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Song Y, Ali N, Nater UM. The effect of music on stress recovery. Psychoneuroendocrinology 2024; 168:107137. [PMID: 39024851 DOI: 10.1016/j.psyneuen.2024.107137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 07/12/2024] [Accepted: 07/13/2024] [Indexed: 07/20/2024]
Abstract
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.
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Affiliation(s)
- Yichen Song
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria; University Research Platform "The Stress of Life (SOLE) - Processes and Mechanisms underlying Everyday Life Stress", Austria
| | - Nida Ali
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria; University Research Platform "The Stress of Life (SOLE) - Processes and Mechanisms underlying Everyday Life Stress", Austria
| | - Urs M Nater
- Department of Clinical and Health Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria; University Research Platform "The Stress of Life (SOLE) - Processes and Mechanisms underlying Everyday Life Stress", Austria.
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Potsch L, Rief W. How to improve reward sensitivity - Predictors of long-term effects of a randomized controlled online intervention trial. J Affect Disord 2024; 367:647-657. [PMID: 39243822 DOI: 10.1016/j.jad.2024.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 08/31/2024] [Accepted: 09/02/2024] [Indexed: 09/09/2024]
Abstract
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.
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Affiliation(s)
- L Potsch
- Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University of Marburg, Gutenbergstr. 18, D-35032 Marburg, Germany.
| | - W Rief
- Clinical Psychology and Psychotherapy, Department of Psychology, Philipps-University of Marburg, Gutenbergstr. 18, D-35032 Marburg, Germany
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Doersam AF, Throm JK, Sörensen F, Martus P, Kraegeloh-Mann I, Preissl H, Micali N, Giel KE. Mother-infant feeding interactions in mothers with and without eating disorder history: Results of a structured observational study. Appetite 2024; 200:107551. [PMID: 38857768 DOI: 10.1016/j.appet.2024.107551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 06/05/2024] [Accepted: 06/07/2024] [Indexed: 06/12/2024]
Abstract
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.
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Affiliation(s)
- Annica Franziska Doersam
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany; Centre of Excellence for Eating Disorders (KOMET), University Hospital Tuebingen, Tuebingen, Germany; German Center for Mental Health (DZPG), Tuebingen, Baden-Wuerttemberg, Germany; Graduate Training Centre of Neuroscience, International Max Planck Research School, Eberhard Karls University Tuebingen, Tuebingen, Germany.
| | - Jana Katharina Throm
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany; Centre of Excellence for Eating Disorders (KOMET), University Hospital Tuebingen, Tuebingen, Germany; German Center for Mental Health (DZPG), Tuebingen, Baden-Wuerttemberg, Germany
| | - Ferdinand Sörensen
- Graduate Training Centre of Neuroscience, International Max Planck Research School, Eberhard Karls University Tuebingen, Tuebingen, Germany; Pediatric Neurology & Developmental Medicine, University Children's Hospital Tuebingen, Tuebingen, Germany; Department of Psychiatry and Psychotherapy, Tübingen Center for Mental Health (TüCMH), University of Tuebingen, Tuebingen, Germany
| | - Peter Martus
- Institute for Medical Biometrics and Clinical Epidemiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Ingeborg Kraegeloh-Mann
- Pediatric Neurology & Developmental Medicine, University Children's Hospital Tuebingen, Tuebingen, Germany
| | - Hubert Preissl
- Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the Eberhard Karls University of Tuebingen, FMEG Center, German Centre for Diabetes Research (DZD), Tuebingen, Germany; Department of Internal Medicine IV, Division of Endocrinology, Diabetology, and Nephrology, University Hospital Tuebingen, Tuebingen, Germany; Institute of Pharmaceutical Sciences, Department of Pharmacy and Biochemistry, Interfaculty Centre for Pharmacogenomics and Pharma Research at the Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Nadia Micali
- Mental Health Services of the Capital Region of Denmark, Center for Eating and Feeding Disorders Research, Psychiatric Centre Ballerup, Ballerup, Denmark; University College London, Great Ormond Street Institute of Child Health, London, UK
| | - Katrin Elisabeth Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tuebingen, Tuebingen, Germany; Centre of Excellence for Eating Disorders (KOMET), University Hospital Tuebingen, Tuebingen, Germany; German Center for Mental Health (DZPG), Tuebingen, Baden-Wuerttemberg, Germany
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Hauck F, Borho A, Romero Gibu L, Atal M, Dederer S, Bendel P, Morawa E, Erim Y, Jansen S, Rohleder N. 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. J Migr Health 2024; 10:100260. [PMID: 39220099 PMCID: PMC11365374 DOI: 10.1016/j.jmh.2024.100260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Revised: 07/10/2024] [Accepted: 07/26/2024] [Indexed: 09/04/2024] Open
Abstract
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.
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Affiliation(s)
- Felicitas Hauck
- Department of Psychology, Friedrich-Alexander-University Erlangen-Nürnberg, Nägelsbachstraße 49a, 91052 Erlangen, Germany
| | - Andrea Borho
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Hartmannstraße 14, 91052 Erlangen, Germany
| | - Lucía Romero Gibu
- Department of Romance Studies, Friedrich-Alexander-University Erlangen-Nürnberg, Bismarkstraße 1, 91054 Erlangen, Germany
| | - Mojib Atal
- Institute of Political Science, Friedrich-Alexander-University Erlangen-Nürnberg, Kochstraße 4, 91054 Erlangen, Germany
| | - Sevil Dederer
- Department of Psychology, Friedrich-Alexander-University Erlangen-Nürnberg, Nägelsbachstraße 49a, 91052 Erlangen, Germany
| | - Petra Bendel
- Institute of Political Science, Friedrich-Alexander-University Erlangen-Nürnberg, Kochstraße 4, 91054 Erlangen, Germany
| | - Eva Morawa
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Hartmannstraße 14, 91052 Erlangen, Germany
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Hartmannstraße 14, 91052 Erlangen, Germany
| | - Silke Jansen
- Department of Romance Studies, Friedrich-Alexander-University Erlangen-Nürnberg, Bismarkstraße 1, 91054 Erlangen, Germany
| | - Nicolas Rohleder
- Department of Psychology, Friedrich-Alexander-University Erlangen-Nürnberg, Nägelsbachstraße 49a, 91052 Erlangen, Germany
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Fernández-García R, Melguizo-Ibáñez E, Zurita-Ortega F, Ubago-Jiménez JL. Development and validation of a mental hyperactivity questionnaire for the evaluation of chronic stress in higher education. BMC Psychol 2024; 12:392. [PMID: 39010177 PMCID: PMC11251370 DOI: 10.1186/s40359-024-01889-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 07/08/2024] [Indexed: 07/17/2024] Open
Abstract
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.
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Affiliation(s)
- Rubén Fernández-García
- Department of Nursing, Physiotherapy and Medicine, University of Almería, La Cañada de San Urbano, Carretera Sacramento s/n, Almería, 04120, Spain
| | - Eduardo Melguizo-Ibáñez
- Department of Didactics of Musical, Artistic and Corporal Expression, University of Granada, Granada, 18071, Spain.
| | - Félix Zurita-Ortega
- Department of Didactics of Musical, Artistic and Corporal Expression, University of Granada, Granada, 18071, Spain
| | - José Luis Ubago-Jiménez
- Department of Didactics of Musical, Artistic and Corporal Expression, University of Granada, Granada, 18071, Spain
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Toth EE, Vujić A, Ihász F, Ruíz-Barquín R, Szabo A. A Fullerton Functional Fitness Test-based exercise intervention for older adults yields quick physical and psychological benefits. Complement Ther Clin Pract 2024; 57:101880. [PMID: 38968691 DOI: 10.1016/j.ctcp.2024.101880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 06/29/2024] [Accepted: 06/30/2024] [Indexed: 07/07/2024]
Abstract
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.
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Affiliation(s)
- Eliza E Toth
- Doctoral School of Psychology, Faculty of Education and Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Institute of Psychology, Faculty of Education and Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Aleksandar Vujić
- Doctoral School of Psychology, Faculty of Education and Psychology, ELTE Eötvös Loránd University, Budapest, Hungary; Institute of Psychology, Faculty of Education and Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Ferenc Ihász
- Institute of Sport Science, Faculty of Education and Psychology, ELTE Eötvös Loránd University, Szombathely, Hungary
| | - Roberto Ruíz-Barquín
- Facultad de Formación de Profesorado y Educación, Universidad Autónoma de Madrid, Madrid, Spain
| | - Attila Szabo
- Institute of Health Promotion and Sport Sciences, Faculty of Education and Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.
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Goreis A, Pfeffer B, Hajek Gross C, Klinger D, Oehlke SM, Zesch H, Claes L, Plener PL, Kothgassner OD. Attentional Biases and Nonsuicidal Self-Injury Urges in Adolescents. JAMA Netw Open 2024; 7:e2422892. [PMID: 39023890 PMCID: PMC11258595 DOI: 10.1001/jamanetworkopen.2024.22892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 05/19/2024] [Indexed: 07/20/2024] Open
Abstract
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.
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Affiliation(s)
- Andreas Goreis
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Bettina Pfeffer
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Carola Hajek Gross
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Diana Klinger
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Sofia M. Oehlke
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Heidi Zesch
- Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
| | - Laurence Claes
- Clinical Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Paul L. Plener
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
| | - Oswald D. Kothgassner
- Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Pediatrics (CCP), Medical University of Vienna, Vienna, Austria
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Ulrich S, Lienhard N, Künzli H, Kowatsch T. A Chatbot-Delivered Stress Management Coaching for Students (MISHA App): Pilot Randomized Controlled Trial. JMIR Mhealth Uhealth 2024; 12:e54945. [PMID: 38922677 PMCID: PMC11237786 DOI: 10.2196/54945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 04/05/2024] [Accepted: 05/03/2024] [Indexed: 06/27/2024] Open
Abstract
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.
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Affiliation(s)
- Sandra Ulrich
- School of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland
| | - Natascha Lienhard
- School of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland
| | - Hansjörg Künzli
- School of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland
| | - Tobias Kowatsch
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- School of Medicine, University of St. Gallen, St.Gallen, Switzerland
- Centre for Digital Health Interventions, Department of Management, Technology and Economics, ETH Zurich, Zurich, Switzerland
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Wekenborg MK, Förster K, Schweden F, Weidemann R, Bechtolsheim FV, Kirschbaum C, Weitz J, Ditzen B. Differences in Physicians' Ratings of Work Stressors and Resources Associated With Digital Transformation: Cross-Sectional Study. J Med Internet Res 2024; 26:e49581. [PMID: 38885014 PMCID: PMC11217711 DOI: 10.2196/49581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 03/20/2024] [Accepted: 04/06/2024] [Indexed: 06/18/2024] Open
Abstract
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.
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Affiliation(s)
- Magdalena Katharina Wekenborg
- Chair of Biopsychology, Faculty of Psychology, TU Dresden, Dresden, Germany
- Else Kröner Fresenius Center for Digital Health, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Katharina Förster
- Clinical Psychology and Behavioural Neuroscience, Faculty of Psychology, TU Dresden, Dresden, Germany
| | - Florian Schweden
- Institute for Work Design and Organizational Development INAGO, Hamburg, Germany
| | - Robin Weidemann
- Clinic of Internal Medicine, Krankenhaus St. Joseph-Stift, Dresden, Germany
| | - Felix von Bechtolsheim
- Department of Gastrointestinal, Thoracic, and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
- Center for Tactile Internet with Human-in-the-Loop (CeTI), TU Dresden, Dresden, Germany
| | - Clemens Kirschbaum
- Chair of Biopsychology, Faculty of Psychology, TU Dresden, Dresden, Germany
| | - Jürgen Weitz
- Department of Gastrointestinal, Thoracic, and Vascular Surgery, Faculty of Medicine and University Hospital Carl Gustav Carus, TU Dresden, Dresden, Germany
- Center for Tactile Internet with Human-in-the-Loop (CeTI), TU Dresden, Dresden, Germany
| | - Beate Ditzen
- Institute of Medical Psychology, Heidelberg University, Heidelberg, Germany
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Krokos O, Brandhorst I, Seizer L, Gawrilow C, Löchner J. 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. Internet Interv 2024; 36:100733. [PMID: 38510271 PMCID: PMC10950738 DOI: 10.1016/j.invent.2024.100733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 02/20/2024] [Accepted: 03/06/2024] [Indexed: 03/22/2024] Open
Abstract
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.
