline questionnaire that included items on dietary habits and stress, a Brief Self-Administered Diet History Questionnaire, the Centre for Epidemiologic Studies Depression Scale and the General Health Questionnaire-28.

FINDINGS TO DATE

For this prospective cohort study, we planned to enrol approximately 10 000 participants. We collected and stored serum samples from all participants for future analyses. The study participants who still were able to participate in these health check-ups and their outcomes were then obtained from the measurements and questionnaire responses.

FUTURE PLANS

Insights emerging from the RECHS study can provide researchers and public health policy administrators with evidence to aid in the prevention of non-communicable diseases and clarify the most malleable status to implement preventive measures.

Mental and physical health changes around transitions into unpaid caregiving in the UK: a longitudinal, propensity score analysis

BACKGROUND

The health of unpaid caregivers is poorer, on average, than in non-caregivers. There has been little focus on how health changes when becoming a caregiver and whether this varies by age, gender, and caregiving intensity. We aimed to investigate the mental and physical health changes involved with becoming a caregiver and whether these associations varied by gender, caregiving intensity, or age.

METHODS

This study used data from the UK Household Longitudinal Study (2009-20) to examine mental and physical health changes around the transition to becoming a caregiver in adults aged 16 years and older. We included adults with information on care, complete covariates needed for matching, and at least one measure of health before or after becoming a caregiver (or matched non-caregiver). Health was measured via General Health Questionnaire-12 (GHQ-12, psychological distress) and 12-item Short Form Survey (SF-12, physical and mental functioning). We applied piecewise growth curve modelling with propensity score matching to model trajectories of mental and physical health for caregivers and matched non-caregivers. Analyses were stratified by age group, gender, and caregiving intensity.

FINDINGS

Sample sizes varied from 3025 (GHQ-12 analyses in early adulthood) to 5785 (SF-12 analyses in early mid-adulthood). Psychological distress increased during transition to caregiving for all ages, particularly in those younger than 64 years, those providing care for 20 h or more per week, and for someone living within the household. Mental health functioning worsened during caregiving transition for those aged 30-64 years, those providing 20 h or more per week, and for those caring for someone within the household. Physical health functioning did not change but there was evidence of lower levels of functioning before caregiving. Changes in mental and physical health upon transition to caregiving did not differ by gender.

INTERPRETATION

Our findings highlight the importance of early identification of and support for caregivers, including younger caregivers. This is important to break the cycle of caregiving and future care need. Health services staff, including general practitioners and hospital discharge teams, are well positioned for early identification of caregivers. We also encourage particular support for the mental health of caregivers and particularly those who become caregivers at a younger age.

FUNDING

The UK Economic and Social Research Council.

Quality of life and associated factors of heroin-dependent patients receiving methadone and buprenorphine maintenance treatment

AIM

Although studies in Western countries have investigated the quality of life (QoL) of heroin users, limited research on this topic has been conducted in Asia. The present study assessed QoL in patients with heroin dependence receiving medications to treat opioid use disorder.

METHODS

We performed a cross-sectional study of patients with heroin dependence receiving methadone and buprenorphine treatment. The demographic and substance use variables of patients receiving methadone and buprenorphine were compared. The Chinese Health Questionnaire (CHQ-12), Obsessive Compulsive Drug Use Scale (OCDUS), and World Health Organization Quality of Life Short Form Taiwan version (WHOQOL-BREF-T) were administered to measure patient mental health problems, addiction severity, and QoL, respectively. Multivariate regression was used to identify the factors associated with QoL.

RESULTS

A total of 149 patients receiving methadone and 31 receiving buprenorphine completed the questionnaires. Individuals in the buprenorphine group were more likely to be married (p = 0.024) or employed (p = 0.024), have a higher educational level (p = 0.013), have lower drug craving (OCDUS: p = 0.035), or have higher QoL (WHOQOL-BREF-T: p = 0.004) than those in the methadone group. After adjustment for other variables, employment was positively associated with the physical, psychological, and environmental domains of QoL. Receiving buprenorphine treatment (p = 0.032) and longer treatment duration (p = 0.016) were associated with higher psychological QoL.

CONCLUSION

Several factors were associated with QoL in patients with heroin dependence. Some measures may improve their QoL, such as reducing employment barriers, improving treatment adherence, or increasing accessibility to buprenorphine treatment.

User-Centered Development of Bolster, an mHealth Intervention for Early Psychosis Caregivers: Needs Assessment, Prototyping, and Field Trial

BACKGROUND

Caregivers play a critical role in the treatment and recovery of youth and young adults at risk for psychosis. Caregivers often report feeling isolated, overwhelmed, and lacking in resources. Mobile health (mHealth) has the potential to provide scalable, accessible, and in-the-moment support to caregivers. To date, few if any mHealth resources have been developed specifically for this population.

OBJECTIVE

The aim of this study was to conduct user-centered design and testing of an mHealth intervention to support early psychosis caregivers.

METHODS

We conducted a multiphase user-centered development process to develop the Bolster mobile app. In phase 1, a total of 21 caregivers were recruited to participate in a qualitative needs assessment and respond to an initial prototype of the Bolster platform. Content analysis was used to identify key needs and design objectives, which guided the development of the Bolster mobile app. In phase 2, a total of 11 caregivers were recruited to participate in a 1-week field trial wherein they provided qualitative and quantitative feedback regarding the usability and acceptability of Bolster; in addition, they provided baseline and posttest assessments of the measures of distress, illness appraisals, and family communication.

RESULTS

In phase 1, participants identified psychoeducation, communication coaching, a guide to seeking services, and support for coping as areas to address. Live prototype interaction sessions led to multiple design objectives, including ensuring that messages from the platform were actionable and tailored to the caregiver experience, delivering messages in multiple modalities (eg, video and text), and eliminating a messaging-style interface. These conclusions were used to develop the final version of Bolster tested in the field trial. In phase 2, of the 11 caregivers, 10 (91%) reported that they would use Bolster if they had access to it and would recommend it to another caregiver. They also reported marked changes in their appraisals of illness (Cohen d=0.55-0.68), distress (Cohen d=1.77), and expressed emotion (Cohen d=0.52).

CONCLUSIONS

To our knowledge, this study is the first to design an mHealth intervention specifically for early psychosis caregivers. Preliminary data suggest that Bolster is usable, acceptable, and promising to improve key targets and outcomes. A future fully powered clinical trial will help determine whether mHealth can reduce caregiver burdens and increase engagement in services among individuals affected by psychosis.

Gender differences in social environmental factors of psychological distress among Indonesian adolescents: Findings from the 2015 Global School-based Student Health Survey

BACKGROUND

This study aimed to investigate gender differences in social environmental factors of psychological distress among Indonesian adolescents.

