How do you feel? Self-esteem predicts affect, stress, social interaction, and symptom severity during daily life in patients with chronic illness

The role of personal, relational, and collective self-esteem in predicting acute salivary cortisol response and perceived stress

Personal self-esteem (PSE) has been well recognized as a buffer against stress; however, the effects of other types of self-esteem, such as relational self-esteem (RSE) and collective self-esteem (CSE), on stress have not been adequately explored. This study investigated the roles of PSE, RSE, and CSE in reducing stress response. The Rosenberg, Relational, and Collective Self-Esteem Scales were adopted to assess PSE, RSE, and CSE, respectively. Participants underwent an acute social stress paradigm, and their acute stress response was assessed using subjective stress reports and salivary cortisol levels. Chronic stress level was estimated using the Perceived Stress Scale and hair cortisol concentration. The results showed that PSE was negatively correlated with salivary cortisol response during acute social stress; however, no significant associations were found between any type of self-esteem and subjective stress reports. For chronic stress, all types of self-esteem were negatively associated with perceived stress level, but not with hair cortisol concentration. Further hierarchical regression analyses suggested that only PSE negatively predicted acute salivary cortisol response and perceived stress level. Overall, the findings suggest the essential role of PSE in predicting acute salivary cortisol responses and perceived stress.

The Association Between Spirituality, Self-Esteem, Anxiety and Depression: A Comparative Exploratory Study Between People with a Spinal Cord Injury and Healthy Subjects in Greece

The purpose of this study was to evaluate spirituality, religiosity, self-esteem, depression, and stress in people with spinal cord injuries. The Royal Free Questionnaire for Spiritual and Religious Beliefs, the Rosenberg Self-Esteem Scale, the Center for Epidemiologic Studies Depression Scale, and the Spielberger State-Trait Anxiety Scale were all designed for the current study to collect demographic and injury-related information. In the study, 88 patients with traumatic SCI and 88 healthy subjects were included. Half of the participants and healthy subjects were women, while the mean age of the healthy subjects was 42.8 years and that of the subjects was 42.4 years. The majority of participants were Greek (97.2%), while 44.1% were married or with a partner and 43.2% were single. The mean depression and stress score was higher in patients than in healthy subjects, and the mean score of self-esteem was lower in patients than healthy subjects. Multivariable linear regression model showed that patients who believed more that a spiritual force or power outside of ourselves can influence what happens in everyday life had less depression and stress. People with spinal cord injuries experience extreme stress, anxiety, and depression. Spirituality and religiosity can play a significant role in their recuperation, rehabilitation, and adaptation.

Mindful Self-Hypnosis Combined with Resistance Training to Reduce Perceived Stress and Improve Other Psychological Factors in Female College Students

Perceived stress is a significant problem among female college students that can impact psychological distress, sleep, and overall well-being. Mindful self-hypnosis (MSH) and resistance training (RT) have both been shown to reduce perceived stress. The rationale for the present study was to investigate whether MSH combined with RT could be more effective at reducing perceived stress as measured by the Perceived Stress Scale than RT alone due to synergistic effects achieved by combining the interventions. Forty-four female college students were randomized to one of the three groups: MSH+RT, RT only, or a wait-list control (WLC). Results indicated that, compared to RT only, the addition of MSH led to pronounced improvements in perceived stress which was significantly greater than WLC. Also, MSH+RT resulted in significant increases in mindfulness, sleep, strength, and well-being in comparison to WLC. MSH+RT was shown to be feasible with highly satisfactory participant ratings. Future research should examine the MSH+RT intervention with a larger population and with older women who are more at risk for stress and declining strength.

Who develops long COVID? Longitudinal pre-pandemic predictors of long COVID and symptom clusters in a representative Dutch population

OBJECTIVES

Prior studies show that long COVID has a heterogeneous presentation. Whether specific risk factors are related to subclusters of long COVID remains unknown. This study aimed to determine pre-pandemic predictors of long COVID and symptom clustering.

METHODS

A total of 3,022 participants of a panel representative of the Dutch population completed an online survey about long COVID symptoms. Data was merged into 2018/2019 panel data covering sociodemographic, medical, and psychosocial predictors. A total of 415 participants were classified as having long COVID. K-means clustering was used to identify patient clusters. Multivariate and lasso regression was used to identify relevant predictors compared to a COVID-19 positive control group.

RESULTS

Predictors of long-term COVID included older age, Western ethnicity, BMI, chronic disease, COVID-19 reinfections, severity, and symptoms, lower self-esteem, and higher positive affect (AUC = 0.79, 95%CI 0.73-0.86). Four clusters were identified: a low and a high symptom severity cluster, a smell-taste and respiratory symptoms cluster, and a neuro-cognitive, psychosocial, and inflammatory symptom cluster. Predictors for the different clusters included regular health complaints, healthcare use, fear of COVID-19, anxiety, depressive symptoms, and neuroticism.

CONCLUSIONS

A combination of sociodemographic, medical, and psychosocial factors predicted long COVID. Heterogenous symptom clusters suggest that there are different phenotypes of long COVID-19 presentation.

Love beyond gluten: self-esteem, illness identity, and social support in romantic rejection concerns among adolescents with celiac disease

Introduction

Fear of stigmatization, high perceived partner burden, or refraining from self-disclosure may manifest in romantic rejection concerns among adolescents with celiac disease (CD), potentially impacting their health-related quality of life (HRQOL). This study examined the prevalence, predictors, and consequences of romantic rejection concerns among adolescents and young adults with CD.

Methods

A cross-sectional online survey was conducted among 165 German adolescents and young adults (aged 14-22) with self-reported CD. Participants completed measures of romantic rejection concerns, illness identity, self-esteem, peer support, and CD-specific HRQOL.

Results

Participants reported moderate levels of concerns about the impact of CD on their romantic relationships, with no significant gender differences. Participants involved in romantic relationships expressed lower concerns of rejection, but similar preference for a "gluten-free partner." Hierarchical regression analysis revealed that higher illness acceptance and peer support predicted lower rejection concerns. Significant interactions emerged between self-esteem and illness acceptance, and between self-esteem and peer support. Higher illness acceptance predicted fewer rejection worries only among those with high self-esteem, while peer support played a mitigating role only for those with low self-esteem. Romantic rejection concerns significantly predicted lower CD-specific HRQOL across all domains.

Discussion

Anxieties about CD's impact on romantic relationships are prevalent among adolescents and may hinder their HRQOL. The findings highlight the complex interplay between self-esteem, illness identity, and social support in shaping romantic concerns. Targeted interventions focusing on peer support and fostering positive illness identity are recommended to alleviate rejection fears and improve HRQOL among youth with CD.

The costs of lying: Consequences of telling lies on liar's self-esteem and affect

Deceiving others is generally viewed as immoral. However, most people lie on a daily basis. This article examines the psychological consequences for the liars themselves, as they are participating in what is generally perceived as immoral behaviour. More specifically, this article focuses on the effects of lying on the liar's self-esteem and affect. We tested if lying, in comparison to telling the truth, lowers people's self-esteem and increases negative experienced affect. In total, three cross sectional and one longitudinal studies were conducted (N = 783). Results showed that lying decreased people's self-esteem and increased negative affect, regardless of the type of lie (self-centred vs. other-oriented). Furthermore, lying on a given day decreased people's self-esteem compared to their self-esteem on the previous day and to their average level of self-esteem across 5 days.

