Quality of life of people with mental health problems: a synthesis of qualitative research

Schizophrenia Quality of Life Scale and Schizophrenia Quality of Life Scale Revision 4: A Systematic Review of Measurement Properties

BACKGROUND AND HYPOTHESIS

Schizophrenia is a severe mental disorder that has a significant impact on quality of life (QOL). Measuring QOL can offer insights into treatment efficacy and areas of intervention, highlighting the importance of valid tools assessing QOL in people with schizophrenia.

STUDY DESIGN

We employed the COSMIN systematic review guideline to assess the psychometric properties of the schizophrenia quality of life scale (SQLS) and its 4th revision, the schizophrenia quality of life scale revision 4 (SQLS-R4), as patient-reported outcome measures (PROMs).

STUDY RESULTS

The search yielded 455 papers, 16 were included, 7 for the SQLS and 9 for the SQLS-R4. Both scales demonstrated good results in risk of bias assessment for internal consistency and convergent validity, the SQLS-R4 additionally for known-groups validity. For the SQLS, PROM development, structural validity, and reliability were suboptimal. The SQLS-R4 showed suboptimality regarding structural validity and reliability and inadequacy for cross-cultural validity and responsiveness. The updated criteria for good measurement properties indicated good convergent validity for the SQLS and good internal consistency, reliability, and convergent validity for the SQLS-R4. The SQLS showed suboptimal results for reliability and known-groups validity, while the SQLS-R4 demonstrated suboptimality in structural validity and known-groups validity. The SQLS had indeterminate structural validity and internal consistency; the SQLS-R4 showed indeterminate responsiveness, and insufficient cross-cultural validity. When using the updated GRADE approach of the COSMIN group, both scales received a very low grade.

CONCLUSIONS

The SQLS and SQLS-R4 hold the potential for recommendation in rating QOL. Identified weaknesses necessitate further validations.

The Role of Intolerance of Uncertainty and Religiousness in Schizotypal Personality and Life Satisfaction: A Cross-Sectional Study

Intolerance of uncertainty is an important trans-diagnostic determinant of mental disorders. It is related to psychotic symptoms and religiousness. Religiousness is related to schizotypal personality and wellbeing. Therefore, in a cross-sectional study, we studied the effects of intolerance of uncertainty and religiousness on schizotypal personality and the schizotypal personality-mediated effects of intolerance of uncertainty and religiousness on life satisfaction. On a sample of 734 college students (age, M = 20.3, SD = 3.48), intolerance of uncertainty, religiousness, life satisfaction, and schizotypal personality were measured through paper-pencil questionnaires. The results showed that intolerance of uncertainty had positive (direct) relationships with all schizotypal personality dimensions. However, intolerance of uncertainty had positive (mediated by ideas of reference and magical thinking) and negative (mediated by eccentric behavior) indirect effects on life satisfaction. Religiousness had direct as well as indirect (mediated by eccentric behavior) positive effects on life satisfaction. However, the behaving (mediated by ideas of reference) and belonging (mediated by magical thinking) sub-dimensions of religiousness had some indirect negative effects on life satisfaction. Thus, the present study shows that intolerance of uncertainty is an important contributor to psychotic proneness. Religiousness is largely health-enhancing. Moreover, there is a nuanced pattern of interactional relationship between intolerance of uncertainty, religiousness, schizotypal personality, and life satisfaction. We have discussed the theoretical and applied implications of the findings.

Association between junk food consumption and mental health problems in adults: a systematic review and meta-analysis

BACKGROUND

Anxiety and depression can seriously undermine mental health and quality of life globally. The consumption of junk foods, including ultra-processed foods, fast foods, unhealthy snacks, and sugar-sweetened beverages, has been linked to mental health. The aim of this study is to use the published literature to evaluate how junk food consumption may be associated with mental health disorders in adults.

METHODS

A systematic search was conducted up to July 2023 across international databases including PubMed/Medline, ISI Web of Science, Scopus, Cochrane, Google Scholar, and EMBASE. Data extraction and quality assessment were performed by two independent reviewers. Heterogeneity across studies was assessed using the I2 statistic and chi-square-based Q-test. A random/fixed effect meta-analysis was conducted to pool odds ratios (ORs) and hazard ratios (HRs).

RESULTS

Of the 1745 retrieved articles, 17 studies with 159,885 participants were suitable for inclusion in the systematic review and meta-analysis (seven longitudinal, nine cross-sectional and one case-control studies). Quantitative synthesis based on cross-sectional studies showed that junk food consumption increases the odds of having stress and depression (OR = 1.15, 95% CI: 1.06 to 1.23). Moreover, pooling results of cohort studies showed that junk food consumption is associated with a 16% increment in the odds of developing mental health problems (OR = 1.16, 95% CI: 1.07 to 1.24).

CONCLUSION

Meta-analysis revealed that consumption of junk foods was associated with an increased hazard of developing depression. Increased consumption of junk food has heightened the odds of depression and psychological stress being experienced in adult populations.

A scoping review to create a framework for the steps in developing condition-specific preference-based instruments de novo or from an existing non-preference-based instrument: use of item response theory or Rasch analysis

BACKGROUND

There is no widely accepted framework to guide the development of condition-specific preference-based instruments (CSPBIs) that includes both de novo and from existing non-preference-based instruments. The purpose of this study was to address this gap by reviewing the published literature on CSPBIs, with particular attention to the application of item response theory (IRT) and Rasch analysis in their development.

METHODS

A scoping review of the literature covering the concepts of all phases of CSPBI development and evaluation was performed from MEDLINE, Embase, PsychInfo, CINAHL, and the Cochrane Library, from inception to December 30, 2022.

RESULTS

The titles and abstracts of 1,967 unique references were reviewed. After retrieving and reviewing 154 full-text articles, data were extracted from 109 articles, representing 41 CSPBIs covering 21 diseases or conditions. The development of CSPBIs was conceptualized as a 15-step framework, covering four phases: 1) develop initial questionnaire items (when no suitable non-preference-based instrument exists), 2) establish the dimensional structure, 3) reduce items per dimension, 4) value and model health state utilities. Thirty-nine instruments used a type of Rasch model and two instruments used IRT models in phase 3.

CONCLUSION

We present an expanded framework that outlines the development of CSPBIs, both from existing non-preference-based instruments and de novo when no suitable non-preference-based instrument exists, using IRT and Rasch analysis. For items that fit the Rasch model, developers selected one item per dimension and explored item response level reduction. This framework will guide researchers who are developing or assessing CSPBIs.

Development and validation of the Autonomy Scale Amsterdam

This paper describes the development and validation of the Autonomy Scale Amsterdam (ASA). We propose that a new measure of autonomy is needed and, as such, we developed and validated an autonomy scale relevant for psychiatry. Based on literature, an expert meeting and three samples of the general population (N = 298, N = 207, N = 309) we provide evidence (a) that supports a 6-factor structure model as a better fit than alternative models with a high reliability to capture the concept of autonomy consisting of: Self-integration, Engagement with life, Goal-directedness, Self-control, External constraints and Social support, (b) for the scale's convergent and discriminant validity with constructs in autonomy's nomological network and (c) for the scale's criterion validity with well-established well-being outcomes, and (d) that the measure is not redundant with a prior measure of autonomy, the autonomy-connectedness scale, and demonstrates incremental validity in the prediction of mental health over and above an existing measure of autonomy. Taken together, the results suggest that the ASA is a useful scale that shows positive evidence of psychometric quality to measure autonomy in a sample of the general population (total N = 856), accounting for a unique predictive value over and above an existing measure of autonomy concerning several mental health outcomes. The ASA can further help our understanding of the role of autonomy in mental disorders.

The perspectives of hospital doctors about end-of-life care in people with mental illness: an observational pilot study

BACKGROUND

Negative attitudes towards people living with mental illness (PLWMI), defined here as mentalism, are a major contribution to health care inequity, which may extend into end-of-life care. There is a clear need for investigation of the attitudes of doctors towards PLWMI at the end of life as doctors may lead processes of care that contribute to this inequity.

AIMS

The aim of this pilot study is to examine the perspectives of hospital-based doctors regarding end-of-life care and medical decision-making in PLWMI.

METHODS

A survey was created to explore whether mentalism is present in the perspectives of hospital doctors regarding end-of-life care for PLWMI. The survey included demographic characteristics of participants and questions comprising statements and vignettes that required agree/disagree responses. Descriptive statistics were used to summarise responses, and chi-square tests examined associations with demographic variables.

RESULTS

The survey was commenced by 48 hospital-based doctors and completed by 45. Descriptive statistics indicated that mentalism is present in the attitudes of hospital doctors regarding end-of-life care of PWLMI, with 47 of 48 participants (98%) endorsing at least one mentalist response. One significant association found that psychiatrists and psychiatry trainees were less likely to endorse a stereotype response in one vignette.