METHODS

This was a cross-sectional study using the data from the 2015 Indonesia Global School-based Student Health Survey. Binary logistic regression was used to assess the influences of main independent variables - social environmental factors (i.e., peer support, having close friends, bullying victimisation, physical fight, physical attack, parental supervision, connectedness, bonding), demographic characteristics, and health-related behaviours on the measures of psychological distress (loneliness, anxiety-induced sleep disturbance, and a combination of both measures as psychological distress).

RESULTS

The prevalence of psychological distress measured as loneliness, anxiety-induced sleep disturbance, and combined psychological distress was 6.12%, 4.52%, and 8.04%, respectively. Findings from multivariate analyses indicated that bullying victimisation, physical attack, experience of hunger (a proxy of socioeconomic status), and sedentary behaviour were associated with all measures of psychological distress. Meanwhile, age, gender, drug use, parental connectedness and bonding, and having no close friends were correlates of one or two measures of psychological distress. Based on gender-stratified analyses, experience of hunger, sedentary behaviour, bullying victimisation, and having no close friends were consistently associated with measures of psychological distress among both girls and boys. In addition, the influence of some social environmental factors, such as parental connectedness, peer support, and physical attack, were more salient among girls.

CONCLUSIONS

The findings suggest that social environmental factors, demographic characteristics, and health-related behaviours were associated with psychological distress, and the associations appeared to differ by gender. Interventions that include improving positive social environmental factors (e.g., reducing interpersonal violence, encouraging positive relationships with parents and peers) and promoting healthy behaviours (e.g., less sedentary behaviour, preventing substance use) might help reduce the risk of psychological distress among Indonesian adolescents.

Health and well-being of serving and ex-serving UK Armed Forces personnel: protocol for the fourth phase of a longitudinal cohort study

INTRODUCTION

This is the fourth phase of a longitudinal cohort study (2022-2023) to investigate the health and well-being of UK serving (Regulars and Reservists) and ex-serving personnel (veterans) who served during the era of the Iraq and Afghanistan conflicts. The cohort was established in 2003 and has collected data over three previous phases including Phase 1 (2004-2006), Phase 2 (2007-2009) and Phase 3 (2014-2016).

METHODS AND ANALYSIS

Participants are eligible to take part if they completed the King's Centre for Military Health Research Health and Wellbeing Cohort Study at Phase 3 (2014-2016) and consented to be recontacted (N=7608). Participants will be recruited through email, post and text message to complete an online or paper questionnaire. Data are being collected between January 2022 and September 2023. Health and well-being measures include measures used in previous phases that assess common mental disorders, post-traumatic stress disorder (PTSD) and alcohol misuse. Other areas of interest assess employment, help-seeking and family relationships. New topics include the impact of the British withdrawal from Afghanistan in 2021, complex PTSD (C-PTSD), illicit drug use, gambling and loneliness. Analyses will describe the effect size between groups deployed to Iraq and/or Afghanistan or not deployed, and those who are currently in service versus ex-service personnel, respectively, reporting prevalences with 95% CIs, and ORs with 95% CI. Multivariable logistic and multiple linear regression analyses will be conducted to assess various health and well-being outcomes and associations with risk and protective factors.

ETHICS AND DISSEMINATION

Ethical approval has been granted by the Ministry of Defence Research Ethics Committee (Ref: 2061/MODREC/21). Participants are provided with information and agree to a series of consent statements before taking part. Findings will be disseminated to UK Armed Forces stakeholders and international research institutions through stakeholder meetings, project reports and scientific publications.

Oral galvanism related to dental implants

BACKGROUND

A range of different chemical interactions can generate an unexpected electronic current in a process called galvanism. Oral galvanism (OG) can also be generated by different chemical actions from diverse intraoral rehabilitated metals, including gold, copper, mercury, titanium, and titanium alloy. The main aim of this manuscript is to review OG, particularly focusing on titanium implants and related metallic materials. We searched the MEDLINE (PubMed), Embase, Scopus, and Google Scholar databases for relevant literature published through December 2019. The keywords included "galvanic current", "galvanism", "galvanic corrosion", "oral galvanism", combined with "oral", "oral cavity", "implant", and "saliva."

RESULTS

Out of 343 articles, 126 articles that met the inclusion criteria were reviewed. We examined and summarized research on OG through a division into four categories: definition and symptoms, diagnosis with testing methods, galvanic corrosion, and oral precancerous lesions with OG.

CONCLUSIONS

Patients with OG have high oral energy and current, and although this phenomenon may be due to the patient's mental illness, OG due to amalgam or mercury occurs. It is evident that the difference in electron potential caused by different elemental components such as titanium alloy and pure titanium, which are essential for manufacturing the implant fixture and the abutment, and chrome and nickel, which are essential for manufacturing the upper crown, causes OG. Since the oral cavity is equipped with an environment in which electric current can be transmitted easily due to saliva, it is imperative that clinicians review the systemic and local effects of salivation.

Military families: the impacts of having a first child during service on military mothers

INTRODUCTION

The rights, roles and responsibilities of servicewomen in the UK Armed Forces has changed dramatically over time. Previously, service personnel were automatically discharged from the military if they became pregnant. As the percentage of servicewomen in the UK Armed Forces increases, having children during service is becoming more common and maternity policies are now in place. Having children during military service can impact on the health and well-being of servicewomen, including a greater risk of illness when returning to work.

METHODS

A cross-sectional, self-report survey was used for data collection. The response rate was approximately 45%. Female Army veterans were recruited via a female military association. The survey collected data on parental status, the timing of their first child (during or after service), and several current mental and physical health and well-being outcomes.

RESULTS

Of the 750 female Army veterans who completed the survey, 406 reported having children. Of those with children, 14.5% had their first child during service compared with 85.5% after service. The most frequently endorsed health outcomes were low social support, loneliness and common mental health difficulties. Participants who had their first child during military service were more likely to have left the service non-voluntarily.

CONCLUSIONS

This study provided insight into the impacts of having a first child during military service on servicewomen. Overall, female Army veterans who had their first child during service had poorer outcomes, including leaving service non-voluntarily. However, none of the health or well-being outcomes remained significant after adjusting the results. This study explored a widely under researched population and field of research. Future research should seek to expand on our findings and continue to explore the impacts of having a first child during military service for military mothers.

Depression, anxiety, and quality of life in patients with systemic lupus erythematosus

Introduction

Systemic lupus erythematosus (SLE) is a multisystem disorder that can affect multiple organs; psychiatric manifestations including depression and anxiety are commonly seen in SLE. The aim of this study is to explore the prevalence of depression, anxiety, and stress, and assess the quality of life (QOL) in patients with SLE and also evaluate associated risk factors.

Material and methods

In this cross-sectional study, adult patients with SLE were identified through our institution's SLE data registry. Participants were evaluated with three questionnaires: Depression, Anxiety, and Stress Scale (DASS-42), General Health Ouestionnaire-28 (GHQ-28), and World Health Organization quality of life instrument short form (WHO-QOL BREF).