Relationship between self-esteem and quality of life in middle-aged and older patients with chronic diseases: mediating effects of death anxiety

BACKGROUND

Many studies have explored the relationship between self-esteem and quality of life. However, few studies have elucidated the mechanisms underlying the relationship between self-esteem and quality of life in middle-aged and older patients with chronic diseases. The present study aimed to explore the mediating role of death anxiety in this relationship.

METHODS

Middle-old-aged patients with chronic diseases were selected as the respondents by using a multi-stage sampling method, random number table method from October 2021 to February 2022 in the Second Affiliated Hospital of Zhejiang University School of Medicine. The Cumulative Disease Rating Scale, the Self-Esteem Scale (SES), the Chinese version of the Death Anxiety Scale (CT-DAS), and the Simplified version of the Quality of Life Scale (SF-12) were used as the researching tools to conduct the survey. SPSS26.0 was used to analysis data. AMOS 23.0 software was used to construct structural equation modeling.

RESULTS

294 valid questionnaires were collected. There were significant differences in quality of life among middle-aged and elderly patients with chronic diseases who have different physical activities, socialization, and chronic pain (P < 0.01); Self-esteem was positively associated with quality of life (r = 0.330, P < 0.01), self-esteem was negatively associated with death anxiety (r = -0.222, P < 0.01), and death anxiety was negatively associated with quality of life (r = -0.263, P < 0.01); Death anxiety partially mediated the relationship between self-esteem and quality of life, with the mediating effect accounting for 18.40% of the total effect.

CONCLUSION

Death anxiety partially mediates the relationship between self-esteem and quality of life. Interventions to improve self-esteem and reduce death anxiety should be used to improve the quality of life of middle-aged and senior patients with chronic diseases.

Protective roles of meditation practice and self-esteem on cognitive functions over time: findings from the Midlife in the United States study

BACKGROUND

Cognitive function is an important component of healthy ageing. However, it is unclear whether relaxation/meditation practices provide cognitive benefits, particularly in midlife and early late life. Meditative practices are associated with higher self-esteem, and self-esteem serves as a general protective factor for many health outcomes. The current study examines associations between meditation practice, self-esteem, and change over 10 years in midlife cognitive performance.

METHODS

Data were from waves 2 (2003-2004) and 3 (2013-2014) of the Midlife in the United States (MIDUS) study. We used structural equation modelling to examine whether persistent meditation practice at both waves or episodic practice at one wave is associated with better cognitive function over 10 years, compared to no meditation practice, while controlling for prior cognitive function and covariates (baseline socio-demographics, health, and functional status). Additionally, we assessed if self-esteem mediates the above associations.

RESULTS

We included 2168 individuals (Mage  = 65 ± 11). After controlling for covariates, the findings revealed that persistent meditation practice in both waves was associated with significantly less decline in episodic memory; however, no such effects were found for executive function. Further, although participants' higher self-esteem was significantly associated with less decline in executive function and episodic memory, it did not mediate the associations between meditation practice and cognitive functions.

CONCLUSIONS

While both persistent meditation practice and self-esteem have associations with cognitive outcomes for middle-aged and older adults in MIDUS, self-esteem as a mediator was not supported. Thus, future investigations should examine mechanisms that underlie these protective factors on cognitive performances across adulthood.

The feasibility of using ecological momentary assessment to understand urinary and fecal incontinence experiences in adults with spina bifida: A 30-day study

In this paper, we evaluate the feasibility of using ecological momentary assessment (EMA) to understand urinary (UI) and fecal (FI) incontinence in adults with spina bifida (SB). As part of a larger 30-day prospective study to understand the incontinence in adults with SB (N = 89), participants completed end-of-day EMA diaries assessing the frequency and context of UI and FI. We used these data to assess the method feasibility across six dimensions: (a) compliance, or data entry which is consistent with study protocol and substantially complete; (b) reactivity, or behavior change attributed to study participation; (c) participant acceptability, or convenience and ease of method beneficial to compliance; (d) data capture, or the volume of incontinence behaviors collected; (e) the accuracy of incontinence reports; and f) participant-provided feedback for future studies. Participants were highly compliant with diary entry protocol and schedule: submitting 95.7% (2576/2700) of the expected total daily entries. The average completion time was two minutes. Neither the total number of submissions nor the completion time varied by demographic characteristics or health history. A sufficient volume of incontinence and affective outcomes were captured, with small downtrends in reporting of UI and affect over time. Exit survey recall was highly correlated with diary reports. Participants found the methodology to be acceptable, reported their experiences honestly, enjoyed and felt comfortable participating in the study and would engage in similar study in the future. Accurate information about the daily context of UI and FI is a key factor in the success of intervention or education programs relying on this information. Our findings demonstrate that EMA is a feasible way to describe UI and FI in adults with SB.

Examining the associations between physical activity, self-esteem, perceived stress, and internalizing symptoms among older adolescents

INTRODUCTION

In older adolescence, stress has been found to be prevalent. It has been seen that higher physical activity (PA) relates to lower stress levels, which, in turn, relates to fewer anxiety and depressive symptoms (internalizing symptoms). However, how these associations function is not fully understood. PA is strongly associated with greater self-esteem in adolescents. As greater self-esteem is thought to aid better coping with stress and has been seen as beneficial for mental health in adolescents, PA may be associated with lower stress and better mental health through self-esteem and more adaptive stress appraisals. Therefore, the aim of the study was to examine the relationships between PA, self-esteem, stress, and mental health.

METHODS

A cross-sectional design was employed, and path analysis was implemented. PA, self-esteem, stress appraisals, distress tolerance, perceived stress, anxiety, and depression were assessed using online questionnaires from 244 adolescent participants from the United Kingdom (aged 15-19, M = 16.75 [SD = 0.82], 145 female).

RESULTS

Path analysis revealed that PA was associated with lower perceived stress through increased self-esteem, adaptive appraisals, and higher distress tolerance (total standardized indirect effect; p = .007 (-0.25 to -0.11). Moreover, lower perceived stress was associated with lower anxiety (standardized direct effect; p < .001 [2.65-4.0] and depressive symptoms (standardized direct effect; p < .001 [0.33-0.63]).

CONCLUSIONS

Findings suggest that higher PA could be effective in improving mental health among older adolescents, due to its association with perceived stress through higher self-esteem and more adaptive appraisals of stress.

The Bahraini food based dietary guidelines: a holistic perspective to health and wellbeing

The impact of food consumption extends well beyond the physical aspect of health to affect the mind, the society, and the environment. The biopsycho-ecological (BSE) theory recognizes the interplay between these factors and emphasizes the need for a holistic perspective to dietary recommendations. This manuscript presents a situation analysis of food consumption and diet-related diseases in Bahrain and describes the themes of the Bahraini Food based dietary guidelines (FBDG) and their alignment with the BSE constructs. Available data revealed low fruit and vegetable intake and excessive consumption of processed meat and sugary drinks in the country. These dietary habits are accompanied by a high burden of non-communicable diseases and their risk factors, anemia, and vitamin D deficiency. The Bahraini FBDG consisted of 11 context-specific themes and key messages that addressed the four dimensions of health depicted by the BSE theory, as follows: diet, physical activity, and food safety (body), physical activity, mindful eating and mental health (mind); family relations and cultural heritage (society), and food waste and environmental footprints of dietary intake (environment). The Bahraini FBDG present a model of dietary guidelines that adopted a holistic perspective to address health as they promote the role of food and dietary habits in maintaining the health of the body and that of the mind, the society, and the environment.

