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Ee JS, Hing MS, Dogbey GY, Cook MA, Agnello RN, Skelly SK, Frost LS. Association Between Clinical Depression, Anxiety, and Chronic Pain in the Active Duty Army Personnel. Mil Med 2023; 188:311-315. [PMID: 37948263 DOI: 10.1093/milmed/usad126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/13/2023] [Accepted: 04/27/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Chronic pain is highly prevalent among soldiers leading to costly impacts on disability and readiness. Depression and anxiety (D&A) are frequently comorbid with chronic pain, but previous studies tend to focus on reporting the odds of co-occurrence. The aim of this study was to examine the association of properly diagnosed D&A disorders on chronic pain indicators among active duty soldiers. MATERIALS AND METHODS Data were drawn from the intake assessments of 203 soldiers seen at an Interdisciplinary Pain Management Center. The Diagnostic and Statistical Manual of Mental Disorders-5 diagnostic criteria and the D&A subscales of the Patient Health Questionnaire were used to identify patients who met criteria for clinical depression or anxiety. Of the 203 patients, 129 met neither depression nor anxiety criteria (No D&A), 12 met clinical depression criteria only, 16 met clinical anxiety only, and 46 showed coexisting D&A disorders. The D&A and No D&A groups were compared using validated measures to assess the pain intensity rating and pain effect on well-being, physical functioning, and catastrophizing tendency. Data were analyzed using descriptive statistics and independent samples t-test analyses. RESULTS Significant differences were found between the D&A and No D&A groups on all pain-related measures (all Ps < .001). Patients in the D&A group reported higher average intensity of pain (6.11 versus 5.05) and greater effect of pain on activity (6.91 versus 5.37), sleep (7.20 versus 4.90), emotional state (7.74 versus 4.47), and stress (8.13 versus 4.78). Depression and anxiety patients also reported higher pain-catastrophizing tendency (38.56 versus 18.50) and greater physical disability (18.20 versus 12.22). CONCLUSIONS Soldiers who have chronic pain with coexisting D&A disorders experience a greater degree of perceived negative impacts. Consequently, attentiveness to proper diagnosis and treatment of coexisting clinical mood disorders is an essential step in fully addressing chronic pain management.
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Affiliation(s)
- Juliana S Ee
- Womack Army Medical Center, Department of Family Medicine, Fort Bragg, NC 28310, USA
| | - Matthew S Hing
- Womack Army Medical Center, Department of Family Medicine, Fort Bragg, NC 28310, USA
| | - Godwin Y Dogbey
- Department of Research and Medical Education, Campbell University, Jerry M. Wallace School of Osteopathic Medicine, Lillington, NC 27546, USA
| | - Marc A Cook
- Department of Primary Care, Weed Army Community Hospital, Fort Irwin, CA 92310, USA
| | - Robert N Agnello
- Department of Family Medicine, Campbell University, Jerry M. Wallace School of Osteopathic Medicine, Lillington, NC 27546, USA
| | - Stephanie K Skelly
- Womack Army Medical Center, Department of Family Medicine, Fort Bragg, NC 28310, USA
| | - Landon S Frost
- Womack Army Medical Center, Department of Family Medicine, Fort Bragg, NC 28310, USA
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Amiri S. Exercise training and depression and anxiety in musculoskeletal pain patients: a meta-analysis of randomized control trials. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2023; 37:88-100. [PMID: 36125624 DOI: 10.1007/s40211-022-00431-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 08/14/2022] [Indexed: 06/03/2023]
Abstract
BACKGROUND Depression and anxiety in patients with musculoskeletal pain harm health and exercise can be effective in improving the condition of these patients. This study was aimed at systematically reviewing and providing a meta-analysis of the effect of exercise training on improving depression and anxiety in patients with musculoskeletal pain. METHODS The search was done in three databases including PubMed, the Cochrane Library, and Google Scholar up to August 2021. For each of the studies included in the meta-analysis, the mean, standard deviation, and sample size were extracted in the post-test, and the effect size was calculated. Publication bias and heterogeneity were assessed in studies at the end of the analysis. RESULTS Nineteen randomized control trials were included in the meta-analysis. Exercise training has a positive effect on depression in patients with musculoskeletal pain, so exercise reduces depression and Hedges' g was equal to -0.21, with confidence intervals of -0.40, -0.02. Exercise training has a positive effect on anxiety in patients with musculoskeletal pain, so exercise reduces anxiety and Hedges' g was equal to -0.63, with confidence intervals of -1.08, -0.19. CONCLUSIONS It was found that exercise training is effective in improving depression and anxiety in patients with musculoskeletal pain and therefore this treatment should be given more attention from clinical specialists.