CONCLUSIONS

This preliminary study addresses a gap within the literature on the potential contribution of mentalist attitudes in doctors to the poorer end-of-life care outcomes for PLWMI. The findings highlight the need for further study of this topic and suggest a role for targeted medical education in the pursuit of health care equality for PLWMI.

Individuals' attitudes toward digital mental health apps and implications for adoption in Portugal: web-based survey

BACKGROUND

The literature is consensual regarding the academic community exhibiting higher levels of mental disorder prevalence than the general population. The potential of digital mental health apps for improving access to resources to cope with these issues is ample. However, studies have yet to be performed in Portugal on individuals' attitudes and perceptions toward digital mental health applications or their preferences and decision drivers on obtaining mental health care, self-assessment, or treatment.

OBJECTIVE

This study aims to understand the determinants of digital mental health applications use in the Portuguese academic community of Porto, along with potential adoption barriers and enablers.

METHODS

A cross-sectional, web-based survey was delivered via dynamic email to the University of Porto's academic community. Data collection occurred between September 20 and October 20, 2022. We used structural equation modeling to build three models, replicating a peer-reviewed and published study and producing a newly full mediation model shaped by the collected data. We tested the relationships between use of digital mental health apps and perceived stress, perceived need to seek help for mental health, perceived stigma, past use of mental health services, privacy concerns, and social influence.

RESULTS

Of the 539 participants, 169 (31.4%) reported having used digital mental health apps. Perceived stress and a latent variable, comprising perceptions of mental health problems and coping strategies, were positively associated with mental health app use, while privacy concerns regarding one's information being accessible to others were negatively associated. Perceived stigma, need to seek help, and close relationships did not have a statistically significant direct effect.

CONCLUSIONS

These findings can inform product and policy development of new, better-targeted digital mental health app interventions, with implications for researchers and academia, industry, and policymakers. Our study concludes that, to maximize adherence to these apps, they should have low to no financial charges, demonstrate evidence of their helpfulness and focus on the timely delivery of care. We also conclude that to foster digital mental health app use, there is a need to improve mental health literacy, namely regarding self-awareness of one's conditions, acceptable stress levels, and overall behavior towards mental health.

TRIAL REGISTRATION

RR2-10.2196/41040.

Cognitive impairment as a predictor of long-term psychological distress in patients with polysubstance use disorders: a prospective longitudinal cohort study

BACKGROUND

The association between polysubstance use disorder (pSUD), mental illness, and cognitive impairments is well established and linked to negative outcomes in substance use disorder treatment. However, it remains unclear whether cognitive impairment predicts long-term psychological distress among treatment seeking patients with pSUD. This study aimed to investigate the associations and predictive ability of cognitive impairment on psychological distress one and 5 years after treatment initiation.

METHODS

N = 164 treatment seeking patients with pSUD were sampled at treatment initiation. We examined associations between cognitive impairment according to Montreal Cognitive Assessment® (MoCA®), Wechsler Abbreviated Scale of Intelligence (WASI), and Behaviour Rating Inventory of Executive Function - Adult version (BRIEF-A) administered at treatment initiation and psychological distress defined by the Symptom Check List-90-Revised (SCL-90-R) at treatment initiation, one and five years later. We ran hierarchical logistic regressions to assess the predictive ability of the respective cognitive instruments administered at treatment initiation on psychological distress measured one and five years later including psychological distress at treatment initiation and substance intake at the time-points of the measurements as covariates.

RESULTS

The main results was that MoCA® and BRIEF-A predicted psychological distress at years one and five, but BRIEF-A lost predictive power when accounting for psychological distress at treatment initiation. WASI predicted psychological distress at year one, but not at year five.

CONCLUSIONS

Results from MoCA® and WASI was found to be less sensitive to the effect of psychological distress than BRIEF-A. Cognitive impairment at treatment initiation may hold predictive value on later psychological distress, yet its clinical utility is uncertain.

The associations among well-being comparisons and affective styles in depression, anxiety, and mental health quality of life

OBJECTIVE

Frame-of-reference theories suggest that individuals use different comparison types to evaluate their well-being. Research indicates that the frequency of aversive well-being comparisons is related to depression, with engendered comparison affective impact partly accounting for this relationship. We aimed to replicate this finding, examine whether this extends to anxiety and mental health quality of life, and whether these pathways are moderated by affective styles of concealing, adjusting, and tolerating. We expected concealing as a response-focused style to be associated with higher effects of comparison affective impact on depression, anxiety, and mental health quality of life. Adjusting as an antecedent-focused strategy was expected to mitigate the effects of aversive comparison frequency on comparison affective impact, and the effects of comparison affective impact on the outcomes. Finally, tolerating was expected to be associated with lower effects on both pathways.

METHODS AND MEASURES

Participants (N = 596) responded to measures of well-being comparisons, affective styles, depression, anxiety, and mental health quality of life.

RESULTS

Frequency of aversive well-being comparisons was associated with all outcomes. These relationships were partially mediated by comparison affective impact. Adjustment moderated the pathway between aversive comparison frequency and comparison affective impact. No other moderation effect emerged.

CONCLUSION

The comparison process appears important in well-being evaluations.

An exploration of the Indonesian lay mental health workers' (cadres) experiences in performing their roles in community mental health services: a qualitative study

BACKGROUND

Volunteers trained to support community mental health programs in Indonesia are known as 'mental health cadres.' These are lay people trained to provide basic support for people with mental illness in their local communities. The role of cadres in community mental health services is to provide health promotion activities and support for people with mental illness, such as home visits and family assistance. Their contribution can potentially address the challenges health services currently face in remote and resource-limited settings. However, little is currently known about implementing this form of the lay workforce and the experiences of mental health cadres in Indonesia in particular. This study aimed to explore the experience of cadres when performing their roles in community mental health services in Indonesia from the cadres' perspective.

METHODS

The study employed a descriptive qualitative design. Purposive sampling was employed to recruit cadres with at least one year of experience handling those diagnosed with schizophrenia across four geographical areas in Java and Sumatra, Indonesia. Data were collected utilising focus groups undertaken between July and November 2020. Due to COVID-19 restrictions, eight focus group sessions for mental health cadres were carried out virtually via Zoom and non-virtual, facilitated by local moderators. Data were analysed using thematic analysis.

RESULTS

The study involved 71 cadres in four regions: Aceh, Jakarta, West Java and East Java. The majority of participants were looking after their families with a minimum of high school-level qualifications. Four themes were interpreted from the data: (1) Motivation for volunteering, (2) The role of cadres in supporting mental health services, (3) Training and support needs in carrying out cadre roles, and (4) Barriers and facilitators to the implementation of cadre roles in local communities.

CONCLUSIONS

Cadres reported a motivation to help people improve their mental health and reduce the stigma associated with mental illness. Cadres also contributed to secondary and primary prevention of mental illness with some limitations. This study's results are relevant to those wishing to understand and optimise the implementation of lay workforces in resource-limited settings.

What quality of life domains are most important to older adults in residential care?

Quality of life is a critically important outcome measure in aged care. However, few studies have provided a detailed examination of what quality of life means to older adults living in residential care. In the current study, N = 43 older adults (67 to 99 years) living in six residential aged care facilities in four Australian states took part in semi-structured interviews. Participants had normal cognition through to mild /moderate cognitive impairment as measured by the PAS-Cog, were able to provide informed consent, and could participate in an interview conducted in English. Interviews were transcribed, and data was analyzed in NVivo using thematic analysis. Both physical and psycho-social aspects were identified as important for older adults' quality of life with six key quality of life domains identified: independence, mobility, pain management, social connections, emotional well-being, and activities. More research is needed to test these domains with a more diverse sample of older adults living in residential aged care, in particular older adults from culturally and linguistically diverse communities. Such qualitative work is essential for the development of suitable quality of life measures for this population and provides valuable information to inform improvements to care practices and service provision. Some ways in which the identified quality of life domains could be used to enhance care provision are discussed.

Life stressors, tobacco use, and mental health among Palestinian youths: The mediating role of quality of life and physical activity

The current study tested the association between life stressors and tobacco use and mental health outcomes, including depression and anxiety, among Palestinian youths and whether quality of life (QoL) and physical activity can mediate the association between these variables. The sample consisted of 405 Palestinian youths, 245 male and 160 female; all were selected using online methods. Our findings revealed that life stressors were positively correlated with tobacco use (r = .20, p < .01), anxiety (r = -0.32, p < .01), and depression (r = .23, p < .01), while life stressors were negatively correlated with physical activity (r = -0.15, p < .01) and QoL (r = -0.41, p < .01). Results of structural equation modeling (SEM) indicated that QoL and physical activity mediated the association between life stressors and depression and anxiety. Our findings underline the importance of increasing physical activity levels among youths as a protective factor against tobacco use, depression, and anxiety. Moreover, community and school-based interventions to promote QoL and positive mental health in adolescents and youths should incorporate frequent physical activity and engagement in individual or team sports.

