The German version of the Perceived Stress Scale - psychometric characteristics in a representative German community sample

Associations of Maternal Salivary Cortisol and Psychological Symptoms With Human Milk's Microbiome Composition

OBJECTIVE

Human milk (HM) is considered the best source of infant nutrition with many benefits for the infant. However, pregnancy changes can lead to increased stress in some women, which might affect HM composition. Although studies have demonstrated a link between maternal psychopathology and child development, it remains unclear how maternal psychobiological changes can be intergenerationally transmitted. We aimed to investigate the associations of maternal stress, depressive symptoms, and anxiety symptoms with the HM microbiome; to analyze these parameters in relation to HM glucocorticoid concentrations; and to explore the influence of HM glucocorticoids on HM bacterial composition.

METHODS

One hundred women completed psychological questionnaires (e.g., EPDS, STAI, GAS) at 34-36 weeks' gestation and in the early postpartum period and provided saliva at 34-36 and 38 weeks' gestation. HM samples were collected in the early postpartum. Microbiota were analyzed using 16S rRNA amplicon sequencing.

RESULTS

Birth anxiety was negatively correlated with Alphaproteobacteria (τ = -0.20, FDR = 0.01), whereas in the postpartum period, anxiety symptoms were negatively correlated with different taxa. The sum of postpartum-related symptoms was linked to lower Propionibacteriales. Salivary cortisol AUCg at 34-36 weeks was negatively correlated with Stenotrophomonas (τ = -0.24, FDR = 0.05), whereas HM cortisol was positively correlated with Streptococcus mitis (τ = 0.26, FDR = 0.03) and Gemella haemolysans (τ = 0.24, FDR = 0.02). No associations emerged between psychobiological parameters and HM glucocorticoids.

CONCLUSIONS

Higher perinatal psychological symptoms and prenatal salivary cortisol AUCg were associated with lower relative abundances of different bacteria, whereas higher HM cortisol was linked to higher Gemella and Streptococcus. These findings suggest a negative association between high maternal psychobiological symptoms and relative abundances of the milk microbiota.

Hatha yoga reduces momentary stress but does not impact diurnal profiles of salivary cortisol and alpha-amylase: A randomized controlled trial

Does the practice of yoga impact stress? Various studies have suggested that yoga may reduce both self-reported stress and stress biomarkers, but the evidence for such claims remains inconclusive, especially for yoga styles with a focus on physical postures. In a randomized controlled trial with 98 participants, we therefore examined whether an eight-week Hatha yoga intervention (60 min, 3×/week or more) led to reduced levels of diurnal salivary cortisol (sCort), salivary alpha-amylase (sAA), and subjective momentary stress as compared to a waitlist control group. To ensure the concomitant assessment of self-report and biological measures in an ecologically valid setting, and to capture the diurnal profile of cortisol and alpha-amylase, we employed an ecological momentary assessment approach. Five times per day, participants reported their momentary stress levels on a visual analogue scale and collected saliva samples for the assessment of salivary biomarkers. The intervention led to a significant reduction of subjective momentary stress but there was no change in diurnal sCort or sAA levels. There are several potential explanations for these findings: The intervention may have helped participants to cope better with stress while leaving diurnal levels of stress biomarkers unaffected, or the change may at least not have been reflected in sCort and sAA. Alternatively, there may have been a self-report bias, insofar as a favorable disposition towards yoga may have led participants to report reductions in stress in order to indicate positive effects of the intervention. Our findings contribute to a better understanding of the effects of distinct yoga interventions, demonstrating their potential to serve as low-risk stress relief tools.

Reliability and validity of the original and brief German version of the Maternal Antenatal Attachment Scale (MAAS): Longitudinal study findings

BACKGROUND

Maternal-foetal attachment (MFA) seems essential for adapting to motherhood and the healthy development of the child, with direct implications for clinical practice. It is often assessed using the Maternal Antenatal Attachment Scale (MAAS), which covers two dimensions: quality and intensity of attachment. However, studies including the MAAS presented missing or inadequate psychometric properties. Therefore, the current study aimed to investigate the reliability and validity of both the original and the recently introduced brief German version of the MAAS.

MATERIALS AND METHODS

Data from 184 pregnant women from a longitudinal study were used. Women (≥ 18 years old) were recruited between the 18th and 22nd weeks of gestation while waiting for routine prenatal diagnostic appointments. Participants answered the MAAS, together with other questionnaires measuring maternal mental health, self-esteem, and social support. For both versions of the MAAS (19 items vs. 13 items), item characteristics, confirmatory factor analysis, internal consistency, and test-retest reliability were calculated and compared. Moreover, associations between the brief German MAAS and theoretically related constructs were analysed using correlation coefficients.

RESULTS

In this study, item analyses revealed better psychometric properties for the brief German MAAS than for the original MAAS, with a significant reduction in items with inadequate discriminatory power. The internal consistency (α ≥ .69) and test-retest reliability (ICC ≥ .62) were acceptable to good for both MAAS versions. With regard to structural validity, factor analysis of the German MAAS presented acceptable to good global model fit indices for the model with correlated factors (GFI > .90; RMSEA ≤ .08; SRMR < .10) in the current sample. In contrast, most global model fit indices of the original MAAS were not acceptable. The construct validity of the German MAAS was demonstrated on the basis of small-to-moderate correlations with a variety of constructs (e.g., measures of depression, anxiety, stress).

CONCLUSIONS

According to the present results, the brief German version of the MAAS represents a reliable and valid measurement instrument of MFA for use in clinical practice. Further studies examining possible cut-off values are needed to identify pregnant women with significant attachment difficulties who may benefit from additional support.

Psychosocial work stressors and mental health in Ph.D. students in Germany-Evidence from two cross-sectional samples

BACKGROUND

Ph.D. students have been shown to report a lower mental health status compared to the general population. However, not much is known about the impact of psychosocial work stressors that could contribute to their increased risks of mental health symptoms. This study aims firstly to assess levels of psychosocial stressors, perceived stress, and mental health symptoms in Ph.D. students. Second, it investigates which psychosocial stressors are most strongly associated with mental health symptoms and perceived stress.

METHODS

One self-reported questionnaire was distributed among Ph.D. students at one university in Germany, in summer 2023 (T1) and winter 2023/2024 (T2). Psychosocial stressors were assessed with the short version of the effort-reward imbalance (ERI) questionnaire and with the 16-item DYNAMIK questionnaire. Mental health symptoms were assessed with the 12-item-version of the general health questionnaire (GHQ-12). Perceived stress levels were assessed with the 10-item perceived stress scale (PSS). Within a cross-sectional study design, multiple linear regression analyses were performed in two study samples (n = 267 at T1; n = 244 at T2).

RESULTS

Ph.D. students reported an imbalance between effort and reward in both study samples (T1: M = 1.34, SD = 0.45; T2: M = 1.27, SD = 0.52). Effort-reward-ratio, boundary permeability, and leader support were associated with mental health symptoms and perceived stress in both study samples, when controlled for age and gender. For example, effort-reward-ratio showed a meaningful impact on mental health symptoms for the study sample at T2 (B = 3.85; p < .05, adj. R2 = 0.288).

DISCUSSION

Both study samples showed high prevalence of mental health symptoms and effort-reward imbalance also in comparison to other research findings. An imbalance between effort and reward, boundary permeability and leader support show the most strongly associations with mental health symptoms and perceived stress. Future longitudinal studies could help to support our findings in terms of a causal stressor-strain association. Universities should focus on mental health of Ph.D. students and direct their support towards promoting student-supervisor relationships and clear guidelines for Ph.D. students' working hours.

Food insecurity and lifestyle behaviours in university students amidst the COVID-19 pandemic: a comparative survey across three countries

BACKGROUND

University students, often unemployed and reliant on low-nutrition foods, are susceptible to food insecurity (FI) with potential physical and mental health challenges. This study explores FI and its impact on lifestyle behaviours among university students.

METHODS

A cross-sectional web-based study was performed by sending an online questionnaire to university students in Lebanon, Cyprus, and Germany during the COVID-19 pandemic. Using validated measures, i.e., the Household Food Insecurity Access Scale, International Physical Activity Questionnaire, Pittsburgh Sleep Quality Index, and Mediterranean Diet Adherence Screener, adjusted linear regression models were performed to assess the associations between country, FI and physical activity, sleep quality, and diet.

RESULTS

In a convenience sample of 611 individuals (350 in Germany, 214 in Lebanon, and 47 in Cyprus) enrolled in the study, 547 provided complete response. 190 (34.7%) experienced FI, of whom 52 (9.5%) were severely food-insecure, with variation of FI prevalence between countries (18.9% in Germany, 14.9% in Cyprus, and 60.3% in Lebanon). Lifestyle behaviours also differed between participants from the three countries, with students in Germany exhibiting the highest physical activity level and the lowest adherence to the Mediterranean diet compared with Lebanon and Cyprus. On the other hand, participants from Lebanon and Cyprus had similar physical activity and diet behaviours. Concerning sleep, students in Cyprus showed the poorest quality. FI significantly correlated with reduced physical activity (beta - 0.171, 95% Confidence Interval (-0.313, -0.029)), but not with sleep or diet. The country of residence independently predicted lifestyle behaviours (p < 0.05).

CONCLUSIONS

This study suggests that FI impacts university students in countries of varying income levels, and the country of residence independently influences lifestyle behaviours. Larger-size studies are essential to confirm these findings and further explore FI's impact on university students outside the context of the pandemic.

COVID-19 and social distancing: pandemic has altered social relationships and contacts in older adults over 4 years

Introduction

Social isolation is a main risk factor for loneliness, health issues and psychological diseases. With its restriction measures, the coronavirus pandemic has led to an objective reduction in meaningful interactions, communication, and social contacts in general (social isolation). However, it has been shown that older adults cope differently with social isolation. Therefore, the aim of the present study was to investigate the changes of social contacts of older adults over the pandemic period of 4 years.

Methods

For this purpose, N = 175 older adults (M age = 72.60, SD age = 6.12 years, Mdn age = 72, Range: 60-87 years) were asked at 3 time points (2019, 2021, 2023) with how many people they had contact in the reference month (May, November). In addition to the number of contacts, participants were also asked about the type of the relationship (e.g., family, friends, neighbors), the type of contact (e.g., telephone, video conference and/or by written messages) and the emotional closeness (close, medium, low). We used an ego-centered "social network" circle to measure social contacts of older adults before, during and after the pandemic. The data collection was limited by the changing corona restrictions.