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Affiliation(s)
- Sohrab Amiri
- Medicine, Quran and Hadith Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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Nguyen T, Behrens M, Broscheid KC, Bielitzki R, Weber S, Libnow S, Malczewski V, Baldauf L, Milberger X, Jassmann L, Wustmann A, Meiler K, Drange S, Franke J, Schega L. Associations between gait performance and pain intensity, psychosocial factors, executive functions as well as prefrontal cortex activity in chronic low back pain patients: A cross-sectional fNIRS study. Front Med (Lausanne) 2023; 10:1147907. [PMID: 37215712 PMCID: PMC10196398 DOI: 10.3389/fmed.2023.1147907] [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: 01/19/2023] [Accepted: 03/13/2023] [Indexed: 05/24/2023] Open
Abstract
Introduction Activities of daily living, such as walking, are impaired in chronic low back pain (CLBP) patients compared to healthy individuals. Thereby, pain intensity, psychosocial factors, cognitive functioning and prefrontal cortex (PFC) activity during walking might be related to gait performance during single and dual task walking (STW, DTW). However, to the best of our knowledge, these associations have not yet been explored in a large sample of CLBP patients. Method Gait kinematics (inertial measurement units) and PFC activity (functional near-infrared spectroscopy) during STW and DTW were measured in 108 CLBP patients (79 females, 29 males). Additionally, pain intensity, kinesiophobia, pain coping strategies, depression and executive functioning were quantified and correlation coefficients were calculated to determine the associations between parameters. Results The gait parameters showed small correlations with acute pain intensity, pain coping strategies and depression. Stride length and velocity during STW and DTW were (slightly to moderately) positively correlated with executive function test performance. Specific small to moderate correlations were found between the gait parameters and dorsolateral PFC activity during STW and DTW. Conclusion Patients with higher acute pain intensity and better coping skills demonstrated slower and less variable gait, which might reflect a pain minimization strategy. Psychosocial factors seem to play no or only a minor role, while good executive functions might be a prerequisite for a better gait performance in CLBP patients. The specific associations between gait parameters and PFC activity during walking indicate that the availability and utilization of brain resources are crucial for a good gait performance.
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Affiliation(s)
- Toan Nguyen
- Department of Sport Science, Institute III, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Martin Behrens
- Department of Sport Science, Institute III, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Kim-Charline Broscheid
- Department of Sport Science, Institute III, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Robert Bielitzki
- Department of Sport Science, Institute III, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Saskia Weber
- Department of Sport Science, Institute III, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Saskia Libnow
- Department of Sport Science, Institute III, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Victoria Malczewski
- Department of Sport Science, Institute III, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Lukas Baldauf
- Department of Sport Science, Institute III, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Xenia Milberger
- Department of Sport Science, Institute III, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Lena Jassmann
- Department of Sport Science, Institute III, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Anne Wustmann
- Department of Orthopaedic Surgery, Klinikum Magdeburg gGmbH, Magdeburg, Germany
| | - Katharina Meiler
- Department of Orthopaedic Surgery, Klinikum Magdeburg gGmbH, Magdeburg, Germany
| | - Steffen Drange
- Department of Orthopaedic Surgery, Klinikum Magdeburg gGmbH, Magdeburg, Germany
| | - Jörg Franke
- Department of Orthopaedic Surgery, Klinikum Magdeburg gGmbH, Magdeburg, Germany
| | - Lutz Schega
- Department of Sport Science, Institute III, Otto von Guericke University Magdeburg, Magdeburg, Germany
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Bertele N, Wendling C, Reinken V, Gross JJ, Talmon A. Somatic symptom profiles are associated with pre-treatment depression and anxiety symptom severity but not inpatient therapy outcomes. Psychother Res 2023; 33:211-221. [PMID: 35729846 DOI: 10.1080/10503307.2022.2090870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE. Although somatic symptoms are common among mental health patients, their association with symptom severity and inpatient treatment outcomes is not yet well understood. METHODS. Using a pre-post design and latent class analysis (LCA), 641 inpatients (63.4% female) were classified based on their self-reported somatic symptoms. We examined how the resulting somatic symptom classes related to depression and anxiety symptom severity pre-treatment (T1) and to symptom reduction post-treatment (T2). RESULTS. Our results suggest four somatic symptom classes, namely (1) unspecific/low somatic symptom burden, (2) sexual problems, (3) gastrointestinal symptoms with pain syndrome, and (4) cardiopulmonary symptoms. While class 1 indicated the lowest pre-treatment depression and anxiety symptom severity, class 2 reported high depressive symptoms coupled with low anxiety, class 3 reported moderate depressive and anxiety symptom severity, and class 4 reported the highest depressive and anxiety symptom burden. Somatic symptom classes, however, did not predict the degree of reduction in either depression or anxiety symptoms post-treatment. CONCLUSIONS. These findings demonstrate somatic heterogeneity in mental health patients and reveal the relationship of somatic symptom patterns to affective symptom severity. Clinical implications are discussed.
