1
|
Giakas A, Mangold K, Androulakis A, Hyduke N, Galynker I, Thiam M, Cai G, Androulakis XM. Risks of suicide in migraine, non-migraine headache, back, and neck pain: a systematic review and meta-analysis. Front Neurol 2023; 14:1160204. [PMID: 37153662 PMCID: PMC10157105 DOI: 10.3389/fneur.2023.1160204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/30/2023] [Indexed: 05/10/2023] Open
Abstract
Objective To conduct a systematic review and meta-analysis on suicidal ideation, attempts, and death in patients with head, neck, and back pain. Method Search was performed using PubMed, Embase, and Web of Science from the date of the first available article through September 31, 2021. A random effects model was used to estimate the pooled odds ratios (ORs) and 95% confidence intervals (95% CI) for the association between suicidal ideation and/or attempt and head, back/neck pain conditions. Articles describing non-migraine headache disorders and death by suicide were also reviewed but not included in the meta-analysis due to an insufficient number of studies. Results A total of 20 studies met criteria for systemic review. A total of 186,123 migraine patients and 135,790 of neck/back pain patients from 11 studies were included in the meta-analysis. The meta-analysis showed that the estimated risk of combined suicidal ideation and attempt in migraine [OR 2.49; 95% CI: 2.15-2.89] is greater than that in back/neck pain pain [OR 2.00; 95% CI: 1.63-2.45] compared to non-pain control groups. Risk of suicide ideation/planning is 2 folds higher [OR: 2.03; 95% CI: 1.92-2.16] and risk of suicide attempt is more than 3 folds higher [OR: 3.47; 95% CI: 2.68-4.49] in migraine as compared to healthy controls. Conclusion There is an elevated risk of suicidal ideation and attempt in both migraine and neck/back pain patients in comparison to healthy controls, and this risk is particularly higher among migraine patients. This study underscores the critical need for suicide prevention in migraine patients.
Collapse
Affiliation(s)
- Alec Giakas
- Department of Orthopedic Surgery, University of South Carolina School of Medicine, Columbia, SC, United States
| | - Kiersten Mangold
- Department of Exercise Science, University of South Carolina, Columbia, SC, United States
| | - Anthony Androulakis
- Department of Biological Sciences, University of South Carolina, Columbia, SC, United States
| | - Noah Hyduke
- Department of Psychiatry, University of South Carolina School of Medicine, Columbia, SC, United States
| | - Igor Galynker
- Department of Psychiatry, Beth Israel Medical Center, New York, NY, United States
| | - Melinda Thiam
- Department of Psychiatry, New Mexico VA Hospital System, Albuquerque, NM, United States
| | - Guoshuai Cai
- Department of Environmental Health Sciences, University of South Carolina, Columbia, SC, United States
| | - X. Michelle Androulakis
- Department of Neurology, Columbia VA Healthcare System, Columbia, SC, United States
- Department of Neurology, University of South Carolina School of Medicine, Columbia, SC, United States
- *Correspondence: X. Michelle Androulakis
| |
Collapse
|
2
|
Tański W, Dudek K, Adamowski T. Work Ability and Quality of Life in Patients with Rheumatoid Arthritis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13260. [PMID: 36293837 PMCID: PMC9603111 DOI: 10.3390/ijerph192013260] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Reduced work participation has social implications (sickness absence, economic impact) and consequences for the individual patient (impoverishment, depression, limited social interaction). As patients with rheumatoid arthritis (RA) are more likely to experience job loss and/or at-work productivity loss and are at higher risk of sickness absence and, ultimately, permanent work productivity, consideration should be given to the association between work productivity or partial work capacity and quality of life (QoL). The aim of the study was to assess the relationship between QoL and the risk of work disability, as well as to estimate the risk of a future event and identify factors affecting the risk of work disability in RA inpatients. MATERIAL AND METHODS This cross-sectional study included 142 inpatients (65 male) aged 47 (38-58) years, who met the established criteria for a diagnosis of RA and treatment with biologic drugs. Only standardized tools were used to examine the patients: WHOQOL-BREF, MFIS and AS-WIS. RESULTS An analysis of the QoL scores on the WHOQOL-BREF demonstrated that the patients' QoL was lowest in the physical health domain and highest in the social relationships domain. The median WHOQOL-BREF total score in the group studied was 62.8, which indicates a moderate QoL. The median total score for the risk of work disability (AS-WIS) was 10.1, which indicates that the level of risk of work disability in the patients was higher than the average level reported in the literature. A multivariate analysis showed that the following were significant independent determinants of a higher risk of work disability: low QoL in the WHOQOL-BREF physical health (β = 0.961; p = 0.029) and psychological health (β = 1.752; p = 0.002) domains, being in a relationship (β = 0.043; p = 0.005) and the use of opioids for pain (β = 3.054; p = 0.012). CONCLUSIONS RA patients presented with moderate QoL, moderate fatigue (MFIS) and high risk of disability (AS-WIS). There is an association between a high risk of work disability and lower QoL, especially in the physical and psychological health domains. The lower the QoL in those domains, the higher the risk of work disability. The identification of factors increasing the risk of work disability will help in planning tailored interventions to improve at-work productivity loss and thus prevent work disability.