Neuroticism and Stress in Older Adults: The Buffering Role of Self-Esteem

BACKGROUND

Chronic stress is associated with accelerated aging and poor health outcomes in older adults. According to the Transactional Model of Stress (TMS), distress is experienced when one perceives the stressor, or threat, to outweigh the ability to cope. The experience of distress is correlated with trait neuroticism, which is associated with greater perceptions of stress and stress reactivity, as well as a tendency to engage in maladaptive coping strategies. However, as individual personality traits do not act in isolation, this study aimed to investigate the moderating role of self-esteem in the relationship between neuroticism and distress using a TMS framework.

METHODS

A total of 201 healthy older adults (Mage = 68.65 years) completed questionnaires measuring self-esteem, neuroticism, perceived stress, and positive coping.

RESULTS

Greater neuroticism was significantly associated with less positive coping at low (b = -0.02, p < 0.001) and mean self-esteem levels (b = -0.01, p < 0.001), but not at high self-esteem levels (b = -0.01, p = 0.06). No moderating effect was found for perceived stress or overall distress.

CONCLUSION

The results support the association between trait neuroticism and indices of stress and suggest a potential buffering effect of self-esteem in moderating the negative association between neuroticism and positive coping.

Love Addiction, Adult Attachment Patterns and Self-Esteem: Testing for Mediation Using Path Analysis

Love addiction is a dysfunctional relational modality that takes on the addiction characteristics and which, for the individuals who suffer from it, can have a negative and pervasive impact on various areas of functioning. The objective of this research was the analysis the factors that can be associated with love addiction, particularly focusing on adult attachment patterns and self-esteem. A sample group of 300 individuals who declared themselves to have a romantic relationship was involved in this research (M_age = 37.83 years, SD = 12.937). They completed an online survey including the Love Addiction Inventory-Short form, Relationship Questionnaire, and Rosenberg Self-Esteem Scale. Results showed significant and positive associations between preoccupied and fearful adult attachment and love addiction. Furthermore, these relationships were totally mediated by self-esteem. Gender and age were controlled as potential covariates and showed significant effects in influencing the levels of self-esteem and love addiction. Such findings may provide useful information for orienting future research and supporting an effective clinical practice.

Self-evaluation and depression in adolescents with a chronic illness: A systematic review

OBJECTIVE

To conduct a systematic review to establish what is known about the relationship between depression and self-evaluation in adolescents with a chronic illness.

METHODS

A systematic search was conducted using MEDLINE, EMBASE, PsycINFO, Web of Science, The Cochrane Library, and hand-searching. We sought to identify primary research that examined both the cross-sectional and longitudinal associations between depression and self-evaluation in adolescents with chronic illness. The search resulted in 8941 retrieved articles that were screened against an inclusion criteria. A total of 4 papers were included in the review. The MMAT used to assess study methodological quality.

RESULTS

A narrative synthesis was conducted, and a summary figure was included. These 4 studies included 236 adolescents aged 9-18 years with depression and either Type 1 Diabetes (T1D), chronic pain, headaches, or Inflammatory Bowel Disease (IBD). The limited existing evidence indicated that that depression was associated with negative self-evaluation in adolescents in some but not all chronic illnesses investigated to date. We also found some evidence that psychological intervention can help to improve self-evaluation, specifically in adolescents with T1D.

CONCLUSIONS

More robust studies of the association between self-evaluation and depression in adolescents with a chronic illness is needed, with attention to the nuances of differences between chronic illnesses. The existing evidence indicates that there may be a stronger association in some chronic illnesses. Pilot data suggest that specific psychological therapies may improve self-evaluation, although much more extensive evaluation is needed.

Development and applicability of a dignity-centred palliative care programme for people with idiopathic pulmonary fibrosis: A qualitative-driven mixed methods study

AIMS

This study evaluated the acceptability of a dignity-centred palliative care programme for people with idiopathic pulmonary fibrosis by converging perceptions of living with idiopathic pulmonary fibrosis qualitative data and quantitative data.

DESIGN

The qualitative-driven mixed methods research addressed the study aim by using a convergent design. This single arm, non-randomized study used purposive sampling.

METHODS

Interviews with 12 stable outpatients with IPF provided qualitative data. Their quantitative data were from six scales: self-esteem, health-related quality of life, anxiety, depression, dyspnoea, cough and programme satisfaction. Intervention was three educational modules: symptom management, enhancing daily activities and life reviews.

RESULTS

Semi-structured interviews yielded eight categories. Self-esteem was not statistically significantly changed. Dyspnoea symptoms improved significantly. Participants (n = 9) holding positive attitudes for living with idiopathic pulmonary fibrosis, had improved lifestyle behaviour and improved or maintained self-esteem. The meta-inference regarding idiopathic pulmonary fibrosis perceptions were related to changes in self-esteem.

Sport and self-esteem in people living with HIV: a cross-sectional study

Background

In the general population, sport activity is associated with better health and better self-esteem. Among people living with HIV (PLHIV), sport activity could also be associated with better self-esteem. The main objective of our study was to assess the association between sport activity and self-esteem among people living with HIV. The secondary objectives were to evaluate the associations between sport activity with fatigue as well as with pain.

Methods

We performed a cross-sectional observational study among PLHIV in our region (Pays de la Loire in France). Each adult seen in routine HIV care was invited to participate in the study. Participants were invited to fill out self-questionnaires about sport activity, self-esteem, fatigue, and pain. The 2 groups of participants with and without sport activity were compared with a T Student test for self-esteem, fatigue, and pain scales.

Results

Among the 1160 people included in the study, 47% performed sport activity. The self-esteem score was better in the “sporting group” compared with the “non sporting group” (Rosenberg mean scale 32.7 ± 5.1/40 vs 31.9 ± 5 p = 0.01). The Functional Assessment of Chronic Illness Therapy Fatigue scale showed a lower fatigue in the sporting group than in the non-sporting group (mean total score 125 ± 22 vs 118 ± 24 p < 0.0001). The sporting group had a lower mean pain score (1.1 ± 1.8) than the non sporting group (1.4 ± 1.9 p = 0.004).

Conclusions

Among PLHIV in our region, sport activity was associated with better self-esteem, lower fatigue and lower pain. Sport activity should be included in patient care for people living with HIV.

Questioning the vulnerability model: Prospective associations between low self-esteem and subsequent depression ratings may be spurious

BACKGROUND

According to the vulnerability model, low self-esteem makes people more depressed. Support for the vulnerability model comes almost exclusively from analyses using cross-lagged panel models, showing a negative effect of initial self-esteem on subsequent depression ratings when adjusting for initial depression. However, it is well known that such adjusted effects are susceptible to regression toward the mean.

METHODS

Data from four waves of measurements in five different samples (total N = 2703) were analyzed with two different cross-lagged panel models, two different random intercept cross-lagged panel models, and two different latent change score models, predicting change forwards as well as backwards in time.

