Understanding the relationship between stress, distress and healthy lifestyle behaviour: a qualitative study of patients and general practitioners

Common mental health problems in medical students and junior doctors - an overview of systematic reviews

BACKGROUND

Common mental health problems (CMHP) are prevalent among junior doctors and medical students, and the COVID-19 pandemic has brought challenging situations with education disruptions, early graduations, and front-line work. CMHPs can have detrimental consequences on clinical safety and healthcare colleagues; thus, it is vital to assess the overall prevalence and available interventions to provide institutional-level support.

AIMS

This overview summarises the prevalence of CMHPs from existing published systematic reviews and informs public health prevention and early intervention practice.

METHODS

Four electronic databases were searched from 2012 to identify systematic reviews on the prevalence of CMHPs and/or interventions to tackle them.

RESULTS

Thirty-six reviews were included: 25 assessing prevalence and 11 assessing interventions. Across systematic reviews, the prevalence of anxiety ranged from 7.04 to 88.30%, burnout from 7.0 to 86.0%, depression from 11.0 to 66.5%, stress from 29.6 to 49.9%, suicidal ideation from 3.0 to 53.9% and one obsessive-compulsive disorder review reported a prevalence of 3.8%. Mindfulness-based interventions were included in all reviews, with mixed findings for each CMHP.

CONCLUSIONS

The prevalence of CMHPs is high among junior doctors and medical students, with anxiety remaining relatively stable and depression slightly increasing during the COVID-19 pandemic. Future research on mindfulness-based interventions is required for a resilient and healthy future workforce.

PRISMA/PROSPERO

the researchers have followed PRISMA guidance. This overview was not registered with PROSPERO as it was conducted as part of an MSc research project.

Canadian Workers' Well-Being During the Beginning of the COVID-19 Pandemic: A Latent Profile Analysis

To explore workers' well-being during COVID-19, researchers have primarily utilized variable-centered approaches (e.g., regression) focusing on describing workers' general level of well-being. Given the diversity of factors that may have impacted workers' well-being during the pandemic, focusing on such well-being trends do not provide sufficient insight into the different lived well-being experiences during the pandemic. Moreover, positive well-being in workers' general lives and work has been understudied in such complex public health crises. To address these issues, we use latent profile analysis, a person-centered analysis, to explore the diverse well-being realities Canadian workers (employed before COVID-19 or working at the time of the survey) experienced at the beginning of COVID-19. Canadian workers (N = 510) were surveyed between May 20-27th, 2020, on positive (meaning in life, flourishing, thriving at work) and negative (distress, stress, impaired productivity, troublesome symptoms at work) well-being indicators, as well as on factors that may be associated with experiencing different well-being profiles. Five well-being profiles emerged: moderately prospering, prospering, moderately suffering, suffering, and mixed. Factors at the self- (gender, age, disability status, trait resilience), social- (marital status, family functioning, having children at home), workplace- (some employment statuses and work industries, financial strain, job security), and pandemic-related (perceived vulnerability to COVID-19, social distancing) ecological levels predicted profile membership. Recommendations for employers, policymakers, and mental health organizations are discussed.

'Scanxiety': Content analysis of pre-MRI patient experience on Instagram

INTRODUCTION

Distress and anxiety are commonly reported during the Magnetic Resonance Imaging (MRI) experience with prior studies suggesting the pre-MRI period is a time of heightened distress. There is a paucity of literature exploring preprocedural distress and anxiety, in particular qualitative research analysing patient experience. Instagram is rapidly becoming an important social media platform though which to conduct health research. A gradually increasing number of studies have examined social media to gain insight into patient experience within medical radiation science (MRS). This study is considered as the first to explore patient experience of MRI using Instagram as a data source.

METHODS

This study investigated the patient experience during the pre-MRI period by performing a content analysis on open-source Instagram posts. Ethical approval for the study was sought and approved by the Charles Sturt University, Human Research Ethics Committee.

RESULTS

Six themes emerged from the extracted data; Journey to the MRI, Waiting, Anticipating the MRI procedure, Preparing for the MRI procedure, Negative interaction, and Fear of the results.

CONCLUSION

The findings of this study provide novel self-reported and unsolicited insight into the diverse, multifactorial, and often concomitant nature of preprocedural MRI anxiety and distress.

IMPLICATIONS FOR PRACTICE

This study adds to a growing body of literature advocating for a compassionate, holistic, and person-centered approach when caring for patients in MRI that also considers their emotional and psychological wellbeing.