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Affiliation(s)
- Olivia Krokos
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Tuebingen, Germany
- German Center for Mental Health (DZPG), Germany
| | - Isabel Brandhorst
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Tuebingen, Germany
- German Center for Mental Health (DZPG), Germany
| | - Lennart Seizer
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Tuebingen, Germany
- German Center for Mental Health (DZPG), Germany
| | - Caterina Gawrilow
- Department of School Psychology, Universität Tübingen, Germany
- German Center for Mental Health (DZPG), Germany
| | - Johanna Löchner
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, Tuebingen, Germany
- German Center for Mental Health (DZPG), Germany
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Berger R, Hurlemann R, Shamay-Tsoory S, Kanterman A, Brauser M, Gorni J, Luhmann M, Schramm E, Schultz J, Philipsen A, Lieberz J, Scheele D. Oxytocin-Augmented Modular-Based Group Intervention for Loneliness: A Proof-Of-Concept Randomized Controlled Trial. PSYCHOTHERAPY AND PSYCHOSOMATICS 2024; 93:169-180. [PMID: 38754399 DOI: 10.1159/000538752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 04/04/2024] [Indexed: 05/18/2024]
Abstract
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.
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Affiliation(s)
- Ruben Berger
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Rene Hurlemann
- Department of Psychiatry, School of Medicine and Health Sciences, University of Oldenburg, Oldenburg, Germany
| | | | - Alisa Kanterman
- Department of Psychology, University of Haifa, Haifa, Israel
| | - Maura Brauser
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Jessica Gorni
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Maike Luhmann
- Faculty of Psychology, Ruhr University Bochum, Bochum, Germany
- German Center for Mental Health (DZPG), Bochum, Germany
| | - Elisabeth Schramm
- Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Johannes Schultz
- Center for Economics and Neuroscience, University of Bonn, Bonn, Germany
- Institute of Experimental Epileptology and Cognition Research, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Jana Lieberz
- Section of Medical Psychology, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Dirk Scheele
- Department of Social Neuroscience, Faculty of Medicine, Ruhr University Bochum, Bochum, Germany
- Research Center One Health Ruhr of the University Alliance Ruhr, Ruhr University Bochum, Bochum, Germany
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12
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Buckert M, Streibel C, Hartmann M, Monzer N, Kopf S, Szendrödi J, Wild B. Cross-sectional associations of self-perceived stress and hair cortisol with metabolic outcomes and microvascular complications in type 2 diabetes. Front Public Health 2024; 12:1289689. [PMID: 38813430 PMCID: PMC11133512 DOI: 10.3389/fpubh.2024.1289689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 04/29/2024] [Indexed: 05/31/2024] Open
Abstract
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.
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Affiliation(s)
- Magdalena Buckert
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Carmen Streibel
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Nelly Monzer
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Stefan Kopf
- Department of Medicine I and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany
| | - Julia Szendrödi
- Department of Medicine I and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany
- German Center for Diabetes Research (DZD), Heidelberg, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
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Dinhof C, Humer E, Haider K, Rabenstein R, Jesser A, Pieh C, Probst T, Gächter A. Comprehensive examination of support needs and mental well-being: a mixed-method study of the Austrian general population in times of crisis. Front Public Health 2024; 12:1345796. [PMID: 38813409 PMCID: PMC11133677 DOI: 10.3389/fpubh.2024.1345796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 04/30/2024] [Indexed: 05/31/2024] Open
Abstract
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.
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Affiliation(s)
- Carina Dinhof
- Department for Psychosomatic Medicine and Psychotherapy, University of Continuing Education Krems (Danube University Krems), Krems an der Donau, Austria
- Division of Psychotherapy, Department of Psychology, Paris Lodron University Salzburg, Salzburg, Austria
| | - Elke Humer
- Department for Psychosomatic Medicine and Psychotherapy, University of Continuing Education Krems (Danube University Krems), Krems an der Donau, Austria
- Faculty of Psychotherapy Science, Sigmund Freud University Vienna, Vienna, Austria
| | - Katja Haider
- Department for Psychosomatic Medicine and Psychotherapy, University of Continuing Education Krems (Danube University Krems), Krems an der Donau, Austria
| | - Rafael Rabenstein
- Department for Psychosomatic Medicine and Psychotherapy, University of Continuing Education Krems (Danube University Krems), Krems an der Donau, Austria
| | - Andrea Jesser
- Faculty of Psychotherapy Science, Sigmund Freud University Vienna, Vienna, Austria
| | - Christoph Pieh
- Department for Psychosomatic Medicine and Psychotherapy, University of Continuing Education Krems (Danube University Krems), Krems an der Donau, Austria
| | - Thomas Probst
- Department for Psychosomatic Medicine and Psychotherapy, University of Continuing Education Krems (Danube University Krems), Krems an der Donau, Austria
- Division of Psychotherapy, Department of Psychology, Paris Lodron University Salzburg, Salzburg, Austria
| | - Afsaneh Gächter
- Department for Psychosomatic Medicine and Psychotherapy, University of Continuing Education Krems (Danube University Krems), Krems an der Donau, Austria
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Domeisen Benedetti F, Hechinger M, Fringer A. Self-Assessment Instruments for Supporting Family Caregivers: An Integrative Review. Healthcare (Basel) 2024; 12:1016. [PMID: 38786426 PMCID: PMC11120749 DOI: 10.3390/healthcare12101016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/21/2024] [Accepted: 04/30/2024] [Indexed: 05/25/2024] Open
Abstract
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.
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Affiliation(s)
- Franzisca Domeisen Benedetti
- School of Health Professions, Institute of Nursing, ZHAW—Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, 8401 Winterthur, Switzerland (A.F.)
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Efimov I, Agricola CJ, Nienhaus A, Harth V, Zyriax BC, Mache S. Stress perception, coping behaviors and work-privacy conflict of student midwives in times of COVID-19 pandemic: the "Healthy MidStudents" study in Germany. BMC Health Serv Res 2024; 24:594. [PMID: 38714981 PMCID: PMC11075225 DOI: 10.1186/s12913-024-10823-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 03/04/2024] [Indexed: 05/12/2024] Open
Abstract
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.
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Affiliation(s)
- Ilona Efimov
- Institute for Occupational and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Seewartenstr. 10, 20459, Hamburg, Germany.
| | - Caroline Johanna Agricola
- Midwifery Science Health Care Research and Prevention, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Albert Nienhaus
- Competence Center for Epidemiology and Health Services Research for Healthcare Professionals, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Volker Harth
- Institute for Occupational and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Seewartenstr. 10, 20459, Hamburg, Germany
| | - Birgit-Christiane Zyriax
- Midwifery Science Health Care Research and Prevention, Institute for Health Services Research in Dermatology and Nursing, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Stefanie Mache
- Institute for Occupational and Maritime Medicine, University Medical Center Hamburg-Eppendorf, Seewartenstr. 10, 20459, Hamburg, Germany
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Marciniak MA, Shanahan L, Myin-Germeys I, Veer IM, Yuen KSL, Binder H, Walter H, Hermans EJ, Kalisch R, Kleim B. Imager-A mobile health mental imagery-based ecological momentary intervention targeting reward sensitivity: A randomized controlled trial. Appl Psychol Health Well Being 2024; 16:576-596. [PMID: 37942875 DOI: 10.1111/aphw.12505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/16/2023] [Indexed: 11/10/2023]
Abstract
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.
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Affiliation(s)
- Marta Anna Marciniak
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital (PUK), University of Zurich, Zurich, Switzerland
| | - Lilly Shanahan
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Inez Myin-Germeys
- Center for Contextual Psychiatry, Department of Neurosciences, KU Leuven, Leuven, Belgium
| | - Ilya Milos Veer
- Research Division of Mind and Brain, Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Kenneth S L Yuen
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Harald Binder
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
- Freiburg Center for Data Analysis and Modelling, University of Freiburg, Freiburg, Germany
| | - Henrik Walter
- Research Division of Mind and Brain, Department of Psychiatry and Psychotherapy CCM, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Erno J Hermans
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Raffael Kalisch
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Birgit Kleim
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital (PUK), University of Zurich, Zurich, Switzerland
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Behzad A, Feldmann-Schulz C, Lenz B, Clarkson L, Ludwig C, Luttenberger K, Völkl S, Kornhuber J, Mühle C, von Zimmermann C. TaKeTiNa Music Therapy for Outpatient Treatment of Depression: Study Protocol for a Randomized Clinical Trial. J Clin Med 2024; 13:2494. [PMID: 38731019 PMCID: PMC11084329 DOI: 10.3390/jcm13092494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Revised: 04/15/2024] [Accepted: 04/18/2024] [Indexed: 05/13/2024] Open
Abstract
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.
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Affiliation(s)
- Ali Behzad
- Department of Internal Medicine 5, Hematology and Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054 Erlangen, Germany; (A.B.)
| | - Christoph Feldmann-Schulz
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054 Erlangen, Germany (K.L.); (C.M.)
| | - Bernd Lenz
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054 Erlangen, Germany (K.L.); (C.M.)
- Department of Addictive Behavior and Addiction Medicine, Central Institute of Mental Health (CIMH), Medical Faculty Mannheim, Heidelberg University, 68159 Mannheim, Germany
| | - Lucy Clarkson
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054 Erlangen, Germany (K.L.); (C.M.)
| | - Celine Ludwig
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054 Erlangen, Germany (K.L.); (C.M.)
| | - Katharina Luttenberger
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054 Erlangen, Germany (K.L.); (C.M.)
| | - Simon Völkl
- Department of Internal Medicine 5, Hematology and Oncology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054 Erlangen, Germany; (A.B.)
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054 Erlangen, Germany (K.L.); (C.M.)
| | - Christiane Mühle
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054 Erlangen, Germany (K.L.); (C.M.)
| | - Claudia von Zimmermann
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, 91054 Erlangen, Germany (K.L.); (C.M.)
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Eckardt M, Stadtmueller L, Zick C, Kupfer J, Schut C. Effects of a Brief Mindfulness-based Intervention in Patients with Psoriasis: A Randomized Controlled Trial. Acta Derm Venereol 2024; 104:adv18277. [PMID: 38639157 DOI: 10.2340/actadv.v104.18277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 01/25/2024] [Indexed: 04/20/2024] Open
Abstract
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.
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Affiliation(s)
- Markus Eckardt
- Institute of Medical Psychology, University of Gießen, Germany
| | | | - Christoph Zick
- Department of Dermatology, Rehabilitation Clinic Borkum Riff, Borkum, Germany
| | - Jörg Kupfer
- Institute of Medical Psychology, University of Gießen, Germany
| | - Christina Schut
- Institute of Medical Psychology, University of Gießen, Germany.
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Brügge S, Günther V, Cascorbi I, Maass N, Ruchay Z, Fischer MR, Huber J, Alkatout I. Encouraging medical students to become surgeons? Impact of psychological and surgical factors on career choice at medical school. GMS JOURNAL FOR MEDICAL EDUCATION 2024; 41:Doc21. [PMID: 38779696 PMCID: PMC11106567 DOI: 10.3205/zma001676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 01/10/2024] [Accepted: 02/12/2024] [Indexed: 05/25/2024]
Abstract
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.