RESULTS

High initial self-esteem predicted both decreased and increased depression ratings between measurements and an increase in self-esteem between measurements predicted a concurrent decrease in depression ratings.

LIMITATIONS

Only data from two western countries, Switzerland and USA, were analyzed. Whether the main finding, that a prospective effect of self-esteem on subsequent depression ratings might be spurious, applies to other countries and cultures remains an open question.

CONCLUSIONS

Due to the incongruent results, any causal effect of self-esteem on depression ratings, and thus the vulnerability model as such, cannot be corroborated by the data and models analyzed here. Instead, we propose, tentatively, that prospective associations between self-esteem and depression ratings may be spurious due to a combination of reasons, including regression toward the mean. The indication that depression might not be affected by measures to improve individuals' self-esteem is of clinical relevance.

The Association of Self-esteem With Caregiving Demands, Coping, Burden, and Health Among Caregivers of Breast Cancer Patients: A Structural Equation Modeling Approach

BACKGROUND

We investigated how caregiver self-esteem was associated with caregiving demands, coping, burden, and health.

OBJECTIVE

The aim of this study was to investigate how caregiver self-esteem is associated with caregiving demands, coping, burden, and health.

METHODS

Sixty-one caregivers of breast cancer patients were selected from a study conducted at a cancer clinic in the Southeastern region of the United States. Guided by the revised Stress and Coping Theory, a secondary analysis of cross-sectional data was conducted. We used structural equation modeling to analyze paths between caregiver self-esteem and caregiving demands (ie, hours spent on caregiving), coping, burden, and health.

RESULTS

Caregivers who effectively coped with stressful situations through strategies such as positive thinking, seeking social support, and problem solving were more likely to have higher levels of self-esteem; in turn, higher levels of self-esteem decreased caregiver burden and improved caregiver overall health.

CONCLUSIONS

This study highlights the importance of self-esteem among caregivers of breast cancer patients. Additional research is needed to provide more insight into the influence of coping strategies on caregiver self-esteem, as well as the role of caregiver self-esteem on caregivers' and patients' well-being.

IMPLICATION FOR PRACTICE

Healthcare providers need to consider caregiver self-esteem and other associated caregiver characteristics to identify caregivers at risk of higher perceived levels of burden and poor overall health.

Associations of family subjective socioeconomic status with hedonic and eudaimonic well-being in emerging adulthood: A daily diary study

Empirical evidence based on retrospective measures has shown that family subjective socioeconomic status (FSSS) was connected to well-being, but few studies have examined this relationship using a daily diary design. Here, we examined the link between FSSS and well-being as well as the mediating roles of social support and self-esteem in a total of 220 emerging adults using a 14-day daily diary design. The multilevel regression analysis found that FSSS positively predicted two types of well-being, including hedonic well-being (HWB) and eudaimonic well-being (EWB). Moreover, the multilevel 2-2-1 mediation analysis indicated that social support and self-esteem performed as independent mediators of the associations between FSSS and two types of well-being. The mediating effect of self-esteem also had no significant difference from that of social support. Furthermore, when age, gender, and family objective socioeconomic status were controlled, these findings remained significant. The implications and limitations of the findings are also discussed.

African Americans, Caribbean Blacks and Depression: Which Biopsychosocial Factors Should Social Workers Focus On? Results from the National Survey of American Life (NSAL)

Research suggests that African Americans may be more likely to experience depression, especially severe depression, than other racial or ethnic groups in the United States. Overall there is scant research comparing the relationship between ethnicity and depression among the U.S. Black population. The purpose of this study is to identify the most significant biopsychosocial factors social workers can address in the prevention and treatment of depression in African American and first generations Caribbean Black clients. Data was from the National Survey of American Life (NSAL). Bivariate associations showed that respondents who reported higher self-esteem, lower hopelessness, higher sense of mastery, and lower discrimination showed lower likelihood of having Major Depressive Disorder (MDD). The logistic regression model suggested that respondents who have ever had a chronic disease were more likely to report depression than those who have not ever had a chronic disease. Caribbean Blacks were more likely to report depression compared to African Americans. Additionally, respondents who reported higher discrimination scores were more likely to report depression. This study suggests that social workers should embrace the interconnectedness and holistic approach of the biopsychosocial model in their case conceptualizations, prevention strategies, and treatment modalities.

Stress of university students before and after campus closure in response to COVID-19

Due to the COVID-19 pandemic, universities were forced to adopt a remote learning model, which introduced a number of stressors into college students' everyday life and study habits. The current study investigates if students' study-related stress increased after the pandemic's onset and how individual and contextual factors moderate this potential stress increase. Longitudinal survey data about students' stress levels and self-efficacy in self-regulation were collected before and after the onset of the COVID-19 pandemic at a public university (N = 274). Regression analysis results show an overall increase in study-related stress levels after the onset of the pandemic. Students with self-efficacy in self-regulation reported lower stress increases; students with higher mental health impairment and limited time for coursework reported larger stress increases. To address students' stress levels and strengthen coping resources, universities should consider providing students with resources to improve their self-regulation and time-management skills.

Improving youth physical, mental and social health through physical activity: A Systematic literature review

BACKGROUND

Across various parts of the world there is an increasing trend in adolescent and young adult physical inactivity, which has been linked to a multitude of illnesses throughout the lifespan. To further understand the link between physical inactivity and illness, it is important to determine the effect that physical activity has various components of wellbeing. The primary aim of this review was to compile and synthesise the recent evidence on physical activity and its effect on physical, mental and social wellbeing across younger populations. The secondary aim was to determine whether there is relationship between the amount, type and intensity of exercise, and changes in wellbeing outcomes.

METHODS

Main databases were searched using MeSH terms for the population of interest (young adult, adolescent), intervention (physical activity) and outcome (wellbeing). Upon screening papers of eligibility, quality appraisal was completed through the Critical Appraisals Skills Programme (CASP).

RESULTS

Nineteen studies were included in this review. The majority of studies found an associated link between the participation of physical activity and improvements in physical, mental and social wellbeing outcomes. There was evidence to suggest that lower levels of physical intensity produced similar results in mental and social outcomes when compared to higher levels of physical intensity.

CONCLUSION

This review supports the encouragement of adolescent and young adult physical activity, noting the improvements seen across the physical, mental and social wellbeing outcomes. Future research is still required to further understand the benefits of lower intensity exercise within the adolescent and young adult population.

Understanding the impact of exposure to adverse socioeconomic conditions on chronic stress from a complexity science perspective

BACKGROUND

Chronic stress increases chronic disease risk and may underlie the association between exposure to adverse socioeconomic conditions and adverse health outcomes. The relationship between exposure to such conditions and chronic stress is complex due to feedback loops between stressor exposure and psychological processes, encompassing different temporal (acute stress response to repeated exposure over the life course) and spatial (biological/psychological/social) scales. We examined the mechanisms underlying the relationship between exposure to adverse socioeconomic conditions and chronic stress from a complexity science perspective, focusing on amplifying feedback loops across different scales.

METHODS

We developed a causal loop diagram (CLD) to interpret available evidence from this perspective. The CLD was drafted by an interdisciplinary group of researchers. Evidence from literature was used to confirm/contest the variables and causal links included in the conceptual framework and refine their conceptualisation. Our findings were evaluated by eight independent researchers.