Estimating a Preference-Based Value Set for the Mental Health Quality of Life Questionnaire (MHQoL)

BACKGROUND

Health economic evaluations using common health-related quality of life measures may fall short in adequately measuring and valuing the benefits of mental health care interventions. The Mental Health Quality of Life questionnaire (MHQoL) is a standardized, self-administered mental health-related quality of life instrument covering 7 dimensions known to be relevant across and valued highly by people with mental health problems. The aim of this study was to derive a Dutch value set for the MHQoL to facilitate its use in cost-utility analyses.

METHODS

The value set was estimated using a discrete choice experiment (DCE) with duration that accommodated nonlinear time preferences. The DCE was embedded in a web-based self-complete survey and administered to a representative sample (N = 1,308) of the Dutch adult population. The matched pairwise choice tasks were created using a Bayesian heterogeneous D-efficient design. The overall DCE design comprised 10 different subdesigns, with each subdesign containing 15 matched pairwise choice tasks. Each participant was asked to complete 1 of the subdesigns to which they were randomly assigned.

RESULTS

The obtained coefficients indicated that "physical health,""mood," and "relationships" were the most important dimensions. All coefficients were in the expected direction and reflected the monotonic structure of the MHQoL, except for level 2 of the dimension "future." The predicted values for the MHQoL ranged from -0.741 for the worst state to 1 for the best state.

CONCLUSIONS

This study derived a Dutch value set for the recently introduced MHQoL. This value set allows for the generation of an index value for all MHQoL states on a QALY scale and may hence be used in Dutch cost-utility analyses of mental healthcare interventions.

HIGHLIGHTS

A discrete choice experiment was used to derive a Dutch value set for the MHQoL.This allows the use of the MHQoL in Dutch cost-utility analyses.The dimensions physical health, mood, and relationships were the most important.The utility values range from -0.741 for the worst state to 1 for the best state.

Quality of life for people with psychiatric disabilities employed in extended employment programs in two Arab towns in Israel: an exploratory study

Introduction

This study aims to examine the quality of life (QOL) for people with psychiatric disabilities who are engaged in extended employment programs (homogeneous versus heterogeneous) in the Arab-populated Triangle Area of Israel. The homogeneous program participants are exclusively Arab while the heterogeneous program includes both Arabs and Jews.

Methods

Quantitative research study of 104 adults with psychiatric disabilities engaged in two communal extended employment programs. Participants completed demographic (age (years), gender, marital status (married, widowed/separated, married, single), religion (Muslim, Jewish, Christian), dichotomous nationality variable (Jewish/Arab), and years of education) and employment questionnaires (length of time in the employment program, number of working days/h and salary satisfaction); SF 12 Scale; and The Personal Wellbeing Index questionnaire. Two-sample T-Test, exploratory factor analysis and multiple linear regressions were conducted for tracking the differences between participants in homogeneous and heterogeneous programs.

Results

A significant difference was found between the programs in two QOL components, insofar as satisfaction with the standard of living, together with health satisfaction were rated higher for participants in the heterogeneous program than for their homogeneous program counterparts. Furthermore, the results indicate that physical health and gender were the most important variables in explaining QOL in both programs, while the employment variables were not significant.

Discussion

Since the research findings show that the employment-related-items aren't significant in predicting the employees' QOL, the definition and suitability of extended employment environments as a mental health service must be reexamined. Cultural elements may also have an impact on QOL when the programs are located in a traditional town, with gender playing a key role. The family's role is pivotal in traditional societies, influencing an individual's ability to participate in employment programs and the support they receive. In patriarchal societies, there can be added pressure on men with psychiatric disabilities to conform to societal expectations. Given the general lack of health awareness in Arab communities, there is a need to develop additional projects or incorporate physical health improvement as a rehabilitation goal when working with individuals with psychiatric disabilities, regardless of the type of community rehabilitation program.

The Power of Self-Labels: Examining Self-Esteem Consequences for Youth with Mental Health Problems

New evidence on a classic sociological debate allows for a test of the consequences of self-labeling with mental illness. While a medicalized "insight" perspective emphasizes the importance of self-labeling for psychological well-being and recovery, a sociologically informed "outsight" perspective draws from modified labeling, self-labeling, and stigma resistance theories to suggest that self-labeling can generate negative consequences for self-esteem. We engage this debate by examining the effects of mental illness self-labels on a crucial component of psychological well-being for persons with mental health problems-self-esteem-by using longitudinal data that followed 427 sixth-grade youth over two years. Our findings support an outsight perspective whereby adopting a self-label led to decreased self-esteem, while those who dropped a self-label experienced increased self-esteem. This conclusion calls for revisions to prevailing public mental health models that overlook how self-labels can impede rather than enhance psychological well-being and recovery efforts.

Comparing mental health and well-being of US undergraduate and graduate students during the early stages of the COVID-19 pandemic

Objective: This study explored how COVID-related mental health and well-being varied between undergraduate and graduate students. Relationships with physical health behaviors were also examined. Participants: Undergraduate (n = 897) and graduate (n = 314) students were recruited from three US universities between mid-April and late-May 2020. Methods: Participants in this cross-sectional survey self-reported perceived stress, financial stress, resilience, repetitive negative thinking, mood, anxiety, diet, sleep, and physical activity using validated instruments. Results: Undergraduate students reported more perceived stress, more repetitive negative thinking, less positive mood, and less support from professors than graduate students. Perceived stress, repetitive negative thinking, negative mood, and anxiety increased among all students (p < .05 for all). Correlations between mental health outcomes and physical health behaviors were weak to moderate (r = .08 to .49). Conclusions: College students, particularly undergraduates, perceived negative mental health impacts during COVID. Creative approaches for meeting student needs are necessary.

Nutritional considerations in major depressive disorder: current evidence and functional testing for clinical practice

Depression is a multifaceted condition with diverse underlying causes. Several contributing and inter-related factors such as genetic, nutritional, neurological, physiological, gut-brain-axis, metabolic and psychological stress factors play a role in the pathophysiology of depression. This review aims to highlight the role that nutritional factors play in the aetiology of depression. Secondly, we discuss the biomedical and functional pathology tests which measure these factors, and the current evidence supporting their use. Lastly, we make recommendations on how practitioners can incorporate the latest evidence-based research findings into clinical practice. This review highlights that diet and nutrition greatly affect the pathophysiology of depression. Nutrients influence gene expression, with folate and vitamin B12 playing vital roles in methylation reactions and homocysteine regulation. Nutrients are also involved in the tryptophan/kynurenine pathway and the expression of brain-derived neurotrophic factor (BDNF). Additionally, diet influences the hypothalamic-pituitary-adrenal (HPA) response and the composition and diversity of the gut microbiome, both of which have been implicated in depression. A comprehensive dietary assessment, combined with appropriate evaluation of biochemistry and blood pathology, may help uncover contributing factors to depressive symptoms. By employing such an approach, a more targeted and personalised treatment strategy can be devised, ultimately leading to improved patient outcomes.

Assessment of health-related quality of life in individuals with depressive symptoms: validity and responsiveness of the EQ-5D-3L and the SF-6D

BACKGROUND

The EQ-5D and the SF-6D are examples of commonly used generic preference-based instruments for assessing health-related quality of life (HRQoL). However, their suitability for mental disorders has been repeatedly questioned.

OBJECTIVE

To assess the responsiveness and convergent validity of the EQ-5D-3L and SF-6D in patients with depressive symptoms.

METHODS

The data analyzed were from cardiac patients with depressive symptoms and were collected as part of the SPIRR-CAD (Stepwise Psychotherapy Intervention for Reducing Risk in Coronary Artery Disease) trial. The EQ-5D-3L and SF-6D were compared with the HADS (Hospital Anxiety and Depression Scale) and PHQ-9 (Patient Health Questionnaire) as disease-specific instruments. Convergent validity was assessed using Spearman's rank correlation. Effect sizes were calculated and ROC analysis was performed to determine responsiveness.

RESULTS

Data from 566 patients were analysed. The SF-6D correlated considerably better with the disease-specific instruments (|rs|= 0.63-0.68) than the EQ-5D-3L (|rs|= 0.51-0.56). The internal responsiveness of the SF-6D was in the upper range of a small effect (ES: - 0.44 and - 0.47), while no effect could be determined for the EQ-5D-3L. Neither the SF-6D nor the EQ-5D-3L showed acceptable external responsiveness for classifying patients' depressive symptoms as improved or not improved. The ability to detect patients whose condition has deteriorated was only acceptable for the EQ-5D-3L.