Collapse
Affiliation(s)
- Wojciech Tański
- Department of Internal Medicine, 4th Military Teaching Hospital, R. Weigla 5, 50-981 Wrocław, Poland
| | - Krzysztof Dudek
- Department of Transport Systems, Faculty of Mechanical Engineering, University of Technology, 50-370 Wrocław, Poland
| | - Tomasz Adamowski
- Department of Nursing and Obstetrics, Wroclaw Medical University, 51-618 Wrocław, Poland
| |
Collapse
|
3
|
Benacek J, Martin-Key NA, Barton-Owen G, Metcalfe T, Schei TS, Sarah Han SY, Olmert T, Cooper JD, Eljasz P, Farrag LP, Friend LV, Bell E, Cowell D, Tomasik J, Bahn S. Personality, symptom, and demographic correlates of perceived efficacy of selective serotonin reuptake inhibitor monotherapy among current users with low mood: A data-driven approach. J Affect Disord 2021; 295:1122-1130. [PMID: 34706424 DOI: 10.1016/j.jad.2021.08.088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 07/31/2021] [Accepted: 08/26/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Selective serotonin reuptake inhibitors (SSRIs) are often the first-line treatment option for depressive symptoms, however their efficacy varies across patients. Identifying predictors of response to SSRIs could facilitate personalised treatment of depression and improve treatment outcomes. The aim of this study was to develop a data-driven formulation of demographic, personality, and symptom-level factors associated with subjective response to SSRI treatment. METHODS Participants were recruited online and data were collected retrospectively through an extensive digital mental health questionnaire. Extreme gradient boosting classification with nested cross-validation was used to identify factors distinguishing between individuals with low (n=37) and high (n=111) perceived benefit from SSRI treatment. RESULTS The algorithm demonstrated a good predictive performance (test AUC=.88±.07). Positive affectivity was the strongest predictor of response to SSRIs and a major confounder of the remaining associations. After controlling for positive affectivity, as well as current wellbeing, severity of current depressive symptoms, and multicollinearity, only low positive affectivity, chronic pain, sleep problems, and unemployment remained significantly associated with diminished subjective response to SSRIs. LIMITATIONS This was an exploratory analysis of data collected at a single time point, for a study which had a different primary aim. Therefore, the results may not reflect causal relationships, and require validation in future prospective studies. Furthermore, the data were self-reported by internet users, which could affect integrity of the dataset and limit generalisability of the results. CONCLUSIONS Our findings suggest that demographic, personality, and symptom data may offer a potential cost-effective and efficient framework for SSRI treatment outcome prediction.
Collapse
Affiliation(s)
- Jiri Benacek
- Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
| | - Nayra A Martin-Key
- Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
| | | | | | | | - Sung Yeon Sarah Han
- Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
| | - Tony Olmert
- Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
| | - Jason D Cooper
- Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
| | - Pawel Eljasz
- Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK
| | | | | | | | | | - Jakub Tomasik
- Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK; Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Drive, Cambridge CB3 0AS, UK.
| | - Sabine Bahn
- Cambridge Centre for Neuropsychiatric Research, Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge, UK; Psyomics Ltd., Cambridge, UK; Department of Chemical Engineering and Biotechnology, University of Cambridge, Philippa Fawcett Drive, Cambridge CB3 0AS, UK.
| |
Collapse
|
4
|
Bezerra HDS, Alves RM, Nunes ADD, Barbosa IR. Prevalence and Associated Factors of Common Mental Disorders in Women: A Systematic Review. Public Health Rev 2021; 42:1604234. [PMID: 34692182 PMCID: PMC8419231 DOI: 10.3389/phrs.2021.1604234] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/06/2021] [Indexed: 11/20/2022] Open
Abstract
Objectives: To identify the prevalence and factors associated with common mental disorders in adult women. Methods: Searches were carried out in the PubMed, Web of Science, Science Direct, Scopus, Cinahl, Google Scholar and Open Gray databases. The study protocol was registered with PROSPERO under number CRD42020168231. Cross-sectional studies showing the prevalence of common mental disorders in women over 18 years were included. Studies with men, children and pregnant women of another age group and with other mental disorders and other types of studies were excluded. The Joanna Briggs Institute checklist was used to assess the risk of bias. Results: Nineteen studies were included in this review. The prevalence of CMD ranged from 9.6% to 69.3%. The main associated factors were unemployment, indebtedness, low income, being a housewife, smoking, low education, poor self-rated health, being single, divorced or widowed. The risk of bias in the studies was classified as low and moderate. Conclusion: This review revealed a variable prevalence rate of CMD in adult women. Public policies are needed to create strategies to prevent the mental illness of these women.