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Affiliation(s)
- Sandra Brügge
- University Hospitals Schleswig-Holstein, Campus Kiel, Clinic for Obstetrics and Gynecology, Kiel, Germany
| | - Veronika Günther
- University Hospitals Schleswig-Holstein, Campus Kiel, Clinic for Obstetrics and Gynecology, Kiel, Germany
| | - Ingolf Cascorbi
- University Hospitals Schleswig-Holstein, Campus Kiel, Institute for Experimental and Clinical Pharmacology, Kiel, Germany
| | - Nicolai Maass
- University Hospitals Schleswig-Holstein, Campus Kiel, Clinic for Obstetrics and Gynecology, Kiel, Germany
| | - Zino Ruchay
- University Hospitals Schleswig-Holstein, Campus Kiel, Clinic for Obstetrics and Gynecology, Kiel, Germany
| | - Martin R. Fischer
- Ludwig-Maximilians University Munich, Institute for Didactics and Training Research in Medicine, Munich, Germany
| | - Johanna Huber
- Ludwig-Maximilians University Munich, Institute for Didactics and Training Research in Medicine, Munich, Germany
| | - Ibrahim Alkatout
- University Hospitals Schleswig-Holstein, Campus Kiel, Clinic for Obstetrics and Gynecology, Kiel, Germany
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Drusko A, Renz M, Schmidt H, Rosin M, Simon J, Beiner E, Charalambides M, Meyer-Lindenberg A, Treede RD, Tost H, Tesarz J. Measuring interpersonal trauma: Development and validation of the German version of the victimization experience schedule (VES). J Psychosom Res 2024; 179:111626. [PMID: 38430794 DOI: 10.1016/j.jpsychores.2024.111626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 02/21/2024] [Accepted: 02/21/2024] [Indexed: 03/05/2024]
Abstract
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.
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Affiliation(s)
- Armin Drusko
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Malika Renz
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Medical Faculty Mannheim, Heidelberg University, Germany
| | - Hannah Schmidt
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Medical Faculty Mannheim, Heidelberg University, Germany; Department of Neurophysiology, MCTN, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Michelle Rosin
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Joe Simon
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Eva Beiner
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany
| | - Monica Charalambides
- Hammersmith & Fulham Community Rehab, West London NHS Trust, London, United Kingdom
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Medical Faculty Mannheim, Heidelberg University, Germany; DZPG (German Centre for Mental Health - Partner Site Heidelberg/ Mannheim/ Ulm), Germany
| | - Rolf-Detlef Treede
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Medical Faculty Mannheim, Heidelberg University, Germany; Department of Neurophysiology, MCTN, Medical Faculty Mannheim, Heidelberg University, Germany
| | - Heike Tost
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health Medical Faculty Mannheim, Heidelberg University, Germany; DZPG (German Centre for Mental Health - Partner Site Heidelberg/ Mannheim/ Ulm), Germany
| | - Jonas Tesarz
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg University, Heidelberg, Germany; DZPG (German Centre for Mental Health - Partner Site Heidelberg/ Mannheim/ Ulm), Germany.
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21
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Karing C. Long-term effects of combined mindfulness intervention and app intervention compared to single interventions during the COVID-19 pandemic: a randomized controlled trial. Front Psychol 2024; 15:1355757. [PMID: 38566946 PMCID: PMC10985326 DOI: 10.3389/fpsyg.2024.1355757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/23/2024] [Indexed: 04/04/2024] Open
Abstract
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.
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Affiliation(s)
- Constance Karing
- Department of Research Synthesis, Intervention and Evaluation, Institute of Psychology, Friedrich-Schiller-University, Jena, Germany
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22
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Hore-Lacy F, Gwini S, Glass DC, Dimitriadis C, Jimenez-Martin J, Hoy RF, Sim MR, Walker-Bone K, Fisher J. Psychometric properties of the Perceived Stress Scale (PSS-10) in silica-exposed workers from diverse cultural and linguistic backgrounds. BMC Psychiatry 2024; 24:181. [PMID: 38439053 PMCID: PMC10913222 DOI: 10.1186/s12888-024-05613-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 02/15/2024] [Indexed: 03/06/2024] Open
Abstract
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.
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Affiliation(s)
- Fiona Hore-Lacy
- Monash University, Melbourne, Australia.
- Alfred Health, Melbourne, Australia.
| | | | | | | | | | - Ryan F Hoy
- Monash University, Melbourne, Australia
- Alfred Health, Melbourne, Australia
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23
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Schwartz K, Vizin G, Boros S. Acute Musculoskeletal Complaints Vary According to the Perceived Stress Among Hungarian Professional Dancers. J Dance Med Sci 2024; 28:21-27. [PMID: 37818918 DOI: 10.1177/1089313x231200471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
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.
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Affiliation(s)
- Kristóf Schwartz
- Doctoral School of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Gabriella Vizin
- Department of Clinical Psychology and Addiction, ELTE Eötvös Loránd University, Budapest, Hungary
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Szilvia Boros
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Budapest, Hungary
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24
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Demirel S, Roke Y, Hoogendoorn AW, Hoefakker J, Hoeberichts K, van Harten PN. Assessing the Effectiveness of STAPP@Work, a Self-Management Mobile App, in Reducing Work Stress and Preventing Burnout: Single-Case Experimental Design Study. J Med Internet Res 2024; 26:e48883. [PMID: 38275128 PMCID: PMC10940977 DOI: 10.2196/48883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 12/06/2023] [Accepted: 01/17/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Work-related stress and burnout remain common problems among employees, leading to impaired health and higher absenteeism. The use of mobile health apps to promote well-being has grown substantially; however, the impact of such apps on reducing stress and preventing burnout is limited. OBJECTIVE This study aims to assess the effectiveness of STAPP@Work, a mobile-based stress management intervention, on perceived stress, coping self-efficacy, and the level of burnout among mental health employees. METHODS The study used a single-case experimental design to examine the use of STAPP@Work among mental health employees without a known diagnosis of burnout (N=63). Participants used the app for 1 week per month repeatedly for a period of 6 months. Using a reversal design, the participants used the app 6 times to assess replicated immediate (1 week after use) and lasting (3 weeks after use) effects. The Perceived Stress Scale, the Coping Self-Efficacy Scale, and the Burnout Assessment Tool were used to measure the outcomes. Linear mixed models were used to analyze the data. RESULTS After 6 months of app use for 1 week per month, the participants showed a statistically significant decrease in perceived stress (b=-0.38, 95% CI -0.67 to -0.09; P=.01; Cohen d=0.50) and burnout symptoms (b=-0.31, 95% CI -0.51 to -0.12; P=.002; Cohen d=0.63) as well as a statistically significant improvement in problem-focused coping self-efficacy (b=0.42, 95% CI 0-0.85; P=.049; Cohen d=0.42). Long-term use of the app provided consistent reductions in burnout symptoms over time, including in the level of exhaustion and emotional impairment. CONCLUSIONS The use of an app-based stress management intervention has been shown to reduce burnout symptoms and enhance coping self-efficacy among mental health workers. Prevention of burnout and minimization of work-related stress are of utmost importance to protect employee health and reduce absenteeism.
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Affiliation(s)
- Sevda Demirel
- Expertise Center for Autism Spectrum Disorder, GGz Centraal, Almere, Netherlands
| | - Yvette Roke
- Expertise Center for Autism Spectrum Disorder, GGz Centraal, Almere, Netherlands
| | - Adriaan W Hoogendoorn
- Department of Psychiatry, Amsterdam Universitair Medische Centra, Amsterdam, Netherlands
- Mental Health Program, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | | | - Kirsten Hoeberichts
- Expertise Center for Autism Spectrum Disorder, GGz Centraal, Almere, Netherlands
| | - Peter N van Harten
- Department of Psychiatry, GGz Centraal, Amersfoort, Netherlands
- Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
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25
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Rothe J, Brückner G, Ring M, Roessner V, Wolff N, Vetter NC. Emotions and worries during 1.5 years of the COVID-19 pandemic - how adults with and without mental health conditions coped with the crisis. BMC Psychiatry 2024; 24:114. [PMID: 38336631 PMCID: PMC10858480 DOI: 10.1186/s12888-024-05573-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND During the COVID 19 pandemic, there were social restrictions with severe mental stress for a long time. Most studies on mental health consequences of the pandemic focused primarily on the beginning of the pandemic. The present study on families of patients or study participants of a child and adolescent psychiatry aimed to examine long-term profiles of emotions and worries in adults with and without mental health condition (mhc) during the first 1.5 years of the COVID-19 pandemic. METHODS We surveyed emotions and worries of 128 adults with (n = 32) and without (n = 96) pre-pandemic mhc over a 1.5-year study period from spring 2020 until summer/autumn 2021. Emotions and worries were captured at four time points: [i] pre-pandemic, [ii] spring 2020 (first lockdown was implemented), [iii] December 2020 (hard lockdown at Christmas time) and [iv] summer/autumn 2021 (considerable ease of regulations); [i] pre-pandemic and [iii] December 2020 were measured retrospectively). First, we run non-parametric tests to compare emotions and worries between adults with and without pre-pandemic mhc at the four time points. Next, we conducted latent profile analysis to identify subgroups from the total sample who share similar trajectories of emotions and worries. Finally, a logistic regression analysis was run to examine whether socio-demographic and psycho-social factors were related to identified trajectories of emotions and worries. RESULTS Adults without pre-pandemic mhc reported a strong worsening of emotions and worries at the beginning of the pandemic and a lower worsening during the course, while adults with pre-pandemic mhc reported a constant worsening of emotions and worries. The latent profile analysis revealed three profiles of adults who show either i) an adaption, ii) no adaption or iii) a continuous high condition. With increasing age, higher perceived stress and pre-pandemic mhc, the likelihood of an adaption was increased. CONCLUSION The results of the present study suggested that adults (both with and without pre-pandemic mhc) coped the crisis with different strategies and that most of them returned to their initial, pre-pandemic levels of emotions and worries when social restrictions were considerably eased or stopped.
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Affiliation(s)
- Josefine Rothe
- Department of Child and Adolescent Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
| | - Greta Brückner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Melanie Ring
- Department of Child and Adolescent Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Veit Roessner
- Department of Child and Adolescent Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Nicole Wolff
- Department of Child and Adolescent Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Nora C Vetter
- Department of Child and Adolescent Psychiatry and Psychotherapy, Technische Universität Dresden, Dresden, Germany
- Faculty of Natural Sciences, Department of Psychology, Medical School Berlin, Berlin, Germany
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26
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Deflorin N, Ehlert U, Amiel Castro RT. Associations of maternal prenatal psychological symptoms and saliva cortisol with neonatal meconium microbiota: A cross-sectional study. Prog Neuropsychopharmacol Biol Psychiatry 2024; 129:110895. [PMID: 37951341 DOI: 10.1016/j.pnpbp.2023.110895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/13/2023]
Abstract
Alterations in the diversity and relative abundances of the gut microbiome have been associated with a broad spectrum of medical conditions. Maternal psychological symptoms during pregnancy may impact on offspring development by altering the maternal and the foetal gut microbiome. We aimed to investigate whether self-reported maternal anxiety, depressive symptoms, and distress as well as saliva cortisol levels in late pregnancy alter the bacterial composition of the infant's meconium. METHODS A total of N = 100 mother-infant pairs were included. Maternal psychological symptoms were measured using psychological questionnaires (EPDS, PSS-10, STAI) at 34-36 weeks gestation and salivary cortisol was measured at 34-36 and 38 weeks gestation. Infant meconium samples were collected in the first five days postpartum and analysed using 16S rRNA amplicon sequencing. RESULTS Correlations showed that lower alpha diversity of the meconium microbiome was significantly associated with increased maternal prenatal depressive symptoms in late gestation (τ = -0.15, p = .04). Increased saliva cortisol AUCg at T2 was significantly related to higher beta diversity of the meconium samples (Pr(>F) = 0.003*). Pseudomonas was the most abundant phylum and was associated with maternal saliva cortisol total decline. No other associations were found. CONCLUSIONS Maternal prenatal depressive symptoms are associated with infant faecal microbiome alpha diversity, whereas maternal saliva cortisol AUCg is linked to increased beta diversity and total decline related to increased Psuedomonas. Future studies are warranted to understand how these microbiota community alterations are linked to child health outcomes.