Coping with COVID-19 Pandemic and Sustained Health Behavior: A Cross-Sectional Study in Bangladesh

During the COVID-19 pandemic, people's health behavioral changes have been transposed into a new dimension. Coping with the COVID-19 pandemic may have an impact on sustained health behavior (SHB). Therefore, this study aimed to explore the validity and reliability of the COVID-19 Coping Scale among working-age individuals and to assess whether coping with COVID-19-related stress could influence SHB in this population. A cross-sectional study was conducted based on the population of the city of Dhaka in Bangladesh. A total of 263 working-age individuals (19-65 years) participated in the study. The present study results confirmed the COVID-19 Coping Scale was a valid and reliable instrument for this population. Moreover, the present finding indicated decreased odds of SHB for individuals who rated lower scores on coping with COVID-19 compared to individuals who rated higher scores; the result remained significant after controlling for gender and education (OR 0.68, 95% CI: 0.54-0.87). The present study suggests two important findings: (i) the instrument used in this study was valid and reliable in this population, and (ii) coping with COVID-19-related stress may be an important aspect of practicing SHB. Policymakers may use the highlighted findings to facilitate sustainable health behavior for long-term health benefits and to tackle future pandemics like COVID-19 or in a similar context.

Participation in the Global Corporate Challenge®, a Four-Month Workplace Pedometer Program, Reduces Psychological Distress

BACKGROUND

Psychological distress (stress) has been linked to an increased risk of chronic diseases and is exacerbated by a range of workplace factors. Physical activity has been shown to alleviate psychological distress. Previous pedometer-based intervention evaluations have tended to focus on physical health outcomes. This study aimed to investigate the immediate and long-term changes in psychological distress in employees based in Melbourne, Australia after their participation in a four-month pedometer-based program in sedentary workplaces.

METHODS

At baseline, 716 adults (aged 40 ± 10 years, 40% male) employed in primarily sedentary occupations, voluntarily enrolled in the Global Corporate Challenge© (GCC©), recruited from 10 Australian workplaces to participate in the GCC^® Evaluation Study, completed the Kessler 10 Psychological Distress Scale (K10). Of these, 422 completed the K10 at baseline, 4 months and 12 months.

RESULTS

Psychological distress reduced after participation in a four-month workplace pedometer-based program, which was sustained eight months after the program ended. Participants achieving the program goal of 10,000 steps per day or with higher baseline psychological distress had the greatest immediate and sustained reductions in psychological distress. Demographic predictors of immediate reduced psychological distress (n = 489) was having an associate professional occupation, younger age, and being 'widowed, separated or divorced'.

CONCLUSIONS

Participation in a workplace pedometer-based program is associated with a sustained reduction in psychological distress. Low-impact physical health programs conducted in groups or teams that integrate a social component may be an avenue to improve both physical and psychological health in the workplace.

Anxiety, depression and stress among internally displaced persons and host community in an armed conflict region: A comparative study

This study compares the psychological profile of Internally Displaced Persons (IDPs) and individuals living in host communities in the war-affected setting. We conducted a cross-sectional survey from October-November 2019. Subjects were recruited from six IDPs camps and the surrounding host communities within the metropolis of Maiduguri, Nigeria by convenience sampling. Data were collected using the Hausa version of Depression Anxiety Stress Scale-21, and analysed by logistic regression using adjusted odds ratio (AOR) at 95% Confidence Interval (CI). A total of 562 subjects were recruited. Living in IDP camp was the most significantly predictor of depression, anxiety, and stress. The common predictors were living in an IDP camp, and marital status (separated). Aged 18-29years was a protective factor compared to those ≥50years. Living in IDP camps, separated from partners, lack of education and pre-conflict employment were significant predictors of depression, anxiety and stress.

Validation of the Beirut Distress Scale (BDS-10), a short version of BDS-22, to assess psychological distress among the Lebanese population

PURPOSE

To develop and validate a short version of the Beirut Distress Scale (BDS-22), the BDS-10, in the Lebanese population, and evaluate the association between psychological distress and other mental disorders.

METHODS

A total of 2260 participants was enrolled in this cross-sectional study (January-July 2019).

RESULTS

Items converged over a solution of two factors (Factor 1 = Mood, affect and cognitive symptoms; Factor 2 = Physical symptoms; total variance explained = 64.51%). A significantly high correlation was found between BDS-10 and BDS-22 (r = 0.963, p < 0.001). Higher depression, anxiety, and insomnia were significantly associated with higher stress (higher BDS-10 and BDS-22 scores).

PRACTICE IMPLICATIONS

This new short tool is valid and reliable to screen for psychological distress, influencing mood and affect, and physical and cognitive functions.