Results

A total of 222 patients were included in the study, 203 (91%) of whom were female and 19 were male (9%). Participants had a mean age of 35.6 ±9.5 years. According to DASS-42 questionnaire, 22.1%, 28.7% and 20.3% of patients had varying degrees of depression, anxiety, and stress, respectively. Based on GHQ-28 questionnaire, 137 (62%) of patients reported some degree of distress. Quality of life score was 12.8, 13, 14.3, and 13.9 in physical health, psychological health, social relationships, and environmental health, respectively.

Conclusions

We found that depression, anxiety, and stress are common in patients with SLE, and quality of life is significantly affected. A high percentage of patients with SLE deal with some degree of distress. Routine evaluation of the quality of life and psychological disturbances is recommended in patients with SLE. Non-pharmacological interventions as well as specialist referral should be considered in patients with anxiety, depression, or stress.

Protective effect of restorative possibilities on cognitive function and mental health in children and adolescents: A scoping review including the role of physical activity

Background The exposome approach can be a powerful tool for understanding the intertwining of social, physical, and internal influences that shape mental health and cognitive development throughout childhood. To distil conceptual models for subsequent analyses, the EU-funded project Early Environmental quality and Life-course mental health effects (Equal-Life) has conducted literature reviews on potential mediators linking the exposome to these outcomes. We report on a scoping review and a conceptual model of the role of restorative possibilities and physical activity. Methods Peer-reviewed studies published since the year 2000 in English, on the association between the exposome and mental health/cognition in children/adolescents, and quantitatively investigating restoration/restorative quality as a mediating variable were considered. Database searches were last updated in December 2022. We used an unstructured expert-driven approach to fill in gaps in the reviewed literature. Results Five records of three distinct studies were identified, indicating a scarcity of empirical evidence in this newly developing research area. Not only were these studies few in numbers, but also cross-sectional, lending only tentative support to the idea that perceived restorative quality of adolescent's living environment might mediate the association between greenspace and mental health. Physical activity emerged as a mediator leading to better psychological outcomes in restorative environments. We provide a critical discussion of potential caveats when investigating the restoration mechanism in children and propose a hierarchical model including restoration, physical activity, and relational dynamics between children and their environment, including social context, as well as restorative environments other than nature. Conclusions It is justified to further explore the role of restoration and physical activity as mediators in the association between early-life exposome and mental health/cognitive development. It is important to consider the child perspective and specific methodological caveats. Given the evolving conceptual definitions/operationalizations, Equal-Life will attempt to fill in a critical gap in the literature.

Development and Validation of the Adaptive Schema Questionnaire

Background

Schemas help with the organization and interpretation of information. Adaptive schemas indicate positive predisposing thinking patterns in an individual. This study aimed to develop a psychometrically robust tool to assess adaptive schema in a nonclinical sample.

Method

This research comprises two independent studies. Study I was multiphased. In Phase I (n = 70), 36 open-ended items were generated following the Young schema therapy model and qualitatively analyzed. This facilitated the generation of 144 items in Phase II (n = 152) which were evaluated for content validity and subjected to rigorous item analysis. Exploratory factor analysis was performed in Phase III (n = 751). Confirmatory factor analysis was conducted in Study II (n = 244).

Results

Exploratory factor analysis resulted in a six-factor solution comprising 25 items. These factors correspond to the six adaptive themes, namely, adequate, secured, self-reliant/autonomous, resistant, successful, and self-assured. The newly developed Adaptive Schema Questionnaire demonstrated adequate reliability (α = 0.86). Significant correlations between the obtained factors and Early Maladaptive Schemas, depression, big five personality factors, and positive and negative effects established the concurrent validity. Confirmatory factor analysis indicated acceptable goodness of fit for the obtained model.

Conclusion

The developed Adaptive Schema Questionnaire is a reliable and valid instrument with promising utility in psychotherapy and research context.

Impact of COVID-19 Pandemic on Well-Being, Social Relationships and Academic Performance in a Sample of University Freshmen: A Propensity Score Match Evaluation Pre- and Post-Pandemic

The COVID-19 pandemic has impacted freshmen, compromising their mental health, lifestyles, and academic performance. There are few studies that have investigated changes in the health status and lifestyles of freshmen before and after the pandemic. The aims of this study were: (1) to carry out a pre-post-COVID-19 pandemic comparison between two freshmen samples, in order to detect differences in their socio-demographic characteristics and in some clinical variables; (2) to assess the effect of the COVID-19 pandemic on the social and academic lives of the second sample of freshmen. The samples recruited in 2019 and 2022, matched by propensity score procedure (N = 553), were mostly female (57.3% vs. 55.3%); the mean age was 22.9 and 20.9 years, respectively. The freshmen recruited after the pandemic had less psychological distress and substance use than freshmen recruited before the pandemic. Seventy-eight percent of the freshmen stated that the pandemic had an impact on their social relationships. This effect was greater for females and Italian students. Forty-seven percent reported that the pandemic has worsened their academic performance, while 60% stated that pandemic has improved their grades. The results of this study can provide valuable insights into the impact of the pandemic on freshmen, in order to implement interventions to mitigate the consequences of the pandemic in some subgroups of this target population.

Obesity as a causal risk factor for depression: Systematic review and meta-analysis of Mendelian Randomization studies and implications for population mental health

BACKGROUND/OBJECTIVES

Obesity has been associated with elevated risk of depression. If this association is causal, the increasing obesity prevalence might lead to worsening population mental health, but the strength of the causal effect has not been systematically evaluated.

SUBJECTS/METHODS

The current study provides a systematic review and meta-analysis of studies examining associations between body mass index and depression using Mendelian randomization with multiple genetic variants as instruments for body mass index. We used this estimate to calculate the expected changes in prevalence of population psychological distress from the 1990s-2010s, which were compared with the empirically observed trends in psychological distress in the Health Survey for England (HSE) and U.S. National Health Interview Surveys (NHIS).

RESULTS

Meta-analysis of 8 Mendelian randomization studies indicated an OR = 1.33 higher depression risk associated with obesity (95% confidence interval 1.19, 1.48). Between 15% and 20% of the participants of HSE and NHIS reported at least moderate psychological distress. The increase of obesity prevalence from the 1990s-2010s in HSE and NHIS would have led to a 0.6 percentage-point increase in population psychological distress.

CONCLUSIONS

Mendelian randomization studies suggest that obesity is a causal risk factor for elevated risk of depression. The increasing obesity rates may have modestly increased the prevalence of depressive symptoms in the general population. Mendelian randomization relies on methodological assumptions that may not always hold, so other quasi-experimental methods are needed to confirm the current conclusions.