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Affiliation(s)
- Nadia Deflorin
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Zurich, Switzerland
| | - Ulrike Ehlert
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Zurich, Switzerland
| | - Rita T Amiel Castro
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Zurich, Switzerland.
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27
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Kastner CT. A lighthearted approach to mindfulness: development and evaluation of a humor-enriched mindfulness-based program in a randomized trial. Front Psychol 2024; 14:1324329. [PMID: 38379846 PMCID: PMC10877944 DOI: 10.3389/fpsyg.2023.1324329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/15/2023] [Indexed: 02/22/2024] Open
Abstract
Objectives Recently, research on mindfulness and humor has begun to spark interest, both being essential contributors to well-being. This article proposes that forms of humor that share intention and attitudinal foundations with mindfulness, constitute the foundation of a mindful-humorous perspective and mindful humor. Once intention and attitude are in alignment, shared mechanisms underlying a mindful-humorous perspective may lead to synergetic effects (e.g., reinforcing a shift in perspective and attitudinal foundations) as summarized in the proposed mindful humor filter model (MHFM). Based on this theoretical framework, the humor-enriched mindfulness-based program (HEMBP) was developed and evaluated for validity and efficacy in a randomized controlled trial as a first step to test the newly introduced model. Methods A total of 60 participants were randomly allocated to either the HEMBP or a wait-list control group. Participants' mindfulness, comic styles (e.g., benevolent humor, sarcasm, and cynicism), psychological well-being, life satisfaction, stress, and gelotophobia (fear of being laughed at) were assessed 1 week before and after training, and at a 1-month follow-up. Linear mixed-effects models were fitted to model changes in outcome variables over time. Results The HEMBP was effective in increasing mindfulness, benevolent humor, and psychological well-being, and in reducing sarcasm, cynicism, stress, and gelotophobia, compared to the control group. Conclusion Results support the validity and efficacy of the HEMBP as a promising approach for improving well-being and reducing stress. The HEMBP broadens the scope of existing mindfulness-based programs by cultivating a mindful-humorous outlook on life, facilitating mindfulness practice and insights, and fostering positive emotions and relationships with others through mindful humor. Results are also suggestive of the validity of the mindful humor filter model.
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Affiliation(s)
- Christian T. Kastner
- Applied Social and Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland
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28
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Nyengaard R, Kallesøe KH, Rimvall MK, Ørnbøl E, Wellnitz KB, Olsen EM, Wyller VBB, Rask CU. Hair cortisol and self-perceived stress in adolescents with multi-system functional somatic disorders. BMC Psychiatry 2024; 24:101. [PMID: 38317120 PMCID: PMC10840144 DOI: 10.1186/s12888-024-05518-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 01/11/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Long-term stress causing altered hypothalamic-pituitary-adrenal (HPA) axis dynamics with cortisol dysfunction may be involved in the pathophysiology of functional somatic disorders (FSD), but studies on adolescents with multi-system FSD are lacking. Therefore, we investigated: 1) whether hair cortisol concentration (HCC) differentiates adolescents with multi-system FSD from a) a population-based sample and b) a subgroup derived from the sample reporting a high physical symptom load, and 2) whether FSD population HCC is associated with primary symptom presentations and self-perceived stress. METHODS We used data from a clinical sample with multi-system FSD (N = 91, age 15-19 years) and a population-based sample (N = 1,450, age 16-17 years) including a subgroup with top 10% total scores on physical symptoms (N = 147). Density plots and multiple linear regression were applied to compare HCC between groups. In the clinical sample, multiple linear regression was employed to assess the association between HCC and primary symptom clusters and self-perceived stress. RESULTS Median HCC was lower in the clinical sample than in the population-based sample (β = 0.80 (95%CI: 0.66, 0.97)), but not significantly different from median HCC in the derived subgroup (β = 0.84 (95%CI: 0.66, 1.07)). In the clinical sample, HCC was not significantly associated with primary symptom clusters (F(2, 82) = 0.13, p = 0.88) or self-perceived stress (F(4, 83) = 1.18, p = 0.33). CONCLUSION Our findings indicate that HCC is lowered in adolescents with multi-system FSD but not significantly associated with primary symptom presentations or self-perceived stress. Future studies including multiple measures of HPA axis dynamics alongside psychological measures may further elucidate the role of long-term stress in FSD. TRIAL REGISTRATION The AHEAD study was pre-registered at ClinicalTrials.gov (NCT02346071), 26/01/2015.
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Affiliation(s)
- Rebecca Nyengaard
- Research Unit Department of Child and Adolescent Psychiatry, Psychiatry, Aarhus University Hospital, Palle Juul-Jensens Boulevard 175, Aarhus N, 8200, Denmark
- Department of Clinical Medicine, Aarhus University, Incuba Skejby, building 2, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
| | - Karen Hansen Kallesøe
- Research Unit Department of Child and Adolescent Psychiatry, Psychiatry, Aarhus University Hospital, Palle Juul-Jensens Boulevard 175, Aarhus N, 8200, Denmark.
| | - Martin Køster Rimvall
- Child and Adolescent Mental Health Centre, Mental Health Services in the Capital Region of Denmark, Kildegaardsvej 28, Entrance 3A, 1st Floor, 2900, Hellerup, Denmark
- Department of Child and Adolescent Psychiatry, Psychiatry Region Zealand, Ny Østergade 12, 4000, Roskilde, Denmark
| | - Eva Ørnbøl
- Department of Clinical Medicine, Aarhus University, Incuba Skejby, building 2, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, Aarhus N, 8200, Denmark
| | - Kaare Bro Wellnitz
- Department of Clinical Medicine, Aarhus University, Incuba Skejby, building 2, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, Aarhus N, 8200, Denmark
| | - Else Marie Olsen
- Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Ndr. Fasanvej 57, 1st Floor, Building 14, 2000, Frederiksberg, Denmark
- Psychiatric Centre Ballerup, Mental Health Services in the Capital Region of Denmark, Maglevænget 2, 2750, Ballerup, Denmark
| | - Vegard Bruun Bratholm Wyller
- Department of Pediatric and Adolescent Medicine, Akershus University Hospital, Postboks 1000, 1478, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Blindern, P.O box 1171, 0318, Oslo, Norway
| | - Charlotte Ulrikka Rask
- Research Unit Department of Child and Adolescent Psychiatry, Psychiatry, Aarhus University Hospital, Palle Juul-Jensens Boulevard 175, Aarhus N, 8200, Denmark
- Department of Clinical Medicine, Aarhus University, Incuba Skejby, building 2, Palle Juul-Jensens Boulevard 82, 8200, Aarhus N, Denmark
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Power C, Weise V, Mack JT, Karl M, Garthus-Niegel S. Does parental mental health mediate the association between parents' perceived stress and parent-infant bonding during the early COVID-19 pandemic? Early Hum Dev 2024; 189:105931. [PMID: 38215651 DOI: 10.1016/j.earlhumdev.2023.105931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/29/2023] [Accepted: 12/31/2023] [Indexed: 01/14/2024]
Abstract
BACKGROUND The spread of the COVID-19 virus was declared a pandemic in March 2020. New restrictions such as 'lockdowns' and 'social distancing' created challenges for individuals' work-life balance, financial situation, family life, and physical and mental health. The global population's stress levels rose in response to these changes, leading to a widespread deterioration of mental health. One group particularly affected was parents of infants and very young children. Poor parental mental health may disrupt parent-infant bonding, with negative consequences for infant well-being and development. AIMS To consider parent-infant bonding in relation to parents' perceived stress and psychological distress during the first lockdown, and to examine whether associations of stress with parent-infant bonding were mediated by parental mental health. METHODS DREAMCORONA (n = 738: 471 mothers and 267 partners) is a sub-study of the prospective German cohort study 'DREAM'. The SPSS modelling tool PROCESS was used to assess whether parental mental health mediated the relationship between parents' perceived stress response to the COVID-19 pandemic and parent-infant bonding, while controlling for covariates. RESULTS Higher levels of parental stress were strongly associated with higher levels of depression, anxiety, and aggression symptoms for both parents. In addition, there was a significant relationship between parents' self-reported stress levels and parent-infant bonding. This relationship was mediated by symptoms of depression and anxiety for fathers and by symptoms of anger-hostility for both parents. CONCLUSION Increased parental stress during the early pandemic was associated with poorer parent-infant bonding. This has important implications for the management of any future public health crises.
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Affiliation(s)
| | - Victoria Weise
- Institute and Outpatient Clinics of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Judith T Mack
- Institute and Outpatient Clinics of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Marlene Karl
- Institute and Outpatient Clinics of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; Department of Psychotherapy and Psychosomatic Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Susan Garthus-Niegel
- Institute and Outpatient Clinics of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; Institute for Systems Medicine (ISM) and Faculty of Medicine, Medical School Hamburg, Hamburg, Germany; Department of Childhood and Families, Norwegian Institute of Public Health, Oslo, Norway.
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Scholaske L, Spallek J, Entringer S. Perceived stress and depressive symptoms during pregnancy and postpartum in Turkish-origin women living in Germany. J Psychosom Res 2024; 177:111570. [PMID: 38141526 DOI: 10.1016/j.jpsychores.2023.111570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 12/01/2023] [Accepted: 12/17/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVE People of Turkish origin (also referred to as "with a Turkish migrant background") are one of the largest migrant groups in Germany and show disparities across different stress-related health outcomes. Specifically, women of Turkish origin in Germany have a greater risk for some mental health issues and adverse pregnancy and birth outcomes compared to women without migrant background. We tested differences between women of Turkish origin and women without migrant background in self-reported pregnancy and postpartum stress experiences and depressive symptoms. METHODS 32 women of Turkish origin (mean age 29.7 years) and 77 women without migrant background (mean age 32 years) participated in a multi-site prospective cohort study with two study visits during pregnancy and one month postpartum. Women provided sociodemographic data and completed the Perceived Stress Scale (PSS) and the Center for Epidemiology - Depression (CESD) scale at each study visit. RESULTS Using hierarchical linear models, we found that women of Turkish origin (both first and second generation) reported more perceived stress (b = 0.57, CI: 0.29-0.84, p < 0.001) and depressive symptoms (b = 0.32, CI = 0.14-0.49, p < 0.001) compared to women without migrant background across gestation. A linear regression analysis showed that there was also a significant difference in depressive symptoms at one month postpartum (b = 0.35, CI = 0.03-0.66, p < 0.05). CONCLUSION Tailored psychosocial interventions are needed to address mental health needs of pregnant Turkish origin women and to intervene on the possible transmission of stress-related health disadvantages to their offspring.
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Affiliation(s)
- Laura Scholaske
- Faculty for Medicine, Department for Human Medicine, MSB Medical School Berlin, Berlin, Germany; German Center for Integration and Migration Research (DeZIM), Berlin, Germany
| | - Jacob Spallek
- Department of Public Health, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany; Lausitz Center for Digital Public Health, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
| | - Sonja Entringer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Medical Psychology, 10117 Berlin, Germany; Department of Pediatrics, and Development, Health and Disease Research Program University of California, Irvine, USA.