Collapse
|
5
|
Yang YC, Cai GQ, Yang QC, Li B, Ge QM, Li QY, Shi WQ, Min YL, Liang RB, Shao Y. Brain Functional Connectivity Changes in Patients with Acute Eye Pain: A Resting-State Functional Magnetic Resonance Imaging (fMRI) Study. Med Sci Monit 2021; 27:e930588. [PMID: 34388144 PMCID: PMC8369943 DOI: 10.12659/msm.930588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background By using functional magnetic resonance imaging (fMRI), we aimed to study the changes in potential brain function network activity in patients with acute eye pain. Also, by using the voxel-wise degree centrality (DC) method, we aimed to explore the relationship between spontaneous brain activity and the clinical features of patients with acute eye pain. Material/Methods A total of 15 patients with acute eye pain (5 women and 10 men; EP group) and 15 healthy controls (5 women and 10 men; HC group), were scanned by fMRI. The DC method was used to evaluate changes in spontaneous brain activity. Receiver operating characteristic (ROC) curves were analyzed, and Pearson correlation analysis was used to study the relationship between DC values and clinical manifestations in different regions of brain. Results The area of the left limbic lobe showed a reduction in DC value in patients in the EP group. DC values were elevated in the left cerebellum posterior lobe, left inferior parietal lobule, left inferior temporal gyrus, left precuneus, and right cerebellum posterior lobe in the EP group. The visual analog scale value of the eyes in the EP group was negatively correlated with the left limbic lobe signal value and positively correlated with the left inferior parietal lobule signal value. Further, the scores of the hospital anxiety and depression scale and DC value of the left limbic lobe were negatively correlated. Conclusions Compared with the HC group, patients with acute eye pain had abnormal patterns of intrinsic brain activity in different brain regions, which may help reveal the potential neural mechanisms involved in eye pain.
Collapse
Affiliation(s)
- Yan-Chang Yang
- Department of Anesthesiology, Nanchang University, Nanchang, Jiangxi, China (mainland)
| | - Guo-Qian Cai
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, Jiangxi, China (mainland)
| | - Qi-Chen Yang
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China (mainland)
| | - Biao Li
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, Jiangxi, China (mainland)
| | - Qian-Min Ge
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, Jiangxi, China (mainland)
| | - Qiu-Yu Li
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, Jiangxi, China (mainland)
| | - Wen-Qing Shi
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, Jiangxi, China (mainland)
| | - You-Lan Min
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center, Nanchang, Jiangxi, China (mainland)
| | - Rong-Bin Liang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center,, Nanchang, Jiangxi, China (mainland)
| | - Yi Shao
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Jiangxi Province Ocular Disease Clinical Research Center,, Nanchang, Jiangxi, China (mainland)
| |
Collapse
|
6
|
Heterogeneity of Treatment Effects in a Randomized Trial of Literacy-Adapted Group Cognitive-Behavioral Therapy, Pain Psychoeducation, and Usual Medical Care for Multiply Disadvantaged Patients With Chronic Pain. THE JOURNAL OF PAIN 2019; 20:1236-1248. [DOI: 10.1016/j.jpain.2019.04.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 03/16/2019] [Accepted: 04/16/2019] [Indexed: 12/17/2022]
|
7
|
Swan AA, Amuan ME, Morissette SB, Finley EP, Eapen BC, Jaramillo CA, Pugh MJ. Long-term physical and mental health outcomes associated with traumatic brain injury severity in post-9/11 veterans: A retrospective cohort study. Brain Inj 2018; 32:1637-1650. [DOI: 10.1080/02699052.2018.1518539] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Alicia A. Swan
- South Texas Veterans Health Care System, San Antonio, TX, USA
| | - Megan E. Amuan
- Center for Health Care Organization and Implementation Research, Edith Nourse Rogers VA Medical Center, Bedford, MA, USA
| | - Sandra B. Morissette
- Department of Psychology, The University of Texas at San Antonio, San Antonio, TX, USA
| | - Erin P. Finley
- Department of Psychology, The University of Texas at San Antonio, San Antonio, TX, USA
| | | | | | - Mary Jo Pugh
- IDEAS 2.0 Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, UT, USA
- Division of Epidemiology, Department of Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| |
Collapse
|
8
|
Gilpin HR, Stahl DR, McCracken LM. A theoretically guided approach to identifying predictors of treatment outcome in Contextual Cognitive Behavioural Therapy for chronic pain. Eur J Pain 2018; 23:354-366. [PMID: 30176099 DOI: 10.1002/ejp.1310] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 08/17/2018] [Accepted: 08/24/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Psychological treatments are known to be effective for chronic pain, but little is understood about which patients are most likely to benefit from which ones. METHODS The study reported here included 609 people who attended a residential, interdisciplinary, pain management programme based on Acceptance and Commitment Therapy between January 2012 and August 2014. A flexible and theoretically guided approach to model building based on fractional polynomials was used to identify potential predictors of outcome in domains of emotional, physical and social functioning and pain intensity. Variables considered for inclusion were baseline demographic variables along with measures reflecting processes of psychological flexibility, including acceptance, cognitive defusion and committed action. RESULTS Employment status, level of distress, decentring (a process like cognitive defusion) and acceptance significantly contributed to the model above and beyond the effects of other baseline variables. The unique effects of these were small but may be clinically relevant. CONCLUSIONS Future research should continue to investigate moderators of treatment outcome and to explicitly link these to treatment mechanisms. Taking a flexible, theoretically driven approach to modelling continuous outcomes may be valuable in furthering our understanding of which patients might respond best to which treatments. SIGNIFICANCE Further research is needed to better understand who benefits most from psychological treatments for chronic pain. This study suggests that a flexible, multivariate and theoretical approach to identifying predictors of outcome may be valuable in furthering research in this area.