Culturally adapted family intervention for people with schizophrenia in Indonesia (FUSION): a development and feasibility study protocol

Background

Mental illnesses comprise the single largest source of health-related economic burden globally, and low- and middle-income countries are disproportionately affected. The majority of people with schizophrenia who need treatment do not receive it and are often wholly reliant on family caregivers for daily care and support. Family interventions have an exceptionally robust evidence base for their efficacy in high-resource settings, but it is unknown whether they can produce equivalent effects in some low-resource settings where cultural beliefs, explanatory models of illness and contextual socio-economic issues differ.

Methods

This protocol describes the methods for a randomised controlled trial to determine the feasibility of testing culturally adapt and refine an evidence-based, family intervention for relatives and caregivers of people with schizophrenia in Indonesia. The feasibility and acceptability of implementing our adapted, co-produced intervention via task shifting in primary care settings will be evaluated using the Medical Research Council framework for complex interventions. We will recruit 60 carer-service-user dyads and randomise them in a 1:1 ratio either to receive our manualised intervention or continue to receive treatment as usual. Healthcare workers in primary care settings will be trained to deliver family interventions using our manualised intervention by a family intervention specialist. Participants will complete the ECI, IEQ, KAST and GHQ. Service-user symptom level and relapse status will be measured using the PANSS at baseline, post-intervention and 3 months later by trained researchers. Fidelity to the intervention model will be measured using the FIPAS. Qualitative evaluation will further assist with refining the intervention, evaluating trial processes and evaluating acceptability.

Discussion

National healthcare policy in Indonesia supports the delivery of mental health services in a complex network of primary care centres. This study will provide important information on the feasibility of delivering family interventions for people with schizophrenia via task shifting in primary care settings in Indonesia and allow further refinement of the intervention and trial processes.

[Psychological impact of the announcement of an abnormal cervical smear: How to improve patient experience and information? COLANX: a multicenter study in Seine-Maritime]

INTRODUCTION

When an anomaly in the screening by cervical smear or by the HPV-HR test is detected, the women are called for a colposcopy. Waiting for colposcopy is often an anxiety-provoking situation for women, probably linked to a widespread ignorance of the value of screening and the pathophysiology of HPV infection.

METHODS

The COLANX was a multicentric study, in Seine-Maritime, conducted with 8 colposcopist practitioners. Self-questionnaires were distributed to volunteer women, summoned for a first abnormal smear result, at the exit of colposcopy and filled out immediately on site. This questionnaire evaluated: the psychological impact of the announcement of the abnormal cervico-uterine smear, its impact on the sexual quality of life, the epidemiological characteristics of the population studied, the modalities of the announcement made of the abnormal result, the satisfaction of the women and their desire for additional information. 131 questionnaires were included, from June 1, 2020 to January 18, 2021.

RESULTS

61.5% of responding women presented proven psychological distress, as evidenced by a GHQ-12 score ≥ 2. The state of psychological distress was significantly different depending on the time left by the practitioner between the announcement of the abnormal cytology result and the colposcopy appointment. The GHQ-12 score was significantly different according to the initial classification of the cervico-uterine smear, high in case of suspicion of high-grade lesions in particular. 36.3% of patients had a significant deterioration in their sexual quality of life, demonstrated by an ASEX score ≥ 18. The women were statistically more satisfied when the announcement of their abnormal screening result had been made by telephone or during a consultation, rather than by mail, but no significant difference was found on the presence or absence of distress psychological according to this mode of announcement. 52.3% of the women in this study expressed a request for additional information support, preferably written support (for 89.4% of these women), to be delivered when the abnormal screening was announced (for 76, 5% of these women).

DISCUSSION

The main results of the COLANX study are consistent with those of the literature, in particular concerning the negative psychological impact in the announcement of an abnormal smear result.

CONCLUSION

The new methods of organized screening will increase the use of colposcopy for many women. There is a significant impact on their psyche and their intimate life. The issuance of additional information during this announcement would probably reduce this anxiety.

Volunteering behaviours among UK military Veterans during the COVID-19 pandemic and associations with health and well-being

LAY SUMMARY

The COVID-19 pandemic influenced ways in which individuals volunteered and created barriers for participation because of differing restrictions. The research assessing how Veterans volunteer is limited, but there may be aspects of military culture that encourage service to others. The authors investigated volunteering among UK Veterans during the COVID-19 pandemic and what factors made Veterans more or less likely to volunteer. The study found that 60% of Veterans had volunteered in the past 12 months, a level similar to that among the UK general population. Overall, Veterans volunteered more often through formal organizations rather than on an informal basis, such as helping individuals such as neighbours. However, in relative terms, levels of formal volunteering decreased and levels of informal volunteering increased during the pandemic. Veterans were more likely to volunteer if they were officers or to increase volunteering if they felt lonely. Veterans who reduced volunteering were more likely to have mental health problems. Understanding volunteering among Veterans may open up more opportunities for participation.

Foreign Nationality, Family Psychiatry History and Pregestational Neoplastic Disease as Predictors of Perinatal Depression in a Cohort of Healthy Pregnant and Puerperal Women during the COVID-19 Pandemic

Background: Perinatal depression (PND) represents one of the most common mental disorders in the pregnancy and/or postpartum period, with a 5-25% prevalence rate. Our aim was to investigate predictors associated with PND in a cohort of pregnant and puerperal women based in an Italian setting during the COVID-19 pandemic. Methods: We retrospectively recruited 199 (55 pregnant and 144 puerperal) women, afferent to our Perinatal Mental Outpatient Service of Ancona (Italy). Participants were administered an ad hoc case-report form, Whooley Questions (WQ), the General Health Questionnaire-12 (GHQ-12), the Stress Holmes-Rahe scale (HR) and the Edinburgh Postnatal Depression Scale (EPDS). Results: Around 10% of the sample had a confirmed PND. Being a foreigner woman (RR = 3.8), having a positive psychiatric family history (RR = 5.3), a pre-pregnancy medical comorbidity (RR = 1.85) and a comorbid medical illness occurring during the pregnancy (RR = 2) were much likely associated with PND. Multiple linear regression analysis demonstrated that GHQ, medium- and high-risk at the HR, foreign nationality, positive family psychiatric history, and neoplastic disease before conception significantly predicted EPDS [F(1, 197) = 10.086, R2 = 0.324, p < 0.001]. Limitations: The sample size, poor heterogeneity in terms of socio-demographic, clinical and gynecological-obstetric characteristics, the cross-sectional design of the study. Conclusions: Our study showed a set of predictors associated with a higher risk for the PND onset, including gestational and pregestational medical disease. Our findings outline the need to screen all fertile women, particularly in gynecological and medical settings, in order to identify at-risk women for PND and promptly suggest a psychiatric consultation.

TElewoRk-RelAted Stress (TERRA), Psychological and Physical Strain of Working From Home During the COVID-19 Pandemic: A Systematic Review

BACKGROUND

Many workers shifted to working from home due to the COVID-19 pandemic. This review aims to investigate if this sudden change caused an increase in TElewoRk-RelAted stress (TERRA) which is defined as physical and mental stress caused by telework.