Results

Results indicate that behavior in social contacts essentially depends on age, gender, and level of depression. We found a clear temporal drop in social contacts independently of age and gender during the pandemic. After the pandemic close contacts did not recover to prepandemic level. Especially, Young-Old (<72 years) recovered less in terms of the number of social contacts than the Old-Old (≥72 years).

Discussion

Our study, thus, provides longitudinal insights into the course of social contacts and suggests that social isolation may have more negative and long-term impact on close contacts, which need further clarification and temporal extension.

How to improve reward sensitivity - Predictors of long-term effects of a randomized controlled online intervention trial

BACKGROUND

Reward sensitivity is a central maintaining factor of depression. Current treatments fail at sufficiently and reliably modifying reward processing. Therefore, we employed interventions targeting reward sensitivity and evaluated the long-term efficacy of different online interventions, additionally exploring predictors of changes in reward sensitivity.

METHODS

This four-arm randomized controlled trial (RCT) tested the long-term stability of treatment effects during a four-month follow-up in 127 participants of a two-week online intervention (behavioral activation vs. mindfulness and gratitude vs. combination of both). In addition, we investigated predictors of treatment success defined as improvement in reward sensitivity. Predictors we investigated were depressive expectations, stress and the type of reward implemented in the exercises of the intervention (physical activities and social encounters).

RESULTS

The improvement concerning reward sensitivity, as well as the reduction of anhedonia and depressive symptoms was stable over a four-month follow-up. We did not find evidence for differences between the active intervention groups. Positive changes in depressive expectations were a significant predictor of long-term improvements in reward sensitivity.

LIMITATIONS

Only self-report measures were used and the interpretation of the long-term efficacy of the online interventions is limited since the waitlist control condition was not extended to the follow-up.

CONCLUSIONS

Clinicians should focus on violating depressive expectations to facilitate updating the prediction and anticipation of future rewarding experiences. This could be a vital mechanism of change in reward sensitivity. However, future research still needs to unravel what kind of interventions are most effective in targeting reward insensitivity.

Impact of neighborhood income inequality on adolescents' mental health. Results from the STARS study

Over recent decades, there has been a simultaneous increase in income inequality and adverse mental health outcomes among adolescents in Western countries and especially in Sweden. Prior research on the relationship between income inequality and mental health has primarily focused on studies involving adults, yielding diverse findings regarding the nature of their association. Given the importance of relationships and comparisons to peers in immediate vicinity, we aimed to investigate the impact of neighborhood income inequality on mental health problems among seven-graders in Western Sweden. We used data collected in the STARS (STudy of Adolescence Resilience and Stress) cohort. A total of 1958 adolescents (mean age 13.6, SD = 0.4, 44% male) in 313 Demographic Statistics Areas (DeSO) were included. Adolescents answered questionnaires regarding stress and psychosomatic symptoms. Neighborhood income inequality was measured as DeSO-level's P90/P10 ratio, defined as the ratio between the 10th (highest) and the 1st (lowest) income decile. In a multilevel linear regression analysis, we found that higher neighborhood income inequality was related to lower stress and psychosomatic symptom scores after controlling for sex, individual parental income, and mean income and child poverty rate at DeSO-level. The associations did not differ significantly among DeSO-areas with different income or child poverty rates. Sex-specific-analysis revealed that the inverse association between income inequality and stress and psychosomatic symptoms was stronger in females than in males, but not significantly so. In summary, this study provided evidence supporting an association between higher neighborhood income inequality and reduced levels of seven-graders' stress and psychosomatic symptoms.

The Relationship Between Body, Mind, and Social Characteristics in a Sample of a Training Program for Developing Social and Personal Resources: A Network Analysis

In this cross-sectional study, the interactions between demographic characteristics and the body, mind, and social dimensions among participants of a holistic training program for social and personal development were examined and compared to a control group. The sample involved 223 adults from Austria, Germany, and Switzerland, with 80 (37.2%) participants in the training group already having finished the training. To explore the variable relationships and compare group structures, advanced network analyses and a network comparison test were applied. The network analysis identified the training as a central variable, being linked to aspirations for societal impact and personal growth (0.31), aspirations for the pursuit of fame and wealth (0.29), transcendence (0.19), the desire to improve the quality of relationships (0.19), aspirations for personal wellbeing and relationships (0.15), and the presence of social resources (0.13). The group comparison revealed that the control group primarily connected through the "Sense of Coherence-Meaning in Life" axis, whereas the training group showed more complex linkages involving wellbeing, life satisfaction, meaning in life, and transcendence, underlining the training program's positive effect on personal growth, societal impact aspirations, and transcendence. Overall, the network comparison test revealed significant differences in network structure and overall connectivity between the training and the control group.

Parental considerations about their childs' mental health: Validating the German adaptation of the Parental Reflective Functioning Questionnaire

INTRODUCTION

Parental Reflective Functioning describes the parents' ability to view their child as motivated by mental states. The Parental Reflective Functioning Questionnaire (PRFQ) represents an 18-item and three-factor self-report measure. Our goal was to conduct the first German validation study.

METHOD

In a community sample of 378 mothers of children aged 10.2-78.6 months, we used Confirmatory Factor Analysis with a cross-validation approach to assess model fit. Reliability was measured using Cronbach's α and McDonald's ω. Concurrent validity was assessed using correlations with relevant constructs.

RESULTS

The three-factor structure of the original validation could be confirmed. The German model only needed minor modifications: two items had to be removed, and one error covariance was added. The resulting 16-item questionnaire with the three subscales "Pre-mentalizing", "Interest and Curiosity about Mental States", and "Certainty about Mental States" was successfully cross-validated (CFI = .94, TLI = .93, SRMR = .07, RMSEA = .04 (CI [.01, .06])). These factors were related in theoretically expected ways to parental attachment dimensions, emotional availability, parenting stress, and infant attachment status.

CONCLUSION

While reliability could still be improved, the German 16-item version of the PRFQ represents a valid measure of parental reflective functioning.

The impact of momentary stress on autobiographical memory recall in a self-efficacy intervention

Recalling positive autobiographical memories has been associated with various positive psychological outcomes, including enhanced mental well-being and self-efficacy. Given the known impact of stress on cognitive functioning, we investigated how momentary stress affects the repeated recall of selected autobiographical mastery memories (e.g., memories of overcoming challenges) in a training to enhance self-efficacy. During this one-week digital training, participants (N = 54) were asked to recall mastery memories, and we assessed their momentary stress levels, memory vividness, and recall feasibility using Ecological Momentary Assessment. Analyses using linear mixed-effects models showed that participants reported greater difficulty and less vividness in recalling self-efficacy memories during moments of increased stress, whereas feeling relaxed facilitated recall feasibility and vividness. Though participants who experienced less recall difficulty appeared to benefit more, recall difficulty and vividness did not significantly moderate improvements in self-efficacy. While replication in a larger, more diverse sample is indicated, our findings underscore the importance of considering momentary affect in memory-based mental health interventions. Effects may be particularly pronounced when interventions are applied during the early stages of stress, when stress levels are still relatively low, aligning with the strategy of Just-in-Time Adaptive Interventions. Our study also highlights the potential benefits of combining memory recall practices with relaxation-promoting interventions to enhance mental health outcomes.

Positive cognitive reappraisal flexibility is associated with lower levels of perceived stress

This study investigates the role of positive cognitive reappraisal (PCR) flexibility and variability in mental health in response to real-life stressors among college students. We employed ecological momentary assessment and intervention through ReApp, a mobile app designed to train and promote PCR. We analyzed data from the intervention group of a randomized controlled trial with a total of 100 participants who used ReApp for three weeks. Stressors due to health problems, uncomfortable environment (e.g., rainy weather, crowded buses, etc.), and lack of time were reported most frequently. Stressors related to the war in Ukraine, fear of the future, exams, and COVID-19 were reported as the most severe. To reappraise these stressors, the participants used mostly acceptance and problem-solving tactics. A key finding is the role of emotional demand-dependent PCR flexibility in mental health. Specifically, the flexible adaptation of PCR tactics in response to stressor severity was associated with a more substantial decline in perceived stress over the study period among participants reporting low tendency to use PCR at the study's baseline (β = - 0.963, p = .016, Cohen's f = 0.26). In contrast, stressor domain-dependent flexibility and contextually independent between-tactic variability had no moderating effect on stress, depression, and anxiety symptoms. This study contributes to the field of emotion regulation flexibility by highlighting the adaptive role of emotional demand-dependent PCR flexibility in mental well-being among young adults navigating real-life stressors and underscores the importance of tailoring interventions based on the emotional demands of stressors.

Insights into psychological characteristics of persons (not) agreeing to use an e-coach-application to reduce elevated Internet Use Disorder tendencies

The present work aims to shed light on the question of whether certain psychological characteristics go along with choosing an e-coach offer to support healthy Internet use when reporting elevated Internet Use Disorder (IUD) tendencies. Data were from a large-scale stepped care approach study to treat persons with varying degrees of IUD tendencies. Recruitment for advertising the download of a smartphone app included social media, videos by influencers, paid ads, TV, radio, newspapers, workshops, and vocational schools. We contrasted a final sample of 184 declining, 907 agreeing, and 216 agreeing but not providing follow-up details needed to use such an e-coach, as well as 995 who did not explicitly decline or agree to participate (but refrained from using the e-coach). Participants were compared on several study variables, including sociodemographics, mental health, fear of missing out, personality, perceived stress, and IUD tendencies. Interestingly, we observed only two significant findings when contrasting the aforementioned groups using ANOVA. First, the group not agreeing to use the e-coach was associated with the lowest IUD tendencies and highest conscientiousness scores. Second, agreeing to use the e-coach was associated with older age. Further significant differences could be observed, but in general the accompanying effect sizes were very mild. In sum, the present study findings support the idea that greater subjective burden of IUD might result in more willingness to seek e-help, but also the personality trait of conscientiousness and a person's age might play a role here.

Recommendations for the quantitative basic evaluation of mind-body medicine courses for university students - results of a consensus-based, systematic decision-making process by experts

BACKGROUND

There is an increasing range of mind-body medicine (MBM) courses in Germany to support university students in dealing with stress. The evaluation of these varies and often only has a small number of participants due to the limited group size of the courses. The aim of this project was the development of a quantitative basic evaluation that can be used across all sites that conduct MBM courses.