Uptake of cancer risk management strategies among women who undergo cascade genetic testing for breast cancer susceptibility genes

BACKGROUND

Uptake of cancer risk management based on inherited predispositions, which encompasses bilateral mastectomy (BLM), bilateral salpingo-oophorectomy (BSO), and intensified screening, is the primary motivation for cascade testing for hereditary breast and ovarian cancer (HBOC). However, long-term outcome data for cascade testers are lacking.

METHODS

Medical records were abstracted for all unaffected women with pathogenic variants in HBOC genes from 2 cancer hospitals (2013-2019) with at least 1 year of follow-up to compare the uptake of surgery and screening between cascade and noncascade testers.

RESULTS

Cascade testers (79.8%) were younger than noncascade testers (mean age, 37.6 vs 43.5 years; P = .002). Among women aged ≥40 years, 43% underwent BLM, and 71.6% underwent BSO, with no significant difference in uptake between cascade and noncascade testers. The mean time to BSO among cascade testers was shorter among women aged ≥40 years versus those aged <40 years (11.8 vs 31.9 months; P = .04); no such difference was observed among noncascade testers. Mammography and breast magnetic resonance imaging rates were low in the recorded 6 years for both groups after genetic counseling.

CONCLUSIONS

Management uptake among cascade testers is high with rates comparable to those for unaffected BRCA-positive women. A large proportion of women act on cascade test results, and this represents a novel report of utilization of cancer management strategies.

Examining the associations between self-care practices and psychological distress among nursing students during the COVID-19 pandemic

There is limited research regarding the impact of self-care practices on psychological distress, specifically on nursing students during a pandemic, such as COVID-19 (Corona Virus Disease- 2019). A 10-minute electronic survey was sent to nursing students at a large academic-medical center, and data from 285 student respondents were analyzed to assess psychological status, attitudes and behaviors in regards to the COVID-19 pandemic. Significant differences were found when comparing self-care practice scores by school grade for total scores (F = 4.48 [df = 4,250], p = .002), emotional subscale (F = 4.78 [df = 4,250], p = .001), and relationship subscale (F = 3.44 [df = 4,250], p = .009). While there were no significant differences in psychological distress by school grade, graduate students had the lowest self-care practice score compared to all the other grades. Finally, the subscale and total self-care practice scores were significantly and negatively associated with psychological distress. These findings suggest that utilization of self-care practices is associated with lower psychological distress, and should therefore be promoted among nursing student populations and integrated into curricula. Future studies should assess specific needs geared towards populations that may have poor self-care practices, such as graduate students, and understand ways to improve sleep quality to mitigate rates of psychological distress during a pandemic.

Worry much? Preventive health behaviours related to worry across countries amid COVID-19

This study examined the relationship between worry and health behaviours using an online survey of 69,033 respondents from 32 countries. We hypothesized that past health behaviours predicted worry experienced, which in turn predicted future health behaviours, and included a metric of cultural distance from the US. Past behaviours such as maintaining physical distance predicted higher worry, whereas worry reduced the likelihood of going outside. Being culturally dissimilar to the US was associated with lower worry. However, cultural distance was not associated with future health behaviours. We analyse worry as an approach-avoidance motivator of health behaviours from a cross-cultural perspective, to facilitate effective health communication strategies.

Factors associated with psychological stress and distress among Korean adults: the results from Korea National Health and Nutrition Examination Survey

The prevalence of stress and distress has been increasing and being important public health issues; nevertheless, few studies have assessed the factors associated at the population level. This study identified factors associated and how they differentially influence stress and distress. A total of 35,105 individuals aged 19 years and older using nationally representative data from the Korea National Health and Nutrition Examination Survey (2007-2012) were included in the study. Subjects were differentiated by gender and psychological state (no symptoms, stress, distress). The associations of socio-demographics, psychosocial factors, health behaviours, and chronic illness with psychological states were analysed by gender. Socio-demographics and psychosocial factors such as lower household income, lower education level, living alone or negative outcome of marriage, and unemployment were associated with distress in both genders. Male and female educated higher and with short sleep duration, male living alone and with higher household income, and female married and with a lower household income was associated with stress. A perceived body image of slim or fat was associated with distress and stress in both genders. Behavioural factors, such as smoking, higher alcohol consumption, and abnormal calorie intake, were associated with stress and distress in both genders, with the exception of alcohol consumption in distress and abnormal calorie intake in stress of male. Socio-economic deprivation and negative psychosocial and behavioural factors were differently associated with psychological distress or stress by gender. Intervention strategies for distress and stress should be specifically tailored regarding these differences.