CONCLUSION

Overall, both the convergent validity and responsiveness of the SF-6D are better than those of the EQ-5D-3L in patients with depressive symptoms. The SF-6D appears, therefore, more recommendable for use in studies to evaluate interventions for this population.

Primary Care Behavioral Health in Sweden - a protocol of a cluster randomized trial evaluating outcomes related to implementation, organization, and patients (KAIROS)

BACKGROUND

Providing comprehensive and continuous care for patients whose conditions have mental or behavioral components is a central challenge in primary care and an important part of improving universal health coverage. There is a great need for high and routine availability of psychological interventions, but traditional methods for delivering psychotherapy often result in low reach and long wait times. Primary Care Behavioral Health (PCBH) is a method for organizing primary care in which behavioral health staff provide brief, flexible interventions to a large part of the population in active collaboration with other providers. While PCBH holds promise in addressing important challenges, it has not yet been thoroughly evaluated.

METHODS

This cluster randomized trial will assess 17 primary care centers (PCCs) that are starting a PCBH implementation process. The PCCs will be divided into two groups, with one starting immediate implementation and the other acting as a control, implementing six months later. The purpose of the study is to strengthen the evidence base for PCBH regarding implementation-, organization-, and patient-level outcomes, taking into consideration that there is a partially dependent relationship between the three levels. Patient outcomes (such as increased daily functioning and reduction of symptoms) may be dependent on organizational changes (such as availability of treatment, waiting times and interprofessional teamwork), which in turn requires change in implementation outcomes (most notably, model fidelity). In addition to the main analysis, five secondary analyses will compare groups based on different combinations of randomization and time periods, specifically before and after each center achieves sufficient PCBH fidelity.

DISCUSSION

A randomized comparison of PCBH and traditional primary care has, to our knowledge, not been made before. While the naturalistic setting and the intricacies of implementation pose certain challenges, we have designed this study in an effort to evaluate the causal effects of PCBH despite these complex aspects. The results of this project will be helpful in guiding decisions on how to organize the delivery of behavioral interventions and psychological treatment within the context of primary care in Sweden and elsewhere.

TRIAL REGISTRATION

ClinicalTrials.gov: NCT05335382. Retrospectively registered on March 13th, 2022.

Profiles of quality of life among patients using emergency departments for mental health reasons

BACKGROUND

This study identified profiles associated with quality of life (QoL) and sociodemographic and clinical characteristics of patients using emergency departments (ED) for mental health reasons and associated these profiles with patient service use.

METHODS

Recruited in four Quebec (Canada) ED networks, 299 patients with mental disorders (MD) were surveyed from March 1st, 2021, to May 13th, 2022. Data from medical records were collected and merged with survey data. Cluster analysis was conducted to identify QoL profiles, and comparison analyses used to assess differences between them.

RESULTS

Four QoL profiles were identified: (1) Unemployed or retired men with low QoL, education and household income, mostly having substance-related disorders and bad perceived mental/physical health conditions; (2) Men who are employed or students, have good QoL, high education and household income, the least personality disorders, and fair perceived mental/physical health conditions; (3) Women with low QoL, multiple mental health problems, and very bad perceived mental/physical health conditions; (4) Mostly women with very good QoL, serious MD, and very good perceived mental/physical health conditions.

CONCLUSION

The profiles with the highest QoL (4 and 2) had better overall social characteristics and perceived their health conditions as superior. Profile 4 reported the highest level of satisfaction with services used. To improve QoL programs like permanent supportive housing, individual placement and support might be better implemented, and satisfaction with care more routinely assessed in response to patient needs - especially for Profiles 1 and 3, that show complex health and social conditions.

Holistic assessment of patients with chronic mental disorders who attend a metabolic clinic in Sligo Town catchment area

BACKGROUND

People with serious mental illness exhibit higher morbidity and mortality rates of chronic diseases than the general population.

AIMS

The aim of this study was to establish a dedicated clinic for patients with chronic mental illness to monitor physical health and quality of life in accordance with best practice guidelines.

METHODS

Patients were invited to attend the clinic. The following areas were examined: personal and family history of cardiovascular disease, diet, exercise, and smoking. Mental state examination, waist circumference, BP, pulse, ECG and BMI. Laboratory tests including U + E, LFTs, HbA1c, Lipid profile and other tests as appropriate such as serum lithium. AIMS scale, HoNOS and WHOQOL-BREF scales as additional indicators of global health.

RESULTS

A total of 80 patients attended during 3.5 years of clinic. Mean age was 54.9 years (SD: 13.81) at first contact and 45% were females. Mean years in the service was 19.66 (SD: 11.54) and mean number of previous hospital admissions was 4.4 (SD: 5.63). Metabolic syndrome was present in 42% at first assessment. A statistically significant improvement was found for the psychological domain of the WHOQOL-BREF and the HoNOs, particularly at third assessment. (β = 4.64, Wald x2 = 7.38, df:1, p = 0.007, CI:1.3-8.1, β =  - .889, Wald x2 = 4.08, df:1, p = 0.043, CI: - 1.752 to - .026) respectively.

CONCLUSION

The results show a high prevalence of physical health conditions in this cohort, some of which represent a new diagnosis. This implicates better allocation of existing resources for screening and early detection, and potential to run joint clinics with primary care.

[Quality of life of Medicine students of the National University of Córdoba, Argentina]

Background

Quality of life (QoL), according to the WHO, includes the perception that a person has about their physical health, level of independence, social relationships, system of values ​​and goals, expectations, standards and concerns. The medical student faces a high level of competitiveness in the course of his academic training with an increase in the workload as he progresses; this causes symptoms such as anxiety, stress, sadness, among others. If these aspects are not treated or are masked, they can turn into depression, generalized anxiety, burnout and even suicide (2).

Aim

To describe the QoL of the students of medicina at the National University of Córdoba, considering the complete training cycle divided into two groups from 1 to 3° and from 4 to 5°.

Methods

Cross-sectional study, through the Guarani System of the UNC. The WHOQoL-BREF online questionnaire, which uses the Likert scale, was applied to all students. This assesses the global QoL and satisfaction regarding the state of physical and psychological health, interpersonal relationships and environment. p was considered significant <0.05. This work was approved by the Adult CIEIS.

Results

854 responses were obtained, 72% were female, 43% were from another province/country and 63% corresponded to the 1-3° group. Of these, 37% rated their QoL as “fairly good”, while 36% of the 4-5th grade group perceived their QoL as “normal” (p:0.0469). The most influential variables correspond to the supply of money for their needs (p:0.0005), sexual satisfaction (p:0.0056) and access to health services (p:0.0042) . Cronbach's alpha was 0.8899.

Conclusion

QoL is better perceived in the 1-3 year group and economic supply, sexual satisfaction and access to health services were the main points to take care of in this medicine students.

Values and preferences related to workplace mental health programs and interventions: An international survey

INTRODUCTION

This study explores the perspectives of workers and managers on workplace programs and interventions that seek to promote mental wellbeing, and prevent and treat mental health conditions The results contributed supporting evidence for the development of the WHO's first global guidelines for mental health and work, which provide evidence-based recommendations to support the implementation of workplace mental health programs and supports, to improve their acceptability, appropriateness, and uptake.

METHODS

An international online survey was used to examine the values and preferences among workers and managers related to workplace mental health prevention, protection, promotion, and support programs and services. The survey was made available in English, French, and Spanish and recruitment consisted of convenience sampling. Descriptive statistics were used to analyse the survey data. Rapid thematic qualitative analysis was used to analyse the results of open-ended questions.

RESULTS

N = 451 responses representing all WHO regions were included in the analysis. These results provide a unique international perspective on programs and supports for mental health at work, from the standpoint of workers and managers. Results suggest that workers value interventions developed in consultation with workers (including indicated, selective and universal interventions), increased training and capacity building among managers, and targeted interventions to address the pervasive impact of stigma on perceptions about mental health at work and help-seeking.

CONCLUSION

The findings of this study seek to reflect the perspectives of workers and their managers, and therein to promote improved access, availability and uptake of mental health programs and supports at work and-ultimately- to support the potential of workplaces as environments that promote and support mental health.