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Paschke K, Diestelkamp S, Zapf A, Busch K, Arnaud N, Prehn-Kristensen A, Reis O, Stark M, Cloes JO, Schulz AL, Brauer H, Krömer T, Thomasius R. An app-based training for adolescents with problematic digital-media use and their parents (Res@t digital): protocol for a cluster-randomized clinical trial. Front Psychiatry 2024; 14:1245536. [PMID: 38328520 PMCID: PMC10847547 DOI: 10.3389/fpsyt.2023.1245536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 12/29/2023] [Indexed: 02/09/2024] Open
Abstract
Background Digital media-use disorders (DMUD) in adolescents are a rising phenomenon associated with psychological distress, comorbid mental disorders, and high burden on affected families. Since the ICD-11 introduced criteria for gaming disorder, these can now be transferred to describe additional DMUD associated with social media platforms and streaming services. Most evidence for effective treatments comes from cognitive-behavioral therapy (CBT). However, interventions based on theoretical models for adolescents and their parents are widely missing, leading to a significant clinical gap. Methods Res@t digital (Resource-Strengthening Training for Adolescents with Problematic Digital-Media Use and their Parents) is the app-based translation of the first model-based digital intervention for adolescents with DMUD and their parents based on CBT. It comprises separate but content-related modules for adolescents (Res@t-A) and parents (Res@t-P), applying multimodal techniques. The effectiveness of Res@t will be evaluated within a multicenter cluster-randomized controlled evaluator-blinded pre-post follow-up trial with the waitlist control group (CG). In addition to the Res@t program in the intervention group, both groups will receive treatment as usual within primary child and adolescent psychiatric/psychotherapeutic healthcare. The primary outcome addresses DMUD symptom reduction after 10 weeks. Secondary outcomes are related to a reduction in psychological and family-related problems and an increase in parental self-efficacy. All outcomes will be assessed using standardized self-report measures. A total of 1,334 participating adolescent-parent dyads from a large clinical network throughout Germany are planned to be included in the primary analyses based on an intention-to-treat approach, applying linear mixed models. Discussion Assuming superiority of Res@t over the control condition, the intervention has the potential to provide evidence-based treatment for a significant number of help-seeking families, supporting local healthcare structures and resources. It is a promising program for practicable implementation and flexible use in different settings. Clinical trial registration https://drks.de, DRKS00031043.
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Affiliation(s)
- Kerstin Paschke
- German Center for Addiction Research in Childhood and Adolescence (DZSKJ), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Silke Diestelkamp
- German Center for Addiction Research in Childhood and Adolescence (DZSKJ), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Antonia Zapf
- Institute of Medical Biometry and Epidemiology (IMBE), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Katharina Busch
- German Center for Addiction Research in Childhood and Adolescence (DZSKJ), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Nicolas Arnaud
- German Center for Addiction Research in Childhood and Adolescence (DZSKJ), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Alexander Prehn-Kristensen
- Institute of Child and Adolescent Psychiatry, Center for Integrative Psychiatry, School of Medicine, Christian-Albrecht University Kiel, Kiel, Germany
| | - Olaf Reis
- Department for Child and Adolescent Psychiatry and Neurology, Rostock University Medical Center, Rostock, Germany
| | - Maria Stark
- Institute of Medical Biometry and Epidemiology (IMBE), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Jan-Ole Cloes
- German Center for Addiction Research in Childhood and Adolescence (DZSKJ), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Anna-Lena Schulz
- German Center for Addiction Research in Childhood and Adolescence (DZSKJ), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Hannah Brauer
- Institute of Child and Adolescent Psychiatry, Center for Integrative Psychiatry, School of Medicine, Christian-Albrecht University Kiel, Kiel, Germany
| | - Thomas Krömer
- Collaborative Practice for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Hamburg, Germany
| | - Rainer Thomasius
- German Center for Addiction Research in Childhood and Adolescence (DZSKJ), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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Ulrich S, Gantenbein AR, Zuber V, Von Wyl A, Kowatsch T, Künzli H. Development and Evaluation of a Smartphone-Based Chatbot Coach to Facilitate a Balanced Lifestyle in Individuals With Headaches (BalanceUP App): Randomized Controlled Trial. J Med Internet Res 2024; 26:e50132. [PMID: 38265863 PMCID: PMC10851123 DOI: 10.2196/50132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/20/2023] [Accepted: 12/12/2023] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Primary headaches, including migraine and tension-type headaches, are widespread and have a social, physical, mental, and economic impact. Among the key components of treatment are behavior interventions such as lifestyle modification. Scalable conversational agents (CAs) have the potential to deliver behavior interventions at a low threshold. To our knowledge, there is no evidence of behavioral interventions delivered by CAs for the treatment of headaches. OBJECTIVE This study has 2 aims. The first aim was to develop and test a smartphone-based coaching intervention (BalanceUP) for people experiencing frequent headaches, delivered by a CA and designed to improve mental well-being using various behavior change techniques. The second aim was to evaluate the effectiveness of BalanceUP by comparing the intervention and waitlist control groups and assess the engagement and acceptance of participants using BalanceUP. METHODS In an unblinded randomized controlled trial, adults with frequent headaches were recruited on the web and in collaboration with experts and allocated to either a CA intervention (BalanceUP) or a control condition. The effects of the treatment on changes in the primary outcome of the study, that is, mental well-being (as measured by the Patient Health Questionnaire Anxiety and Depression Scale), and secondary outcomes (eg, psychosomatic symptoms, stress, headache-related self-efficacy, intention to change behavior, presenteeism and absenteeism, and pain coping) were analyzed using linear mixed models and Cohen d. Primary and secondary outcomes were self-assessed before and after the intervention, and acceptance was assessed after the intervention. Engagement was measured during the intervention using self-reports and usage data. RESULTS A total of 198 participants (mean age 38.7, SD 12.14 y; n=172, 86.9% women) participated in the study (intervention group: n=110; waitlist control group: n=88). After the intervention, the intention-to-treat analysis revealed evidence for improved well-being (treatment: β estimate=-3.28, 95% CI -5.07 to -1.48) with moderate between-group effects (Cohen d=-0.66, 95% CI -0.99 to -0.33) in favor of the intervention group. We also found evidence of reduced somatic symptoms, perceived stress, and absenteeism and presenteeism, as well as improved headache management self-efficacy, application of behavior change techniques, and pain coping skills, with effects ranging from medium to large (Cohen d=0.43-1.05). Overall, 64.8% (118/182) of the participants used coaching as intended by engaging throughout the coaching and completing the outro. CONCLUSIONS BalanceUP was well accepted, and the results suggest that coaching delivered by a CA can be effective in reducing the burden of people who experience headaches by improving their well-being. TRIAL REGISTRATION German Clinical Trials Register DRKS00017422; https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00017422.
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Affiliation(s)
- Sandra Ulrich
- School of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland
| | - Andreas R Gantenbein
- Pain and Research Unit, ZURZACH Care, Bad Zurzach, Switzerland
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Viktor Zuber
- School of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland
| | - Agnes Von Wyl
- School of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland
| | - Tobias Kowatsch
- Institute for Implementation Science in Health Care, University of Zurich, Zurich, Switzerland
- School of Medicine, University of St.Gallen, St. Gallen, Switzerland
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Hansjörg Künzli
- School of Applied Psychology, Zurich University of Applied Sciences, Zurich, Switzerland
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Rus-Calafell M, Teismann T, Kullmann F, Alatas D, Ballero-Reque C, Holewa J, Rüsberg M, Brüne M, Paino M, Schneider S. Internet-based psychoeducation and support programme for relatives of young people with early psychosis: results of the first German-language intervention. Front Psychiatry 2024; 15:1248526. [PMID: 38292904 PMCID: PMC10824940 DOI: 10.3389/fpsyt.2024.1248526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 01/02/2024] [Indexed: 02/01/2024] Open
Abstract
Background International clinical guidelines recommend Family Interventions (FIs) especially for families of people at early stages of psychosis. The German S3 treatment guideline for schizophrenia gives FIs the highest level of clinical recommendation. However, some family relatives have limited access to these services due to health system constrains. Digital interventions have emerged as a solution to overcome this hindered access to evidence-based family interventions. Objective The present pilot study evaluates the feasibility and potential efficacy of the first German moderated online psychoeducation and support programme (ePSP) for relatives of people with early psychosis, with the additional purpose to improve accessibility and reduce waiting times. Methods A pre-post study was performed. A brief recruitment period was pre-established (10 weeks) to test potential improvement of regular therapy waiting times in Germany. A total of 25 relatives of people with early psychosis were recruited and received the 12-week moderated online intervention. Assessments were conducted at baseline and at post intervention. Acceptance of the intervention and the user's experience were also evaluated at post intervention. Results Recruitment, retention rates and qualitative data support the feasibility and acceptability of the ePSP. Significant positive effects of the interventions were found on key therapeutic targets, including both primary outcomes (i.e., perceived stress and beliefs about the illness). Twenty-one participants also completed the open-ended questions of the user experience questionnaire, which yielded three main themes: most important modules, difficulties in using the programme and ways to improve ePSP. Discussion These results provide preliminary efficacy estimates for a fully powered RCT to investigate superiority (or equipoise) effects of the ePSP in comparison to the routine face-to-face family therapy groups. This future RCT will also allow further exploration of ePSP to improve access to psychological therapy for relatives of young people with psychosis, also in relation to the new ground-breaking Digital Healthcare Act in Germany.
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Affiliation(s)
- Mar Rus-Calafell
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
- German Center of Mental Health (DZPG), Partner Site Bochum/Marburg, Bochum, Germany
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
- German Center of Mental Health (DZPG), Partner Site Bochum/Marburg, Bochum, Germany
| | - Fine Kullmann
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Dilara Alatas
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Cristina Ballero-Reque
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Julia Holewa
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Marilena Rüsberg
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Martin Brüne
- LWL University Hospital Bochum, Department of Psychiatry, Psychotherapy and Preventive Medicine, Division of Social Neuropsychiatry and Evolutionary Medicine, Ruhr University Bochum, Bochum, Germany
| | - Mercedes Paino
- Department of Psychology, University of Oviedo, Oviedo, Spain
| | - Silvia Schneider
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
- German Center of Mental Health (DZPG), Partner Site Bochum/Marburg, Bochum, Germany
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Hoferichter F, Lohilahti J, Hufenbach M, Grabe HJ, Hageman G, Raufelder D. Support from parents, teachers, and peers and the moderation of subjective and objective stress of secondary school student. Sci Rep 2024; 14:1161. [PMID: 38216714 PMCID: PMC10786930 DOI: 10.1038/s41598-024-51802-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 01/09/2024] [Indexed: 01/14/2024] Open
Abstract
During adolescence, students increasingly report suffering from stress and school burnout, which poses a risk to students' healthy development. However, social support may counteract perceived stress according to the Buffering Hypothesis and the Conservation of Resources Theory. In search of factors that would support healthy student development, studies have primarily focused on self-report data and neglected biophysiological processes. Addressing this research desideratum, this study examined whether perceived social support buffers the interplay of self-reported stress considering biophysiological markers (i.e., cortisol, alpha-amylase, oxidative stress, and telomere length). 83 secondary school students (Mage = 13.72, SD = 0.67; 48% girls) from Germany participated in a questionnaire study and biophysiological testing. Moderation analyses in R revealed that support from parents moderated the relationships between psychological stress as well as cynicism and inadequacy at school linked to alpha-amylase.
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Affiliation(s)
- Frances Hoferichter
- Institute of Educational Science, University of Greifswald, Greifswald, Germany.
| | - Jonne Lohilahti
- Institute of Educational Science, University of Greifswald, Greifswald, Germany
| | - Miriam Hufenbach
- Institute of Psychology Greifswald, University of Greifswald, Greifswald, Germany
| | - Hans Jörgen Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Greifswald, Germany
| | - Geja Hageman
- Department of Pharmacology and Toxicology, Research Institute of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, The Netherlands
| | - Diana Raufelder
- Institute of Educational Science, University of Greifswald, Greifswald, Germany
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Liem T, Bohlen L, Jung AM, Hitsch S, Schmidt T. Does Osteopathic Heart-Focused Palpation Modify Heart Rate Variability in Stressed Participants with Musculoskeletal Pain? A Randomised Controlled Pilot Study. Healthcare (Basel) 2024; 12:138. [PMID: 38255026 PMCID: PMC10815744 DOI: 10.3390/healthcare12020138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/23/2023] [Accepted: 12/27/2023] [Indexed: 01/24/2024] Open
Abstract
Heart rate variability (HRV) describes fluctuations in time intervals between heartbeats and reflects autonomic activity. HRV is reduced in stressed patients with musculoskeletal pain and improved after osteopathic manipulative treatment and mind-body interventions. Heart-focused palpation (HFP) combines manual and mind-body approaches to facilitate relaxation. This randomised controlled pilot study investigated the feasibility and sample size for a future randomised controlled trial and the effect of a single treatment with HFP or sham HFP (SHAM) on short-term HRV. A total of Thirty-three adults (47.7 ± 13.5 years old) with stress and musculoskeletal pain completed the trial with acceptable rates of recruitment (8.25 subjects per site/month), retention (100%), adherence (100%), and adverse events (0%). HFP (n = 18), but not SHAM (n = 15), significantly increased the root mean square of successive RR interval differences (p = 0.036), standard deviation of the NN intervals (p = 0.009), and ratio of the low-frequency to high-frequency power band (p = 0.026). HFP and SHAM significantly decreased the heart rate (p < 0.001, p = 0.009) but not the stress index and ratio of the Poincaré plot standard deviation along and perpendicular to the line of identity (p > 0.05). A power analysis calculated 72 participants. Taken together, the study was feasible and HFP improved HRV in stressed subjects with musculoskeletal pain, suggesting a parasympathetic effect.