Collapse
Affiliation(s)
- Helen R Gilpin
- INPUT Pain Management, Guys and St.Thomas NHS Foundation Trust Hospitals, London, UK.,Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Daniel R Stahl
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Lance M McCracken
- INPUT Pain Management, Guys and St.Thomas NHS Foundation Trust Hospitals, London, UK.,Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| |
Collapse
|
9
|
Newman AK, Kapoor S, Thorn BE. Health Care Utilization for Chronic Pain in Low-Income Settings. PAIN MEDICINE 2018; 19:2387-2397. [DOI: 10.1093/pm/pny119] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Andrea K Newman
- Psychology Department, The University of Alabama, Tuscaloosa, Alabama
| | - Shweta Kapoor
- Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Beverly E Thorn
- Psychology Department, The University of Alabama, Tuscaloosa, Alabama
| |
Collapse
|
10
|
Tang LY, Li HJ, Huang X, Bao J, Sethi Z, Ye L, Yuan Q, Zhu PW, Jiang N, Gao GP, Shao Y. Assessment of synchronous neural activities revealed by regional homogeneity in individuals with acute eye pain: a resting-state functional magnetic resonance imaging study. J Pain Res 2018; 11:843-850. [PMID: 29719418 PMCID: PMC5916265 DOI: 10.2147/jpr.s156634] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Objective Previous neuroimaging studies have demonstrated that pain-related diseases are associated with brain function and anatomical abnormalities, whereas altered synchronous neural activity in acute eye pain (EP) patients has not been investigated. The purpose of this study was to explore whether or not synchronous neural activity changes were measured with the regional homogeneity (ReHo) method in acute EP patients. Methods A total of 20 patients (15 males and 5 females) with EP and 20 healthy controls (HCs) consisting of 15 and 5 age-, sex-, and education-matched males and females, respectively, underwent resting-state functional magnetic resonance imaging. The ReHo method was applied to assess synchronous neural activity changes. Results Compared with HCs, acute EP patients had significantly lower ReHo values in the left precentral/postcentral gyrus (Brodmann area [BA]3/4), right precentral/postcentral gyrus (BA3/4), and left middle frontal gyrus (BA6). In contrast, higher ReHo values in acute EP patients were observed in the left superior frontal gyrus (BA11), right inferior parietal lobule (BA39/40), and left precuneus (BA7). However, no relationship was found between the mean ReHo signal values of the different areas and clinical manifestations, which included both the duration and degree of pain in EP patients. Conclusion Our study highlighted that acute EP patients showed altered synchronous neural activities in many brain regions, including somatosensory regions. These findings might provide useful information for exploration of the neural mechanisms underlying acute EP.
Collapse
Affiliation(s)
- Li-Yuan Tang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Hai-Jun Li
- Department of Radiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xin Huang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jing Bao
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Zubin Sethi
- The Department of Medicine, University of Miami, Coral Gables, FL, USA
| | - Lei Ye
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Qing Yuan
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Pei-Wen Zhu
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Nan Jiang
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Gui-Ping Gao
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Yi Shao
- Department of Ophthalmology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| |
Collapse
|
11
|
The relationship of sociodemographic and psychological variables with chronic pain variables in a low-income population. Pain 2017; 158:1687-1696. [DOI: 10.1097/j.pain.0000000000000964] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
12
|
Haldar P, Sagar R, Malhotra S, Kant S. Burden of psychiatric morbidity among attendees of a secondary level hospital in Northern India: Implications for integration of mental health care at subdistrict level. Indian J Psychiatry 2017; 59:176-182. [PMID: 28827864 PMCID: PMC5547858 DOI: 10.4103/psychiatry.indianjpsychiatry_324_16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND There is little information available on the type, pattern, trend, and demographic differentials of psychiatric cases attending a subdistrict level facility in India. Our objectives were to describe the sociodemographic profile of the patients availing the psychiatric outpatient department services and document the diagnosis. MATERIALS AND METHODS This study is based on a retrospective analysis of routinely recorded administrative data collected during psychiatry consultations that took place between January 2010 and June 2014, at the subdistrict level hospital, Ballabgarh, Faridabad district, Haryana, Northern India. The data were abstracted in Microsoft Excel, scrutinized for duplicates, and cleaned in terms of the International Classification of Diseases 10th Revision coding. Descriptive analysis was done for dependent variables and continuous variables were compared using independent t-test. RESULTS A total of 2806 people (new registrations) were provided psychiatric consultations between January 2010 and June 2014. The mean age of males was 33.7 years (95% confidence interval [CI], 32.9, 34.5) and of females was 35.6 years (95% CI, 34.9, 36.3). Neurotic, stress-related, and somatoform disorders (F40-F48) comprised the major category of diagnoses with 661 cases (24%), followed by unspecified mental disorders (F99) with 528 cases (19%), mood (affective) disorders (F30-F39) with 448 cases (16%), and episodic and paroxysmal disorders (G40-G47) with 334 cases (12%). CONCLUSIONS We reported an increase in level and trend in the monthly attendance of patients who required psychiatric at a secondary care hospital in Northern India. We suggest that setting up of mental health units only at district hospital might not be a sufficient health system's approach as has been envisaged under the District Mental Health Program.