RESULTS

Adverse socioeconomic conditions imply an accumulation of stressors and increase the likelihood of exposure to uncontrollable childhood and life course stressors. Repetition of such stressors may activate mechanisms that can affect coping resources and coping strategies and stimulate appraisal of subsequent stressors as uncontrollable. We identified five feedback loops describing these mechanisms: (1) progressive deterioration of access to coping resources because of repeated insolvability of stressors; (2) perception of stressors as uncontrollable due to learned helplessness; (3) tax on cognitive bandwidth caused by stress; (4) stimulation of problem avoidance to provide relief from the stress response and free up cognitive bandwidth; and (5) susceptibility to appraising stimuli as stressors against a background of stress.

CONCLUSIONS

Taking a complexity science perspective reveals that exposure to adverse socioeconomic conditions implies recurrent stressor exposure which impacts chronic stress via amplifying feedback loops that together could be conceptualised as one vicious cycle. This means that in order for individual-level psychological interventions to be effective, the context of exposure to adverse socioeconomic conditions also needs to be addressed.

Type D personality and acceptance of illness in people with inflammatory bowel diseases. Mediating role of self-esteem

BACKGROUND

Type D personality is analyzed more and more frequently in the context of various chronic illnesses, including bowel diseases. Acceptance of illness is affected by many factors that facilitate adaptation to the difficulties and limitations and support the healing process. One of those factors may be self-esteem.

PARTICIPANTS AND PROCEDURE

One hundred fifty-nine individuals, aged 18 to 65, participated in the study. 67% (n = 107) stated that they have ulcerative colitis (UC), and the remaining 33% (n = 52) reported suffering from Crohn's disease (CD). The following measurement tools were used: Rosenberg Self-Esteem Scale (SES), Acceptance of Illness Scale (AIS), and Personality Type D Scale (D14).

RESULTS

The conducted analyses revealed significant correlations between all studied elements. Self-esteem was proven to be a full mediator in relations between one of the dimensions of type D personality, negative affectivity, as well as between both dimensions of type D personality (negative affectivity and social inhibition) and acceptance of illness in individuals with bowel diseases. However, mediation analysis did not confirm that self-esteem is a mediator between social inhibition and acceptance of illness.

CONCLUSIONS

The results show that self-esteem is, for an individual, an essential resource in coping with an illness and adjusting to it. Therefore, providing patient support in the scope of reinforcing self-esteem may prove to be one of the key elements affecting illness acceptance.

Self-compassion predicting pain, depression and anger in people suffering from chronic pain: A prospective study

Self-compassion is associated with disability, pain-related anxiety as well as depression and anger in patients with chronic pain. However, the unique value of self-compassion versus other concepts such as psychological flexibility and self-esteem is unknown. The present study therefore aimed to clarify these relationships. Individuals with chronic pain (N_CP = 872) and without chronic pain (N_NP = 356) took part in a longitudinal study. Participants completed self-report instruments: Pain Disability Index (PDI), Pain Catastrophizing Scale (PCS), Pain Anxiety Symptom Scale (PASS-20), Patient Health Questionnaire (PHQ-9), State Trait Anger Expression Inventory (STAXI), Self-Compassion Scale (SCS), Psychological Inflexibility in Pain Scale (PIPS) and Rosenberg Self-Esteem Scale (RSES). Assessments were repeated after 8 weeks. We found differences in baseline levels of all relevant variables except for anger-out and anger-control between people with and without chronic pain. Subsequently, we computed a path model analysis regarding individuals suffering from chronic pain (N_CP), addressing the predictive value of reduced uncompassionate self-responding (RUS), compassionate self-responding (CS), avoidance (PIPS), cognitive fusion (PIPS) and self-esteem (RSES) regarding pain-related (PDI, PCS, PASS) and emotional variables (PHQ-9, STAXI). Avoidance predicted disability, catastrophizing, anxiety and depression. RUS predicted catastrophizing and pain-related anxiety. Self-esteem predicted depression. CS and cognitive fusion had no unique predictive value. The model explained 65.4%-72.1% of the variance in pain-related variables, 68.7% of the variance in depression and 38.7%-60.7% in the variance of anger-related variables. In conclusion, psychological flexibility, in terms of avoidance, seems to be more relevant for chronic pain than self-compassion. Future research should focus on subgroups and tailored-treatment approaches. SIGNIFICANCE: Applying a longitudinal design, this study examined the predictive value of self-compassion regarding pain, depression and anger. The relevance of self-compassion was compared to psychological flexibility and self-esteem. We can conclude that psychological flexibility, in terms of avoidance behaviour, is the most relevant predictor concerning pain.

Testing the neurocognitive framework for regulation expectation: The relationship between actual/ideal self-esteem and proactive/reactive autonomic stress regulation

BACKGROUND AND OBJECTIVES

According to the Neurocognitive Framework for Regulation Expectation (NFRE), actual and ideal self-esteem are related to how individuals anticipate and respond to a stressful event. Based on this framework, we investigated whether in individuals with low ideal self-esteem (moderator), a positive relationship between actual self-esteem and reactive autonomic regulation would be mediated by the amount of anticipatory autonomic regulation.

METHODS

Forty-five healthy females prepared a speech (i.e., anticipation) and performed it in front of a camera (i.e., stressor). Actual and ideal self-esteem were measured with the Implicit Relational Assessment Procedure. Anticipatory and reactive autonomic stress regulation were indexed by heart rate variability, and affective responses were assessed via self-report.

RESULTS

Results were in line with predictions based on the NFRE: when ideal self-esteem was low, higher actual self-esteem was associated with higher reactive autonomic regulation, and this association was mediated by higher anticipatory autonomic regulation.

LIMITATIONS

Because only female undergraduates were recruited, replication within a more heterogeneous sample is necessary to further generalize these findings.

CONCLUSIONS

These results support the hypothesis, based on the NFRE, that actual and ideal self-esteem interact in predicting the relationship between anticipatory and reactive stress regulation, and are a step forward in the understanding of the mechanisms underlying successful stress regulation.

Concern with dental appearance and associated factors among the elderly of two southern Brazilian cities

Aim: This study aimed to evaluate the prevalence of concern with dental appearance (DA) and associated factors among the elderly of two southern Brazilian cities. Methods: A cross-sectional study was conducted in the cities of Cruz Alta and Veranópolis, Brazil. Oral health examination and a structured questionnaire were applied. Questions from the PCATool-SB Brasil tool and the Questionnaire about Teeth Appearance, both validated to Brazilian samples, were used. The collected independent variables were: sex, age, ethnicity, education level, marital status, retirement, health problem, use of medication, smoking exposure, alcohol exposure, access to the dentist, toothbrushing frequency, use of dental floss, edentulism, use of and need for dental prosthesis. Concern with DA was dichotomized into yes/no. Associations between dependent and independent variables were assessed by Chi-square or Mann-Whitney tests. Moreover, uni- and multivariate analyses were conducted by Poisson regression with robust variance. Level of significance was established as p<0.05. Results: The prevalence of concern with DA was 18.8% (n=107). The prevalence ratio (PR) of concern with DA decreased 5.8% for each year increase (PR:0.942; 95% confidence interval [95%CI]:0.911–0.973). Elderly without access to the dentist in the last 12 months presented 62.5% (p=0.006) higher PR of concern with DA when compared to those with access to dental care. Dentate elderly showed 219% higher PR for concern with DA (PR:2.197; 95%CI:1.364–3.539) in comparison to edentulous individuals. Conclusion: Prevalence of concern with DA was low and associated with demographics, access to dental care and edentulism.