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Affiliation(s)
- Nina Bertele
- Psychology Department, Stanford University, Stanford, CA, USA
| | | | | | - James J Gross
- Psychology Department, Stanford University, Stanford, CA, USA
| | - Anat Talmon
- Psychology Department, Stanford University, Stanford, CA, USA
- Paul Baerwald School of Social Work and Social Welfare, The Hebrew University of Jerusalem, Israel
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Amiri S. The effect of exercise on health-related quality of life in persons with musculoskeletal pain: A meta-analysis of randomised control trials. Musculoskeletal Care 2022; 20:812-820. [PMID: 35686507 DOI: 10.1002/msc.1659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVES Exercise has positive effects on musculoskeletal pain. In this project, the impact of exercise was studied on improving health-related quality of life in persons with musculoskeletal pain. METHOD The study design was a systematic review and meta-analysis. A search was conducted to find original studies in four sources, including PubMed, Web of Science, the Cochrane Library and Scopus, and this search was limited to the original articles published until April 2021, which were in English. For each study, the effect size was calculated. The analysis was based on the random-effects method. RESULT Twenty-Seven randomised control trial studies were included in the meta-analysis. The total population of participants in the meta-analysis was 1927 persons. Exercise improves health-related quality of life in these persons and the hedges' g was 0.66 (95% CI = 0.38-0.94; I2 = 88.29%). DISCUSSION Overall, based on the findings, exercise is associated with improving the health-related quality of life of persons with musculoskeletal pain, and therefore the health implications of this finding are beneficial to the general population and professionals.
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Affiliation(s)
- Sohrab Amiri
- Medicine, Quran and Hadith Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Felício DC, Filho JE, de Oliveira TMD, Pereira DS, Rocha VTM, Barbosa JMM, Assis MG, Malaguti C, Pereira LSM. Risk factors for non-specific low back pain in older people: a systematic review with meta-analysis. Arch Orthop Trauma Surg 2022; 142:3633-3642. [PMID: 34021388 DOI: 10.1007/s00402-021-03959-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/13/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE To conduct a systematic review about risk factors associated with non-specific low back pain (LBP) in older people. METHODS The study protocol was prospectively registered with Prospero (CRD42020191619). This systematic review with meta-analysis included cohort studies that investigated risk factors for LBP in older people. The following databases were searched up to 12 December 2020: MEDLINE (Ovid), Embase, CINAHL, SCOPUS and Web of Science. Two independent reviewers appraised methodological quality using the Critical Appraisal Checklist for Cohort Studies instrument. RESULTS We identified 3939 potentially relevant publications. After removing duplicates, screening title, and abstracts, we assessed 86 publications in full text. We included the remaining 11 publications for analysis. There is strong evidence that depressive symptoms are a risk of reporting future back pain onset (I2 = 52,7%, Odds ratio 1.4, CI 1.28-1.53). CONCLUSION Depressive symptoms are a risk factor for LBP in older people. Due to the limitations of the literature, the role of some risk factors remains unclear. An additional high-quality prospective cohort is needed to better elucidate these relationships.
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Affiliation(s)
- Diogo Carvalho Felício
- Programa Pós-Graduação Em Ciências da Reabilitação da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil. .,Faculdade de Fisioterapia da Universidade Federal de Juiz de Fora (UFJF), Programa Pós-Graduação Em Ciências da Reabilitação E Desempenho Físico-Funcional, Juiz de Fora, MG, Brazil.