Collapse
Affiliation(s)
- Partha Haldar
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Sumit Malhotra
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shashi Kant
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| |
Collapse
|
13
|
Zale EL, Maisto SA, Ditre JW. Interrelations between pain and alcohol: An integrative review. Clin Psychol Rev 2015; 37:57-71. [PMID: 25766100 PMCID: PMC4385458 DOI: 10.1016/j.cpr.2015.02.005] [Citation(s) in RCA: 162] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 02/16/2015] [Accepted: 02/17/2015] [Indexed: 11/23/2022]
Abstract
Pain and alcohol use are both highly prevalent in the general population, and pain-alcohol interrelations are of increasing empirical interest. Previous research has identified associations between pain and alcohol dependence, and the current review provides novel contributions to this emerging domain by incorporating studies that have tested relations between pain and low-to-moderate alcohol consumption, and by identifying potential psychosocial mechanisms of action. Specifically, we sought to integrate evidence of pain-alcohol relations derived from two directions of empirical inquiry (i.e., effects of alcohol on pain and effects of pain on alcohol use) across psychological, social, and biological literatures. We observed converging evidence that associations between alcohol consumption and pain may be curvilinear in nature. Whereas moderate alcohol use was observed to be associated with positive pain-related outcomes (e.g., greater quality of life), excessive drinking and alcohol use disorder appear to be associated with deleterious pain-related outcomes (e.g., greater pain severity). We also observed evidence that alcohol administration confers acute pain-inhibitory effects, and that situational pain may motivate alcohol consumption (e.g., drinking for pain-coping). Future research can inform theoretical and clinical applications through examination of temporal relations between pain and alcohol consumption, tests of hypothesized mechanisms, and the development of novel interventions.
Collapse
Affiliation(s)
- Emily L Zale
- Syracuse University, Syracuse, NY 13244, United States
| | - Stephen A Maisto
- Syracuse University, Syracuse, NY 13244, United States; Center for Integrated Healthcare, Syracuse Veteran's Affairs Medical Center, Syracuse, NY 13210, United States
| | - Joseph W Ditre
- Syracuse University, Syracuse, NY 13244, United States; Center for Integrated Healthcare, Syracuse Veteran's Affairs Medical Center, Syracuse, NY 13210, United States.
| |
Collapse
|
14
|
Beckett MK, Elliott MN, Clemens JQ, Ewing B, Berry SH. Consequences of interstitial cystitis/bladder pain symptoms on women's work participation and income: results from a national household sample. J Urol 2013; 191:83-8. [PMID: 23872030 DOI: 10.1016/j.juro.2013.07.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE We describe differences in work participation and income by bladder symptom impact and comorbidities among women with interstitial cystitis/bladder pain syndrome. MATERIALS AND METHODS Cross-sectional data from 2,767 respondents younger than 65 years identified with interstitial cystitis/bladder pain syndrome symptoms were analyzed. The data were taken from the RAND Interstitial Cystitis Epidemiology (RICE) survey, and included retrospective self-reports of interstitial cystitis/bladder pain syndrome impact, severity, years since onset, related comorbidities (depressive symptomatology, number of conditions), work participation and income, and personal characteristics. Multiple regressions predicted 5 current work outcomes of works now, kept from working by pain, missed work days, days worked when bothered by symptoms and real income change since symptom onset. RESULTS Controlling for work status at symptom onset and personal characteristics, greater bladder symptom impact predicted a greater likelihood of not now working, kept more days from working by pain, missed more work days and working more days with symptoms. More depressive symptomatology and greater number of comorbidities predicted reduced work participation. Women experienced no growth in real income since symptom onset. Measures of symptom severity were not associated with any of the economic outcomes. CONCLUSIONS Greater interstitial cystitis/bladder pain syndrome symptom impact, depressive symptomatology and count of comorbidities (but not symptom severity) were each associated with less work participation and leveling of women's long-term earnings. Management of bladder symptom impact on nonwork related activities and depressive symptomatology may improve women's work outcomes.