Psychosocial Adjustment in Ugandan Children: Coping With Human Immunodeficiency Virus Exposure, Lifetime Adversity, and Importance of Social Support

Cumulative lifetime adversity and social support were investigated as determinants of psychosocial adjustment (esteem, distress, hopefulness, positive outlook/future aspirations, and sense of purpose) over 12 months in 6-10-years-old HIV-infected, HIV-exposed uninfected and HIV-unexposed uninfected children from Uganda. Each determinant and psychosocial adjustment indicator was self-reported using standardized questionnaires administered at baseline, 6, and 12 months. Linear mixed effects models were used to relate time-varying lifetime adversity and social support to psychosocial adjustment over 12 months. Regardless of HIV status, higher adversity predicted lower esteem (coefficient b = -2.98, 95% confidence interval (CI): [-4.62, -1.35]) and increased distress (b =3.96, 95% CI: [1.29, 6.62]) but was not associated with hopefulness, positive outlook or sense of purpose. Low social support predicted higher distress (b =9.05, 95% CI: [7.36, 10.73]), lower positive outlook (b = -10.56, 95% CI: [-2.34, -8.79]) and low sense of purpose (b = -9.90, 95% CI: [-11.44, -8.36]) over 12 months. Pragmatic interventions that enhance coping with adversity and provide emotional/instrumental support should be tested for effectiveness in promoting resilient psychosocial adjustment trajectory in vulnerable children.

The longitudinal association of psychological resources with chronic conditions and the mediating roles of health behaviours and allostatic load

Objective: To investigate the association of psychological resources with the prevalence of chronic conditions up to 10 years later, and the mediating roles of health behaviours and allostatic load. Design: Participants from the Midlife in the United States study (N = 850) completed surveys and biomarker assessments over the course of 10 years. Main Outcome Measures: Primary outcome was the prevalence of chronic conditions later in life, controlling for baseline chronic conditions. Secondary outcomes were health behaviours and allostatic load. Direct and indirect associations between psychological resources and chronic conditions were examined. Results: Psychological resources were negatively associated with chronic conditions directly (ƅ = -.177, p < .05) and indirectly through health behaviours (ƅ = -.026, p < .05), but not through allostatic load (ƅ = -.000, p > .05). Psychological resources were positively associated with health behaviours (ƅ = .130, p < .01), but no association was found between psychological resources and allostatic load (ƅ = -.002, p > .05). Health behaviours were negatively associated with chronic conditions (ƅ = -.201, p < .01), and allostatic load was positively associated with chronic conditions (ƅ = .197, p < .05). Conclusion: Findings highlight the beneficial influence of psychological resources on chronic conditions, and the mediating role of health behaviours.

Self-esteem in patients with inflammatory bowel disease

Purpose

The purpose of this study was to explore self-esteem and associations between self-esteem and sociodemographic, clinical, and psychological factors in patients with inflammatory bowel disease (IBD), a disease of chronic relapsing inflammation of the gastrointestinal tract. IBD symptoms, including pain, fatigue, and diarrhea, as well as potential life-long medical treatment and surgery, may be demanding, cause significant challenges, and influence self-esteem.

Methods

In this cross-sectional multicenter study, participants were recruited from nine hospitals in the southeastern and western regions of Norway from March 2013 to April 2014. Data were collected using self-report questionnaires. Self-esteem was assessed by the Rosenberg Self-Esteem Scale, fatigue was assessed by the Fatigue Questionnaire, self-efficacy was assessed by the General Self-Efficacy Scale, and disease activity was assessed by the Simple Clinical Colitis Activity Index for ulcerative colitis (UC) and Harvey Bradshaw Index for Crohn’s disease (CD). Multiple linear regression analysis was applied to examine associations between self-esteem and sociodemographic, clinical, and psychological factors.

Results

In total, 411 of 452 (91%) patients had evaluable data and were included in this study. The mean scores on self-esteem, self-efficacy, total fatigue, anxiety, and depression were similar between UC patients and CD patients. Male gender, being employed, and higher self-efficacy were independently associated with higher self-esteem, whereas anxiety and depression were independently associated with lower self-esteem. Neither disease activity nor fatigue were associated with self-esteem in the final multiple regression analyses.

Conclusion

Patient-centered interventions that improve self-esteem and reduce anxiety and depression seem to be important to optimize IBD management.

Incidence and temporal trends of co-occurring personality disorder diagnoses in immune-mediated inflammatory diseases

AIMS

Although immune-mediated inflammatory diseases (IMID) are associated with multiple mental health conditions, there is a paucity of literature assessing personality disorders (PDs) in these populations. We aimed to estimate and compare the incidence of any PD in IMID and matched cohorts over time, and identify sociodemographic characteristics associated with the incidence of PD.

METHODS

We used population-based administrative data from Manitoba, Canada to identify persons with incident inflammatory bowel disease (IBD), multiple sclerosis (MS) and rheumatoid arthritis (RA) using validated case definitions. Unaffected controls were matched 5:1 on sex, age and region of residence. PDs were identified using hospitalisation or physician claims. We used unadjusted and covariate-adjusted negative binomial regression to compare the incidence of PDs between the IMID and matched cohorts.

RESULTS

We identified 19 572 incident cases of IMID (IBD n = 6,119, MS n = 3,514, RA n = 10 206) and 97 727 matches overall. After covariate adjustment, the IMID cohort had an increased incidence of PDs (incidence rate ratio [IRR] 1.72; 95%CI: 1.47-2.01) as compared to the matched cohort, which remained consistent over time. The incidence of PDs was similarly elevated in IBD (IRR 2.19; 95%CI: 1.69-2.84), MS (IRR 1.79; 95%CI: 1.29-2.50) and RA (IRR 1.61; 95%CI: 1.29-1.99). Lower socioeconomic status and urban residence were associated with an increased incidence of PDs, whereas mid to older adulthood (age 45-64) was associated with overall decreased incidence. In a restricted sample with 5 years of data before and after IMID diagnosis, the incidence of PDs was also elevated before IMID diagnosis among all IMID groups relative to matched controls.

CONCLUSIONS

IMID are associated with an increased incidence of PDs both before and after an IMID diagnosis. These results support the relevance of shared risk factors in the co-occurrence of PDs and IMID conditions.

The Validity of Daily Self-Assessed Perceived Stress Measured Using Smartphones in Healthy Individuals: Cohort Study

Background

Smartphones may offer a new and easy tool to assess stress, but the validity has never been investigated.

Objective

This study aimed to investigate (1) the validity of smartphone-based self-assessed stress compared with Cohen Perceived Stress Scale (PSS) and (2) whether smartphone-based self-assessed stress correlates with neuroticism (Eysenck Personality Questionnaire-Neuroticism, EPQ-N), psychosocial functioning (Functioning Assessment Short Test, FAST), and prior stressful life events (Kendler Questionnaire for Stressful Life Events, SLE).