METHODS

In a consensus-based and systematic decision-making process, the learning objectives and various questionnaires for the evaluation of MBM courses were discussed and evaluated by experts according to defined criteria. The process was iterative, in which the reflection and definition of the learning objectives and the questionnaires were conditional and adapted if necessary. The recommendations for the basic evaluation of students' MBM courses were developed by consensus among the experts.

RESULTS

For the experts, the most important learning objectives of the MBM courses were stress reduction and self-experience with the exercises. A total of 21 questionnaires were evaluated from nine topics: mindfulness, empathy, self-reflection, self-efficacy, resilience, stress, sense of coherence, quality of life, and well-being. Finally, eight questionnaires were recommended by the expert group for use in a basic evaluation: stress (PSS-10), quality of life (WHOQOL-Bref), mindfulness (MAAS), self-efficacy (GSE), self-compassion (SCS), empathy (SPF), self-reflection (GRAS) and sense of coherence (SOC-13). Further questionnaires were recommended as "optional". An additional qualitative evaluation is recommended for a broader and deeper understanding of the quantitative results.

CONCLUSIONS

The proposed basic evaluation is the central result of the iterative consensus-based decision-making process, which reflects the learning objectives of the underlying MBM courses. We hope that the basic evaluation will be integrated into other MBM courses so that results of various courses can be pooled and compared across sites in the future. This could increase the informative value of the evaluations. Furthermore, researchers could consider the use of the basic evaluation in clinically controlled trials on MBM.

TRIAL REGISTRATION

The project was not registered in a clinical trial registry because no results from health care interventions on human participants have been analyzed or reported.

Interventions to modify the habituation of biological responses to repeated stress in healthy adults: a randomized controlled trial

BACKGROUND

Changes in response patterns of biological stress systems, including responses of the sympathetic nervous system (SNS) and the hypothalamus-pituitary-adrenal (HPA) axis to repeated stress, can promote the development and progression of chronic diseases via changes in downstream inflammatory processes. The aim of this project is thus to investigate, whether habituation of biological stress system activity including responses of the inflammatory system can be modified. Aiming to test for possible paths of action, a randomized controlled study with two intervention programs designed to manipulate cognitive coping strategies will be carried out. By increasing either ruminative or self-compassionate thoughts among healthy young adults, the intervention programs are expected to affect the regulation of occurring emotions as expressed by the responsiveness of biological systems during repeated stress exposure.

METHODS

In this study, a total of 120 healthy adults will complete the Trier Social Stress Test (TSST) on two consecutive days. Immediately after the first stress induction, participants will be randomly assigned to two experimental conditions designed to manipulate cognitive coping strategies (rumination vs. self-compassion) or a control condition. Measures of HPA axis (salivary cortisol) and autonomic activity (salivary alpha amylase, heart rate, heart rate variability) as well as inflammatory markers (plasma interleukin(IL)-6, expression rates of pro- and anti-inflammatory cytokine genes) will be repeatedly assessed throughout the experimental sessions. Response and habituation indices of these measures will be calculated and compared between the experimental conditions and the control condition.

DISCUSSION

The results should provide insight into whether modifying response patterns of biological stress systems could reverse a significant biological mechanism in the development of stress-related diseases.

TRIAL REGISTRATION

German Clinical Trials Register (DKRS), DRKS00034790. Registered on August 12, 2024,  https://www.drks.de/DRKS00034790 .

One-year ecological momentary assessment of alcohol use, mood, and stress among individuals with alcohol use disorder during SARS-CoV-2 pandemics: a gender-specific reflection

Alcohol consumption (AC) is a leading risk factor for death, morbidity, and disability worldwide. Gender-specific differences in AC and its moderators, which may serve as markers for preventing severe alcohol use disorders (AUD), showed inconsistent results. Additionally, the impact of COVID-19-related lockdowns on these differences remains unclear. We examined gender-specific differences in short- and long-term factors affecting AC in individuals at risk for alcohol dependence, focusing on mood, stress, and the influence of restriction-dependent lockdown phases. 358 subjects with AUD aged 16 to 65 were studied over one year. Daily electronic diaries and monthly questionnaires were conducted from 10/01/2020 to 09/30/2021, assessing real-world trajectories of AC, mood (MDMQ), and stress (PSS-10) during Germany's second COVID-19 wave. Multi-level models were used to assess associations between these measures and with several within- and between-subject variables. During lockdown, women experienced lower and even decreasing mood (valence: β = - 0.2, p < .039; calmness: β = - 0.3, p < .010), while men's mood increased from the most restrictive lockdown phase (valence: β = 0.2, p < .001; calmness: β = 0.3, p < .001) to post-lockdown (valence: β = 0.5, p < .001; calmness: β = 0.6, p < .001). Stress increased earlier (β = 0.8, p < .001) and more prolonged (β = 0.4, p = .021) in women than in men. For both genders, daily mood was positively associated with daily AC (valence: β = 0.6, p = .004; calmness: β = 0.4, p = .013), leading to stronger drinking on days with elevated mood. Conversely, average mood was negatively associated with average AC (valence: β = - 1.6, p = .011; calmness: β = - 1.2, p = .041), indicating higher overall consumption with worse overall mood. Our findings highlight the need for interventions targeting mental distress in women with AUD during pandemics, as this group faces increased mental burden during social isolation and increased risk of alcohol dependence during persistent distress.

Insufficient capacity to cope with stressors decreases dietary quality in females

BACKGROUND

Previous studies had found the effects of stress on eating behaviors. The aim of this study was to explore the effects of perceived stress on dietary quality by sexes in Chinese adults.

METHODS

The study population consisted of individuals aged 18 to 59 years participating in the China Health and Nutrition Survey. Perceived stress levels were measured using the 10-item Perceived Stress Scale (PSS-10), with scores ranging from 0 to 40. Dietary quality was evaluated by Chinese Dietary Guidelines Index (CDGI) ranging 0-110. Using a two-level mixed effects model with community as level 2 and individual as level 1, the study analyzed the impact of PSS-10 scores on CDGI. Additionally, a two-level mixed effects structural equation model was employed to explore the effects of distress factor scores and coping stressor factor scores on dietary quality among different sexes within the population.

RESULTS

This study involved in 2515 males and 3165 females, and the average age was 45.9 ± 9.6.The PSS-10 score and CDGI were 14.6 ± 5.1 and 44.8 ± 11.6, separately. After adjusting for confounders, there were no effects of PSS-10 score, distress factor score, and coping stressors factor score on CDGI in males. After adjusting for confounders, CDGI in the highest tertile of PSS-10 score group was 1.64 lower than that in the lowest tertile group in females(P = 0.001). The distress factor score was not associated with CDGI (standardized β=-0.164, P = 0.488), while the coping with stressors factor score was significantly negative with CDGI (standardized β=-0.834, P < 0.001) in females. CDGI in the highest tertile of coping with stressors factor score group was 4.36 lower than that in the lowest tertile group (P < 0.0001).

CONCLUSIONS

There was no association between perceived stress and dietary quality in adult males. The perceived stress, especially the insufficient capacity to cope with stressors, was negatively associated with dietary quality in adult females.

A Fullerton Functional Fitness Test-based exercise intervention for older adults yields quick physical and psychological benefits

OBJECTIVES

Functional fitness is essential for healthy living in older adults. Specially targeted fitness programs might be the most beneficial. This intervention study aimed to assess the efficacy of a specific 16-week exercise program in improving functions as measured by the Fullerton Functional Fitness Test (FFFT), also known as the Senior Test, in older adults.

PARTICIPANTS

Thirty-eight participants (66 % women, Mage = 80.15, SD = 7.21) were randomized into an exercise group (n = 24) and a waiting list control group (n = 14). The exercise group trained three times a week for 1 h.

METHODS

Objective tests (FFFT and handgrip power) and subjective psychological measures (life satisfaction, resilience, happiness, perceived stress, and well-being) were obtained at baseline, after eight weeks, and after 16 weeks. The data were analyzed using mixed-effect regression models.

RESULTS

The results yielded statistically significant group-by-time interactions in all models, indicating improvements in physical and psychological measures over time in the treatment group compared to the control group. Significant differences between the groups in the estimated marginal means (with adjusted 95 % confidence intervals) emerged after 16 weeks in happiness (-3.5 [-6.5, -0.4]), resilience (-5.5 [-9.9, -1.2]), perceived stress (2.2 [0.2, 4.2]), well-being (-5.8 [-7.9, -3.6]), upper limb strength (-5.7 [-9.0, -2.4]), upper body flexibility (-8.7 [-16.4, -1.0]), and agility and balance (4.6 [1.2, 8.1]). Except for happiness and resilience, these differences surfaced already after eight weeks.

CONCLUSION

The here-employed 16-week exercise program, targeting the test elements of the FFFT, efficiently induced physical and mental improvements in older adults.

Assessing last month's stress levels with an automated facial behavior scan

Stress is one of the most pressing problems in society as it severely reduces the physical and mental wellbeing of people. It is therefore of great importance to accurately monitor stress levels, especially in work environments. However, contemporary stress assessments, such as questionnaires and physiological measurements, have practical limitations, mostly related to their subjective or contact-based nature. To assess stress objectively and conveniently, we developed an automated model that detects biomarkers in webcam-recorded facial behavior indicative of heightened stress levels, using computer vision, artificial intelligence, and machine learning techniques. Heart-rate induced skin pulsations and facial muscle activity were extracted from videos of 264 participants that performed an online mental capacity test under considerable time pressure. The model could successfully use these facial biomarkers to explain a significant proportion of individual differences in scores on a self-perceived stress scale. Next, we used the model to objectively score stress levels of 63 military candidates (pre-hiring) and 69 military personnel (post-hiring) that also performed the mental capacity test. Results showed that military personnel expressed facial behavior indicative of significantly higher stress levels than military candidates. This suggests that joining the military heightens overall stress levels. With this study we take the first steps towards a non-contact, automated, and objective measure of stress that is easily applicable in a variety of health and work contexts.

Effects of a digital self-efficacy training in stressed university students: A randomized controlled trial

OBJECTIVE

Self-efficacy is associated with positive mental health outcomes. We developed and tested a digital self-efficacy training for daily recall of autobiographical self-efficacy memories (e.g., memories of successfully overcoming a personal challenge).