METHODS

A systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was performed of three scientific databases (PubMed, ISI Web of Knowledge, and Scopus), which also included a quality assessment. Articles measuring stress, psychological or physical, in remote workers, published from December 2019 through August 2021 were included in the review. Results were extracted by reporting: authors, country, study design, type of workers, sample, questionnaires and measurements, and outcomes. Data were synthesized quantitatively for country, type of workers, and outcomes.

RESULTS

Out of the 518 articles found in the three databases, 19 articles were included in the systematic review (10,012 participants overall), and 78.9% of these highlighted an increase in TERRA levels in remote workers. Among 85.7% of the studies considering gender as a variable, TERRA levels were higher in female workers. Twelve (63.2%) of the studies investigated psychological well-being, two (10.5%) focused on the physical well-being of remote workers, three (15.8%) investigated both, and two studies had other outcomes (10.5%).

CONCLUSIONS

Considering the redefinition of workplaces dictated by the COVID-19 pandemic, this review highlights the emerging issue of remote work and the use of technology in working from home, emphasizing a rapidly growing occupational health problem. Remote workers need to be provided with emotional and technical support to prevent TERRA in remote workers.

Pharmacists' Satisfaction with Work and Working Conditions in New Zealand-An Updated Survey and a Comparison to Canada

BACKGROUND

As roles have evolved over time, changes in workplace environments have created higher patient expectations creating stressful conditions for pharmacists.

AIM

To evaluate pharmacists' perceptions of their working conditions, work dissatisfaction, and psychological distress; determine their predictors in New Zealand (NZ); and compare results with Canadian studies and historic NZ data.

METHODS

A cross-sectional online survey was distributed to registered pharmacists in NZ. The survey included demographics, work satisfaction, psychological distress, and perceptions of their working conditions (six statements with agreement rated on a 5-point Likert scale). Comparisons were made with surveys from Canada and NZ. Chi-square, t-tests, and non-parametric statistics were used to make comparisons.

RESULTS

The response rate was 24.7% (694/2815) with 73.1% practicing in a community pharmacy (45.8% independent, 27.3% chains). Pharmacists disagreed on having adequate time for breaks and tasks, while the majority contemplated leaving the profession and/or not repeating their careers again if given the choice. Working longer hours and processing more prescriptions per day were predictive factors for poorer job satisfaction. More NZ pharmacists perceived their work environment to be conducive to safe and effective primary care (57% vs. 47%, p < 0.001) and reported that they had enough staff (45% vs. 32%, p = 0.002) as compared to Canadian pharmacists. Pharmacists' job satisfaction and psychological distress have not improved compared to the assessment 20 years prior.

CONCLUSIONS

NZ pharmacists perceive working conditions to be sub-optimal yet had higher satisfaction than their Canadian counterparts. Work dissatisfaction and psychological distress are high and have not improved over the last two decades.

The association of depression with mortality and major adverse limb event outcomes in patients with peripheral artery disease: A systematic review and meta-analysis

BACKGROUND

Peripheral artery disease (PAD) is highly prevalent and associated with poor outcomes. Depression is a risk factor for adverse outcomes in patients with coronary artery disease. Despite evidence showing that depression is common in patients with PAD, less is known about its association with adverse prognostic outcomes. To address this, we conducted a systematic review and meta-analysis to summarize the association between depression and outcomes in patients with PAD.

METHODS

We performed a systematic search of eight databases to January 2022 including studies that reported a risk estimate for the association of depression or depressive symptoms with all-cause mortality or major adverse limb events (MALE) in patients with PAD and pooled results in a meta-analysis. Risk of bias was assessed using ROBINS-I.

RESULTS

Of the 7048 articles screened, 5 observational studies with 119,123 patients were included. A total of 16.2 % had depression or depressive symptoms. Depression was associated with a statistically significant increased risk of all-cause mortality (HR 1.24, confidence interval 1.07-1.25, p = .005). The association between depression and MALE was not significant but trended toward a positive association.

LIMITATIONS

Due to lack of data, results were limited by a single study with a large sample size, overrepresentation of men, and lack of information of depression severity or treatment status.

CONCLUSION

Depression or depressive symptoms are associated with a 24 % increased risk of all-cause mortality in patients with PAD. Future work should explore the mechanisms and directionality of this association and identify depression as an important comorbidity to address for patients with PAD.

REGISTRATION

PROSPERO CRD 42021223694.

Psychological well-being among Saudi adults during the context of COVID-19 lockdown: a psychometric analysis of the 12-item General Health Questionnaire

BACKGROUND

Most communities' mental health and perceptions of psychological well-being are known to be profoundly disrupted by large-scale pandemics. Despite the wide range of available screening measures, few reliable and valid screening measures exist for assessing overall psychological well-being in nonclinical populations during a health emergency situation such as the COVID-19 outbreak.

OBJECTIVE

This study aims to conduct a psychometric analysis of Goldberg's 12-item General Health Questionnaire (GHQ-12) to validate its use among a sample of Saudi adults during the COVID-19 lockdown using reliability and factor analyses.

METHODS

A total of 473 individuals (aged 18 years and over) were recruited from the general Saudi population living in the Makkah (Western) Province of Saudi Arabia to complete the virtual format of the Arabic GHQ-12 (Ar-GHQ-12). In addition to a descriptive statistics measurement and reliability analysis, confirmatory factor analyses (CFA) were performed to examine the unidimensionality and validity of the Ar-GHQ-12.

RESULTS

In line with previous works from several cultures, the Ar-GHQ-12 with two-factor solution considered to be the best-fitting model because it fits the data better than the one-factor (unidimensional) model did, and adequate reliability indices were achieved for each factor (.83 for factor 1 and .65 for factor 2).

DISCUSSION

The Ar-GHQ-12 was determined to be suitable for assessing the overall psychological well-being of the general population in Saudi Arabia in emergency contexts and may be applied among Saudis and other Arabic-speaking populations in research and primary care settings.

Psychological Well-Being during the COVID-19 Lockdown: Labour Market and Gender Implications

In the Spring of 2020, a great number of countries introduced different restrictive measures in order to cope with the COVID-19 pandemic. This article examines the labour market transitions of individuals brought about by some of those measures, and the effect of such transitions on psychological well-being. The fact that it has been possible to distinguish between unemployment transitions before the pandemic began and those resulting from the lockdowns is worth highlighting. Evidence is provided showing that unemployment due to the lockdown had a greater negative impact on psychological well-being than furloughs and teleworking. Gender differences confirm that women experienced greater adverse effects as compared to men. Specifically, women working at home exhibited greater negative effects when compared with those on furlough, probably due to a combination of work disruption and increased family obligations. Finally, on the contrary to men, women living in areas with more rigorous restrictions show a reduced probability of worse PWB when compared to those residing in areas without restrictions. This finding suggests that women are willing to sacrifice freedom of movement as long as restrictions protect their at-risk relatives.