An Epigenetics-Based, Lifestyle Medicine-Driven Approach to Stress Management for Primary Patient Care: Implications for Medical Education

Over 75% of patients in the primary care setting present with stress-related complaints. Curiously, patients and health care providers all too often see stress as a relatively benign sequela of many common illnesses such as heart disease, cancer, lung disease, dementia, diabetes, and mental illness. Unfortunately, various day-to-day lifestyle choices and environmental factors, unrelated to the presence of any disease, can cause stress sufficient to contribute to the development of various diseases/disorders and suboptimal health. There is evidence suggesting that counseling in stress management-oriented therapeutic interventions (as offered by lifestyle medicine-oriented practitioners) may prevent or reduce the onset, severity, duration, and/or overall burden of stress-related illnesses. Such counseling often involves considerations such as the patient's nutrition, physical activity, interest in/capacity to meditate, drug abuse/cessation, and so on. Unfortunately, lifestyle medicine-oriented approaches to stress management are rarely offered in primary care-the patient care arena wherein such counseling would likely be best received by patients. Would health care outcomes improve if primary care providers offered counseling in both stress management and positive lifestyle choices? The purpose of this article is to provide both primary care practitioners and educators in health care training programs with an introductory overview of epigenetics. An emerging field of science offering insights into how factors such as stress and lifestyle choices interact with our genes in ways that can both positively and negatively impact the various micro (eg, cellular) through macro (eg, physiologic, pathophysiologic) processes that determine our tendencies toward illness or wellness. A deeper understanding of epigenetics, as provided herein, should enable primary care providers and medical educators to more confidently advocate for the primary benefits associated with counseling in both stress reduction and the pursuit of healthy lifestyle choices.

Personalized eHealth Program for Life-style Change: Results From the "Do Cardiac Health Advanced New Generated Ecosystem (Do CHANGE 2)" Randomized Controlled Trial

OBJECTIVE

Unhealthy life-style factors have adverse outcomes in cardiac patients. However, only a minority of patients succeed to change unhealthy habits. Personalization of interventions may result in critical improvements. The current randomized controlled trial provides a proof of concept of the personalized Do Cardiac Health Advanced New Generation Ecosystem (Do CHANGE) 2 intervention and evaluates effects on a) life-style and b) quality of life over time.

METHODS

Cardiac patients (n = 150; mean age = 61.97 ± 11.61 years; 28.7% women; heart failure, n = 33; coronary artery disease, n = 50; hypertension, n = 67) recruited from Spain and the Netherlands were randomized to either the "Do CHANGE 2" or "care as usual" group. The Do CHANGE 2 group received ambulatory health-behavior assessment technologies for 6 months combined with a 3-month behavioral intervention program. Linear mixed-model analysis was used to evaluate the intervention effects, and latent class analysis was used for secondary subgroup analysis.

RESULTS

Linear mixed-model analysis showed significant intervention effects for life-style behavior (Finteraction(2,138.5) = 5.97, p = .003), with improvement of life-style behavior in the intervention group. For quality of life, no significant main effect (F(1,138.18) = .58, p = .447) or interaction effect (F(2,133.1) = 0.41, p = .67) was found. Secondary latent class analysis revealed different subgroups of patients per outcome measure. The intervention was experienced as useful and feasible.

CONCLUSIONS

The personalized eHealth intervention resulted in significant improvements in life-style. Cardiac patients and health care providers were also willing to engage in this personalized digital behavioral intervention program. Incorporating eHealth life-style programs as part of secondary prevention would be particularly useful when taking into account which patients are most likely to benefit.

TRIAL REGISTRATION

https://clinicaltrials.gov/ct2/show/NCT03178305.

Preventing chronic disease in patients with low health literacy using eHealth and teamwork in primary healthcare: protocol for a cluster randomised controlled trial

INTRODUCTION

Adults with lower levels of health literacy are less likely to engage in health-promoting behaviours. Our trial evaluates the impacts and outcomes of a mobile health-enhanced preventive intervention in primary care for people who are overweight or obese.

METHODS AND ANALYSIS

A two-arm pragmatic practice-level cluster randomised trial will be conducted in 40 practices in low socioeconomic areas in Sydney and Adelaide, Australia. Forty patients aged 40-70 years with a body mass index ≥28 kg/m2 will be enrolled per practice. The HeLP-general practitioner (GP) intervention includes a practice-level quality improvement intervention (medical record audit and feedback, staff training and practice facilitation visits) to support practices to implement the clinical intervention for patients. The clinical intervention involves a health check visit with a practice nurse based on the 5As framework (assess, advise, agree, assist and arrange), the use of a purpose-built patient-facing app, my snapp, and referral for telephone coaching. The primary outcomes are change in health literacy, lifestyle behaviours, weight, waist circumference and blood pressure. The study will also evaluate changes in quality of life and health service use to determine the cost-effectiveness of the intervention and examine the experiences of practices in implementing the programme.