METHOD

In this randomized controlled trial, we investigated the effects of the week-long digital self-efficacy training on key mental health outcomes, including anxiety, stress, and hopelessness, and on self-efficacy in 93 university students (mean age 23.3 years, SD: 3.49) with elevated self-reported stress levels. Participants completed either the self-efficacy training combined with ecological momentary assessment (EMA) (training group) or EMA only (control group).

RESULTS

We found significantly reduced hopelessness and trait anxiety in the training group compared to the control group at post-assessment (one day post intervention). Effects on ratings of self-efficacy at post-assessment were also significant when controlling for baseline self-efficacy.

CONCLUSIONS

This stand-alone digital self-efficacy training was significantly associated with a number of positive effects on outcomes compared to a control condition, including reduced hopelessness, trait anxiety, and increased self-efficacy. Future work is needed to replicate and investigate the long-term effects of the training and explore its implementation in clinical populations.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05617248.

Perceived Changes in Anxiety Symptom Burden During Treatment with Bryophyllum pinnatum: A Prospective, Single-Arm Study

BACKGROUND/OBJECTIVES

Bryophyllum spp. preparations are widely used in Anthroposophic Medicine, most often for mental and behavioral disorders, including anxiety. Studies in animals revealed various anxiolytic and neurosedative effects for Bryophyllum pinnatum. We set out to investigate the effectiveness of Bryophyllum 50% chewable tablets, a product registered without indication by means of notification in Switzerland, in the treatment of anxiety symptoms in psychiatric and psychosomatic patients.

METHODS

A total of 99 patients with anxiety symptoms were recruited from the waiting list for an inpatient stay at the hospital "Klinik Arlesheim", Department of Psychiatry and Psychosomatics; of these, 54 completed the study and returned fully completed questionnaires. Patients were treated with Bryophyllum 50% chewable tablets (350 mg tablets, made from leaf press juice, 3 × 2 per day; Weleda AG Arlesheim, Switzerland) and filled out questionnaires at baseline and after two and three weeks of tablet intake. The primary endpoint of the study was the change in anxiety symptoms measured with the Beck Anxiety Inventory (BAI).

RESULTS

A clinically relevant decrease in BAI score from baseline (27.4 ± 12.0) to after two (22.4 ± 12.1; p < 0.001) and three (20.6 ± 12.9; p < 0.001) weeks of treatment was observed. Additional improvements were observed in the secondary endpoints (including in depression, sleep quality, and stress); tolerability and compliance were very good.

CONCLUSIONS

The results suggest that Bryophyllum 50% chewable tablets have beneficial effects on anxiety-related symptoms. Since the study design does not allow us to conclude causality between treatment and observed improvements, a randomized clinical trial is urgently needed.

[On the effectiveness of a new advisory service for parents of children in need of care: a controlled study]

On the effectiveness of a new advisory service for parents of children in need of care: a controlled study Abstract: Background: Families with children in need of care are exposed to great stress. This results in risks that often lead to a poor living and care situation for families. To support them, an innovative regionally anchored support service is being developed by so-called Family Health Partners (FGP) as part of the NEST research project. Aim/Objective: The primary endpoint of the study is the quality of life of the families. Secondary outcomes are resilience factors and associated measures as well as access to care services. Methods: The effectiveness of the FGP will be tested in a controlled study with four measurement times (baseline, after 6, 12 and 18 months) between January 2022 and April 2024. A total of 204 families with children in need of care were recruited for an intervention and control group. Multilevel models are used to analyze the longitudinal data. Results: Between T0 and T1 there are statistically significant improvements in the intervention group, especially in daily and social stress in the family, in mental health and resilience. In addition, knowledge about general benefit rights as well as specific support and relief offers for caring parents has increased. Conclusions: The results of the first two measurement times indicate that a positive change in quality of life, resilience and health literacy can be achieved through the FGP.

Towards international collaboration of clinical research networks for EMDR: the EMDR Pain Network Germany

Background

Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based treatment, primarily established for post-traumatic stress disorder (PTSD). While it is increasingly being applied to chronic pain, its efficacy in this area is not yet supported by the same level of evidence as that which exists for PTSD. Studies in this area often show heterogeneous results with small case numbers, and the potential side effects of EMDR in the treatment of chronic pain are not well understood. Systematic documentation of treatment effects, potential predictors of treatment response and non-response, and side effects is crucial for progress in this field.

Aim

The primary aim is to establish a research framework to systematically investigate the delivery of EMDR therapies by outpatient clinicians in the field of pain. This study aims to provide a comprehensive analysis of treatment outcomes, side effects and determinants of treatment effectiveness, whether positive response or non-response.

Methods

This framework will oversee the documentation and evaluation of EMDR interventions delivered in outpatient settings using an Embedded Continuous Cumulative Evaluation Design (ECCED). It will focus on detailed characterisation of positive and negative therapeutic effects. It will also identify and analyse prognostic factors that influence individual variability in response to treatment. Treatment materials, standardised assessments and an intervision platform for regular exchange will be provided.

Discussion

The establishment of the EMDR Pain Network Germany and an interdisciplinary scientific-clinical platform is essential to promote clinical exchange and understanding of the effects of EMDR in pain therapy. This platform offers standardised treatment protocols, an online data collection system with anonymised data, comprehensive baseline assessments and an intervision platform for regular exchange. The knowledge gained is intended to personalise future therapies and serve as a basis for large randomised clinical trials.

The effect of music on stress recovery

OBJECTIVE

Previous research has suggested beneficial effects of music in reducing stress levels. However, there is no consistent conclusion demonstrating that music can contribute to stress recovery, primarily due to limitations in stress measurement, and inconsistent methodology within existing studies. Our study explores whether relaxing music, especially when self-selected, outperforms non-music acoustic, and silence conditions, fostering both subjective and biological stress recovery.

METHODS

One hundred and five healthy female participants underwent the Trier Social Stress Test (TSST) before being randomly allocated to one of four conditions: condition 1 (n = 25) listened to researcher-selected relaxing music; condition 2 (n = 27) listened to self-selected relaxing music; condition 3 (n = 26) listened to the sound of rippling water; and condition 4 (n = 27) remained in silence. Stress parameters were repeatedly measured nine times before and after the TSST. Saliva samples were collected for cortisol and saliva alpha-amylase (sAA) analysis, Movisens equipment was used to measure heart rate (HR) and skin conductance levels (SCL), and Visual Analogue Scales (VAS) were used for subjective stress measurement.

RESULTS

The examination of SCL, and VAS scores revealed no significant changes following the four relaxation interventions. Although sAA displayed a significant main effect of condition, post hoc tests did not pinpoint specific differences. HR recovery patterns varied among the four relaxation interventions, with the sound of rippling water condition exhibiting a later significant decrease compared to the other conditions. Exploratory analyses revealed that cortisol levels continued increase in all conditions during intervention phase except the researcher-selected music condition.

CONCLUSIONS

The subjective and biological stress markers did not exhibit better recovery after the music stimulus, except for a tendency in the researcher-selected music condition to mitigate the continued increase in cortisol levels after the stress test. Our study provides the first evidence comparing the impact of researcher- and participant-selected music with silence and a non-music acoustic stimulus, on both subjective and biological stress recovery. Our findings contribute to a more nuanced understanding of the impact of music on stress recovery.

Investigating thyroid function and iodine status in adolescents with and without paediatric major depressive disorder

Depression has been associated with subclinical hypothyroidism and altered hypothalamic-pituitary-thyroid axis functioning. Adequate iodine nutrition is essential for healthy thyroid functioning. We therefore determined associations of iodine and thyroid status with paediatric major depressive disorder (pMDD) among Swiss adolescents and explored whether associations are sex-specific and mediated by stress. We conducted a matched case-control study in 95 adolescents with diagnosed pMDD and 95 healthy controls. We assessed depression severity using the Children's Depression Rating Scale-Revised and stress using the perceived stress scale (PSS) and measuring hair cortisol levels. We determined iodine status by measuring urinary iodine concentrations (UIC) and thyroid status by thyroid-stimulating hormone (TSH) and free thyroxine (FT4) in serum. Median (IQR) UIC did not differ between cases (121 (87, 174) µg/l) and controls (114 (66, 183) μg/l, P = 0·3). Median TSH and FT4 were lower in cases than controls (TSH: 1·36 (0·91, 2·00) mlU/l v. 1·50 (1·18, 2·06) mlU/l, P = 0·039; FT4: 14·7 (12·9, 16·9) pmol/l v. 15·7 (14·3, 17·2) pmol/l, P = 0·004). The prevalence of hypothyroxinaemia (normal TSH; low FT4) was higher among female cases than controls (21 % v. 4%, P = 0·006). PSS scores were higher while hair cortisol was lower in cases than controls (PSS: 25 (20, 28) v. 11 (7, 15), P < 0·001; cortisol: 2·50 (1·34, 3·57) pg/mg v. 3·23 (1·79, 4·43) pg/mg, P = 0·044). After adjusting for confounders, the associations of TSH and hair cortisol with pMDD were no longer significant. Furthermore, TSH and FT4 were not associated with PSS scores and hair cortisol levels. Summarising, iodine nutrition was adequate for adolescents with and without pMDD. However, FT4 concentrations were lower in those with pMDD, and 1 in 5 female adolescents with pMDD were hypothyroxinaemic.

A custom tailored, evidence-based, theory-informed intervention for healthcare professionals to prevent burnout (LAGOM): study protocol for a pragmatic randomized controlled trial

BACKGROUND

Healthcare professionals in hospitals are exposed to a high level of professional stress, time pressure, workload, and often times poor organizational support. This makes them especially susceptible to burnout. In this pragmatic randomized controlled trial, we test the hypothesis that participation in a 9-week program (LAGOM) that was designed in close collaboration with healthcare professionals, incorporating both individual and organizational aspects reduces emotional exhaustion in healthcare professionals (primary outcome).