Methods

A cohort of 40 healthy blood donors with no history of personal or first-generation family history of psychiatric illness and who used an Android smartphone were instructed to self-assess their stress level daily (on a scale from 0 to 2; beta values reflect this scale) for 4 months. At baseline, participants were assessed with the FAST rater-blinded and filled out the EPQ, the PSS, and the SLE. The PSS assessment was repeated after 4 months.

Results

In linear mixed-effect regression and linear regression models, there were statistically significant positive correlations between self-assessed stress and the PSS (beta=.0167; 95% CI 0.0070-0.0026; P=.001), the EPQ-N (beta=.0174; 95% CI 0.0023-0.0325; P=.02), and the FAST (beta=.0329; 95% CI 0.0036-0.0622; P=.03). No correlation was found between smartphone-based self-assessed stress and the SLE.

Conclusions

Daily smartphone-based self-assessed stress seems to be a valid measure of perceived stress. Our study contains a modest sample of 40 healthy participants and adds knowledge to a new but growing field of research. Smartphone-based self-assessed stress is a promising tool for measuring stress in real time in future studies of stress and stress-related behavior.

Social interactions and physical symptoms in daily life: quality matters for older adults, quantity matters for younger adults

Objective: The present study examined how the different attributes of daily social interactions (quality and quantity) were associated with physical health, and how these associations vary with age. Method: Using an ecological momentary assessment approach, participants from an adulthood lifespan sample (n = 172; aged 20-79 years) reported their social interactions five times daily, and physical symptoms and symptom severity at the end of each day, for one week. Main outcome measures: Number of physical symptoms and physical symptom severity. Results: There was a within-person main effect of the quality (positivity), but not the quantity (frequency), of social interactions on the number of reported physical symptoms and their severity. Moderation analyses further revealed that the quality of daily social interactions predicted fewer physical symptoms for older adults, but not for younger adults; in contrast, the frequency of social interactions predicted less severe physical symptoms for younger adults, but not for older adults. Finally, the reported severity of physical symptoms predicted less frequent but more positive social interactions the next day. Conclusions: Our findings point to the bidirectional associations between social interactions and health and highlight the importance of considering individuals' developmental context in future research and interventions.

Sex and intimacy in people with severe asthma: a qualitative study

Introduction

People with severe asthma experience unpredictable daily symptoms requiring an intense treatment regimen impacting on health-related quality of life (QoL). Sexuality contributes to this, yet there is a dearth of research exploring intimacy in people with severe asthma. We aimed to explore the patient's perception of the impact of severe asthma on intimacy, establish their information needs and their perceived role of the healthcare practitioner.

Methods

We have performed a qualitative study guided by Interpretive Phenomenological Analysis. We interviewed patients diagnosed with severe asthma recruited from a dedicated clinic using purposive sampling. Interviews were audio recorded and transcribed verbatim. Using thematic analysis, the data were analysed for emergent themes.

Results

The nine interviews provided unique and detailed insights into their perspectives on how living with severe asthma impinges on sexual intimacy. Four superordinate themes emerged: (1) 'Physical intimacy': including disclosure of physical limitations of severe asthma on intimacy; (2) 'Emotional intimacy': the cyclical impact of the often-negative emotional struggle of living with severe asthma on relationships; (3) 'The role of the healthcare professional': a perceived failure of healthcare professionals (HCPs) to tackle sexual intimacy in consultations and (4) 'Image of self': the reported struggle to deal with negative body image and confusion regarding changing relationship roles.

Discussion

This study is the first to explore the impact of severe asthma on intimacy. We suggest an emphasis on education to raise awareness and help HCPs to address this sensitive topic in this cohort and adopt positive strategies to help improve QoL.

General Well-Being in Adult Black Males With Chronic Illness

As individuals age, they witness a decline in physical health and functional capacities. The presence of one or more chronic illnesses challenges their quality of life and general well-being, thus, impacting their abilities to function physically, psychologically, and socially. We investigated reports of general well-being in older Black males with chronic illness(es) in a study of N = 145 participants, aged 35 to 63, and identified as Black/African American male. Participants responded to items assessing general well-being; ethnic identity; self-esteem; active coping; the presence of chronic illness(es); and additional demographic, social and ecological characteristics. Analyses of responses indicated that marital status (β = -.17, p < .05), ethnic identity (β = -.34, p = .00), self-esteem (β = .22, p = .03) are significant determinants of general well-being in Black males with chronic illness(es). Data further showed active coping (β = -.41 p = .09) to be negatively correlated with well-being. We discuss the implications of results for the understanding of health outcomes among this marginalized population.

Returning to Social Life: Development of Social Identity for Adolescent and Young Adult Survivors of Leukemia in Korea

OBJECTIVE

The purpose of this study is to investigate the life experiences and processes that occur as adolescent and young adult leukemia survivors return to social life using grounded theory.

METHOD

This study comprised 14 adolescents and young adults who visited a hospital for follow-up care after treatment of leukemia. We used in-depth interviews to examine the participants' experiences in returning to social life. The semistructured questionnaire examined "good and bad experiences in returning to social life," "sources of happiness and stress," and "strategies for managing stressful events."

RESULTS

We extracted 6 categories and 21 concepts from the interviews. We grouped the 6 categories into a core category and three phases: "catching up with others," "discovering myself," and "planning my future." A core category shown through all phases was "fear of recurrence." The "catching up with others" phase included themes of "feeling different from others" and "wanting to be like others." The "discovering myself" phase included "completing one thing at a time" and "recognizing myself as special." The "planning my future" phase included "looking for things I can do."

CONCLUSIONS

Self-esteem was an important issue for adolescent leukemia survivors; negative illness perception affected self-esteem in both adolescents and young adults. It is important for health care providers to develop programs to help adolescent and young adult leukemia survivors to perceive their disease experiences more positively and to take part in social life, including school life.

Physical and psychosocial factors associated with depression among adults with type 2 diabetes mellitus at a Federally Qualified Healthcare Center

PURPOSE

The purpose of this study is to examine the prevalence of depression and physical and psychosocial factors associated with depression among adults with Type 2 Diabetes Mellitus (T2DM).

METHODS

The sample included 421 patients with T2DM at a Federally Qualified Healthcare Center in a southern state. The Patient Health Questionnaire (PHQ-9) was used to measure the severity of depression.

RESULTS

The multiple logistic regression analyses revealed that the likelihood of depression increased as the level of pain increased and as the level of ambulation difficulties increased. The likelihood of depression increased as the number of traumatic events increased and as the number of SES-related stressors increased. Expectedly, the likelihood of depression decreased as levels of self-esteem increased.

CONCLUSIONS

The findings support that health care providers developing care plans for individuals with diabetes need to include assessments and interventions that address both the physical and psychosocial needs of patients.

Enhancing Online Patient Support through Health-Care Knowledge in Online Health Communities: A Descriptive Study

Online health communities (OHCs) should utilize health-care knowledge for enhancing online patient support. To examine the use of existing OHCs to identify the challenges and strategies of enhancing online patients’ decision-making support, we conducted a descriptive study to evaluate the information availability, user availability and knowledge usability in 100 carefully-selected health-related websites. On the basis of criteria for effective OHCs, we used three evaluation instruments for health-care professionals to review and score the websites. Questionnaire results were examined from the perspective of information, user and knowledge support. Results corroborate that over 80% of the websites facilitate effective social functions, whereas only 33% provide health-care decision-making services to online patients. Approximately 46% of them satisfy four or five effective OHCs’ criteria. Three of them only offer the functions of patients’ charts and journals to support health data management. Although the existing OHCs are facilitated with good social interaction and support, only a few can assist patients in making effective health-care decisions, not to mention properly using health-care knowledge support.