Collapse
Affiliation(s)
| | | | - J Quentin Clemens
- Department of Urology, University of Michigan Medical Center, Ann Arbor, Michigan
| | | | | |
Collapse
|
15
|
Zale EL, Lange KL, Fields SA, Ditre JW. The relation between pain-related fear and disability: a meta-analysis. THE JOURNAL OF PAIN 2013; 14:1019-30. [PMID: 23850095 DOI: 10.1016/j.jpain.2013.05.005] [Citation(s) in RCA: 210] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 03/24/2013] [Accepted: 05/20/2013] [Indexed: 01/21/2023]
Abstract
UNLABELLED Within a biopsychosocial framework, psychological factors are thought to play an important role in the onset and progression of chronic pain. The cognitive-behavioral fear-avoidance model of chronic pain suggests that pain-related fear contributes to the development and maintenance of pain-related disability. However, investigations of the relation between pain-related fear and disability have demonstrated considerable between-study variation. The main goal of the current meta-analysis was to synthesize findings of studies investigating cross-sectional associations between pain-related fear and disability in order to estimate the magnitude of this relation. We also tested potential moderators, including type of measure used, demographic characteristics, and relevant pain characteristics. Searches in PubMed and PsycINFO yielded a total of 46 independent samples (N = 9,579) that reported correlations between pain-related fear and disability among persons experiencing acute or chronic pain. Effect size estimates were generated using a random-effects model and artifact distribution method. The positive relation between pain-related fear and disability was observed to be moderate to large in magnitude, and stable across demographic and pain characteristics. Although some variability was observed across pain-related fear measures, results were largely consistent with the fear-avoidance model of chronic pain. PERSPECTIVE Results of this meta-analysis indicate a robust, positive association between pain-related fear and disability, which can be classified as moderate to large in magnitude. Consistent with the fear-avoidance model of chronic pain, these findings suggest that pain-related fear may be an important target for treatments intended to reduce pain-related disability.
Collapse
|
16
|
Schofield DJ, Callander EJ, Shrestha RN, Passey ME, Percival R, Kelly SJ. The indirect economic impacts of co-morbidities on people with depression. J Psychiatr Res 2013; 47:796-801. [PMID: 23507049 DOI: 10.1016/j.jpsychires.2013.02.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 02/20/2013] [Accepted: 02/27/2013] [Indexed: 11/29/2022]
Abstract
It is known that people with depression often have other co-morbid conditions; however this is rarely acknowledged in studies that access the economic impacts of depression. This paper aims to quantify the association between co-morbid health conditions and labour force status and economic circumstances of people with depression. This study undertakes cross-sectional analysis using a dataset that is representative of the 45-64 year old Australian population with depression. The probability of being out of the labour force increases with increasing number of co-morbidities, and the amount of weekly income received by people with depression decreased with increasing numbers of co-morbidities. Those with depression and three or more co-morbidities were 4.31 times more likely to be out of the labour force (95% CI: 1.74-10.68), and received a weekly private income 88% lower (95% CI: -94%, -75%) than people with depression alone. It is important to consider the co-morbid conditions an individual has when assessing the impact of depression on labour force participation and economic circumstances.
Collapse
|
17
|
Gayman MD, Pai M, Kail BL, Taylor MG. Reciprocity between depressive symptoms and physical limitations pre- and postretirement: exploring racial differences. J Aging Health 2013; 25:555-73. [PMID: 23509115 DOI: 10.1177/0898264313480239] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study assesses (a) the reciprocity between mental and physical health pre- and postretirement, and (b) the extent to which these associations vary by race. METHOD Data are from the 1994 to 2008 waves of the Health and Retirement Study. RESULTS Analyses based on structural equation modeling reveal that depression and physical health exert reciprocal effects for Whites pre- and postretirement. For Blacks preretirement, physical limitations predict changes in depression but there is no evidence of the reverse association. Further, the association between physical limitations and changes in depressive symptoms among Blacks is no longer significant after retirement. DISCUSSION The transition into retirement alleviates the translation of physical limitations into depressive symptoms for Blacks only. The findings underscore the relevance of retirement for reciprocity between mental and physical health and suggest that the health implications associated with this life course transition vary by race.
Collapse
Affiliation(s)
- Mathew D Gayman
- Department of Sociology, Georgia State University, Atlanta, GA 30302-5020, USA.
| | | | | | | |
Collapse
|
18
|
Influences of Labour Participation Among Persons With Disabilities: A Systematic Review and Best Evidence Synthesis. ACTA ACUST UNITED AC 2012. [DOI: 10.1017/idm.2012.5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A systematic literature review was conducted to assess the individual, organisation, societal, and legal influences of labour participation among individuals with a disability.Methods: Nine databases were searched, for peer-reviewed studies of individual, organisation, societal, and legal influences among disabled populations published between 1990 and 2010.Results: Of a total of 809 papers initially selected, only 46 studies were deemed to be of sufficient quality to be included in the review.Conclusions: Numerous studies have examined labour participation among persons with physical disabilities, some among persons with chronic disabilities, and few among persons with mental disabilities. Strong evidence was found for individual and organisation influences of labour participation among persons with physical disabilities in particular pain, catastrophising, job strain, and support. Only individual influences provided strong evidence among persons with chronic disabilities and no influences provided strong evidence among those with mental disabilities. The results are presented along with methodological weaknesses and future recommendations.