METHODS

Eighty four nurses and physicians working at the Charité - Universitätsmedizin Berlin and the Immanuel Hospital Berlin are automatically randomized to the LAGOM program (n = 42) or to usual care (n = 42) in a one-to-one allocation rate. The primary outcome emotional exhaustion is measured by the Maslach Burnout Inventory-Human Services Survey at baseline, post-intervention, and 1-month follow-up via an online survey. Secondary outcomes include depersonalization, personal accomplishment, subjective stress, mental well-being, self-care, self-efficacy, working conditions, mindfulness, and adverse events. Electrophysiological measures for heart rate variation analysis are captured. The PRECIS-2 tool is used to characterize the degree of pragmatism in our trial. Data analysis and primary intention-to-treat analysis using repeated measures analysis of variance are performed blind to intervention allocation. Per-protocol, subgroup, and secondary outcome analyses are conducted exploratively. An advisory board consisting of various stakeholders accompanies the study process.

DISCUSSION

If LAGOM proves to be effective in reducing symptoms of burnout, the program could make an important contribution to tackling the problem of the very high burnout rates among healthcare professionals and become an integral part of preventive services offered by hospitals.

TRIAL REGISTRATION

German Clinical Trials Register, DRKS00034060. Registered 31 May 2024.

Remote fitness assessment in younger and middle-aged to older adults: a comparison between laboratory- and videoconference-based assessment of selected measures of physical and cognitive fitness

BACKGROUND

Digital technologies can play an important role in improving the limited accessibility of healthcare services in rural regions (e.g., via remote assessment). However, whether remote fitness assessments (RFA) of selected physical and cognitive fitness parameters are feasible both in younger and older persons and whether they can reproduce laboratory tests needs yet to be established. Thus, this study aimed to address this knowledge gap by investigating the feasibility, and reproducibility of RFA in younger and middle-aged to older adults (MOA).

METHODS

A total of 31 younger adults and 32 MOAs participated in this study. At an interval of seven days, laboratory-based and remote assessments (via videoconferencing software) were conducted which included the quantification of the following parameters: (i) measurement of heart rate variability [HRV]; followed by (ii) cognitive testing to examine the level of attention, executive functions (oral Trail Making Test [A and B]), working memory, verbal short-term memory (digit span memory test and word list test (immediate recall)) and episodic memory (word list test (delayed recall)); followed by (iii) physical fitness assessments including performance tests of balance (balance test), functional strength ability of the lower limbs (5-time-sit-to-stand-test) and endurance capacity (3-min step test). Parameters of absolute and relative reliability were determined to assess the reproducibility of the laboratory-based and remote assessments.

RESULTS

The selected physical and cognitive fitness parameters showed moderate to excellent relative reliability (intraclass correlation coefficient [ICC] = 0.52-0.95). The parameters of absolute reliability (Bland-Altman plot and standard error of measurement [SEM]) provide evidence for good reproducibility of HRV parameters and measures of physical fitness, whereas measures of cognitive fitness showed moderate to good reproducibility. On a descriptive level, the absolute and relative reliability of the selected measures of physical and cognitive fitness did not vary as a function of participants' age.

CONCLUSION

Our results suggest that RFA of selected measures of physical and cognitive fitness is feasible and reproduces corresponding laboratory results to a moderate to excellent level in both younger adults and MOA. Data showed that the reproducibility of laboratory-based and remote assessments is not influenced by the age of the participants. These findings support the use of digital technologies to improve the accessibility of healthcare services (e.g., in remote areas). However, as the reproducibility varies considerably across the different parameters, further studies are needed to evaluate the effects of an optimised standardisation of the remote assessments and confounding factors.

Chronic stress and functional health in older adults with concerns about falling: a study protocol of a randomized controlled trial with multicomponent exercise intervention (FEARFALL)

BACKGROUND

Maintenance of physical function, mobility, and independent living are important goals for older adults. However, concerns about falling (CaF) play a central role in the vicious cycle of CaF, inflammation, loss of muscle mass, and decreasing physical function ultimately resulting in negative health outcomes. CaF, like other states of chronic stress and anxiety, can be considered as enduring adverse stimuli affecting the stress systems and the inflammatory system. Therefore, the aim of this study is to investigate whether a reduction of CaF leads to a reduction of stress and therefore possibly reduces chronic low-grade inflammation. Understanding the role and directionality of the effects of inflammation on CaF increases our understanding of age-related loss of mobility and physical function.

METHODS

In this study, community-dwelling older adults, aged 70 years and older, will be randomly assigned to either a 4-month, multi-component intervention with exercise training and cognitive-behavioral components or to a sham control group with light stretching exercises, cognitive training, and educational health lectures. For the operationalization of specific CaF, the Falls Efficacy Scale-International will be used. Stress and related psychological symptoms will be monitored using established self-reports and by measuring salivary cortisol. Concentrations of C-reactive protein, interleukin 6, interleukin 10, and tumor-necrosis-factor-alpha, as well as gene expression of selected inflammatory transcripts, will be used as surrogate parameters of the inflammatory status at baseline, after the 4-month intervention and 8-month follow-up.

DISCUSSION

This study will be the first to test whether CaF are related with stress system activity or reactivity or with markers of inflammation in the context of a multi-component intervention with exercise training and cognitive-behavioral components addressing CaF. The reduction of specific CaF or general psychological symptoms should reverse alterations in stress systems, and / or slow down low-grade inflammation. Changes in activity, as well as psychological and biological pathways leading from CaF to muscle loss will be measured, to disentangle the individual contribution to sarcopenia, and to provide an additional pathway to break or slow-down the vicious cycle of CaF and sarcopenia.

TRIAL REGISTRATION

German Clinical Trials Register (DRKS): DRKS00029171 . Registered 22 July 2022.

Online eurythmy therapy for cancer-related fatigue: a prospective repeated-measures observational study exploring fatigue, stress, and mindfulness

Introduction

Cancer is a debilitating disease with an often chronic course. One of the most taxing and prevalent sequelae in this context is cancer-related fatigue (CRF) resulting from the disease and/or associated treatments. Over the last years mindfulness-based interventions such as eurythmy therapy (ERYT), a mindful-movement therapy from anthroposophic medicine, have emerged as promising adjunct therapies in oncology. This prospective study investigated an online implementation of ERYT for CRF using a single arm repeated-measures design based on two consecutive studies.

Method

Study 1 consisted of an initial assessment before, during, after, and at follow up of a 6-week online ERYT-based program in a mixed sample of N = 165 adults with or without cancer diagnosis. Study 2 involved a similar design with an adapted 8-week online ERYT-based program in a sample of N = 125 adults who had been diagnosed with cancer. Outcomes were assessed using the Functional Assessment of Chronic Illness Therapy-Fatigue, Perceived Stress Scale, Mindful Attention Awareness Scale, and Insomnia Severity Index (for Study 1 all, for Study 2 only the former three). We additionally performed an exploratory analysis regarding practice frequency and duration. Data were analyzed using Linear Mixed-Effect Models per outcome; ANOVA was used for practice times.

Results

For Study 1, mixed-effects model estimates showed no significant effect on fatigue, but pointed to significantly improved emotional and physical well-being, reduced stress, as well as increased mindfulness (mixed subjects). Functional and social well-being or sleep quality did not change significantly. Study 2 model estimates on the other hand showed significantly improved CRF in conjunction with the ERYT-based online intervention, as well as improved stress and mindfulness scores (cancer-diagnosed subjects).

Conclusion

Taken together, while our results should be interpreted with caution given the single-arm design and relatively high dropout, they suggest online ERYT may be associated with a reduction in fatigue for individuals diagnosed with cancer, an increase in mindfulness, and benefits for stress and certain well-being indicators. The online group format is advantageous in view of affordability and accessibility, the latter being particularly relevant for individuals who due to high symptom severity cannot leave their homes. Randomized-controlled studies will be needed to confirm these findings.

Effects of Vibroacoustic Stimulation on Psychological, Physiological, and Cognitive Stress

Global stress is widespread in today's post-pandemic world of political and economic uncertainty. Vibroacoustic technology is a vibrotactile intervention with multiple uses, but its impact on stress lacks interpretation. This research assessed if the vibroacoustic technology of a Vibroacoustic Sound Massage (VSM) can reduce psychological, physiological, and cognitive stress. The Perceived Stress Scale (PSS-10) and electrocardiogram (ECG) and electroencephalogram (EEG) biosignals were used to quantify results. Participants were divided into Low-Stress and High-Stress groups. The ECG results show VSM increased parasympathetic activity for all participants, with the Low-Stress group being more affected. The EEG results indicate increased concentration, reduced arousal, and increased relaxation, with participant well-being non-significantly affected, though variability in this metric was homogenised after VSM. Together, these results validate VSM as an effective support tool for stress management; however, further research is required.

Mother-infant feeding interactions in mothers with and without eating disorder history: Results of a structured observational study

BACKGROUND

A growing body of evidence suggests that children of mothers with eating disorders (EDs) have a greater risk of early feeding problems. Recognizing and reacting adequately to the infant's signals during feeding is crucial for the child's development of internal and external regulatory mechanisms of food intake. Parental EDs might affect this ability. Therefore, we investigated the quality of mother-infant interactions during feeding using video recording and a structured coding system.

METHODS

The data of this pilot study was collected in a prospective cohort study investigating the influence of maternal EDs on child outcomes. Twenty women with ED history and 31 control women were videotaped while feeding their infant during a main meal at ten months postpartum. The mother-infant interactions were evaluated by two raters using the Chatoor Feeding Scale. We assessed birth outcomes, the mother's ED and depression status, breastfeeding practices, infant feeding problems and infant temperament by maternal self-report.

RESULTS

Mothers with and without ED history scored very similar on the Feeding Scale, however mothers from the control group experienced more struggle for control with their infants during feeding (p = 0.046) and made more negative comments about the infant's food intake (p = 0.010). Mothers with ED history were more concerned about infant feeding at three months postpartum and reported significantly more problems with solid foods in their children. Birth outcomes were comparable between groups, except for lower weight-for-length birth percentiles in children of women with ED history.

CONCLUSION

Whilst examined mothers with ED history are more concerned about feeding their children, ED psychopathology does not affect the quality of mother-infant interaction during feeding at the transition to autonomous eating at ten months of age.