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Affiliation(s)
- Torsten Liem
- Osteopathic Research Institute, 22297 Hamburg, Germany
- Research Department, Osteopathie Schule Deutschland, 22297 Hamburg, Germany
| | - Lucas Bohlen
- Osteopathic Research Institute, 22297 Hamburg, Germany
- Research Department, Osteopathie Schule Deutschland, 22297 Hamburg, Germany
| | - Anna-Moyra Jung
- Research Department, Osteopathie Schule Deutschland, 22297 Hamburg, Germany
- Department of Healthcare, Dresden International University, 01067 Dresden, Germany
| | - Samira Hitsch
- Research Department, Osteopathie Schule Deutschland, 22297 Hamburg, Germany
- Department of Healthcare, Dresden International University, 01067 Dresden, Germany
| | - Tobias Schmidt
- Osteopathic Research Institute, 22297 Hamburg, Germany
- Research Department, Osteopathie Schule Deutschland, 22297 Hamburg, Germany
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, 20457 Hamburg, Germany
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Basedow LA, Zerth SF, Salzmann S, Uecker C, Bauer N, Elsenbruch S, Rief W, Langhorst J. Pre-treatment expectations and their influence on subjective symptom change in Crohn's disease. J Psychosom Res 2024; 176:111567. [PMID: 38100897 DOI: 10.1016/j.jpsychores.2023.111567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/07/2023] [Accepted: 12/09/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Treatment expectations reportedly shape treatment outcomes, but have not been studied in the context of multimodal therapy in Crohn's disease (CD). Therefore, the current study investigated the role of treatment expectations for subjective symptom changes in CD patients who have undergone an integrative multimodal therapy program. METHODS Validated questionnaires were completed at the start of the treatment program and post intervention. Pre-treatment expectations and experienced symptom change were assessed with the Generic Rating Scale for Previous Treatment Experiences, Treatment Expectations, and Treatment Effects (GEEE); stress levels were quantified with the Perceived Stress Scale (PSS-10) and disease specific quality of life was quantified with the disease-specific Inflammatory Bowel Disease Questionnaire (IBDQ). We performed multiple linear and Bayesian regression to determine how expectations related to symptom change. RESULTS N = 71 CD patients (66.2% female) were included. Stronger expectations regarding symptom improvement (b = 0.422, t = 3.70, p < .001) were associated with higher experienced symptom improvement. Additionally, Bayesian analysis provided strong evidence for including improvement expectations as a predictor of improvement experience (BFinclusion = 13.78). CONCLUSIONS In line with research in other disorders, we found that positive treatment expectations were associated with experienced symptom improvement. In contrast, we found no indication that an experience of symptom worsening was associated with positive or negative baseline treatment expectations. Induction of positive expectations might be a potential avenue for improving treatment outcomes in CD therapy.
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Affiliation(s)
- Lukas Andreas Basedow
- Philipps-Universität Marburg, Department of Clinical Psychology and Psychotherapy, 35037 Marburg, Germany.
| | - Simon Felix Zerth
- Philipps-Universität Marburg, Department of Clinical Psychology and Psychotherapy, 35037 Marburg, Germany.
| | - Stefan Salzmann
- Philipps-Universität Marburg, Department of Clinical Psychology and Psychotherapy, 35037 Marburg, Germany; Health and Medical University, Medical Psychology, 99084 Erfurt, Germany.
| | - Christine Uecker
- Sozialstiftung Bamberg, Department of Internal and Integrative Medicine, 96049 Bamberg, Germany; University of Duisburg Essen, Medicinal Faculty, Department of Integrative Medicine, 96049 Bamberg, Germany.
| | - Nina Bauer
- Sozialstiftung Bamberg, Department of Internal and Integrative Medicine, 96049 Bamberg, Germany; University of Duisburg Essen, Medicinal Faculty, Department of Integrative Medicine, 96049 Bamberg, Germany
| | - Sigrid Elsenbruch
- Department of Medical Psychology and Medical Sociology, Ruhr University Bochum, 44789 Bochum, Germany; Department of Neurology, Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University Hospital Essen, University of Duisburg-Essen, 45122 Essen, Germany.
| | - Winfried Rief
- Philipps-Universität Marburg, Department of Clinical Psychology and Psychotherapy, 35037 Marburg, Germany.
| | - Jost Langhorst
- Sozialstiftung Bamberg, Department of Internal and Integrative Medicine, 96049 Bamberg, Germany; University of Duisburg Essen, Medicinal Faculty, Department of Integrative Medicine, 96049 Bamberg, Germany.
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Marciniak MA, Shanahan L, Yuen KSL, Veer IM, Walter H, Tuescher O, Kobylińska D, Kalisch R, Hermans E, Binder H, Kleim B. Burst versus continuous delivery design in digital mental health interventions: Evidence from a randomized clinical trial. Digit Health 2024; 10:20552076241249267. [PMID: 38698832 PMCID: PMC11064753 DOI: 10.1177/20552076241249267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 04/08/2024] [Indexed: 05/05/2024] Open
Abstract
Objective Digital mental health interventions delivered via smartphone-based apps effectively treat various conditions; however, optimizing their efficacy while minimizing participant burden remains a key challenge. In this study, we investigated the potential benefits of a burst delivery design (i.e. interventions delivered only in pre-defined time intervals) in comparison to the continuous delivery of interventions. Methods We randomly assigned 93 participants to the continuous delivery (CD) or burst delivery (BD) group. The CD group engaged in ReApp, a mobile app that increases positive cognitive reappraisal with a consistent delivery schedule that provides five prompts per day throughout the 3-week-long study, while the BD group received five daily prompts only in the first and third weeks of the study. Results No significant differences were found between the groups in terms of adherence, mental health outcomes (specifically depressive and anxiety symptoms), level of perceived stress, and perceived helpfulness of intervention. The BD group showed a significantly decreased perceived difficulty of intervention over time. Conclusions The results suggest that the burst delivery may be as suitable for digital mental health interventions as the continuous delivery. The perceived difficulty of the intervention declined more steeply for the BD group, indicating that it improved the feasibility of the positive cognitive reappraisal intervention without hurting its efficacy. This outcome may inform the design of less burdensome interventions with improved outcomes in future research.
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Affiliation(s)
- Marta Anna Marciniak
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital (PUK), University of Zurich, Zurich, Switzerland
| | - Lilly Shanahan
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Kenneth S L Yuen
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Ilya Milos Veer
- Department of Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands; Research Division of Mind and Brain, Department of Psychiatry and Psychotherapy CCM
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Henrik Walter
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Oliver Tuescher
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
- Institute for Molecular Biology (IMB), Mainz, Germany
| | | | - Raffael Kalisch
- Leibniz Institute for Resilience Research (LIR), Mainz, Germany
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Erno Hermans
- Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Nijmegen, The Netherlands
| | - Harald Binder
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
- Freiburg Center for Data Analysis and Modelling, University of Freiburg, Freiburg, Germany
| | - Birgit Kleim
- Freiburg Center for Data Analysis and Modelling, University of Freiburg, Freiburg, Germany
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Chechko N, Losse E, Frodl T, Nehls S. Baby blues, premenstrual syndrome and postpartum affective disorders: intersection of risk factors and reciprocal influences. BJPsych Open 2023; 10:e3. [PMID: 38044681 PMCID: PMC10755547 DOI: 10.1192/bjo.2023.612] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 10/09/2023] [Accepted: 10/15/2023] [Indexed: 12/05/2023] Open
Abstract
BACKGROUND The aetiology and consequences of 'baby blues' (lower mood following childbirth) are yet to be sufficiently investigated with respect to an individual's clinical history. AIMS The primary aim of the study was to assess the symptoms of baby blues and the relevant risk factors, their associations with clinical history and premenstrual syndrome (PMS), and their possible contribution to the early recognition of postpartum depression (PPD). METHOD Beginning shortly after childbirth, 369 mothers were followed up for 12 weeks. Information related to their clinical history, PMS, depression, stress and mother-child attachment was collected. At 12 weeks, mothers were classified as non-depressed, or with either PPD or adjustment disorder. RESULTS A correlation was found between the severity of baby blues and PMS (r = 0.397, P < 0.001), with both conditions increasing the possibility of adjustment disorder and PPD (baby blues: OR = 6.72, 95% CI 3.69-12.25; PMS: OR = 3.29, 95% CI 2.01-5.39). Baby blues and PMS independently predicted whether a mother would develop adjustment disorder or PPD after childbirth (χ2(64) = 198.16, P < 0.001). Among the non-depressed participants, baby blues were found to be associated with primiparity (P = 0.012), family psychiatric history (P = 0.001), PMS (P < 0.001) and childhood trauma (P = 0.017). CONCLUSIONS Baby blues are linked to a number of risk factors and a history of PMS, with both conditions adding to the risk of PPD. The neuroendocrine effects on mood need be understood in the context of individual risk factors. The assessment of both baby blues and PMS symptoms within the first postpartum days may contribute to an early identification of PPD.
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Affiliation(s)
- Natalia Chechko
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Aachen, Germany; JARA-Institute Brain Structure Function Relationship (INM-10), Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany; and Institute of Neuroscience and Medicine, Brain & Behavior (INM-7), Research Center Jülich, Jülich, Germany
| | - Elena Losse
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Aachen, Germany
| | - Thomas Frodl
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Aachen, Germany; Department of Psychiatry and Psychotherapy, University Hospital, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - Susanne Nehls
- Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen, Aachen, Germany; and JARA-Institute Brain Structure Function Relationship (INM-10), Institute of Neuroscience and Medicine, Research Center Jülich, Jülich, Germany
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O'Rourke T, Humer E, Plener PL, Pieh C, Probst T. Moderation effects of health behaviors on stress and suicidal ideation in adolescents: a cross-sectional survey during COVID-19. Sci Rep 2023; 13:21376. [PMID: 38049631 PMCID: PMC10696036 DOI: 10.1038/s41598-023-48972-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 12/02/2023] [Indexed: 12/06/2023] Open
Abstract
This cross-sectional online survey study investigated whether certain health behaviors moderated the relationship between perceived stress and suicidal ideation in Austrian adolescents during the COVID-19 pandemic. A total of 1505 14-20-year-old (median age = 16) high school students (77.9% female) filled out an online survey from September to November 2021. Perceived stress was measured with the PSS10, suicidal ideation with item 9 of the PHQ-9. The following health behaviors were assessed: Physical activity (days/week), phone use (hours/day), problematic drinking behavior (CAGE). All three health behaviors significantly moderated the relationship between perceived stress and suicidal ideation (all p < .05), but effects were small. The moderation analyses revealed that higher physical activity and less time spent on the phone were associated with less suicidal ideation at higher stress levels. Showing signs of problematic drinking behavior was associated with higher suicidal ideation at higher stress levels. In conclusion, these results suggest that some health behaviors may be able to act as a buffer between perceived stress and suicidal ideation. However, more research is needed to confirm these potentially buffering effects.