ETHICS AND DISSEMINATION

The study has been approved by the University of New South Wales (UNSW) Human Research Ethics Committee (HC17474) and ratified by the University of Adelaide Human Research Ethics committee. There are no restrictions on publication, and findings of the study will be made available to the public via the Centre for Primary Health Care and Equity website and through conference presentations and research publications. Deidentified data and meta-data will be stored in a repository at UNSW and made available subject to ethics committee approval.

TRIAL REGISTRATIONREGISTRATION NUMBER

ACTRN12617001508369; Pre-results.

Self-reported domain-specific and accelerometer-based physical activity and sedentary behaviour in relation to psychological distress among an urban Asian population

Background

The interpretation of previous studies on the association of physical activity and sedentary behaviour with psychological health is limited by the use of mostly self-reported physical activity and sedentary behaviour, and a focus on Western populations. We aimed to explore the association of self-reported and devise-based measures of physical activity and sedentary behaviour domains on psychological distress in an urban multi-ethnic Asian population.

Methods

From a population-based cross-sectional study of adults aged 18–79 years, data were used from an overall sample (n = 2653) with complete self-reported total physical activity/sedentary behaviour and domain-specific physical activity data, and a subsample (n = 703) with self-reported domain-specific sedentary behaviour and accelerometry data. Physical activity and sedentary behaviour data were collected using the Global Physical Activity Questionnaire (GPAQ), a domain-specific sedentary behaviour questionnaire and accelerometers. The Kessler Screening Scale (K6) and General Health Questionnaire (GHQ-12) were used to assess psychological distress. Logistic regression models were used to calculate odds ratios (ORs) and 95% confidence intervals, adjusted for socio-demographic and lifestyle characteristics.

Results

The sample comprised 45.0% men (median age = 45.0 years). The prevalence of psychological distress based on the K6 and GHQ-12 was 8.4% and 21.7%, respectively. In the adjusted model, higher levels of self-reported moderate-to-vigorous physical activity (MVPA) were associated with significantly higher odds for K6 (OR = 1.47 [1.03–2.10]; p-trend = 0.03) but not GHQ-12 (OR = 0.97 [0.77–1.23]; p-trend = 0.79), when comparing the highest with the lowest tertile. Accelerometry-assessed MVPA was not significantly associated with K6 (p-trend = 0.50) nor GHQ-12 (p-trend = 0.74). The highest tertile of leisure-time physical activity, but not work- or transport-domain activity, was associated with less psychological distress using K6 (OR = 0.65 [0.43–0.97]; p-trend = 0.02) and GHQ-12 (OR = 0.72 [0.55–0.93]; p-trend = 0.01). Self-reported sedentary behaviour was not associated with K6 (p-trend = 0.90) and GHQ-12 (p-trend = 0.33). The highest tertile of accelerometry-assessed sedentary behaviour was associated with significantly higher odds for K6 (OR = 1.93 [1.00–3.75]; p-trend = 0.04), but not GHQ-12 (OR = 1.34 [0.86–2.08]; p-trend = 0.18).

Conclusions

Higher levels of leisure-time physical activity and lower levels of accelerometer-based sedentary behaviour were associated with lower psychological distress. This study underscores the importance of assessing accelerometer-based and domain-specific activity in relation to mental health, instead of solely focusing on total volume of activity.

Electronic supplementary material

The online version of this article (10.1186/s12966-018-0669-1) contains supplementary material, which is available to authorized users.

Do singles or couples live healthier lifestyles? Trends in Queensland between 2005-2014

Objectives

To compare the frequency of and trends in healthy lifestyle factors between singles and couples.

Methods

Cross-sectional data from annual surveys conducted from 2005–2014 were used. The pooled sample included 15,001 Australian adults (mean age: 52.9 years, 50% male, 74% couples) who participated in the annual Queensland Social Survey via computer-assisted telephone interviews. Relationship status was dichotomised into single and couple. Binary logistic regression was used to assess associations between relationship status, and the frequency of and trends in healthy lifestyle factors.