The association of perceived ethnic discrimination and institutional verbal violence with chronic stress in an immigrant sample: The role of protective factors - results from the VIOLIN study

Immigrants are exposed to a variety of stressors, such as ethnic discrimination, and therefore experience a higher risk of developing adverse health outcomes. However, the role of potentially protective psychological factors is not well-studied. The present study addresses the question how discrimination and institutional verbal violence (IVV) are associated with chronic stress in an immigrant sample. In addition, this study highlights moderating effects of migration-specific variables (first or second migration generation and citizenship status). Participants (n = 232; 69.4 % female) completed an online-survey, which included demographics, questionnaires (Everyday Discrimination Scale, EDS; Perceived Stress Scale, PSS-4; Resilience Scale, RS-11; Self-Compassion Scale, SCS-SF) as well as a self-developed questionnaire on institutional verbal violence. Only participants living in Germany with migration background (self or one parent migrated to Germany) were included. Results showed that perceived discrimination and institutional verbal violence were highly associated with chronic stress. Further, self-compassion buffered the connection between discrimination and stress, whereas resilience was no protective factor. The inclusion of migration-specific variables showed that the second-generation sub-group experienced less discrimination-related stress and self-compassion was shown to be particularly protective within this sub-group. Citizenship status did not appear to be a moderator, but especially persons with temporary or permanent residence status, compared to German/EU-citizens, reported higher values of verbal violence and discrimination-related stress. These findings highlight the importance of considering not only psychological but also structural and societal protective and risk factors, as they may be differentially associated with immigrants' stress perceptions. Implications for future research and practical implementations are presented.

Development and validation of a mental hyperactivity questionnaire for the evaluation of chronic stress in higher education

BACKGROUND

Examination and understanding of neural hyperactivity are some of the greatest scientific challenges faced in the present day. For this reason, the present study aimed to examine this phenomenon in the context of higher education.

METHOD

Likewise, this work will enable an instrument to be created to appropriately and reliably estimate neural hyperactivity associated with chronic stress in university students undertaking a Physiotherapy degree.

RESULTS

Analysis of content validity was carried out according to agreement and consensus between nineteen experts with Education Science or Psychology degrees, via the Delphi method. On the other hand, face validity was established by administering the questionnaire to a sample of 194 university students aged between 18 and 45 years (M = 30.48%; SD = 13.152).

CONCLUSION

The final self-report measure, denominated mental hyperactivity, was composed of 10 items which showed adequate fit with regards to face and content validity (α = 0.775). Confirmatory factor analysis confirmed that the questionnaire was unidimensional.

Attentional Biases and Nonsuicidal Self-Injury Urges in Adolescents

Importance

Nonsuicidal self-injury (NSSI) is a significant clinical concern among adolescents. Exposure to NSSI-related content on social media platforms has been suspected to potentially act as a trigger for NSSI.

Objective

To use free-viewing eye-tracking and dot-probe paradigms to examine attentional bias and psychophysiological responses to NSSI-related pictorial and textual stimuli in adolescents with and without a history of NSSI.

Design, Setting, and Participants

From June 2022 to April 2023, adolescent participants in Vienna, Austria with and without a history of NSSI were exposed to NSSI-related stimuli in this nonrandomized controlled trial. Data were analyzed from December 2023 to January 2024.

Exposure

Exposure to NSSI-related stimuli.

Main Outcomes and Measures

During both tasks, subjective arousal, NSSI urges, and autonomic nervous system activity were assessed.

Results

A total of 50 adolescents in 2 groups, 25 who engaged in NSSI (mean [SD] age 15.86 [1.14] years; 19 female participants [76%]) and 25 who did not (mean [SD] age 16.40 [1.71] years; 19 female participants [76%]) were included. Adolescents with a history of NSSI-but not those without a history of NSSI-showed a clear attentional bias toward NSSI-related images during eye-tracking, as indicated by increased initial fixations (500 ms stimulus presentation mean difference, 28.64%; 95% CI, 18.31%-38.98%; P < .001; 1000 ms stimulus presentation mean difference, 18.50%; 95% CI, 9.05%-27.95%; P < .001) and longer fixation durations (500 ms mean difference, 29.51 ms; 95% CI, 4.3-54.72 ms; P < .001; 1000 ms mean difference, 39.83 ms; 95% CI, 6.90-72.76 ms; P < .001), regardless of stimulus duration. This bias was associated with a heightened urge to engage in NSSI (d = 1.22; 95% CI, 0.69-1.73; P < .001), a trend not seen in adolescents without a history of NSSI. Similarly, in the dot-probe task, only the NSSI group showed an attentional bias toward NSSI images but not toward trauma images, emphasizing the specificity of their attentional bias. Physiological measures revealed no significant differences, suggesting that viewing NSSI images is not associated with increased autonomic arousal. Textual NSSI content did not provoke an attentional bias or heighten NSSI urges in either group.

Conclusions and Relevance

In this nonrandomized controlled trial of 50 adolescents, results highlighted a specific attentional bias toward NSSI-related pictorial stimuli in adolescents with a history of NSSI, particularly a difficulty in disengaging from NSSI images. These findings contribute to understanding maladaptive information processing in NSSI and suggest implications for clinical management and cognitive models addressing NSSI triggers.

Trial Registration

German Clinical Trials Register identifier: DRKS00025905.

A Chatbot-Delivered Stress Management Coaching for Students (MISHA App): Pilot Randomized Controlled Trial

BACKGROUND

Globally, students face increasing mental health challenges, including elevated stress levels and declining well-being, leading to academic performance issues and mental health disorders. However, due to stigma and symptom underestimation, students rarely seek effective stress management solutions. Conversational agents in the health sector have shown promise in reducing stress, depression, and anxiety. Nevertheless, research on their effectiveness for students with stress remains limited.

OBJECTIVE

This study aims to develop a conversational agent-delivered stress management coaching intervention for students called MISHA and to evaluate its effectiveness, engagement, and acceptance.

METHODS

In an unblinded randomized controlled trial, Swiss students experiencing stress were recruited on the web. Using a 1:1 randomization ratio, participants (N=140) were allocated to either the intervention or waitlist control group. Treatment effectiveness on changes in the primary outcome, that is, perceived stress, and secondary outcomes, including depression, anxiety, psychosomatic symptoms, and active coping, were self-assessed and evaluated using ANOVA for repeated measure and general estimating equations.

RESULTS

The per-protocol analysis revealed evidence for improvement of stress, depression, and somatic symptoms with medium effect sizes (Cohen d=-0.36 to Cohen d=-0.60), while anxiety and active coping did not change (Cohen d=-0.29 and Cohen d=0.13). In the intention-to-treat analysis, similar results were found, indicating reduced stress (β estimate=-0.13, 95% CI -0.20 to -0.05; P<.001), depressive symptoms (β estimate=-0.23, 95% CI -0.38 to -0.08; P=.003), and psychosomatic symptoms (β estimate=-0.16, 95% CI -0.27 to -0.06; P=.003), while anxiety and active coping did not change. Overall, 60% (42/70) of the participants in the intervention group completed the coaching by completing the postintervention survey. They particularly appreciated the quality, quantity, credibility, and visual representation of information. While individual customization was rated the lowest, the target group fitting was perceived as high.

CONCLUSIONS

Findings indicate that MISHA is feasible, acceptable, and effective in reducing perceived stress among students in Switzerland. Future research is needed with different populations, for example, in students with high stress levels or compared to active controls.

TRIAL REGISTRATION

German Clinical Trials Register DRKS 00030004; https://drks.de/search/en/trial/DRKS00030004.

Differences in Physicians' Ratings of Work Stressors and Resources Associated With Digital Transformation: Cross-Sectional Study

BACKGROUND

The emergence of the COVID-19 pandemic rapidly accelerated the need and implementation of digital innovations, especially in medicine.

OBJECTIVE

To gain a better understanding of the stress associated with digital transformation in physicians, this study aims to identify working conditions that are stress relevant for physicians and differ in dependence on digital transformation. In addition, we examined the potential role of individual characteristics (ie, age, gender, and actual implementation of a digital innovation within the last 3 years) in digitalization-associated differences in these working conditions.

METHODS

Cross-sectional web-based questionnaire data of 268 physicians (mean age 40.9, SD 12.3 y; n=150, 56% women) in Germany were analyzed. Physicians rated their chronic stress level and 11 relevant working conditions (ie, work stressors such as time pressure and work resources such as influence on sequence) both before and after either a fictional or real implementation of a relevant digital transformation at their workplace. In addition, a subsample of individuals (60; n=33, 55% women) submitted self-collected hair samples for cortisol analysis.

RESULTS

The stress relevance of the selected working conditions was confirmed by significant correlations with self-rated chronic stress and hair cortisol levels (hair F) within the sample, all of them in the expected direction (P values between .01 and <.001). Multilevel modeling revealed significant differences associated with digital transformation in the rating of 8 (73%) out of 11 working conditions. More precisely, digital transformation was associated with potentially stress-enhancing effects in 6 working conditions (ie, influence on procedures and complexity of tasks) and stress-reducing effects in 2 other working conditions (ie, perceived workload and time pressure). Younger individuals, women, and individuals whose workplaces have implemented digital innovations tended to perceive digitalization-related differences in working conditions as rather stress-reducing.

CONCLUSIONS

Our study lays the foundation for future hypothesis-based longitudinal research by identifying those working conditions that are stress relevant for physicians and prone to differ as a function of digital transformation and individual characteristics.

Improving mental health by improving the mental health literacy? Study protocol for a randomised controlled evaluation of an e-mental health application as a preventive intervention for adolescents and young adults

Background

From the age of 14, many adolescents enter a vulnerable developmental phase, with a sharp increase in mental illness at 16. The COVID19 pandemic has further exacerbated this issue. Hence, universal and easily accessible prevention in the young is needed. E-mental health interventions are on the rise due to numerous benefits such as potential low-costs, low-threshold and high scalability. However, effectiveness and acceptance of mobile health (mHealth) preventive interventions remain unresearched.

Method

In a two-armed, randomised controlled study design adolescents and young adults from 14 years old will be recruited. Following an initial baseline assessment, they will be randomised to a) the intervention group (IG, n = 75), which will receive a mHealth intervention (the application 'Mental Health Guide', co-developed by lived experience experts) or b) the waiting list control group (CG, n = 75). Both groups will be followed up after 3 and 6 months following post assessment. We hypothesize an increase in mental health literacy in the IG compared to the CG for post and follow-up assessment (primary outcome: Mental Health Literacy Scale). In addition, we expect an improvement in mental health and psychological well-being, improved emotion regulation, reduced psychological distress, as well as good quality ratings in usability and acceptance in the use of the 'Mental Health Guide' We performed multiple simulations of possible outcome scenarios, incorporating an array of factors, to generate realistic datasets and obtain accurate estimates of statistical power.