Caregiving for older people living with chronic pain: analysis of the English longitudinal study of ageing and health survey for England

Background

Chronic pain is a disabling condition. Many people with chronic pain seek informal support for everyday activities of daily living (ADL). However, there remains uncertainty on the type of people with chronic pain who access this support, what types of support they need and who provides such support. The purpose of this analysis was to answer these uncertainties.

Methods

Data from the Health Survey for England (HSE) and English Longitudinal Study of Ageing (ELSA) were accessed. People who reported chronic pain (moderate or above for minimum of 12 months) were identified. From these cohorts, we determined if individuals self-reported receiving informal care. Data on caregiver profiles and caregiving activities were reported through descriptive statistics. Logistic regression analyses were performed to compare health status outcomes between people with pain who received and who did not receive informal care.

Results

2178 people with chronic pain from the ELSA cohort and 571 from the HSE cohort were analysed. People who received care were frequently female, older aged with several medical morbidities including musculoskeletal diseases such as arthritis. People with chronic pain received informal care for several diverse tasks. Most frequently these related to instrumental activities of daily living (IADL) such as shopping and housework. They were most frequently provided by partners or their children. Although they reported greater disability and symptoms ( p < 0.001), people who received care did not report differences in health status, loneliness or wellbeing ( p = 0.27; p = 0.46).

Conclusions

Whilst it may be possible to characterise people living in chronic pain who receive informal care, there is some uncertainty on the impact of informal caregiving on their health and wellbeing. Consideration should now be made on how best to support both care recipients and informal caregivers, to ensure their health and quality of life is promoted whilst living with chronic pain.

Paediatric health-related quality of life in congenital cytomegalovirus

OBJECTIVE

Congenital cytomegalovirus (cCMV) is the most common congenital infection globally. This cross-sectional study aimed to describe the health-related quality of life (HRQoL) of children with cCMV and that of their parents.

METHODS

Families of children with cCMV in the UK were approached through the charity CMV Action. Parents completed questionnaires about their own HRQoL and that of their child. Children who were able to self-report completed questionnaires about their own HRQoL. Demographic characteristics of the sample were described using descriptive statistics. Questionnaire responses were scored, and domain and summary scores were calculated and compared with UK population norms, where available.

RESULTS

Seventy families participated, with children aged between 5 months and 18 years. Children with cCMV had poorer HRQoL compared with children from UK population data. HRQoL of children whose health was more severely affected by cCMV was poorer than that of children whose health was less severely affected. Parents of children whose health was moderately or severely affected had greater psychological morbidity and poorer HRQoL in physical, emotional, social, and cognitive functioning domains than parents of less severely affected children.

CONCLUSIONS

cCMV has a significant effect on the HRQoL of children with cCMV and their parents, with the children with the most significant health needs having the lowest HRQoL compared with those children with little or no effects on their health. This data could contribute to health economic analyses, informing resource allocation to potential interventions for the prevention and treatment of cCMV.

The development and clinical application of a novel schizophrenia screening system using yoga-induced autonomic nervous system responses

Background: In severe cases, schizophrenia can result in suicide and social isolation. Diagnosis delay can lead to worsening symptoms, and often results in prolonged therapy. An estimated 50%–80% of patients with schizophrenia are unaware of their condition. Biomarkers for schizophrenia are important for receiving a diagnosis from a psychiatrist at an early stage. Although previous studies have investigated near-infrared spectroscopy as a biomarker for schizophrenia, the required equipment is expensive and not designed for home use. Hence, we developed a novel home-use schizophrenia screening system that uses a wearable device to measure autonomic nervous system responses induced by yoga, which is frequently adopted in rehabilitation for schizophrenia.

Materials and methods: The schizophrenia screening system automatically distinguishes patients with schizophrenia from healthy subjects via yoga-induced transient autonomic responses measured with a wearable wireless electrocardiograph (ECG) using linear discriminant analysis (LDA; Z score ≥ 0 → suspected schizophrenia, Z-score &lt; 0 → healthy). The explanatory variables of LDA are averages of four indicators: components of heart rate variability (HRV): the very low-frequency (VLF), the low-frequency (LF), HR, and standard deviation of the NN intervals (SDNN). In the current study, HRV is defined as frequency domain HRV, which is determined by integrating RRI power spectrum densities from 0.0033 to 0.04 Hz (VLF) and 0.04–0.15 Hz (LF), and as time domain HRV, SDNN of which is calculated as the mean of the standard deviations of the RR intervals. These variables were measured before (5 min), during (15 min), and after (5 min) yoga in a 15-min mindfulness-based yoga program for schizophrenia (MYS). The General Health Questionnaire-28 (GHQ28) score was used to assess the severity of mental disorders for patients with schizophrenia and healthy volunteers. Twelve patients with schizophrenia (eight female and four male, 23–60 years old) and 16 healthy volunteers (seven female and nine male, 22–54 years old) were recruited.

Results: The schizophrenia screening system achieved sensitivity of 91% and specificity of 81%. Z-scores of LDA were significantly correlated with GHQ28 scores (r = 0.45, p = 0.01).

Conclusion: Our proposed system appears to be promising for future automated preliminary schizophrenia screening at home.

Sociodemographic and Digital Education Factors Are Associated to General Health, Coping Strategies, and Academic Outcomes of Undergraduate Students during the Post-Pandemic Period

The COVID-19 pandemic suddenly and forever changed the lives of many undergraduate students around the globe, forcing them to switch to online learning while undergoing social confinement within their homes. It is now well-established that this prolonged period of uncertainty impacted students’ well-being, health, and academic achievement. However, how student-related factors, such as coping strategies as well as sociodemographic, contextual, and technological variables, are linked to digital education factors is currently less understood. Using multiple regression analysis, this study investigates the results of an online questionnaire administered to students from two universities in southern Italy, differing in positioning and size, as well as policies and attitude towards digital learning. The results of this study show the positive effects of expertise with digital devices and university digital learning policies on students’ perceived general health. Conversely, isolation and lack of relational connectedness negatively impacted students’ health. Furthermore, this study highlights the role of different coping strategies, demonstrating that active forms of coping have a positive effect on students’ health, whereas avoidance strategies have the opposite effect. Taken together, this study provides crucial links between the many factors influencing students’ experience with online learning and health, and provides useful indications to promote the uptake of and adaptation to online learning.

Mental wellbeing among urban young adults in a developing country: A Latent Profile Analysis

Introduction

This study aimed to explore the mental wellbeing profiles and their related factors among urban young adults in Vietnam.

Methods

A cross-sectional study was conducted in Hanoi, which is the capital of Vietnam. There were 356 Vietnamese who completed the Mental Health Inventory-5 (MHI-5) questionnaire. The Latent Profile Analysis (LPA) was used to identify the subgroups of mental wellbeing through five items of the MHI-5 scale as the continuous variable. Multinomial logistic regression was used to determine factors related to subgroups.