Results

Compared to singles, couples were significantly more likely to be a non-smoker (OR = 1.82), and meet recommendations for limited fast food (OR = 1.12), alcohol consumption (OR = 1.27) and fruit and vegetable intake (OR = 1.24). Fruit and vegetable intake was not significantly associated with relationship status after adjusting for the other healthy lifestyle factors. Conversely, couples were significantly less likely to be within a normal weight range (OR = 0.81). In both singles and couples, the trend data revealed significant declines in the rates of normal weight (singles: OR = 0.97, couples: OR = 0.97) and viewing TV for less than 14 hours per week (singles: OR = 0.85, couples: OR = 0.84), whilst non-smoking rates significantly increased (singles: OR = 1.12, couples: OR = 1.03). The BMI trend was no longer significant when adjusting for health behaviours. Further, in couples, rates of meeting recommendations for physical activity and fruit/vegetable consumption significantly decreased (OR = 0.97 and OR = 0.95, respectively), as did rates of eating no fast food (OR = 0.96). These trends were not significant when adjusting for the other healthy lifestyle factors. In singles, rates of meeting alcohol recommendations significantly increased (OR = 1.08).

Conclusions

Health behaviour interventions are needed in both singles and couples, but relationship status needs to be considered in interventions targeting alcohol, fast food, smoking and BMI. Further research is needed to understand why health behaviours differ by relationship status in order to further improve interventions.

Psychological symptoms and subsequent healthy lifestyle after a colorectal cancer diagnosis

OBJECTIVE

Although medical professionals recommend lifestyle changes following a colorectal cancer (CRC) diagnosis to improve outcomes, such changes are not consistently implemented. This study examines whether higher distress is associated with lower likelihood of engaging in favorable behaviors after CRC diagnosis.

METHOD

Women from the Nurses' Health Study prospective cohort who completed anxiety (n = 145) and depression (n = 227) symptom scales within 4 years after receiving a CRC diagnosis were included. Measures of lifestyle (diet, physical activity, alcohol, smoking, body mass index [BMI]) were queried prediagnosis, when psychological symptoms were assessed (1988 and 1992, respectively), and then every 4 years thereafter until 2010. Women were categorized according to initial psychological symptoms levels and followed through 2010 or until last follow-up completed.

RESULTS

Higher versus lower anxiety symptoms were significantly related to unhealthier lifestyle scores throughout follow-up (β = -0.25, CI [-0.44, -0.05]); however, the rate of change over time was similar across groups (pinteraction effect = 0.41). Stratified analyses hinted that higher anxiety and depression symptoms were related to increased odds of reporting a future unhealthy lifestyle within 10-years postdiagnosis. Beyond 10 years, anxiety became statistically unrelated with future lifestyle, and higher depressive symptoms were associated with lower odds of subsequently having an unhealthy lifestyle, albeit nonstatistically significant (OR = 0.35, 95% CI [0.10, 1.24], p = 0.10).

CONCLUSIONS

Among women with CRC, higher anxiety and depression symptoms were associated with subsequent unhealthier lifestyle in the 10 years following diagnosis. With replication, such findings may suggest that treating psychological symptoms early in the cancer trajectory may not solely reduce psychological distress but also promote healthier lifestyle. (PsycINFO Database Record

Understanding knee osteoarthritis from the patients' perspective: a qualitative study

BACKGROUND

No studies of Health Coach Interventions for knee OA sufferers that include patients' perspectives have been published. The study assesses current clinical practice and primary care professionals' advice from the patients' perspective, in order to obtain a participative design for a complex intervention based on coaching psychology. Moreover, wants to analyse the experiences, perceptions, cognitive evaluation, values, emotions, beliefs and coping strategies of patients with knee osteoarthritis, and secondly the impact of these factors in the Self-management of this condition.

METHODS

It is an interpretative qualitative study. The study included patients with diagnosis of knee osteoarthritis (OA) from 4 primary health care centres in Barcelona. A theoretical sampling based on a prior definition of participants' characteristics was carried out. Ten semi-structured interviews with knee OA patients were carried out. A content thematic analysis was performed following a mixed-strategy text codification in Lazarus framework and in emerging codes from the data.

RESULTS

The results are structured in two blocks: Experiences and perceptions of informants and Experiences of knee osteoarthritis according to the Lazarus model. Regarding experiences and perceptions of informants: Some participants reported that the information was mostly provided by health professionals. Informants know which food they should eat to lose weight and the benefits of weight loss. Moreover, participants explained that they like walking but that sometimes it is difficult to put into practice. Regarding experiences of knee osteoarthritis according Lazarus model: Cognitive evaluation is influenced by cognitive distortions such as obligation, guilt, dramatization and catastrophism.

VALUES

Family is the value most associated with wellbeing. Helping others is another recurring value. Emotions: Most participants explain that they feel anxiety, irritability or sadness. Beliefs: To some, physiotherapy helps them feel less pain. However, others explain that it is of no use to them. Participants are aware of the association overweight- pain. Coping strategies: The strategies for coping with emotions aim to reduce psychological distress (anxiety, sadness, anger) and some are more active than others.

CONCLUSIONS

The study highlights that patients with knee osteoarthritis require a person-centered approach that provides them with strategies to overcome the psychological distress caused by this condition.