Collapse
|
19
|
Valkanoff TA, Kline-Simon AH, Sterling S, Campbell C, Von Korff M. Functional disability among chronic pain patients receiving long-term opioid treatment. ACTA ACUST UNITED AC 2012; 11:128-42. [PMID: 22630601 DOI: 10.1080/1536710x.2012.677653] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study of 2,163 adult chronic, non-cancer-pain, long-term opioid therapy patients examines the relationship of depression to functional disability by measuring average pain interference, activity limitation days, and employment status. Those with more depression symptoms compared to those with fewer were more likely to have worse disability on all 3 measures (average pain interference score >5, OR = 5.36, p < .0001; activity limitation days ≥ 30, OR = 4.05, p < .0001; unemployed due to health reasons, OR = 4.06, p < .0001). Depression might play a crucial role in the lives of these patients; identifying and treating depression symptoms in chronic pain patients should be a priority.
Collapse
Affiliation(s)
- Tina A Valkanoff
- Division of Research, Kaiser Permanente Northern California, Oakland, CA 94612, USA.
| | | | | | | | | |
Collapse
|
20
|
Wang SJ, Rushiti F, Sejdiu X, Pacolli S, Gashi B, Salihu F, Modvig J. Survivors of war in northern Kosovo (III): The role of anger and hatred in pain and PTSD and their interactive effects on career outcome, quality of sleep and suicide ideation. Confl Health 2012; 6:4. [PMID: 22846511 PMCID: PMC3492011 DOI: 10.1186/1752-1505-6-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2011] [Accepted: 07/12/2012] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED BACKGROUND The management of chronic debilitating health conditions after trauma remains a challenge in post-conflict settings. The study aimed to expand current understanding of the diagnostic overlap of pain and PTSD and explore their independent and interactive effect on career change, sleep disorder and suicide ideation. The role of anger and hatred as contributing factors to the persistence of pain and PTSD were also examined. METHODS 125 victims of torture and massive violence identified in a household survey took part in the in-depth assessment. Socio-demographic data and information on trauma, emotional disturbance, injuries and medication history were collected. PTSD was diagnosed according to DSM-IV criteria. Pain was assessed using the McGill Pain Questionnaire and the Margolis Pain Diagram. RESULTS Nearly 95% participants experienced pain during the last 2 weeks, 47% were diagnosed with PTSD, 50% were taking medication against depression and anxiety. There is substantial overlap of pain, PTSD and emotional disturbance. Injury history, PTSD and negative emotions were related to the pain score and the number of pain locations. Anger, hatred or an inferiority complex particularly amplified pain experience. Headache was constant and especially prevalent in those with recent experience of anger, aggressiveness and hatred. The risk of having chest and abdominal pain within 2 weeks was very high in those who had chest injury and had recently been crying. An increased risk of changing jobs or stopping work or schooling due to depression or injury was observed for those with a higher pain score, and for pain in neck, shoulder and upper limbs. The prevalence of sleep disorders was 80%, that of suicide ideation 70%, and these were found to be associated with greater pain and anger. PTSD was also related to suicide ideation. CONCLUSIONS The findings provide an overview of pain characteristics in individuals with PTSD and injury and confirm the hypothesized effects on career outcome, sleep disorders and suicide ideation. The study revealed a high level of persistent anger and hatred. The findings suggest the need for new approaches to rehabilitation in a post-war setting, including ways in which to address collective emotional hurt in the society.
Collapse
Affiliation(s)
- Shr-Jie Wang
- Rehabilitation and Research Centre for Torture Victims (RCT), Copenhagen, Denmark.
| | | | | | | | | | | | | |
Collapse
|
21
|
Ditre JW, Brandon TH, Zale EL, Meagher MM. Pain, nicotine, and smoking: research findings and mechanistic considerations. Psychol Bull 2012; 137:1065-93. [PMID: 21967450 DOI: 10.1037/a0025544] [Citation(s) in RCA: 237] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Tobacco addiction and chronic pain represent 2 highly prevalent and comorbid conditions that engender substantial burdens upon individuals and systems. Interrelations between pain and smoking have been of clinical and empirical interest for decades, and research in this area has increased dramatically over the past 5 years. We conceptualize the interaction of pain and smoking as a prototypical example of the biopsychosocial model. Accordingly, we extrapolated from behavioral, cognitive, affective, biomedical, and social perspectives to propose causal mechanisms that may contribute to the observed comorbidity between these 2 conditions. The extant literature was 1st dichotomized into investigations of either effects of smoking on pain or effects of pain on smoking. We then integrated these findings to present a reciprocal model of pain and smoking that is hypothesized to interact in the manner of a positive feedback loop, resulting in greater pain and increased smoking. Finally, we proposed directions for future research and discussed clinical implications for smokers with comorbid pain disorders. We observed modest evidence that smoking may be a risk factor in the multifactorial etiology of some chronically painful conditions and that pain may come to serve as a potent motivator of smoking. We also found that whereas animal studies yielded consistent support for direct pain-inhibitory effects of nicotine and tobacco, results from human studies were much less consistent. Future research in the emerging area of pain and smoking has the potential to inform theoretical and clinical applications with respect to tobacco smoking, chronic pain, and their comorbid presentation. (PsycINFO Database Record (c) 2011 APA, all rights reserved).