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Affiliation(s)
- Teresa O'Rourke
- Department of Psychosomatic Medicine and Psychotherapy, Danube University Krems, Dr.-Karl-Dorrek-Str. 30, 3500, Krems, Austria.
| | - Elke Humer
- Department of Psychosomatic Medicine and Psychotherapy, Danube University Krems, Dr.-Karl-Dorrek-Str. 30, 3500, Krems, Austria
- Faculty of Psychotherapy Science, Sigmund Freud University Vienna, 1020, Vienna, Austria
| | - Paul L Plener
- Department of Child and Adolescence Psychiatry, Medical University of Vienna, 1090, Vienna, Austria
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, 89075, Ulm, Germany
| | - Christoph Pieh
- Department of Psychosomatic Medicine and Psychotherapy, Danube University Krems, Dr.-Karl-Dorrek-Str. 30, 3500, Krems, Austria
| | - Thomas Probst
- Department of Psychosomatic Medicine and Psychotherapy, Danube University Krems, Dr.-Karl-Dorrek-Str. 30, 3500, Krems, Austria
- Division of Psychotherapy, Department of Psychology, University of Salzburg, 5020, Salzburg, Austria
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Berninger NM, Crutzen R, Ruiter RAC, Kok G, Plasqui G, Ten Hoor GA. Moderators of the Effectiveness of UPcomplish on Office Workers' Sedentary Behaviour, Quality of Life, and Psychosocial Determinants: A Stepped Wedge Design. Int J Behav Med 2023; 30:849-866. [PMID: 36720773 PMCID: PMC10713801 DOI: 10.1007/s12529-022-10147-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND In the earlier developed and evaluated 12-week UPcomplish intervention, the aim was to reduce sedentary behaviour (SB) among office workers and increase their quality of life (QoL). In the current study, we explored moderators of effectiveness. METHOD We applied a stepped wedge design with five intervention groups starting with time lags of seven weeks (n = 142, 96 females). Participants wore the VitaBit to continuously measure SB and received surveys about QoL and psychosocial determinants at the beginning, middle, and end of the intervention. We regressed baseline participant characteristics and behaviours onto intra-individual improvements (centred around calendar week means) in determinants, SB, performance objectives, and QoL. RESULTS Those scoring high in baseline intention, task performance, stress, vitality, and emotional well-being improved less in these variables. Baseline stress (β = - 0.05 [SE = 0.01; 95% CI = - 0.08, - 0.02; pcorrected = .02]) and emotional well-being (β = 0.02 [SE = 0.01; 95% CI = 0.01, 0.03; pcorrected = .02]) were associated with improvement in contextual performance. Baseline attitude (β = - 12.92 [SE = 3.93; 95% CI = - 20.80, - 5.04; pcorrected = .02]) and perceived behavioural control (PBC; β = - 9.27 [SE = 3.04; 95% CI = - 15.37, - 3.16; pcorrected = .03]) were negatively associated with improvements in emotional well-being. Post hoc analyses with a sub-group scoring lower in determinants revealed that improvement in PBC was positively associated with SB registration. CONCLUSION Participants scoring low in baseline determinants might profit from UPcomplish via an increase in PBC. In combination with changes within organizations (e.g. the implementation of standing desks), UPcomplish might potentially reduce SB. TRIAL REGISTRATION NL7503 - registered 1 February 2019.
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Affiliation(s)
- Nathalie M Berninger
- Department of Work and Social Psychology, Faculty of Psychology and Neuroscience, Maastricht University, Universiteitssingel 40, PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - Rik Crutzen
- Department of Health Promotion, CAPHRI, Maastricht Universit, Maastricht, the Netherlands
| | - Robert A C Ruiter
- Department of Work and Social Psychology, Faculty of Psychology and Neuroscience, Maastricht University, Universiteitssingel 40, PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - Gerjo Kok
- Department of Work and Social Psychology, Faculty of Psychology and Neuroscience, Maastricht University, Universiteitssingel 40, PO Box 616, 6200 MD, Maastricht, The Netherlands
| | - Guy Plasqui
- Department of Human Biology and Movement Sciences, Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Gill A Ten Hoor
- Department of Work and Social Psychology, Faculty of Psychology and Neuroscience, Maastricht University, Universiteitssingel 40, PO Box 616, 6200 MD, Maastricht, The Netherlands.
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Mínguez-Alarcón L, Chagnon O, Tanaka A, Williams PL, James-Todd T, Ford JB, Souter I, Rexrode KM, Hauser R, Chavarro JE. Preconception Stress and Pregnancy Serum Glucose Levels Among Women Attending a Fertility Center. J Endocr Soc 2023; 8:bvad152. [PMID: 38178907 PMCID: PMC10766068 DOI: 10.1210/jendso/bvad152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Indexed: 01/06/2024] Open
Abstract
Context The association between women's stress and pregnancy glucose levels remain unclear, specifically when considering the preconception period as a sensitive window of exposure. Objective We investigated whether preconception perceived stress was associated with glucose levels during pregnancy among women attending a fertility center (2004-2019). Methods Before conception, women completed a psychological stress survey using the short version of the validated Perceived Stress Scale 4 (PSS-4), and blood glucose was measured using a 50-gram glucose load test during late pregnancy as a part of screening for gestational diabetes. Linear and log-binomial regression models were used to assess associations of total PSS-4 scores with mean glucose levels and abnormal glucose levels ( ≥ 140 mg/dL), adjusting for age, body mass index, race, smoking, education, physical activity, primary infertility diagnosis, number of babies, and mode of conception. Results Psychological stress was positively associated with mean abnormal glucose levels. The adjusted marginal means (95% CI) of mean glucose levels for women in the first, second, and third tertiles of psychological stress were 115 (110, 119), 119 (115, 123), and 124 (119, 128), and mg/dL, respectively (P for trend = .007). Also, women in the second and third tertiles of psychological stress had 4% and 13% higher probabilities of having abnormal glucose compared with women in the first tertile of psychological stress (P trend = .01). Conclusion These results highlight the importance of considering preconception when evaluating the relationship between women's stress and pregnancy glucose levels.
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Affiliation(s)
- Lidia Mínguez-Alarcón
- Channing Division of Network Medicine, Harvard Medical School & Brigham and Women's Hospital, Boston 02115, USA
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston 02115, USA
| | - Olivia Chagnon
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston 02115, USA
| | - Aya Tanaka
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston 02115, USA
| | - Paige L Williams
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston 02115, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston 02115, USA
| | - Tamarra James-Todd
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston 02115, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston 02115, USA
| | - Jennifer B Ford
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston 02115, USA
| | - Irene Souter
- Division of Reproductive Medicine and IVF, Department of Obstetrics and Gynecology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
| | - Kathryn M Rexrode
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Russ Hauser
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston 02115, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston 02115, USA
- Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston 02115, USA
| | - Jorge E Chavarro
- Channing Division of Network Medicine, Harvard Medical School & Brigham and Women's Hospital, Boston 02115, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston 02115, USA
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, USA
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Xiao T, Zhu F, Wang D, Liu X, Xi SJ, Yu Y. Psychometric validation of the Perceived Stress Scale (PSS-10) among family caregivers of people with schizophrenia in China. BMJ Open 2023; 13:e076372. [PMID: 38035751 PMCID: PMC10689371 DOI: 10.1136/bmjopen-2023-076372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/09/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND The 10-item Perceived Stress Scale (PSS-10) is a widely used measure of perceived stress that has been validated in various populations, yet with inconsistent results on its factor structure. The present study examines the reliability and validity of the PSS-10 in a population not previously examined: Chinese family caregivers of persons with schizophrenia, with a focus on factor analysis. METHODS A sample of 449 family caregivers of persons with schizophrenia was recruited for psychometric testing of the scale. The factor structure of PSS-10 was tested by randomly dividing the sample into two groups for both exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). The scale was further tested for internal consistency, test-retest reliability, convergent validity, discriminant validity and concurrent validity. RESULTS EFA extracted two factors: perceived helplessness with six negative phrasing items and perceived efficacy with four positive phrasing items. CFA confirmed the structure of two factors with satisfactory model fit indices. Convergent validity was supported by high standard regression weight (0.78-0.92), average variance extracted (AVE=0.79-0.81) and composite reliability (0.88-0.94), while discriminant validity was confirmed by higher AVE estimates than the squared interconstruct correlations. The PSS-10 showed good internal consistency and test-retest reliability, with Cronbach's alpha of 0.79 and intraclass correlation coefficient of 0.91, respectively. Concurrent validity was demonstrated by its significant positive correlations with stigma, depression and anxiety, as well as significant negative correlations with social support, family functioning and positive caregiving experiences. CONCLUSION The two-factor PSS-10 has good psychometric characteristics assessing the perceived stress of family caregivers of people with schizophrenia. The findings indicate that the PSS-10 can be used to measure perceived stress in future research and practice among caregivers of people with schizophrenia, and potentially, other caregiving samples.
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Affiliation(s)
- Tao Xiao
- Nursing Department, The Third Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Feng Zhu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Dan Wang
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Xiang Liu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
| | - Shi-Jun Xi
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
- Foshan Center for Disease Control and Prevention, Foshan, China
| | - Yu Yu
- Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, Changsha, Hunan, China
- Division of Prevention and Community Research, Department of Psychiatry, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
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Rupp LH, Keinert M, Böhme S, Schindler-Gmelch L, Eskofier B, Schuller B, Berking M. Sadness-Based Approach-Avoidance Modification Training for Subjective Stress in Adults: Pilot Randomized Controlled Trial. JMIR Form Res 2023; 7:e50324. [PMID: 38032725 PMCID: PMC10722377 DOI: 10.2196/50324] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/14/2023] [Accepted: 10/02/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND A key vulnerability factor in mental health problems is chronic stress. There is a need for easy-to-disseminate and effective interventions to advance the prevention of stress-related illnesses. App-based stress management trainings can fulfill this need. As subjectively experienced stress may be influenced by dysfunctional beliefs, modifying their evaluations might reduce subjective stress. Approach-avoidance modification trainings (AAMT) can be used to modify stimulus evaluations and are promising candidates for a mobile stress intervention. As the standard training reactions of the AAMT (swiping and joystick motion) have little valence, emotions could be incorporated as approach and avoidance reactions to enhance the effectiveness of AAMTs. OBJECTIVE We aimed to evaluate the feasibility of a mobile emotion-enhanced AAMT that engages users to display sadness to move stress-enhancing beliefs away and display positive emotions to move stress-reducing beliefs toward themselves (emotion-based AAMT using sadness and positive emotions [eAAMT-SP]). We explored the clinical efficacy of this novel intervention. METHODS We allocated 30 adult individuals with elevated stress randomly to 1 of 3 conditions (eAAMT-SP, a swipe control condition, and an inactive control condition). We evaluated the feasibility of the intervention (technical problems, adherence, usability, and acceptability). To explore the clinical efficacy of the intervention, we compared pretest-posttest differences in perceived stress (primary clinical outcome) and 3 secondary clinical outcomes (agreement with and perceived helpfulness of dysfunctional beliefs, emotion regulation, and depressive symptoms) among the conditions. RESULTS The predetermined benchmarks of 50% for intervention completion and 75% for feasibility of the study design (completion of the study design) were met, whereas the cutoff for technical feasibility of the study design (95% of trials without technical errors) was not met. Effect sizes for usability and acceptability were in favor of the eAAMT-SP condition (compared with the swipe control condition; intelligibility of the instructions: g=-0.86, distancing from dysfunctional beliefs: g=0.22, and approaching functional beliefs: g=0.55). Regarding clinical efficacy, the pretest-posttest effect sizes for changes in perceived stress were g=0.80 for the comparison between the eAAMT-SP and inactive control conditions and g=0.76 for the comparison between the eAAMT-SP and swipe control conditions. Effect sizes for the secondary clinical outcomes indicated greater pretest-posttest changes in the eAAMT-SP condition than in the inactive control condition and comparable changes in the swipe control condition. CONCLUSIONS The findings regarding the feasibility of the intervention were satisfactory except for the technical feasibility of the intervention, which should be improved. The effect sizes for the clinical outcomes provide preliminary evidence for the therapeutic potential of the intervention. The findings suggest that extending the AAMT paradigm through the use of emotions may increase its efficacy. Future research should evaluate the eAAMT-SP in sufficiently powered randomized controlled trials. TRIAL REGISTRATION German Clinical Trials Registry DRKS00023007; https://drks.de/search/en/trial/DRKS00023007.