The Development of Game-Based Digital Mental Health Interventions: Bridging the Paradigms of Health Care and Entertainment

Game elements are increasingly used to improve user engagement in digital mental health interventions, and specific game mechanics may yield therapeutic effects per se and thereby contribute to digital mental health intervention efficacy. However, only a few commercial game-based interventions are available. We suggest that the key challenge in their development reflects the tension between the 2 underlying paradigms, health care and entertainment, which have disparate goals and processes in digital development. We describe 3 approaches currently used to negotiate the 2 paradigms: the gamification of health care software, designing serious games, and purpose shifting existing entertainment games. We advanced an integrative framework to focus attention on 4 key themes in intervention development: target audience, engagement, mechanisms of action, and health-related effectiveness. On each theme, we show how the 2 paradigms contrast and can complement each other. Finally, we consider the 4 interdependent themes through the new product development phases from concept to production. Our viewpoint provides an integrative synthesis that facilitates the research, design, and development of game-based digital mental health interventions.

Psychological distress in community-dwelling individuals living with severe and persistent mental illness

OBJECTIVES

To explore psychological distress levels, using the validated Kessler 6 (K6), as well as the relationship between demographics and K6 scores, and incidence of mental health crises in a cohort of community-dwelling people living with severe and persistent mental illness (SPMI).

METHODS

People living with SPMI taking antipsychotic or mood stabiliser medications were recruited from Australian community pharmacies between September 2020 and Februrary 2021 and completed an electronic survey, including the K6 scale. Pharmacists were interviewed and supplied written reports with details of the consultation when participants obtained 'very high' (⩾19/30) K6 scores. Records were reviewed and coded by an independent coder. Multivariate linear regression was used to determine predictors of K6 scores.

RESULTS

The median K6 score was 16/30 (IQR = 11,21; range = 6-30). Younger age, unemployment and multimorbid mental health diagnoses were significant predictors of higher K6 scores (p < .01; R2 = .24). Fifty-nine (39.3%) consumers scored ⩾19, of which 25/59 (42.4%) were reported to be exhibiting signs of psychological distress and none were experiencing mental health crises.

CONCLUSION

People living with SPMI have high levels of psychological distress as measured by the K6. Further work is needed to understand the prevalence, extent, precipitating factors and impact of psychological distress in people living with SPMI.

Expectations of Leaders' Mental Health

Understanding the causes and consequences of varying mental health experiences in the workplace has gained significant research attention, yet little is known about the assumptions people hold about mental health at work, especially with regard to the expectations people may have of their leaders' mental health. Given people tend to romanticize organizational leaders and have expectations regarding prototypical leader attributes, we consider whether people also hold expectations of leaders' mental health. Drawing on implicit leadership theories, we propose that people will expect leaders experience better mental health compared to those occupying other organizational roles (e.g., subordinates). Using mixed methods, Study 1 (n = 85) showed that people expect that those in leadership roles enjoy higher well-being and experience less mental illness than those in non-leadership roles. Using vignettes in which an employee's health was manipulated, Study 2 (n = 200) demonstrated that mental illness is incongruent with leadership prototypes. Using vignettes in which organizational role was manipulated, Study 3 (n = 104) showed that compared to subordinates, leaders are perceived as having more job resources and demands, but people expect that it is leaders' greater access to organizational resources that facilitates their well-being and inhibits mental illness. These findings extend the occupational mental health and leadership literatures by identifying a novel attribute upon which leaders are evaluated. We conclude by considering the consequences of leader mental health expectations for organizational decision-makers, leaders, and employees aspiring to lead.

The relations between socio-demographic information and negative symptoms, mental health, and quality of life: a latent profile analysis with psychotic patients in Kosovo

The current study aims to identify meaningful psychotic patients' profiles by examining certain combinations of patient's demographic and socio-economic variables (sex, age, marital status, number of children, cohabitant and level of education). Moreover, we aim to assess whether there is any significant effect of class membership (profile) on negative symptoms, health state, and quality of life among psychotic patients. A convenience sample of 103 patients (age: M = 22, SD = 1.75), was drawn from the clinical populations of Kosovo. Demographic and socio-economic data was obtained through individual interviews, meanwhile a battery of questionnaires was used to assess negative symptoms, mental health, and quality of life of patients. The 4-class solution was selected as the best fitting model and used in subsequent analyses. Results indicated a significant effect of class membership on health state, quality of life and negative symptoms. Practical implications are discussed.

Prevalence and predictors of depressive and anxiety symptoms in a sample of women who use drugs in Tanzania: the key role of drug use stigma

BACKGROUND

Globally, women who use drugs face multiple health vulnerabilities, including poor mental health. Little is known about the mental health burden among women who use drugs in sub-Saharan Africa. This cross-sectional study examined the prevalence and predictors of depressive and anxiety symptoms among a sample of women who use drugs in Dar es Salaam, Tanzania.

METHODS

We administered a cross-sectional survey to a non-random sample of 200 women who use drugs in Dar es Salaam between November 2018 and March 2019. We used descriptive statistics to characterize the study sample and fitted separate logistic regression models to assess depressive and anxiety symptoms and their predictors.

RESULTS

The percentages of women reporting depressive and anxiety symptoms were 67.5% and 43.7%, respectively. Internalized drug use stigma (AOR = 1.34, 95% CI: 1.03-1.75) and prior attempts to stop heroin use (AOR = 2.99, 95% CI: 1.28-7.00) were associated with depressive symptoms. Enacted drug use stigma from health workers (AOR = 2.02, 95% CI: 1.34-3.04) and anticipated drug use stigma from family (AOR = 1.49, 95% CI: 1.02-2.16) were associated with anxiety symptoms.

CONCLUSIONS

Depressive and anxiety symptoms were high among our study sample, with higher reports of symptoms of depression than anxiety. Drug use stigma was a key factor that contributed to elevated symptoms of depression and anxiety.

Oral health and individuals with a lived experience of an eating disorder: a qualitative study

BACKGROUND

Limited evidence exists describing the impact to oral health when living with an eating disorder and the availability of information or access to oral health services. This study investigated the perceptions of individuals with a lived experience of an eating disorder specifically to understand their needs and recommendations for improving access to early intervention and oral health promotion.

METHODS

Using purposive sampling a total of 12 semi-structured interviews were conducted with participants across Australia who had a lived experience of an eating disorder. A hybrid inductive and deductive approach to thematic analysis was used to construct salient themes and subthemes.

RESULTS

Most participants had experienced some oral health manifestation as part of their eating disorder hence, many felt quite knowledgeable on the topic. Following their eating disorder many participants felt confident in engaging with dental services, although, barriers including embarrassment, shame, and cost compromised access at times. Participants felt strongly that greater emphasis on oral health promotion during an eating disorder was important and this may be achieved by increasing the availability of resources and using trusted non-dental health professionals like dietitians.

CONCLUSIONS

The need for oral health promotion while experiencing an eating disorder was evident, however, dentists can often be a costly option. Non-dental health professionals like dietitians working with clients with an eating disorder may be an acceptable alternative for closing this gap.

Lived Experiences of Persons with Chronic Schizophrenia Living in the Community

Background

Each individual with schizophrenia experiences life uniquely, despite the sameness in their diagnosis. Understanding their experiences is vital for their better community integration and social work practice.

Method

We used the interpretative phenomenological approach. Persons with schizophrenia seeking outpatient services at a tertiary care institute in Bengaluru, India, were recruited through purposive sampling. In-depth interviews were conducted with six participants.

Results

Some of the meta-themes and subthemes identified were as follows: (a) perception about self (struggling with the sense of self, desire for normalcy, wanting to be in control of self and desire to live independently), (b) relationship with others (feeling supported by others and feeling rejected by others), (c) coping with consequences of illness (coping with disruptions in personal life and coping with disruptions in family life), and (d) experience of seeking treatment (reasons for seeking treatment, being on medication, and behavior of mental health professionals). The participants tried to find meaning in their lives by making sense of their illness. Family and community can have a significant impact on how persons with schizophrenia perceive their lives.

Conclusion

Mental health professionals need to encourage persons' and their families' greater participation in treatment planning and clinical interventions, which will enhance persons integration within the community and will help decrease the feeling of isolation commonly experienced when one lives with chronic mental illnesses.

Validation of the Spanish version of the eating disorders quality of life instrument (EDQOL)

BACKGROUND

The Eating Disorders Quality of Life instrument (EDQOL) is a disease-specific health related quality of life self-report questionnaire designed for disordered eating patients. Although the EDQOL is one of the most suitable and widely used questionnaires in many countries, no prior research has addressed the psychometric properties of the Spanish adaptation of the EDQOL. Therefore, the aim of this study is to examine the psychometric properties of the Spanish version of the EDQOL among ED patients.