| | - José E Filho
- Faculdade de Fisioterapia da Universidade Federal de Juiz de Fora (UFJF), Programa Pós-Graduação Em Ciências da Reabilitação E Desempenho Físico-Funcional, Juiz de Fora, MG, Brazil
| | - Túlio M D de Oliveira
- Faculdade de Fisioterapia da Universidade Federal de Juiz de Fora (UFJF), Programa Pós-Graduação Em Ciências da Reabilitação E Desempenho Físico-Funcional, Juiz de Fora, MG, Brazil
| | - Daniele S Pereira
- Programa Pós-Graduação Em Ciências da Reabilitação da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Vitor T M Rocha
- Programa Pós-Graduação Em Ciências da Reabilitação da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Juliana M M Barbosa
- Programa Pós-Graduação Em Ciências da Reabilitação da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Marcella Guimarães Assis
- Programa Pós-Graduação Em Ciências da Reabilitação da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Carla Malaguti
- Faculdade de Fisioterapia da Universidade Federal de Juiz de Fora (UFJF), Programa Pós-Graduação Em Ciências da Reabilitação E Desempenho Físico-Funcional, Juiz de Fora, MG, Brazil
| | - Leani S M Pereira
- Programa Pós-Graduação Em Ciências da Reabilitação da Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
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Villarreal-Zegarra D, Lázaro-Illatopa WI, Castillo-Blanco R, Cabieses B, Blukacz A, Bellido-Boza L, Mezones-Holguin E. Relationship between job satisfaction, burnout syndrome and depressive symptoms in physicians: a cross-sectional study based on the employment demand-control model using structural equation modelling. BMJ Open 2022; 12:e057888. [PMID: 36261241 PMCID: PMC9582405 DOI: 10.1136/bmjopen-2021-057888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate the relationship between job satisfaction, burnout syndrome (BS) and depressive symptoms (DS) based on the job demand-control framework model on a nationally representative sample of physicians working in the Peruvian Health System. SETTING We carried out a secondary data analysis of the National Survey of Satisfaction of Users in Health 2016 in Peru. PRIMARY AND SECONDARY OUTCOME MEASURES Our study assessed the development of the predictive model and had two parts: (1) to evaluate the association among the variables based on the job demand-control framework, and (2) to assess the proposed model acceptability using the structural equation modelling approach to estimate goodness-of-fit indices (GOFIs). PARTICIPANTS We excluded physicians older than 65 years, who did not report income levels or who had missing data related to the workplace. Thus, we analysed 2100 participants. RESULTS The prevalence of DS was 3.3%. Physicians' work-related illnesses had more probability to result in DS (prevalence ratio=2.23). DS was moderately related to BS dimensions (r>0.50); nevertheless, the relationships between DS and the three job satisfaction scales were weak (r<0.30). The first predictive model based on the variables, DS, BS and job satisfaction, had low GOFIs (comparative fit index (CFI)=0.883; root mean square error of approximation (RMSEA)=0.125). In a second evaluation, we used models with correlated errors obtaining optimal GOFIs (CFI=0.974; RMSEA=0.060). CONCLUSIONS Our study identified a stable model to explain the relationship between job satisfaction, BS and DS among physicians. The results are consistent with the job demand-control framework. They could be applied to decision-making in occupational contexts in Latin American low/middle-income countries.
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Affiliation(s)
- David Villarreal-Zegarra
- Escuela de Medicina, Universidad César Vallejo, Trujillo, Peru
- Instituto Peruano de Orientación Psicológica, Lima, Lima, Peru
| | | | - Ronald Castillo-Blanco
- Departamento de Gestión del Aprendizaje y Aseguramiento de la Calidad, Universidad del Pacífico, Lima, Peru
| | - Baltica Cabieses
- Facultad de Medicina Clínica Alemana, Instituto de Ciencias e Innovación en Medicina (ICIM), Universidad del Desarrollo, Santiago de Chile, Chile
| | - Alice Blukacz
- Facultad de Medicina Clínica Alemana, Instituto de Ciencias e Innovación en Medicina (ICIM), Universidad del Desarrollo, Santiago de Chile, Chile
| | - Luciana Bellido-Boza
- Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Edward Mezones-Holguin
- Centro de Excelencia en Investigaciones Económicas y Sociales en Salud, Universidad San Ignacio de Loyola, Lima, Peru
- Epi-gnosis Solutions, Piura, Peru
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Bohlen L, Shaw R, Cerritelli F, Esteves JE. Osteopathy and Mental Health: An Embodied, Predictive, and Interoceptive Framework. Front Psychol 2021; 12:767005. [PMID: 34777176 PMCID: PMC8578726 DOI: 10.3389/fpsyg.2021.767005] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/06/2021] [Indexed: 11/13/2022] Open
Abstract
Globally, mental and musculoskeletal disorders present with high prevalence, disease burden, and comorbidity. In order to improve the quality of care for patients with persistent physical and comorbid mental health conditions, person-centered care approaches addressing psychosocial factors are currently advocated. Central to successful person-centered care is a multidisciplinary collaboration between mental health and musculoskeletal specialists underpinned by a robust therapeutic alliance. Such a collaborative approach might be found in osteopathy, which is typically utilized to treat patients with musculoskeletal disorders but may arguably also benefit mental health outcomes. However, research and practice exploring the reputed effect of osteopathy on patients with mental health problems lack a robust framework. In this hypothesis and theory article, we build upon research from embodied cognition, predictive coding, interoception, and osteopathy to propose an embodied, predictive and interoceptive framework that underpins osteopathic person-centered care for individuals with persistent physical and comorbid mental health problems. Based on the premise that, for example, chronic pain and comorbid depression are underlined by overly precise predictions or imprecise sensory information, we hypothesize that osteopathic treatment may generate strong interoceptive prediction errors that update the generative model underpinning the experience of pain and depression. Thus, physical and mental symptoms may be reduced through active and perceptual inference. We discuss how these theoretical perspectives can inform future research into osteopathy and mental health to reduce the burden of comorbid psychological factors in patients with persistent physical symptoms and support person-centered multidisciplinary care in mental health.