Results

Three classes represented three levels of MHI-5 score, which included “Poor mental health,” “Fair mental health,” and “Good mental health,” were, respectively, 14.3, 46.6, and 39.0%. Compared to a low household economy, participants with an average household economy had 2.11 and 4.79 times higher odds of being in a good mental health class relative to fair and poor mental health classes. Respondents with more than two acute symptoms had 3.85 times higher odds of being in a good mental health class relative to a poor mental health class, as compared to those without acute symptoms. Regarding the measurement of the Perceived Social Support Scale (MSPSS), people having support from their family had 1.80 and 2.23 times higher odds of being in classes of fair and good mental health relative to the poor mental health class; and participants having friend support also had 1.87 times higher odds of being in a good mental health class compared with the fair mental health class, as the MSPSS score increased by 1 unit. People with Rosenberg’s self-esteem scale increased by 1 score, those who had 1.17, 1.26, and 1.47 times higher odds of being in a good compared to fair mental health class, fair compared to poor mental health class, and good compared to poor mental health class, respectively.

Conclusion

Our findings were given to promote a new classification method for mental health screening among the general population. The current findings could be used as evidence to develop policies and plans that focus on encouraging early screening for mental health problems among the general young population in the future.

Wellbeing, burnout and substance use amongst medical students: A summary of results from nine countries

OBJECTIVE

There has been increasing interest in the physical health, mental wellbeing and burnout afflicting medical students over recent years. This paper describes the overall results from phase two of an international study including a further nine countries across the world.

METHODS

We sampled large groups of medical students in nine countries at the same time and with exactly the same method in order to aid direct comparison of demographics, burnout and mental wellbeing through validated instruments.

RESULTS

A total of 4,942 medical students from these countries participated in this study. Around 68% of respondents screened positive for mild psychiatric illness using the General Health Questionnaire-12. Around 81% and 78% of respondents were found to be disengaged or exhausted respectively using the Oldenburg Burnout Inventory. Around 10% were found to be CAGE positive and 14% reported cannabis use. The main source of stress reported by medical students was their academic studies, followed by relationships, financial difficulties and housing issues.

CONCLUSION

Cultural, religious and socioeconomic factors within each country are important and understanding their effects is fundamental in developing successful local, regional and national initiatives. Further quantitative and qualitative research is required to confirm our results, clarify their causes and to develop appropriate preventative strategies.

Mental health and wellbeing of Indonesian medical students: A regional comparison study

BACKGROUND

Our previous research found very high levels of burnout and mental health problems among medical students across Indonesia, in line with rates in many other countries. This study further analyses the data by comparing six different regions of Indonesia to determine any differences between them on such measures and to look for possible explanations.

RESULTS

Our sample of 1,729 students reported high levels of burnout and 'mild' psychiatric illness across all six regions. There were however significant differences between some regions. Sumatran students reported the lowest scores for both the Oldenburg Burnout Inventory (OLBI) and General Health Questionnaire 12 (GHQ12) scales. Sources of stress also varied among regions, with relationships and study the most reported. Further exploration of possible cultural differences is needed as well as prompt mental health support for medical students.

Hypnosis Intervention for Couples Confronted with Alzheimer’s Disease: Promising Results of a First Exploratory Study

Background: Dementia has a negative impact on the quality of life of the person with dementia and their spouse caregivers, as well as on the couple’s relationship, which can lead to high levels of distress for both partners. Hypnosis has been shown to be effective in managing distress and increasing the quality of the relationship. Objective: The aim was to develop a standardized hypnosis intervention for couples confronted with Alzheimer’s disease and evaluate its feasibility, acceptability, and helpfulness in managing the distress of both partners and increasing the quality of the relationship. Methods: In a single-arm study, sixteen couples received the 8-week intervention. Qualitative and quantitative assessments were conducted pre- and post-intervention as well as three months after. Results: 88.9% of couples (n = 16) of the final sample (n = 18) completed the intervention. Despite the negative representations of hypnosis, several factors led couples to accept to participate in this study: positive expectations, professional endorsement, medical application, non-drug approach, home-based, free, flexible, and couple-based intervention. The results showed a significant decrease in distress for both partners. These effects were maintained three months after the intervention. Couples felt more relaxed, had fewer negative emotions, accepted difficulties more easily, were more patient, and reported better communication and more affection in the relationship. Conclusion: Overall, this pilot study shows the feasibility and acceptability of hypnosis with couples confronted with Alzheimer’s disease. Although measures of the preliminary pre- and post-intervention effects are encouraging, confirmatory testing with a randomized controlled trial is needed.

Employment Industry and Occupational Class in Relation to Serious Psychological Distress in the United States

Occupational characteristics may influence serious psychological distress (SPD) and contribute to health inequities; yet, few studies have examined multiple employment industries and occupational classes in a large, racially diverse sample of the United States. Using data from the National Health Interview Survey, we investigated employment industry and occupational class in relation to SPD in the overall population and by race/ethnicity, gender, age, household income, and health status. We created eight employment industry categories: professional/administrative/management, agricultural/manufacturing/construction, retail trade, finance/information/real estate, educational services, health care/social assistance, accommodation/food services, and public administration/arts/other services. We also created three occupational class categories: professional/management, support services, and laborers. SPD was measured using the Kessler Psychological Distress Scale and scores ≥13 indicated SPD. We adjusted for confounders and used Poisson regression to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs). Among the 245,038 participants, the mean age was 41.7 ± 0.1 years, 73% were Non-Hispanic (NH)-White, and 1.5% were categorized as having SPD. Compared to the professional/administrative/management industry, working in other industries (e.g., manufacturing/construction (PR = 0.82 [95% CI: 0.70-0.95]) and educational services (PR = 0.79 [95% CI: 0.66-0.94])) was associated with lower SPD. Working in support services and laborer versus professional/management positions were both associated with 19% higher prevalence of SPD (95% CI: 1.04-1.35; 95% CI: 1.04-1.38, respectively). Furthermore, working in a support services or laborer versus professional/management position was associated with higher SPD in most employment industries. Industry-specific workplace interventions to equitably improve mental health are warranted.

Internet addiction in adolescents: Role of family, personality and comorbid psychopathology in school children in Eastern India

CONTEXT

There is an increasing prevalence of internet addiction among adolescents during the COVID-19 pandemic, but very few Indian studies have assessed and taken into account various factors that can explain internet addiction in this vulnerable population.

AIMS

We examine the differences in family functioning, temperament, character and psychopathology in adolescents with and without internet addiction.

SETTINGS AND DESIGN

1000 adolescents from urban middle-class families were included in this cross-sectional, two-randomized-group designed, comparative study. Clinical and control group population were selected from high schools. Those with severe internet addiction were compared to those with no addiction.