METHODS

141 female eating disorder patients, with a mean age of 18.06 years (SD = 6.31), completed the EDQL in addition to the Eating Disorder Examination Questionnaire (EDEQ), the Depression, Anxiety and Stress Scales (DASS-21), the Clinical Impairment Assessment (CIA 3.0) and the Health Survey (SF-12). We calculated item/scale characteristics, internal consistencies and bivariate correlations with other measures of quality of life and adjustments. We assessed the goodness-of-fit of the 4-factor model using confirmatory factors analysis and explored the sensitivity of change following skill-based interventions.

RESULTS

The fit of the 4-factor model was acceptable (Root Mean Square Error of Approximation: 0.07, Standard Root Mean Square Residual: 0.07). Cronbach's alpha was excellent for the total (.91) and acceptable for all subscales (0.78-0.91). The construct validity was found with measures of psychological distress, depression, anxiety, quality of life and clinical impairment. The psychological and physical/cognitive scales and the EDQOL global scale were responsive to change.

CONCLUSION

The Spanish EDQOL version is a useful instrument to assess quality of life in eating disorder patients and to evaluate outcomes of skills-based interventions.

An Insight into Cellular and Molecular Mechanisms Underlying the Pathogenesis of Neurodegeneration in Alzheimer's Disease

Alzheimer's disease (AD) is the most prominent neurodegenerative disorder in the aging population. It is characterized by cognitive decline, gradual neurodegeneration, and the development of amyloid-β (Aβ)-plaques and neurofibrillary tangles, which constitute hyperphosphorylated tau. The early stages of neurodegeneration in AD include the loss of neurons, followed by synaptic impairment. Since the discovery of AD, substantial factual research has surfaced that outlines the disease's causes, molecular mechanisms, and prospective therapeutics, but a successful cure for the disease has not yet been discovered. This may be attributed to the complicated pathogenesis of AD, the absence of a well-defined molecular mechanism, and the constrained diagnostic resources and treatment options. To address the aforementioned challenges, extensive disease modeling is essential to fully comprehend the underlying mechanisms of AD, making it easier to design and develop effective treatment strategies. Emerging evidence over the past few decades supports the critical role of Aβ and tau in AD pathogenesis and the participation of glial cells in different molecular and cellular pathways. This review extensively discusses the current understanding concerning Aβ- and tau-associated molecular mechanisms and glial dysfunction in AD. Moreover, the critical risk factors associated with AD including genetics, aging, environmental variables, lifestyle habits, medical conditions, viral/bacterial infections, and psychiatric factors have been summarized. The present study will entice researchers to more thoroughly comprehend and explore the current status of the molecular mechanism of AD, which may assist in AD drug development in the forthcoming era.

Impact of antidepressant use on the autonomic nervous system: A meta-analysis and systematic review

Changes in cardiac autonomic nervous system (ANS) regulation observed in psychiatric disorders may be mitigated by antidepressants. We meta-analyzed and systematically reviewed studies examining antidepressants' effects on ANS outcomes, including heart rate variability (HRV). We conducted a PRISMA/MOOSE-compliant search of PubMed and Scopus until March 28th, 2022. We included randomized placebo-controlled trials (RCTs) and pre-post studies, regardless of diagnosis. We pooled results in random-effects meta-analyses, pooling homogeneous study designs and outcomes. We conducted sensitivity analyses and assessed quality of included studies. Thirty studies could be meta-analyzed. Selective serotonin reuptake inhibitors (SSRIs) were significantly associated with a reduction in the square root of the mean-squared difference between successive R-R intervals (RMSSD) (SMD= -0.48) and skin conductance response (SMD= -0.55) in RCTs and with a significant increase in RMSSD in pre-post studies (SMD=0.27). In pre-post studies, tricyclic antidepressants (TCAs) were associated with a significant decrease in several HRV outcomes while agomelatine was associated with a significant increase in high frequency power (SMD= 0.14). In conclusion, SSRIs reduce skin conductance response but have no or inconclusive effects on other ANS outcomes, depending on study design. TCAs reduce markers of parasympathetic function while agomelatine might have the opposite effect. Studies are needed to investigate the impact of SSRIs on the recovery of cardiac ANS regulation after acute myocardial infarction, and the effects of newer antidepressants.

Changes in Quality of Life in Treatment-Resistant Schizophrenia Patients Undergoing Avatar Therapy: A Content Analysis

Avatar Therapy has a significant impact on symptoms, beliefs, and quality of life of patients with treatment-resistant schizophrenia. However, little is known about how these changes are implemented into their lives and to which aspects of their lives these improvements relate. Ten consecutive patients enrolled in an ongoing clinical trial were assessed using semi-guided interviews before as well as three months after Avatar Therapy. These encounters have been recorded and transcribed so that the discourse could be thoroughly analyzed, leading to the generation of an extensive theme grid. As the cases were analyzed, the grid was adapted in a back-and-forth manner until data saturation occurred. The content analysis allowed the identification of nine main themes representing different aspects of the patients’ lives, each of which was subdivided into more specific codes. By analyzing the evolution of their frequency, it was observed that, following therapy, patients presented with fewer psychotic symptoms, better self-esteem, more hobbies and projects, and an overall improved lifestyle and mood. Finally, investigating the impact of Avatar Therapy on quality of life allows for a deeper understanding of how people with treatment-resistant schizophrenia can achieve meaningful changes and move towards a certain recovery process.

Quality of life among Iranian major depressive disorder patients: a qualitative study

Background

Research indicates that the prevalence of Major Depressive Disorder (MDD) is high and it reduces patient’s Quality of Life (QoL). Nowadays, in addition to reducing the symptoms of MDD, emphasis is on the concept of QoL as the purpose of treating these patients. However, we still do not know what these patient’s attitudes and perceptions are about QoL. This study aims to clarify the Iranian patient’s attitudes and perceptions of QoL’s meaning through a qualitative paradigm.

Results

During the data analysis, “Agitation factors”, “Destructive effects”, and “Gratifications” were developed as three main themes with 13 main categories, 39 sub-categories, and 879 codes. According to the findings the main priority of patients with MDD was Agitation factors, which plays a remarkable role in the concept of QoL.

Conclusions

MDD leads to deterioration in the QoL of these individuals in different parts. The novelty of this study leads to the creation of a deep and realistic attitude in national and global nurses towards the QoL of majorly depressed patients in order to remove the aggravating factors of the disorder and create a pleasant life based on the adequate and specialized understanding of the consequences of this disorder according to the preferences of patients and provide a suitable quality of life for these patients.

Cost-effectiveness of transdiagnostic group cognitive behavioural therapy for anxiety disorders v. treatment as usual: economic evaluation of a pragmatic randomized controlled trial over an 8-month time horizon using self-reported data

BACKGROUND

This economic evaluation supplements a pragmatic randomized controlled trial conducted in community care settings, which showed superior improvement in the symptoms of adults with anxiety disorders who received 12 sessions of transdiagnostic cognitive-behavioural group therapy in addition to treatment as usual (tCBT + TAU) compared to TAU alone.

METHODS

This study evaluates the cost-utility and cost-effectiveness of tCBT + TAU over an 8-month time horizon. For the reference case, quality-adjusted life years (QALYs) obtained using the EQ-5D-5L, and the health system perspective were chosen. Alternatively, anxiety-free days (AFDs), derived from the Beck Anxiety Inventory, and the limited societal perspective were considered. Unadjusted incremental cost-effectiveness/utility ratios were calculated. Net-benefit regressions were done for a willingness-to-pay (WTP) thresholds range to build cost-effectiveness acceptability curves (CEAC). Sensitivity analyses were included.

RESULTS

Compared to TAU (n = 114), tCBT + TAU (n = 117) generated additional QALYs, AFDs, and higher mental health care costs from the health system perspective. From the health system and the limited societal perspectives, at a WTP of Can$ 50 000/QALY, the CEACs showed that the probability of tCBT + TAU v. TAU being cost-effective was 97 and 89%. Promising cost-effectiveness results using AFDs are also presented. The participation of therapists from the public health sector could increase cost-effectiveness.

CONCLUSIONS

From the limited societal and health system perspectives, this first economic evaluation of tCBT shows favourable cost-effectiveness results at a WTP threshold of Can$ 50 000/QALY. Future research is needed to replicate findings in longer follow-up studies and different health system contexts to better inform decision-makers for a full-scale implementation.

Mechanistic Insights, Treatment Paradigms, and Clinical Progress in Neurological Disorders: Current and Future Prospects

Neurodegenerative diseases (NDs) are a major cause of disability and are related to brain development. The neurological signs of brain lesions can vary from mild clinical shortfalls to more delicate and severe neurological/behavioral symptoms and learning disabilities, which are progressive. In this paper, we have tried to summarize a collective view of various NDs and their possible therapeutic outcomes. These diseases often occur as a consequence of the misfolding of proteins post-translation, as well as the dysfunctional trafficking of proteins. In the treatment of neurological disorders, a challenging hurdle to cross regarding drug delivery is the blood-brain barrier (BBB). The BBB plays a unique role in maintaining the homeostasis of the central nervous system (CNS) by exchanging components between the circulations and shielding the brain from neurotoxic pathogens and detrimental compounds. Here, we outline the current knowledge about BBB deterioration in the evolving brain, its origin, and therapeutic interventions. Additionally, we summarize the physiological scenarios of the BBB and its role in various cerebrovascular diseases. Overall, this information provides a detailed account of BBB functioning and the development of relevant treatments for neurological disorders. This paper will definitely help readers working in the field of neurological scientific communities.