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Affiliation(s)
- Lucas Bohlen
- Osteopathic Research Institute, Osteopathie Schule Deutschland, Hamburg, Germany
| | - Robert Shaw
- Scandinavian College of Osteopathy, Gothenburg, Sweden
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Ultimo, NSW, Australia
| | - Francesco Cerritelli
- Australian Research Centre in Complementary and Integrative Medicine (ARCCIM), University of Technology Sydney, Ultimo, NSW, Australia
- Clinical-based Human Research Department, Foundation COME Collaboration, Pescara, Italy
| | - Jorge E. Esteves
- Clinical-based Human Research Department, Foundation COME Collaboration, Pescara, Italy
- Research Department, University College of Osteopathy, London, United Kingdom
- International College of Osteopathic Medicine, Malta, Italy
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9
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Lewis JH, Lage OG, Grant BK, Rajasekaran SK, Gemeda M, Like RC, Santen S, Dekhtyar M. Addressing the Social Determinants of Health in Undergraduate Medical Education Curricula: A Survey Report. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2020; 11:369-377. [PMID: 32547288 PMCID: PMC7250290 DOI: 10.2147/amep.s243827] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 04/10/2020] [Indexed: 05/22/2023]
Abstract
PURPOSE Social determinants of health (SDH) are recognized as important factors that affect health and well-being. Medical schools are encouraged to incorporate the teaching of SDH. This study investigated the level of commitment to teaching SDH; learning objectives/goals regarding student knowledge, skills, and attitudes; location in the curriculum and teaching strategies; and perceived barriers to teaching SDH. METHODS A team from the American Medical Association's Accelerating Change in Medical Education Consortium developed a 23-item inventory survey to document consortium school SDH curricula. The 32 consortium schools were invited to participate. RESULTS Twenty-nine (94%) schools responded. Most respondents indicated the teaching of SDH was low priority (10, 34%) or high priority (12, 41%). Identified learning objectives/goals for student knowledge, skills, and attitudes regarding SDH were related to the importance of students developing the ability to identify and address SDH and recognizing SDH as being within the scope of physician practice. Curricular timing and teaching strategies suggested more SDH education opportunities were offered in the first and second undergraduate medical education years. Barriers to integrating SDH in curricula were identified: addressing SDH is outside the realm of physician responsibility, space in curriculum is limited, faculty lack knowledge and skills to teach material, and concepts are not adequately represented on certifying examinations. CONCLUSION Despite the influence of SDH on individual and population health, programs do not routinely prioritize SDH education on par with basic or clinical sciences. The multitude of learning objectives and goals related to SDH can be achieved by increasing the priority level of SDH and employing better teaching strategies in all years. The discordance between stated objectives/goals and perceived barriers, as well as identification of the variety of strategies utilized to teach SDH during traditional "preclinical" years, indicates curricular areas in need of attention.
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Affiliation(s)
- Joy H Lewis
- School of Osteopathic Medicine in Arizona, A.T. Still University of Health Sciences, Mesa, AZ, USA
| | - Onelia G Lage
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
| | - B Kay Grant
- Office of Health Professions Education, Nebraska Medicine, Omaha, NE, USA
| | | | - Mekbib Gemeda
- Diversity and Inclusion, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Robert C Like
- Department of Family Medicine and Community Health, Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, USA
| | - Sally Santen
- Department of Emergency Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Michael Dekhtyar
- Medical Education Outcomes, American Medical Association, Chicago, IL, USA
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