METHODS AND MATERIALS

Internet Addiction Test, Temperament and Character Inventory, Devereux Scale of Mental Disorders and McMaster Family Assessment Device were administered along with General Health and CRAFFT Questionnaire as screening tool.

STATISTICAL ANALYSIS USED

Mann-Whitney U test was done along with Spearman's rank-difference coefficient of correlation.

RESULT

Adolescents with internet addiction had high novelty seeking and low persistence. Internet addiction was also associated with conduct problems and depression. There was a significant positive association between depression and years of internet usage. Family of adolescents with internet addiction had increased difficulty in problem solving, communication, affective responsiveness, affective involvement and behavior control.

CONCLUSION

Adolescents with internet addiction have temperament difficulties, more psychopathology and belong to dysfunctional families. Since the family plays a central role in an Indian context, family-focused strategies must also be included in the management of internet addiction.

Are We All the Same When Faced with an Ill Relative? A Person-Oriented Approach to Caring Activities and Mental Health in Emerging Adult Students

Dealing with the illness/disability of a relative is part of everyday life for many students, who may have to take on caring responsibilities. Fulfilling a caring role during emerging adulthood has been associated with poorer mental health. This study adopts a person-oriented approach in exploring the caring experience in relation to mental health. The sample comprised 3273 students (Mage = 20.19 years, SDage = 1.89; 80.35% female) who answered a series of questionnaires. A cluster analysis identified six patterns of caregiving activities in terms of their nature and extent: few caring activities; household chores; household and financial/practical help; emotional care; sibling care; and many caring activities with emotional and personal care. A series of analyses showed that caring activities differed according to age, gender, living arrangements, financial status, the ill/disabled relative being supported, and the relative's type of illness/disability. A multivariate analysis of covariance showed that emerging adult students with patterns featuring household chores had better mental health than those with few caring activities. Overall, our findings indicate that having an ill/disabled relative can lead an individual to take on a wide range of caring responsibilities that may have varying consequences for emerging adult students' mental health.

Effects of Regular Low-Level Alcohol Consumption in Healthy Individuals: A Randomized, Double-Blind, Placebo-Controlled Crossover Study

The effects of alcohol consumption on health are suggested to depend on the amount of alcohol consumed. We investigated the objective and subjective health effects of the daily consumption of a small amount of alcohol in healthy individuals using a randomized, double-blind, placebo-controlled crossover study. Accordingly, 15 male and 27 female Japanese adults with average or lower general well-being schedule (GWBS) scores were asked to consume a beverage with 0.5% (v/v) alcohol (~4 g of alcohol a day; test beverage) and a placebo beverage two times daily for 4 weeks each. Regular low-level alcohol consumption significantly decreased the serum liver function indexes (aspartic aminotransferase, alanine aminotransferase, and lactate dehydrogenase) before and after consumption (p = 0.034, 0.033, and 0.013, respectively). The small amount of alcohol did not affect the participants’ GWBS scores; however, a stratified analysis with poor subjective well-being revealed that these changes differed significantly between low-level alcohol consumption and placebo-treated subjects (16.0 vs. 11.5, p = 0.041). In addition, changes in serum testosterone levels demonstrated a higher trend in the group that received the test beverage compared with the group that received the placebo beverage (p = 0.051). Daily low-level alcohol consumption may have positive effects on liver function and subjective well-being.

COVID-19 Worry and Mental Health Among the Economically Active Population in Guangdong, China

Background

The rapid spread of the coronavirus disease 2019 (COVID-19) pandemic has caused people to worry, which has affected their mental health. This study aimed to access the impact of COVID-19 worry on the mental health of the economically active population (EAP) in a province of China.

Methods

An online cross-sectional survey study was conducted during an outbreak of COVID-19 in Guangdong, China. The survey used the 12-item General Health Questionnaire (GHQ-12) to evaluate participants' mental health status and was completed by 1,584 of the 1,708 participants (a response rate of 92.74%). Ordinary least squares (OLS) regression models were used to identify the correlation between COVID-19 worry and mental health.

Results

Approximately 42.05% of participants reported that they were very worried or extremely worried about the COVID-19 pandemic. COVID-19 worry was negatively correlated with mental health (p < 0.01) and exhibited a stronger influence on the mental health of participants who were male, younger (aged 16–45), or unemployed than on the mental health of participants who were women, older (aged over 45), or employed.

Conclusion

The findings suggest that COVID-19 worry has generated new inequalities in mental health among the EAP of China. The government should provide more public reassurance and psychological support to the EAP to mitigate the effects of COVID-19 worry and prevent mental health disorders.

Compassion and complex interpersonal trauma in adolescence: An early systematic review

BACKGROUND

Whilst childhood trauma has been identified as a transdiagnostic risk factor for poly-psychopathology, compassion-focused interventions have emerged as transdiagnostic treatment modality. However, no previous systematic review has specifically explored the relationship between complex interpersonal trauma and compassion in adolescence. The aim of this early systematic review was to evaluate the existing evidence on the role of compassion in adolescents with complex interpersonal trauma.

METHODS

A systematic search of electronic databases was undertaken to identify cross-sectional and intervention studies that examined the role of compassion in the amelioration of psychopathology in adolescence.

RESULTS

Nine studies, including three intervention studies and six cross-sectional studies, met the inclusion criteria. The findings suggested a mediating role of compassion in trauma-specific and overall psychopathology.

CONCLUSION

Despite the dearth of research, this review suggests that integrating compassion might mediate the relationship between complex trauma and psychopathology in adolescents.

Mode of delivery and short-term maternal mental health: A follow-up study in the Danish National Birth Cohort

OBJECTIVE

To estimate associations between mode of delivery and maternal mental health 6 months postpartum.

METHODS

Follow-up of mothers in the Danish National Birth Cohort. Symptoms of anxiety, depression or stress were self-reported at gestational week 30 and 6 months postpartum. Mode of delivery was categorized as spontaneous vaginal birth, instrumental vaginal birth, planned cesarean section and emergency cesarean section. Multiple linear and logistic regression models were used to compute differences and odds ratios (ORs) with 95% confidence intervals (CIs) for associations between delivery mode and mental health indicators adjusted for mental health before and during pregnancy.

RESULTS

Among 54 474 mothers, mental health indicators improved from pregnancy to 6 months postpartum for all delivery modes. Improvement was smallest in mothers with emergency cesarean section. Thus, compared to women with a spontaneous vaginal birth, women with emergency cesarean section more frequently reported symptoms of anxiety (OR 1.11; 0.98-1.24), depression (OR 1.25; 1.09-1.43) and stress (OR 1.14; 1.01-1.29) 6 months postpartum, and women with planned cesarean section more frequently reported symptoms of anxiety (OR 1.15; 1.01-1.29).

CONCLUSION

Mental health improved from pregnancy to 6 months postpartum regardless of delivery mode. Mothers with emergency cesarean section experienced more symptoms of emotional distress 6 months postpartum.