Exploring the impact of mental health conditions on vaccine uptake in high-income countries: a systematic review

BACKGROUND

Vaccination is an essential public health intervention to reduce morbidity and mortality from infectious diseases. Despite being at higher at risk of infectious diseases, health inequalities towards vaccine uptake in people with mental health issues have not been systematically appraised.

METHODS

We searched 7 databases from 1994 to 26/03/2021. We included all studies with a relative measure of effect comparing a group with a mental health issue to a control group. All studies covering any mental health issue were eligible with no constraints to study population, vaccine type or region, provided in a high-income country for comparability of health care systems. The study outcomes were synthesised by study population, mental health issue and type of vaccine.

RESULTS

From 4,069 titles, 23 eligible studies from 12 different countries were identified, focusing on adults (n = 13) or children (n = 4) with mental health issues, siblings of children with mental health issues (n = 2), and mothers with mental health issue and vaccine uptake in their children (n = 6). Most studies focused on depression (n = 12), autism, anxiety, or alcoholism (n = 4 respectively). Many studies were at high risk of selection bias.

DISCUSSION

Mental health issues were associated with considerably lower vaccine uptake in some contexts such as substance use disorder, but findings were heterogeneous overall and by age, mental health issue or types of vaccine. Only individuals with mental health issues and physical comorbidities had consistently higher uptake in comparison to other adults. Mental health should be considered as a health inequality for vaccine uptake but more context specific research is needed focusing more on specific mental health issues and subgroups of the population to understand who misses vaccination and why.

The effect of social determinants of health on quality of life among Afghan refugees in Iran during the COVID-19 pandemic: a path analysis

BACKGROUND

The COVID-19 pandemic has created significant challenges in 2020 in the world and Iran. To help vulnerable groups such as refugees during the response and recovery phases of the COVID-19 pandemic, identifying the quality of life (QOL) and its associated factors is helpful. Considering that research in this field is limited, this study evaluated the effect of social determinants of health on the quality of life among Afghan refugees in Iran during the COVID-19 pandemic.

METHODS

We conducted a cross-sectional study on 300 Afghan refugees and migrants in Alborz province, Iran, from February to May 2022 using Convenience sampling. Data were completed using the socioeconomic status scale (SES), World Health Organization's quality of life -BREF (WHOQOL), Depression, Anxiety and Stress Scale-21 Items (DASS-21), and COVID-19 Post-Traumatic Stress Disorder Checklist (COVID-PTSD). In addition, path analysis was applied to evaluate the relationships among the research variables with quality of life.

RESULTS

64.3% of the study participants were male, with a mean of 29.29 ± 9.64 years. The path analysis showed that SES had the most positive relationship (B = .266), and the number of COVID-19 cases had the most negative relationship (B = -.169) with the quality of life from both paths. The self-rated health had the most positive relationship (B = .25), and the DASS score had the most negative relationship (B = -.2) with the quality of life through only one path. Access to medical services was the only variable that indirectly had a positive causal relationship with QOL (B = .044).

CONCLUSION

We provided an empirical model that illustrates the relationships between quality of life and social determinants of health among Afghan refugees and migrants during the Covid19 pandemic. The negative emotional states of Depression, Anxiety, and Stress (DAS) as a mediator play an essential role in the quality of life and other variables.

Effectiveness of Nurse-led Lifestyle Modification Intervention on Obesity Among Young Women in India

Background

Obesity management in young women necessitates interventions that include dietary modification and physical exercise. High-intensity lifestyle modification is effective in managing obesity in young women.

Objectives

The study determined the effectiveness of a nurse-led lifestyle modification intervention (NLLMI) on obesity among young women in India.

Methods

The study adopted a quasi-experimental pre- and post-interventional control group research design. The study was conducted among obese young women in the communities of Jabalpur, Madhya Pradesh, India. The participants were selected using convenient sampling technique. The sample included 150 women in the study group and 150 in the control group. The NLLMI comprising of exercises and dietary modifications were taught to the participants for 30 min three times a week for 24 weeks. Thereafter, they were encouraged to follow the diet and perform the exercises on their own for the next 12 weeks. Practice diary was maintained by the participants and they were encouraged to continue the intervention through the phone. The participants in the control group did not engage in the NLLMI until the post-test. However, they did receive the same NLLMI after the trial was over.

Results

There was a high statistically significant difference (p = 0.001) between the study group and the control group the after 12th and 24th weeks of NLLMI. The study group had a significant reduction in BMI after the intervention.

Conclusions

Young obese women may benefit from a NLLMI if they regularly follow the healthy eating habits and physical exercise.

Quality of Life of People Living with HIV in Australia: The Role of Stigma, Social Disconnection and Mental Health

HIV is a manageable chronic illness, due to advances in biomedical management. However, many people living with HIV (PLHIV) continue to experience psychosocial challenges, which have been associated with poorer quality of life (QoL). This study aimed to explore how psychosocial factors contributed to the QoL of PLHIV in Australia; specifically, the relationship between HIV-related stigma, social connectedness, mental health, and QoL. Participants were 122 PLHIV attending The Albion Centre (a tertiary HIV clinic in Sydney, Australia), who completed questionnaires which measured HIV-related stigma, social support, mental health symptomology and QoL. Results indicated that HIV-related stigma predicted poorer QoL, as did mental health symptomology. Conversely, social connectedness improved QoL. Additionally, social connectedness was found to mediate the relationship between HIV-related stigma and QoL, whereas the hypothesized moderating role of mental health symptomology on this model was not significant. These findings provide insight into the impact of psychosocial factors on QoL, offering practitioners various points of clinical intervention.

Neurite Orientation Dispersion and Density Imaging in Psychiatric Disorders: A Systematic Literature Review and a Technical Note

While major psychiatric disorders lack signature diagnostic neuropathologies akin to dementias, classic postmortem studies have established microstructural involvement, i.e., cellular changes in neurons and glia, as a key pathophysiological finding. Advanced magnetic resonance imaging techniques allow mapping of cellular tissue architecture and microstructural abnormalities in vivo, which holds promise for advancing our understanding of the pathophysiology underlying psychiatric disorders. Here, we performed a systematic review of case-control studies using neurite orientation dispersion and density imaging (NODDI) to assess brain microstructure in psychiatric disorders and a selective review of technical considerations in NODDI. Of the 584 potentially relevant articles, 18 studies met the criteria to be included in this systematic review. We found a general theme of abnormal gray and white matter microstructure across the diagnostic spectrum. We also noted significant variability in patterns of neurite density and fiber orientation within and across diagnostic groups, as well as associations between brain microstructure and phenotypical variables. NODDI has been successfully used to detect subtle microstructure abnormalities in patients with psychiatric disorders. Given that NODDI indices may provide a more direct link to pathophysiological processes, this method may not only contribute to advancing our mechanistic understanding of disease processes, it may also be well positioned for next-generation biomarker development studies.

The relationship between psychopathology, occupational balance, and quality of life among people with schizophrenia

OBJECTIVE

There is an increased risk of occupational imbalance and poor quality of life (QoL) if one has schizophrenia. Although evidence suggests a relationship between psychopathology and QoL, the association of occupational balance (OB) with QoL in schizophrenia is unclear. This study aimed to investigate the associations among psychopathology, occupational balance, and QoL in schizophrenia.

METHODS

This was a cross-sectional study carried out in a Community Mental Health Center (CMHC). Ninety-five individuals aged 18 years or older with the diagnosis of schizophrenia participated in the study. All participants completed a sociodemographic form, Positive and Negative Syndrome Scale (PANSS), Calgary Depression Scale in Schizophrenia (CDSS), Occupational Balance Questionnaire-11 Turkish Version (OBQ11-T), and the World Health Organisation Quality of Life Assessment Instrument (WHOQOL-100-TR). Relationships among clinical and depressive symptoms, OB, and QoL variables were examined through correlation analysis, and then multiple linear regression analysis was performed to determine the variables that have influences on QOL.