Conclusion

As a first-of-its-kind in this field, this study investigates whether a mHealth intervention based on mental health literacy may improve the mental health literacy and further aspects of psychological functioning of young people in a vulnerable phase. Furthermore, the results promise to provide important knowledge of how universal prevention may be implemented with low costs for diverse populations.

Trial registration

This trial was registered in the DRKS register (DRKS-ID: DRKS00031810) on 23 June 2023.

Oxytocin-Augmented Modular-Based Group Intervention for Loneliness: A Proof-Of-Concept Randomized Controlled Trial

INTRODUCTION

Loneliness poses a significant health problem and existing psychological interventions have shown only limited positive effects on loneliness. Based on preliminary evidence for impaired oxytocin signaling in trait-like loneliness, the current proof-of-concept study used a randomized, double-blind, placebo-controlled design to probe intranasal oxytocin (OT) as an adjunct to a short-term modular-based group intervention for individuals suffering from high trait-like loneliness (HL, UCLA Loneliness Scale ≥55).

METHODS

Seventy-eight healthy HL adults (56 women) received five weekly group psychotherapy sessions. HL participants received OT or placebo before the intervention sessions. Primary outcomes were trait-like loneliness measured at baseline, after the intervention, and again at two follow-up time points (3 weeks and 3 months), and, assessed at each session, state loneliness (visual analog scale), perceived stress (Perceived Stress Scale, PSS-10), quality of life (World Health Organization Five Well-Being Index, WHO-5), and the therapeutic relationship (Group Questionnaire, GQ-D).

RESULTS

The psychological intervention was associated with significantly reduced perceived stress and improved trait-like loneliness across treatment groups, which was still evident at the 3-month follow-up. OT had no significant effect on trait-like loneliness, quality of life, or perceived stress. However, compared to placebo, OT significantly facilitated the decrease in state loneliness within sessions and significantly improved positive bonding between the group members.

CONCLUSION

Despite significantly improved trait-like loneliness after the intervention, OT did not significantly augment this effect. Further studies are needed to determine optimal intervention designs to translate the observed acute effects of OT into long-term benefits.

Cross-sectional associations of self-perceived stress and hair cortisol with metabolic outcomes and microvascular complications in type 2 diabetes

Introduction

Increasing evidence supports chronic psychological stress as a risk factor for the development of type 2 diabetes. Much less is known, however, about the role of chronic stress in established diabetes.

Methods

The aim of the current study was to comprehensively assess chronic stress in a sample of 73 patients with type 2 diabetes and 48 non-diabetic control participants, and to investigate associations with indicators of glycemic control (HbA1c), insulin resistance (HOMA-IR), β-cell functioning (C-peptide), illness duration, and the presence of microvascular complications. Chronic stress was measured using questionnaires [the Perceived Stress Scale (PSS), the Screening Scale of the Trier Inventory of Chronic Stress (SSCS), the Perceived Health Questionnaire (PHQ) as well as the Questionnaire on Stress in Patients with Diabetes-Revised (QSD-R)]; hair cortisol was used as a biological indicator.

Results

We found that patients with type 2 diabetes had higher levels of hair cortisol in comparison to the control group (F(1,112) = 5.3; p = 0.023). Within the diabetic group, higher hair cortisol was associated with a longer duration of the illness (r = 0.25, p = 0.04). General perceived stress did not show significant associations with metabolic outcomes in type 2 diabetes patients. In contrast, higher diabetes-related distress, as measured with the QSD-R, was associated with lower glycemic control (r = 0.28, p = 0.02), higher insulin resistance (r = 0.26, p = 0.03) and a longer duration of the illness (r = 0.30, p = 0.01).

Discussion

Our results corroborate the importance of chronic psychological stress in type 2 diabetes. It appears, however, that once type 2 diabetes has developed, diabetes-specific distress gains in importance over general subjective stress. On a biological level, increased cortisol production could be linked to the course of the illness.

Comprehensive examination of support needs and mental well-being: a mixed-method study of the Austrian general population in times of crisis

Introduction

In the recent years, the Austrian general population has faced a confluence of multiple crises. This study investigates the support wishes and mental health parameters of the Austrian general population aiming to comprehending the unmet needs and providing guidance for future psychosocial interventions and research endeavors.

Methods

1,031 participants attended the online survey and one third (n = 332) wished for further support to improve mental well-being in April 2022. A total of 280 participants accompanied their support wish with written accounts. Participants' mental health status was evaluated using the PHQ-9 (depression), GAD-7 (anxiety), ISI (insomnia), PSS-10 (perceived stress), CAGE (alcohol abuse), WHO-5 (well-being), and the SCOFF (eating disorder) questionnaires. Data analysis employed a mixed-methods approach.

Results

The preeminent support wish identified was the need for professional mental support (29.3%), followed by communication (21.6%), other professional support except mental and medical support (13.9%). In line with these findings, participants expressing a support wish experienced increased mental health distress across all assessed parameters.

Conclusion

The findings indicate the presence of a vulnerable population within the Austrian general population, which may benefit from targeted support interventions. Consequently, this study contributes to the identification of unmet support needs among the Austrian populace during times of crisis, facilitating the development and enhancement of precisely tailored intervention strategies.

Self-Assessment Instruments for Supporting Family Caregivers: An Integrative Review

Family caregivers take on a variety of tasks when caring for relatives in need of care. Depending on the situation and the intensity of care, they may experience multidimensional burdens, such as physical, psychological, social, or financial stress. The aim of the present study was to identify and appraise self-assessment instruments (SAIs) that capture the dimensions of family caregivers' burdens and that support family caregivers in easily identifying their caregiving role, activities, burden, and needs. We performed an integrative review with a broad-based strategy. A literature search was conducted on PubMed, Google Scholar, Google, and mobile app stores in March 2020. After screening the records based on the eligibility criteria, we appraised the tools we found for their usefulness for family care and nursing practice. From a total of 2654 hits, 45 suitable SAIs from 274 records were identified and analyzed in this way. Finally, nine SAIs were identified and analyzed in detail based on further criteria such as their psychometric properties, advantages, and disadvantages. They are presented in multi-page vignettes with additional information for healthcare professionals. These SAIs have proven useful in assessing the dimensions of caregiver burden and can be recommended for application in family care and nursing practice.

Stress perception, coping behaviors and work-privacy conflict of student midwives in times of COVID-19 pandemic: the "Healthy MidStudents" study in Germany

BACKGROUND

Student midwives deliver care for women under challenging job demands, which may affect their mental health- thus creating a high need for health promotion. Given the lack of research addressing this topic, the aim of this study is to examine the links between stress perception, coping behaviors, work-privacy conflict, and perception of COVID-19 pandemic impact on studies of student midwives in northern Germany.

METHODS

Data were collected using a cross-sectional online-survey at nine midwifery study sites in northern Germany from October 2022 to January 2023. 342 student midwives (response rate: 61.3%) were surveyed on stress perception, coping behaviors, work-privacy conflict, and perceived impact of the COVID-19 pandemic on their studies. Descriptive, linear regression and moderation analyses were run to test explorative assumptions.

RESULTS

Results revealed that higher levels of perceived stress were reported by 13.4% of student midwives. Social support (M = 13.76, SD = 2.19) and active stress coping (M = 10.72, SD = 2.01) were identified as most prevalent coping behaviors in the present sample. It was found that work-privacy conflict was positively associated with stress perception (ß = 0.53, p =.001) and maladaptive coping behaviors (alcohol and cigarette consumption: ß = 0.14, p =.015), and negatively associated with adaptive coping behaviors (positive thinking: ß = - 0.25, p =.001, social support: ß = - 0.23, p =.001). Students with children reported significantly lower levels of social support than students without children. 55.6% of student midwives perceived a negative impact of the COVID-19 pandemic on their studies (mostly on lectures, seminars, and contact with fellow students).

CONCLUSIONS

Key findings highlighted moderate stress levels among student midwives during theoretical study stage. Based on current research, prevalence of high stress levels among student midwives remains unclear. Given the overall heterogeneous, limited research on student midwives' stress perception, coping behaviors, work-privacy conflict and perceptions of COVID-19 pandemic impact on studies, implications for research are suggested, e.g. longitudinal studies at different time points and settings and interventional studies. Findings provide a starting point for implementation of workplace health promotion in theoretical and practical stages of midwifery science study programs, e.g. training courses on stress prevention and adaptive coping, and for improvement of working conditions.

Imager-A mobile health mental imagery-based ecological momentary intervention targeting reward sensitivity: A randomized controlled trial

Robust reward sensitivity may help preserve mental well-being in the face of adversity and has been proposed as a key stress resilience factor. Here, we present a mobile health application, "Imager," which targets reward sensitivity by training individuals to create mental images of future rewarding experiences. We conducted a two-arm randomized controlled trial with 95 participants screened for reward sensitivity. Participants in the intervention group received an ecological momentary intervention-Imager, which encouraged participants to create mental images of rewarding events for 1 week. The control group participants received only ecological momentary assessment, without the instruction to generate mental images. Adherence to Imager was high; participants in the intervention group engaged in 88% of the planned activities. In the follow-up assessment, the intervention group reported less mental health symptoms, mainly in depression (β = -0.34, df = 93, p = .004) and less perceived stress (β = -0.18, df = 93, p = .035), than control group participants and compared with the baseline assessment. Our results show the positive effects of Imager on mental health symptoms. The encouraging effects of the app on mental health outcomes may lead to greater use of ecological momentary interventions in the clinical preventive practice of affective disorders.

TaKeTiNa Music Therapy for Outpatient Treatment of Depression: Study Protocol for a Randomized Clinical Trial

BACKGROUND/OBJECTIVES

Depression is a prevalent and debilitating illness that significantly affects psychological and physical well-being. Apart from conventional therapies such as psychotherapy and medication, individuals with depression often lack opportunities for activities that are generally perceived as enjoyable, such as music, meditation, and arts, which have demonstrated therapeutic effectiveness. TaKeTiNa music therapy has been employed as a therapeutic intervention for more than two decades. However, there is a notable absence of well-designed clinical trials investigating its antidepressant effects, a gap we aim to address in our current study. Furthermore, shifts in the progression of depression may manifest both psychologically, by influencing emotional states, and physiologically, by leading to alterations in lipid and sphingolipid metabolism, cortisol levels, and immune system function. Our study seeks to analyze the impact of TaKeTiNa music therapy on both levels.