Virtually Being Einstein Results in an Improvement in Cognitive Task Performance and a Decrease in Age Bias

The brain's body representation is amenable to rapid change, even though we tend to think of our bodies as relatively fixed and stable. For example, it has been shown that a life-sized body perceived in virtual reality as substituting the participant's real body, can be felt as if it were their own, and that the body type can induce perceptual, attitudinal and behavioral changes. Here we show that changes can also occur in cognitive processing and specifically, executive functioning. Fifteen male participants were embodied in a virtual body that signifies super-intelligence (Einstein) and 15 in a (Normal) virtual body of similar age to their own. The Einstein body participants performed better on a cognitive task than the Normal body, considering prior cognitive ability (IQ), with the improvement greatest for those with low self-esteem. Einstein embodiment also reduced implicit bias against older people. Hence virtual body ownership may additionally be used to enhance executive functioning.

Written accounts of living with psychogenic nonepileptic seizures: A thematic analysis

PURPOSE

Qualitative studies examining lived experiences of psychogenic nonepileptic seizures (PNES) have predominantly relied on datasets collected using clinical or research interviews. This study pursued a different approach by investigating individuals' written accounts of their condition.

METHODS

Participants (n=19) were recruited from membership-led organisations for individuals living with seizures and from a United Kingdom hospital. Participants were instructed to produce four pieces of writing: 1) about their thoughts and feelings about their condition; 2) a letter to their condition; 3) a letter to their younger self; and 4) about a personal value. All writings were analysed using thematic analysis.

RESULTS

Six main-themes emerged from the data. Theme 1: 'living with PNES' demonstrated that all participants presented the condition as having a debilitating effect. Theme 2: 'Emotions' revealed that individuals were struggling with anxiety, low mood and self-worth. Theme 3: 'Seizure symptoms' showed variability was a prominent feature in the description of ictal events. Theme 4: 'Treatment and outcomes' demonstrated that individual's perception of diagnosis and therapy differed greatly. Theme 5: 'Causation and development' revealed that the majority of participants spontaneously reported experiencing a traumatic event in the past. Theme 6: 'Lack of understanding' by themselves, the public and healthcare professionals appeared to pose considerable challenges to participants.

CONCLUSIONS

Qualitative research has an important role to play for improving our understanding of PNES. The findings contribute to the literature by highlighting the nature of stigma that people with PNES experience, and also their proneness to demonstrate problems with self-worth.

Differences and similarities in the trajectories of self-esteem and positive and negative affect in persons with chronic illness: an explorative longitudinal study

BACKGROUND

Chronic illness is a risk factor for low self-esteem, and the research literature needs to include more studies of self-esteem and its development in chronic illness groups using longitudinal and comparative designs. The aim of this study was to explore the trajectories of self-esteem and of positive and negative affect in persons with morbid obesity and in persons with chronic obstructive pulmonary disease (COPD).

METHODS

Patient education course attendants in Norway having morbid obesity (n=139) or COPD (n=97) participated in the study. Data concerning self-esteem, positive and negative affect, and sociodemographic background were collected at the start and at the end of the patient education, with subsequent follow-ups at 3, 6, and 12 months. Data were analyzed using linear mixed models for repeated measures.

RESULTS

Taking all measurements into account, our data revealed a statistically significant increase in self-esteem for participants with morbid obesity but not for those with COPD. There were no significant differences in levels of negative and positive affect between the two groups, and the time-trajectories were also similar. However, participants in both groups achieved lower levels of negative affect for all the successive measurement points.

CONCLUSION

An increase in self-esteem during the first year after the patient education course was observed for persons with morbid obesity, but not for persons with COPD. Initial higher levels of self-esteem in the participants with COPD may indicate that they are less troubled with low self-esteem than people with morbid obesity are. The pattern of reduced negative affect for both groups during follow-up is promising.

Social and Temporal Comparisons as Moderators of Psychological Resources Associations With Wellbeing

Abstract. The current study investigated the associations of psychological resources, social comparisons, and temporal comparisons with general wellbeing. The sample included 142 community participants (47.9% men; age range 23–83 years), who compared themselves with others, and with their younger selves, on eight dimensions (e.g., physical health, resilience). They also completed questionnaires assessing psychological resources of mastery and self-esteem, and three components of subjective wellbeing: life satisfaction and negative and positive affect. The main results showed that high levels of psychological resources contributed to wellbeing, with self-enhancing social and temporal comparisons moderating the effects of resources on certain wellbeing components. Specifically, under low levels of mastery or self-esteem self-enhancing social or temporal comparisons were related to either higher life satisfaction or positive affect. The results highlight the role of resources and comparisons in promoting people’s wellbeing, and suggest that self-enhancing comparisons function as cognitive coping mechanisms when psychological resources are low.

Multidimensional analysis of food-allergic children and adolescents' self-concept: A comparison with a healthy matched sample

The study investigated self-concept in food-allergic youths and matched healthy controls. Global and domain-specific self-concepts were assessed in 154 participants (9-19 years) using the Multidimensional Self-Concept Scale. Statistical analysis assessed differences between the two samples and effects of asthma, dermatitis, age, and gender among patients. Significant differences were found for Total Scale score and for Competence and Physical scores. Patients showed clinically problematic self-concepts in Global, Competence, and Family domains. Age was found to be associated with the Total score. Health professionals should consider food-allergic patients' personality development. Further studies could examine disease-specific consequences and interventions.

How does self stigma differ across people with psychiatric diagnoses and rheumatoid arthritis, and how does it impact on self-esteem and empowerment?

Self stigmatising attitudes have been found in people who have psychiatric diagnoses, however, research assessing self stigma in physical illnesses is rare. It is known that receiving a diagnosis of rheumatoid arthritis (RA) can affect a person's identity and self esteem. This study aimed to compare levels of self stigma, self esteem and empowerment between people diagnosed with psychiatric illnesses and people diagnosed with RA to establish whether self stigma, and specifically endorsement of negative stereotypes, is associated with self esteem and empowerment across these two groups. A total of 202 participants (psychiatric group n = 102; RA group n = 100) were interviewed using the Internalised Stigma of Mental Illness scale (ISMI), or the Internalized Stigma of Mental Illness scale- Rheumatoid Arthritis (ISMI-RA), the Index of Self Esteem (ISE) and the Mental Health Confidence Scale (MHCS). Overall, the psychiatric group had higher self stigma scores (2.5 vs. 2.2, p < .01), lower self esteem (48.7 vs. 36.8, p < .001) and lower empowerment scores (3.8 vs. 4.3, p < .001) than the RA group. However, sizable proportions of both groups had high self stigma scores. ISMI/ISMI-RA was associated with the ISE and the MHCS. The stereotype endorsement subscale of the ISMI/ISMI-RA was not related to self esteem or empowerment in either group. Interventions that aim to decrease self stigma and increase self esteem could focus on alienation.