Collapse
Affiliation(s)
- Joseph W Ditre
- Department of Psychology, Texas A&M University, College Station, USA.
| | | | | | | |
Collapse
|
22
|
Braden JB, Young A, Sullivan MD, Walitt B, Lacroix AZ, Martin L. Predictors of change in pain and physical functioning among post-menopausal women with recurrent pain conditions in the women's health initiative observational cohort. THE JOURNAL OF PAIN 2012; 13:64-72. [PMID: 22208802 PMCID: PMC3249604 DOI: 10.1016/j.jpain.2011.10.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Revised: 07/03/2011] [Accepted: 10/05/2011] [Indexed: 12/12/2022]
Abstract
UNLABELLED Pain complaints are commonly reported symptoms among postmenopausal women and can have significant effects on health-related quality of life. We sought to identify medical and psychosocial factors that predict changes in pain and overall physical functioning over a 3-year period among postmenopausal women with recurrent pain conditions. We examined data from postmenopausal women age 50 to 79 with recurrent pain conditions (low back pain, neck pain, headache or migraines, or joint pain or stiffness) over a 3-year period using the Women's Health Initiative Observational Study Cohort (N = 67,963). Multinomial logistic regression models controlling for demographic and clinical characteristics were used to identify baseline predictors of change in the SF-36 subscales for pain and physical functioning between baseline and 3-year follow-up. Body mass index (BMI) was associated with worsening of pain (OR [95% CI] 1.54 [1.45-1.63] for BMI ≥30) and physical functioning (1.83 [1.71-1.95] for BMI ≥30). A higher reported number of nonpain symptoms, higher medical comorbidity, and a positive screen for depression (1.13 [1.05-1.22] for worsened pain) were also associated with worsening of pain and physical functioning. Baseline prescription opioid use was also associated with lack of improvement in pain (OR .42, 95% CI .36-.49) and with worsened physical functioning (1.25 [1.04-1.51]). PERSPECTIVE This study presents prospective data on change in pain and physical functioning in postmenopausal women over a 3-year period. Our results suggest depression, nonpain physical symptoms, obesity, and possibly opioid treatment are associated with worse long-term pain outcomes in this population.
Collapse
Affiliation(s)
- Jennifer Brennan Braden
- Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.
| | | | | | | | | | | |
Collapse
|
23
|
|
24
|
|
25
|
Braden JB, Sullivan MD, Ray GT, Saunders K, Merrill J, Silverberg MJ, Rutter CM, Weisner C, Banta-Green C, Campbell C, Von Korff M. Trends in long-term opioid therapy for noncancer pain among persons with a history of depression. Gen Hosp Psychiatry 2009; 31:564-70. [PMID: 19892215 PMCID: PMC2774904 DOI: 10.1016/j.genhosppsych.2009.07.003] [Citation(s) in RCA: 171] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2009] [Revised: 07/07/2009] [Accepted: 07/08/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE We report trends in long-term opioid use among patients with a history of depression from two large health plans. METHODS Using claims data, age- and gender-adjusted rates for long-term (>90 days) opioid use episodes were calculated for 1997-2005, comparing those with and without a depression diagnosis in the prior 2 years. Opioid use characteristics were calculated for those with a long-term episode in 2005. RESULTS Incident and prevalent long-term opioid use rates were three times higher in those with a history of depression. Prevalent long-term use per 1000 in patients with a history of depression increased from 69.8 to 125.9 at Group Health and from 84.3 to 117.5 at Kaiser Permanente of Northern California between 1997 and 2005. Those with a history of depression were more likely to receive a higher average daily dose, greater days supply, and Schedule II opioids than nondepressed persons. CONCLUSION Persons with a history of depression are more likely to receive long-term opioid therapy for noncancer pain than those without a history of depression. Results suggest that long-term opioid therapy for noncancer pain is being prescribed to a different population in clinical practice than the clinical trial populations where opioid efficacy has been established.
Collapse
Affiliation(s)
- Jennifer Brennan Braden
- Department of Psychiatry and Behavioral Sciences, Box 356560, University of Washington, Seattle, WA 98195-6560, USA.
| | - Mark D. Sullivan
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA
| | - G. Thomas Ray
- Division of Research, Kaiser Permanente of Northern California, Oakland, CA
| | | | - Joseph Merrill
- Department of Medicine, University of Washington, Seattle, WA
| | | | | | - Constance Weisner
- Division of Research, Kaiser Permanente of Northern California, Oakland, CA, Department of Psychiatry, University of California, San Francisco, CA
| | - Caleb Banta-Green
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA
| | - Cynthia Campbell
- Division of Research, Kaiser Permanente of Northern California, Oakland, CA
| | | |
Collapse
|