RESULTS

The study participants had low OB scores and the lowest mean in the WHOQOL-social relationships subscale. WHOQOL-overall QoL score demonstrated a moderate negative correlation with the PANSS-total score and PANSS-general psychopathology subscale score (r = -0.422, r = -0.463, P < 0.001) and a mild negative correlation with the CDSS-total score (r = -0.390, P < 0.001). OBQ11-T total score showed a moderate positive correlation with the WHOQOL-overall score (r = 0.549; P < 0.001). Findings from the multiple linear regression analysis revealed that OBQ11-T (β = -0.467, P = 0.000) and PANSS-general psychopathology (β = -0.221, P = 0.045) were significant predictors of the overall QoL, explaining 48% of the variance in the overall QoL (adjusted R²  = .43, P < 0.001).

CONCLUSION

Our study findings showed that OB and general psychopathology are determinants that should be considered in improving the QoL in individuals with schizophrenia. Thereby, addressing the symptoms of general psychopathology and occupational factors to improve the QoL may be achieved with the incorporation of occupation-based programmes to routine treatment. However, further research is required.

The Achieved Capabilities Questionnaire for Community Mental Health (ACQ-CMH): A consumer-based measure for the evaluation of community mental health interventions

The capabilities approach offers a multidimensional, ecological, and agent-centered framework that may inspire models of intervention and evaluation. A growing number of measures grounded on the capabilities approach for outcome measurement are appearing. Regarding community mental health, new consumer-valued measures-constructed in collaboration with consumers-are here considered crucial for a transformative shift. Meanwhile, new measurements need to provide psychometric evidence to enable proper choice and application. The Achieved Capabilities Questionnaire for Community Mental Health (ACQ-CMH) was developed in collaboration with consumers of community mental health services. It aims to assess consumers' capabilities achieved through program support. The present paper shows advancements in the measure validation through a confirmatory factor analysis within a sample of community mental health consumers (N = 225). Reliability and construct-related validity were also observed. A structural solution composed of five factors and 43 items revealed a better model fit than that obtained in a previous exploratory study. Findings support the reliability, sensibility, and both convergent and discriminant validity of using the ACQ-CMH in the evaluation of community mental health interventions. The ACQ-CMH offers a consumer-valued framework with specific dimensions and indicators of capabilities for use in a routine service evaluation setting.

Experiences of digital exclusion and the impact on health in people living with severe mental illness

Background

The covid-19 pandemic has accelerated the use of digital tools within health and social care services. However, for a range of different reasons, across the UK there continue to be people who are digitally excluded. People living with a disability have been identified as being more likely to be digitally excluded and many of these people, including people with severe mental illness (SMI) already experience health inequalities. Therefore, understanding the perceived impact digital exclusion has on health and potential facilitators of increased inclusion is an important area for research. This study had two aims: 1. To understand experiences of digital exclusion and the impact on health in people with SMI. 2. To explore the influences and mechanisms which would increase engagement with digital health tools.

Methods

This was an observational qualitative study, conducting focus groups (with the option of a 1:1 interview for those uncomfortable in groups) with nine people with severe mental illness.

Results

Participant’s responses were themed in to four key areas in relation to digital exclusion and impact on health: 1. Reduced social connectedness, 2. The impact on wider determinants of health 3. Negative perception of self, 4. Disempowerment. Key facilitators for increased engagement with digital tools included, local digital skills support with mental health lived experience involvement in the delivery, digitally engaged social referents, access to digital tools and data, personalised and straightforward digital tools. In addition, increasing health and social care staff’s awareness of digital exclusion was also viewed as important in promoting inclusion.

Conclusion

The research findings suggest that digital inclusion should be viewed as a wider determinant of health. Many of the identified consequences of exclusion are particularly important in relation to mental health and mental health recovery. This research suggests that identifying and addressing digital exclusion should be viewed as a priority for mental health services.

Systematic Literature Review of Text Messaging Interventions to Promote Medication Adherence Among People With Serious Mental Illness

OBJECTIVE

Mobile health tools are feasible options to encourage behavior change among patients with serious mental illness. Mobile health tools vary widely, both in platforms used and content delivered. This literature review assessed the use of text messaging interventions to promote medication adherence among patients with serious mental illness.

METHODS

A systematic literature review using PRISMA guidelines examined short message service (SMS) text messaging interventions promoting medication adherence to people with a serious mental illness diagnosis. Databases included PubMed, Cochrane, CINAHL, and PsycINFO. Data extraction included demographic information, participant diagnoses, intervention components, medication class, adherence measures, research design, and study outcomes. Study quality was also assessed.

RESULTS

Of 114 full-text articles screened, 10 articles were selected from nine unique interventions (N=937 people with serious mental illness). Study durations ranged from 30 days to 18 months, with frequency of SMS ranging from twice weekly to 12 times daily. Of the nine unique trials, most reported using an automated server to deliver SMS messages (N=7), two-way SMS capabilities (N=6), customized message content or timing (N=7), and additional components (e.g., provider contact, educational content, and monetary rewards) (N=7). Seven of the 10 articles reported statistically significant improvement in medication adherence and in at least one clinical outcome.

CONCLUSIONS

Evidence to date indicates that text messaging interventions are feasible and appear to improve medication adherence and clinical outcomes among patients with serious mental illness. Future research should assess implementation approaches and how to scale up efforts in nonresearch settings.

Correlates and predictors of perceived stigma and self-stigma in Chinese patients with psychosis

AIMS

In patients with psychosis, perceived stigma (i.e., beliefs about discriminative viewpoints held by the public) and self-stigma (i.e., internalization of such perceived stereotypes) could have devastating consequences. Knowledge about their correlates bears importance for understanding individual differences in stigma experiences, and further, given the social nature of stigma, Asians may show more distinctive features than Westerners.

METHODS

A total of 142 Chinese patients who originally enrolled into a randomized controlled trial during their first-episode psychosis were followed up at 10 years. We explored potential demographics, clinical and psychosocial correlates of perceived stigma and self-stigma.

RESULTS

Stepwise multiple regression analyses indicated that both perceived- and self-stigma were predicted by a more negative attitude to treatment, whereas differential factors including perceived recovery predicted perceived stigma, and quality of life and attention predicted self-stigma.

CONCLUSIONS

These results can help identify individuals susceptible to experiencing perceived- or self-stigma, highlighting the need to consider factors such as attitude towards treatment when designing anti-stigma strategies.

Risk Factors for Developing Concurrent Posttraumatic Stress Injury After Work-Related Musculoskeletal Injury: A Case-Control Study

OBJECTIVE

This study aimed to study risk factors for developing concurrent posttraumatic stress injury (PTSI) among workers experiencing work-related musculoskeletal injury (MSI).

METHODS

A case-control study was conducted using workers' compensation data on injured workers undergoing rehabilitation programs for concurrent MSI and PTSI (cases) and MSI only (controls). A variety of measures known at the time of the compensable injury were entered into logistic regression models.

RESULTS

Of the 1948 workers included, 215 had concurrent MSI and PTSI. Concurrent MSI and PTSI were predicted by type of accident (adjusted odds ratio [OR], 25.8), experiencing fracture or dislocation fracture or dislocation (adjusted OR, 3.7), being public safety personnel (adjusted OR, 3.1), and lower level of education (adjusted OR, 1.9).

CONCLUSIONS

Experiencing a concurrent PTSI diagnosis with MSI after work-related accident and injury appears related to occupation, type of accident, and educational background.

Social networks and internet emotional relationships on mental health and quality of life in students: structural equation modelling

BACKGROUND

Social networks and relationships create a sense of belonging and social identity; hence, can affect mental health and the quality of life, especially in young people. The present study was conducted to determine the predicting role of social networks and internet emotional relationships on students' mental health and quality of life.

METHODS

The present cross-sectional study was conducted in 2021 on 350 students at Alborz University of Medical Sciences selected by convenience sampling. Data were collected using five questionnaires: socioeconomic status, social networks, internet emotional relationships, stress, anxiety, depression scale (DASS-21), quality of life, and a checklist of demographic details. Data were analyzed in SPSS-25, PLS-3, and Lisrel-8.8.

RESULTS

According to the path analysis, the DASS-21 score had the most significant positive causal association with internet emotional relationships in the direct path (B = 0.22) and the most negative association with socioeconomic status (B = - 0.09). Quality of life had the highest negative causal association with the DASS-21 score in the direct path (B = - 0.26) and the highest positive association with socioeconomic status in the indirect path (B = 0.02). The mean duration of using social networks (B ≈ - 0.07) and internet emotional relationships (B ≈ - 0.09) had the highest negative association with quality of life.

CONCLUSION

The use of the internet and virtual networks, internet emotional relationships, and unfavorable socioeconomic status were associated with higher DASS-21 scores and reduced quality of life in the students. Since students are the future of countries, it is necessary for policymakers to further address this group and their concerns.