Prospective Changes in Healthy Lifestyle Among Midlife Women: When Psychological Symptoms Get in the Way

INTRODUCTION

Anxiety and depression are linked to increased risk of cardiometabolic disease and mortality, and unhealthy behaviors may be the key mechanisms underlying these associations. Although higher levels of psychological symptoms are associated with individual unhealthy behaviors (e.g., physical activity, smoking), their roles in overall lifestyle remain understudied.

METHODS

Midlife women (n=55,395) from the cohort Nurses' Health Study reported anxiety and depression symptoms in 1988 and 1992, respectively. Health behaviors (i.e., physical inactivity, BMI, diet, and alcohol and tobacco consumption) were measured in self-administered questionnaires in 1988 or 1992, and every 4 years until the last assessment available (2010; follow-up, 18-22 years). Data were analyzed in 2014-2015. Women were categorized according to initial level of psychological symptoms (e.g., lower versus higher anxiety symptoms).

RESULTS

Despite slight improvements in healthy lifestyle over time among women with higher versus lower anxiety (βinteraction=0.002, 95% CI=0.001, 0.003), those experiencing more severe symptoms had a consistently less healthy lifestyle over time (p<0.0001). Each SD increase in anxiety symptoms was related to a decrease in healthy lifestyle score throughout follow-up (βpooled=-0.09, 95% CI=-0.09, -0.08). Women with higher versus lower anxiety symptoms also had decreased odds of having a healthy lifestyle in 2010 (AOR=0.78, 95% CI=0.75, 0.81), particularly among women with an initially unhealthy lifestyle (pinteraction≤0.0001). Comparable patterns were observed with depression symptoms.

CONCLUSIONS

Among midlife women, anxiety and depression symptoms were associated with unhealthier lifestyle throughout follow-up and reduced odds of having a healthy lifestyle 20 years later. Treating psychological symptoms may promote healthier lifestyles.

Assessment of healthy behaviors for metabolic syndrome among Korean adults: a modified information-motivation-behavioral skills with psychological distress

BACKGROUND

Since the worldwide incidence of metabolic syndrome (Mets) has rapidly increased, healthy behaviors such as weight control, engaging in physical activity, and healthy diet have been crucial in the management of Mets. The purpose of this study was to examine healthy behaviors practice and factors that affect the practice in relation to Mets on the basis of a modified Information-Motivation-Behavioral skills model (IMB) with psychological distress, which is a well-known factor affecting healthy behaviors among individuals with Mets.

METHODS

Study participants were 267 community dwelling adults (M age: 54.0 ± 8.1 years) with Mets who were attending public health centers located in Seoul, South Korea. A structured questionnaire was administered in the areas of information, motivation, behavioral skills, and practice of Mets healthy behaviors and levels of psychological distress from May 2014 to September 2014. Structural equation modeling was used to test the modified IMB model.

RESULTS

The modified IMB model had a good fit with the data, indicating that motivation and behavioral skills directly influenced the practice of Mets healthy behaviors, whereas information and psychological distress directly influenced motivation and influenced the practice of healthy behaviors through behavioral skills. These components of the modified IMB model explained 29.8 % of the variance in healthy behaviors for Mets.

CONCLUSION

Findings suggested that strengthening motivation and behavioral skills for healthy behaviors can directly enhance healthy behavior practice. Providing information about Mets related healthy behaviors and strategies for psychological distress management can be used as the first line evidence based intervention to systemically enhance motivation and behavioral skills among individuals with Mets.

Medication overuse, healthy lifestyle behaviour and stress in chronic headache: Results from a population-based representative survey

Aim

This cross-sectional study investigated associations between chronic headache (CH) with and without medication overuse, healthy lifestyle behaviour, and stress.

Methods

Questionnaires were sent to 129,150 adults. Those with headache ≥15 days per month for three months were classified as having CH then further described as having medication-overuse headache (MOH) or CH without medication overuse. Associations between headache and daily smoking, physical inactivity, obesity, excessive drinking, illicit drug use, and high stress were analysed by logistic regression.

Results

CH with and without medication overuse (prevalence 1.8% and 1.6%, respectively) had strong, graded associations with stress. Associations with daily smoking, physical inactivity, and obesity were significant only for MOH. Odds for MOH were highest among people who had all three factors compared to those who had none (OR 2.8 in women and 5.1 in men). High stress plus any of these three factors had synergistic effects in MOH but not clearly in those who had CH without overuse. Associations between CH subtypes and excessive drinking or illicit drug use were not statistically significant.