METHODS

This is a prospective monocentric randomized waitlist-controlled clinical trial. It investigates the influence of TaKeTiNa music therapy on patients with major depression in an outpatient setting. Therefore, interested persons are randomly assigned to two groups, an intervention group or a control group, after completing a screening procedure. The intervention group starts with an eight-week TaKeTiNa music therapy intervention. The waiting group receives the same therapy program after completing the follow-up period. Blood and saliva sampling as well as responses to questionnaires are obtained at specific time points.

DISCUSSION

Our study investigates the effects of TaKeTiNa music therapy, a non-pharmacological antidepressant treatment option, on depressive symptoms. We also address functional and causal immunological changes; hormonal changes, such as changes in cortisol levels; and metabolic changes, such as changes in serum lipids and sphingolipids, during the course of depression. We expect that this study will provide evidence to expand the range of treatment options available for depression.

Effects of a Brief Mindfulness-based Intervention in Patients with Psoriasis: A Randomized Controlled Trial

Mindfulness is a special type of attention, namely focusing on the current moment in a non-judgmental manner. Extensive mindfulness-based interventions have been shown to have positive effects in patients with psoriasis. However, it is unclear whether brief (2-week) interventions are also beneficial. Therefore, the aim of this study was to investigate the effects of a 2-week mindfulness-based intervention in patients with psoriasis. Patients were randomly assigned to an experimental (treatment-as-usual + mindfulness-based intervention) or control group (treatment-as-usual) during their clinic stay. All variables were measured by self-report using validated questionnaires: primary outcomes were mindfulness and self-compassion, secondary outcomes were itch catastrophizing, social anxiety, stress and skin status. Variables were assessed prior to, immediately and 3 months after the intervention. Effects were tested by repeated-measures analysis of variance (ANOVA). Analyses of pre-post-measurements (n = 39) revealed a significant interaction effect on self-reported mindfulness [F(1,35) = 7.46, p = 0.010, η2p = 0.18] and a tendency to a significant effect on self-reported self-compassion [F(1,36) = 3.03, p = 0.090, η2p = 0.08]. There were no other significant effects, but most descriptive data were in favour of the experimental group. However, the control group showed a greater improvement in skin status. Further studies are needed to replicate these findings and investigate which subgroups especially profit from such an intervention.

Encouraging medical students to become surgeons? Impact of psychological and surgical factors on career choice at medical school

Aim

Training decisions are viewed as a problem by the majority of medical students.In the present study we compared sociodemographic and psychological characteristics of students who are interested in surgical training to those who preferred a non-surgical specialty. Furthermore, we examined whether students who wish to be trained as surgeons performed better than their non-surgical counterparts in a course designed to acquire skills in minimally invasive surgery.

Method

From October 2020 to January 2021 we performed a cross-sectional survey among 116 medical students prior to their year of practical training at Christian-Albrechts University in Kiel. Based on their intended field of specialization, the students were divided into a non-surgical and a surgical group. Sociodemographic and psychological characteristics such as self-efficacy expectations, resilience and stress perception were evaluated and compared between groups. Simultaneously, we compared their surgical performance in two laparoscopic exercises and their self-assessment as surgeons. Statistical differences between the training groups were determined by the Mann-Whitney U test or Pearson's Chi square test.

Results

Ninety-two students participated in the study, of whom 64.1% intended to train in a non-surgical specialty and 35.9% in a surgical specialty. Students who wished to be trained as surgeons had higher general self-efficacy expectations (p<0.001) and greater resilience (p=0.009). However, on comparison they had a lower stress level (p=0.047). The inter-group comparison of training results and self-assessment as surgeons revealed no unequivocal differences in surgical performance.

Conclusion

Interest in surgical specialties is correlated, among other factors, with the strength of psychological skills such as general self-efficacy expectations, resilience and stress perception. Early attention to these psychological resources in academic training might assist medical students in future career choices.

Measuring interpersonal trauma: Development and validation of the German version of the victimization experience schedule (VES)

OBJECTIVE

Interpersonal victimization experiences (VEs) significantly affect mental and physical health, particularly in disorders associated with life-time adversities, like fibromyalgia syndrome (FMS) and major depressive disorder (MDD). However, assessing VEs comprehensively remains challenging due to limited tools that encompass sub-traumatic events, such as bullying or discrimination, and contextual dimensions. We aimed to address this gap by validating the Victimization Experience Schedule (VES) in German, examining its reliability, and assessing VEs in clinical populations with FMS and MDD.

METHODS

We investigated the relationship between VEs and clinical symptoms in individuals with FMS, MDD and healthy controls (N = 105) in a case-control study. We also analyzed correlations between different types of VEs and categories of early childhood abuse and posttraumatic-stress-disorder instruments. Additionally, we validated our findings in an independent sample of individuals with FMS (N = 97) from a clinical study.

RESULTS

We observed excellent inter-rater reliability (Kw = 0.90-0.99), and VEs assessed using the VES were in alignment with subcategories of early childhood abuse. The prevalence of VEs extended beyond the categories covered by traditional survey instruments and was higher in individuals with MDD (4.0 ± 2.6) and FMS (5.9 ± 3.1) compared to controls (1.5 ± 1.7). We consistently identified a significant association between the number of VEs, the associated subjective distress, and clinical scores. Furthermore, distinct correlation patterns between VEs and clinical outcomes emerged across different cohorts.

CONCLUSION

Our study emphasizes the VES's value in understanding VEs within MDD and FMS. These experiences span from traumatic to sub-traumatic and correlate with posttraumatic-stress and clinical symptoms, underscoring the VES's importance as an assessment tool.

Long-term effects of combined mindfulness intervention and app intervention compared to single interventions during the COVID-19 pandemic: a randomized controlled trial

Objectives

The study examines the short-, middle-, and long-term effects of a combined intervention (face-to-face mindfulness intervention plus the mindfulness app 7Mind), compared to single interventions (face-to-face mindfulness intervention alone and an intervention via app 7Mind alone). The subgroups were compared with an active control group on mindfulness, mindful characteristics, mental health, emotion regulation, and attentional abilities during the COVID-19 pandemic. Additionally, the study explores whether students' engagement with the app and their formal mindfulness practice at home improves intervention outcomes.

Methods

The study employs a randomized controlled trial approach involving three intervention groups and an active control group, with two follow-ups conducted over 12 months. The study included 177 university students who were randomly assigned to a mindfulness group (n = 42), a mindfulness app group (7Mind app, n = 44), a mindfulness + app group (n = 45), and an active control group (n = 46). The duration of the interventions was 4 weeks. The outcome variables were assessed at pre- and post-intervention, at 4 and 12 months post-intervention.

Results

At post-intervention and during both follow-ups, students in the combined mindfulness intervention did not demonstrate better outcomes compared to students in the single interventions or the active control group across all measures. Additionally, no statistically significant difference was observed between all interventions and the active control groups on any of the measures. However, it is noteworthy that all intervention groups and the active control group exhibited improvement in mindfulness, body awareness, emotion regulation, stress, and attentional abilities over the short, medium, and long term. Moreover, higher app usage in the app groups was significantly associated with increased body awareness. However, greater app use was also correlated with higher stress.

Conclusion

The results suggest that the mindfulness intervention and the mindfulness app were similar to the active control condition (communication training) on the investigated variables in the short, medium, and long term. Furthermore, an increased use of a mindfulness app can negatively affect stress.

Psychometric properties of the Perceived Stress Scale (PSS-10) in silica-exposed workers from diverse cultural and linguistic backgrounds

BACKGROUND

The Perceived Stress Scale (PSS-10) has been used in a range of occupational cohorts, but only recently in stone benchtop workers undergoing screening for silicosis. The aim of this study was to compare psychometric properties of the PSS-10 in stone benchtop workers amongst those born overseas or who used an interpreter.

METHODS

Stone benchtop workers in Melbourne, Australia completed the PSS-10 as part of their occupational screening for silicosis. Internal consistency was assessed with Cronbach's α for the total score and the positive and negative subscales. Validity was assessed using confirmatory factor analysis (CFA). Analysis was performed for the total group and for subgroups according to sex, interpreter use, overseas-born, and language spoken at home.

RESULTS

The results of 682 workers with complete PSS-10 scores were included in analysis. Most participants were male (93%), with mean age 36.9 years (SD 11.4), with just over half (51.6%) born in Australia, 10.1% using an interpreter, and 17.5% using a language other than English at home. Cronbach's α for the overall group (α = 0.878) suggested good internal consistency.

DISCUSSION

CFA analysis for validity testing suggested PSS-10 performance was good for both sexes, moderate for country of birth and language spoken at home categories, but poorer for those who used an interpreter. Whilst professional interpreters provide a range of benefits in the clinical setting, the use of translated and validated instruments are important, particularly in cohorts with large numbers of migrant workers.

CONCLUSION

This study describes the psychometric properties of the PSS-10 in a population of stone benchtop workers, with good internal consistency, and mixed performance from validity testing across various subgroups.

Acute Musculoskeletal Complaints Vary According to the Perceived Stress Among Hungarian Professional Dancers

Introduction: Studies showed that professional dance is often associated with a high degree of acute musculoskeletal injuries. These injuries' etiology predominantly describes their biomechanical or other extrinsic factors, but there is a limited number of scientific reports dealing with the perceived stress or mental health status concerning the physical complaints especially, among Hungarian professional dancers. Materials and Methods: In this study, we used validated questionnaires (RESTQ, SEFIP, Mental Health Test) filled out by Hungarian professional female dancers (N = 168) via an online platform anonymously and analyzed statistically. Results: Our findings showed a significantly positive relationship between musculoskeletal complaints and perceived stress, an elevated level of general stress, and a higher level of resilience in this population compared to the general population. Conclusion: Dancers demonstrate a heightened perception of stress; however, they exhibit elevated scores on resilience assessments, indicative of heightened functionality in their daily lives. Stress, per se, may not be directly regarded as a causative factor for acute musculoskeletal conditions, but it could potentially influence the severity of pain sensations and subjective pain levels in the context of existing injuries. Additional investigations are warranted to elucidate the precise mechanisms by which stress exacerbates the pain experience among dancers.