Conclusion

Results suggest strong links between healthy lifestyle behaviour and stress in MOH. Stress reduction and promoting healthy behaviour are highly relevant in MOH management.

Understanding the patient multidimensional experience: a qualitative study on coping in hospitals of Assistance Publique-Hôpitaux de Paris, France

OBJECTIVE

Time spent in hospitals is complex and entails a number of distinct phases that fluctuate depending on many variables. Attempts to understand patients' experiences often involve focusing on their needs using self-evaluation, but this does not clearly highlight the complexity of coping. Questionnaires based on telephone surveys and emails do not facilitate a sufficient assessment of the coping effort. However, when patients express themselves through spontaneous narration, different dimensions may emerge in their experience at the hospital. This qualitative study explores the various forms of coping among patients with a hospital experience.

METHODS

Interviews were conducted with 75 patients in six hospital departments. Transcripts from interviews were thematically analyzed and a conceptual, multidimensional model was developed to explain the relationship between patient experience and coping complexity.

RESULTS

Patients used a set of about 50 different terms to describe their experiences in the hospital. They described with the greatest number of words the aspects that triggered their stress or distress and forced them to cope. Stress resulting from the experienced situation was classifiable into five dimensions: trauma, environment, medical, interpersonal affective, and social impact, which constitute invariants that may require individual complex coping strategies.

CONCLUSION

Patient experience is hard to evaluate, and this represents a permanent challenge for medical teams. Considering the five coping dimensions delineated in this study may be helpful in improving the patient's hospital experience.

Health behaviors in family members of patients completing cancer treatment

PURPOSE/OBJECTIVES

To describe the impact of the cancer experience on the health behaviors of survivors' family members and to determine factors associated with family members' intentions for health behavior change.

DESIGN

Descriptive, cross-sectional, correlational.

SETTING

A National Cancer Institute-designated comprehensive cancer center in the midwestern United States.

SAMPLE

39 family members and 50 patients with diagnoses of breast, colorectal, head and neck, lung, or prostate cancer who were completing definitive cancer treatment.

METHODS

Patients and family members were approached in the clinic at three weeks or fewer before the completion of their course of treatment. Family members completed surveys and a structured interview in person or via telephone.

MAIN RESEARCH VARIABLES

Intention, perceived benefit, and confidence about eating a healthful diet, physical activity, and smoking cessation; emotional distress; and family cohesion, conflict, and expressiveness.

FINDINGS

Family members had high ratings for intention, perceived benefit, and confidence related to the behaviors of eating a healthful diet and performing 30 minutes of daily moderate-intensity physical activity. They also had high ratings for the extent to which the cancer experience had raised awareness of their cancer risk and made them consider undergoing screening tests for cancer; ratings were lower for making changes in their health behaviors.

CONCLUSIONS

Family members expressed strong intentions to engage in health-promoting behaviors related to physical activity and nutrition at the post-treatment transition.

IMPLICATIONS FOR NURSING

Oncology nurses are in a key position to engage family members and patients in behavior change. Nurses should assess family members at the completion of treatment for distress and provide interventions to influence the trajectory of distress in survivorship.

Health behaviors in family members of patients completing cancer treatment

PURPOSE/OBJECTIVES

To describe the impact of the cancer experience on the health behaviors of survivors' family members and to determine factors associated with family members' intentions for health behavior change.

DESIGN

Descriptive, cross-sectional, correlational.

SETTING

A National Cancer Institute-designated comprehensive cancer center in the midwestern United States.

SAMPLE

39 family members and 50 patients with diagnoses of breast, colorectal, head and neck, lung, or prostate cancer who were completing definitive cancer treatment.

METHODS

Patients and family members were approached in the clinic at three weeks or fewer before the completion of their course of treatment. Family members completed surveys and a structured interview in person or via telephone.

MAIN RESEARCH VARIABLES

Intention, perceived benefit, and confidence about eating a healthful diet, physical activity, and smoking cessation; emotional distress; and family cohesion, conflict, and expressiveness.

FINDINGS

Family members had high ratings for intention, perceived benefit, and confidence related to the behaviors of eating a healthful diet and performing 30 minutes of daily moderate-intensity physical activity. They also had high ratings for the extent to which the cancer experience had raised awareness of their cancer risk and made them consider undergoing screening tests for cancer; ratings were lower for making changes in their health behaviors.

CONCLUSIONS

Family members expressed strong intentions to engage in health-promoting behaviors related to physical activity and nutrition at the post-treatment transition.

IMPLICATIONS FOR NURSING

Oncology nurses are in a key position to engage family members and patients in behavior change. Nurses should assess family members at the completion of treatment for distress and provide interventions to influence the trajectory of distress in survivorship.