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Affiliation(s)
- Lydia Helene Rupp
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Marie Keinert
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Stephanie Böhme
- Department of Clinical Psychology and Psychotherapy, Technische Universität Chemnitz, Chemnitz, Germany
| | - Lena Schindler-Gmelch
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Bjoern Eskofier
- Machine Learning and Data Analytics Lab, Department Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Björn Schuller
- Chair of Embedded Intelligence for Health Care and Wellbeing, University of Augsburg, Augsburg, Germany
- Group on Language, Audio, & Music, Imperial College London, London, United Kingdom
| | - Matthias Berking
- Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
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Blaser BL, Weymar M, Wendt J. The effect of a single-session heart rate variability biofeedback on attentional control: does stress matter? Front Psychol 2023; 14:1292983. [PMID: 38034309 PMCID: PMC10687403 DOI: 10.3389/fpsyg.2023.1292983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction Vagally mediated heart rate variability is an index of autonomic nervous system activity that is associated with a large variety of outcome variables including psychopathology and self-regulation. While practicing heart rate variability biofeedback over several weeks has been reliably associated with a number of positive outcomes, its acute effects are not well known. As the strongest association with vagally mediated heart rate variability has been found particularly within the attention-related subdomain of self-regulation, we investigated the acute effect of heart rate variability biofeedback on attentional control using the revised Attention Network Test. Methods Fifty-six participants were tested in two sessions. In one session each participant received a heart rate variability biofeedback intervention, and in the other session a control intervention of paced breathing at a normal ventilation rate. After the biofeedback or control intervention, participants completed the Attention Network Test using the Orienting Score as a measure of attentional control. Results Mixed models revealed that higher resting baseline vagally mediated heart rate variability was associated with better performance in attentional control, which suggests more efficient direction of attention to target stimuli. There was no significant main effect of the intervention on attentional control. However, an interaction effect indicated better performance in attentional control after biofeedback in individuals who reported higher current stress levels. Discussion The results point to acute beneficial effects of heart rate variability biofeedback on cognitive performance in highly stressed individuals. Although promising, the results need to be replicated in larger or more targeted samples in order to reach stronger conclusions about the effects.
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Affiliation(s)
- Berenike L. Blaser
- Department of Biological Psychology and Affective Science, Faculty of Human Sciences, University of Potsdam, Potsdam, Germany
| | - Mathias Weymar
- Department of Biological Psychology and Affective Science, Faculty of Human Sciences, University of Potsdam, Potsdam, Germany
- Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany
| | - Julia Wendt
- Department of Biological Psychology and Affective Science, Faculty of Human Sciences, University of Potsdam, Potsdam, Germany
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Du X, Liu X, Zhao Y, Wang S. Psychometric testing of the 10-item perceived stress scale for Chinese nurses. BMC Nurs 2023; 22:430. [PMID: 37964241 PMCID: PMC10647153 DOI: 10.1186/s12912-023-01602-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 11/08/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Nurses bear a lot of stressors at work. The 10-item Perceived Stress Scale (PSS-10) is a widely used self-reported scale for measuring the global perception of stress. However, there is a lack of use of the PSS-10 in Chinese nurses. This study aimed to test the psychometric properties of the PSS-10 among Chinese nurses. METHODS A total of 708 Chinese nurses completed the PSS-10, the Big Five Inventory (BFI), and the Depression Anxiety and Stress Scale (DASS). Confirmatory factor analysis (CFA) tested the factor structure of the PSS-10. Cronbach's α and test-retest correlation examined the scale reliability. Pearson correlation and hierarchical regression analyses tested the convergent, discriminant and criterion validity of the PSS-10. RESULTS CFA revealed that a two-factor model fits the structure of the PSS-10 in Chinese nurses (χ2/df = 6.25, p < 0.001; comparative fit index [CFI] = 0.94, non-normal fit index [NNFI] = 0.92, Tucker-Lewis index [TLI] = 0.91, root mean square error of approximation [RMSEA] = 0.08, standardized root mean square residual [SRMR] = 0.05). The scale demonstrated adequate internal consistency (α = 0.86) and test-retest reliability (r = 0.66, p < 0.001), satisfactory convergent and discriminant validity with relations to Big Five personalities, as well as good criterion validity such that the PSS-10 score could explain incremental variance in predicting anxiety, depression and stress. CONCLUSIONS Our findings suggest that PSS-10 is a reliable and valid measure of perceived stress among Chinese nurses and can be used in future research and practice on stress management and coping in Chinese nurses.
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Affiliation(s)
- Xiaoyu Du
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Xiqin Liu
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China
| | - Yajun Zhao
- School of Education and Psychology, Southwest Minzu University, Chengdu, China
| | - Song Wang
- Department of Radiology and Huaxi MR Research Center (HMRRC), Functional and Molecular Imaging Key Laboratory of Sichuan Province, West China Hospital, Sichuan University, Chengdu, China.
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Palm S, Doering BK, Kubiak T, Geschke K, Fellgiebel A, Wuttke A. Influence of loss- and restoration-oriented stressors on grief in times of COVID-19. Sci Rep 2023; 13:19584. [PMID: 37949946 PMCID: PMC10638438 DOI: 10.1038/s41598-023-46403-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023] Open
Abstract
This study aimed to examine the influence of COVID-specific stressors on cross-sectional and longitudinal bereavement outcomes. According to the Dual Process Model of grief these stress-inducing factors can relate to the loss (loss-oriented stressors) or to manage everyday life (restoration-oriented stressors) and require coping in the grief process. A total of 491 participants (94.1% female; 43.92 years on average; 44.4% loss of a parent) were included at the first measurement time point (T0), of whom 99 individuals also participated in a follow-up assessment 6 months later (T1). Participants frequently reported loss-oriented (on average 7.30 out of 21 queried) and restoration-oriented stressors (on average 6.99 out of 19 queried). Cross-sectionally, higher acute grief intensity was associated with a higher number of loss-oriented stressors, poorer mental well-being, and sociodemographic variables. This effect disappeared longitudinally, with only acute grief intensity and poorer mental well-being at T0 predicting higher prolonged grief at T1. Common resilience factors did not buffer the effects of the pandemic on grief. Loss-oriented stressors seem to be especially relevant for understanding grief and might be a mediator of higher long-term grief. The findings suggest that COVID-specific strains need to be specifically taken into account in the support of bereaved individuals.
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Affiliation(s)
- Svenja Palm
- Center for Mental Health in Old Age (ZpGA), Landeskrankenhaus (AöR), Hartmühlenweg 2-4, 55122, Mainz, Germany.
| | - Bettina K Doering
- Institute of Psychology, Kiel University, Grippstraße 2, 24118, Kiel, Germany
| | - Thomas Kubiak
- Institute of Psychology, Johannes Gutenberg University, Binger Str. 14-16, 55122, Mainz, Germany
| | - Katharina Geschke
- Center for Mental Health in Old Age (ZpGA), Landeskrankenhaus (AöR), Hartmühlenweg 2-4, 55122, Mainz, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Untere Zahlbacher Straße 8, 55131, Mainz, Germany
| | - Andreas Fellgiebel
- Center for Mental Health in Old Age (ZpGA), Landeskrankenhaus (AöR), Hartmühlenweg 2-4, 55122, Mainz, Germany
- Department of Psychiatry and Psychotherapy, University Medical Center Mainz, Untere Zahlbacher Straße 8, 55131, Mainz, Germany
- Hospital for Psychiatry, Psychosomatic and Psychotherapy, Agaplesion Elisabethenstift, Landgraf-Georg-Str. 100, 64287, Darmstadt, Germany
| | - Alexandra Wuttke
- Center for Mental Health in Old Age (ZpGA), Landeskrankenhaus (AöR), Hartmühlenweg 2-4, 55122, Mainz, Germany.
- Center for Mental Health, University Hospital Würzburg, Margarete-Höppel Platz 1, 97080, Würzburg, Germany.
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Basedow LA, Fischer A, Benson S, Bingel U, Brassen S, Büchel C, Engler H, Mueller EM, Schedlowski M, Rief W. The influence of psychological traits and prior experience on treatment expectations. Compr Psychiatry 2023; 127:152431. [PMID: 37862937 DOI: 10.1016/j.comppsych.2023.152431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 10/09/2023] [Accepted: 10/12/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Placebo and nocebo responses are modulated by the treatment expectations of participants and patients. However, interindividual differences predicting treatment expectations and placebo responses are unclear. In this large-scale pooled analysis, we aim to investigate the influence of psychological traits and prior experiences on treatment expectations. METHODS This paper analyses data from six different placebo studies (total n = 748). In all studies, participants' sociodemographic information, treatment expectations and prior treatment experiences and traits relating to stress, somatization, depression and anxiety, the Big Five and behavioral inhibition and approach tendencies were assessed using the same established questionnaires. Correlation coefficients and structural equation models were calculated to investigate the relationship between trait variables and expectations. RESULTS We found small positive correlations between side effect expectations and improvement expectations (r = 0.187), perceived stress (r = 0.154), somatization (r = 0.115), agitation (r = 0.108), anhedonia (r = 0.118), and dysthymia (r = 0.118). In the structural equation model previous experiences emerged as the strongest predictors of improvement (β = 0.32, p = .005), worsening (β = -0.24, p = .005) and side effect expectations (β = 0.47, p = .005). Traits related to positive affect (β = - 0.09; p = .007) and negative affect (β = 0.04; p = .014) were associated with side effect expectations. DISCUSSION This study is the first large analysis to investigate the relationship between traits, prior experiences and treatment expectations. Exploratory analyses indicate that experiences of symptom improvement are associated with improvement and worsening expectations, while previous negative experiences are only related to side effect expectations. Additionally, a proneness to experience negative affect may be a predictor for side effect expectation and thus mediate the occurrence of nocebo responses.
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Affiliation(s)
- Lukas A Basedow
- Philipps-Universität Marburg, Department of Clinical Psychology and Psychotherapy, 35037 Marburg, Germany.
| | - Anton Fischer
- Philipps-Universität Marburg, Department of Differential Psychology and Personality Research, 35037 Marburg, Germany.
| | - Sven Benson
- Institute of Medical Psychology and Behavioral Immunobiology, Center for Translational Neuro- and Behavioral Sciences, University Hospital of Essen, Essen, Germany.
| | - Ulrike Bingel
- Department of Neurology, Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, Essen, DE, Germany.
| | - Stefanie Brassen
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Christian Büchel
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Harald Engler
- Institute of Medical Psychology and Behavioral Immunobiology, Center for Translational Neuro- and Behavioral Sciences, University Hospital of Essen, Essen, Germany.
| | - Erik M Mueller
- Philipps-Universität Marburg, Department of Differential Psychology and Personality Research, 35037 Marburg, Germany.
| | - Manfred Schedlowski
- Institute of Medical Psychology and Behavioral Immunobiology, Center for Translational Neuro- and Behavioral Sciences, University Hospital of Essen, Essen, Germany; Osher Center for Integrative Health, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Winfried Rief
- Philipps-Universität Marburg, Department of Clinical Psychology and Psychotherapy, 35037 Marburg, Germany.
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Moumni H, Elghazouani F. The impact of COVID-19 and the confinement on the secondary level students of the Eastern region of Morocco. Indian J Psychiatry 2023; 65:1176-1183. [PMID: 38249140 PMCID: PMC10795673 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_363_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 09/23/2023] [Accepted: 10/26/2023] [Indexed: 01/23/2024] Open
Abstract
Context In March 2020, Morocco announced the first COVID-19 case and implemented preventive measures, including home confinement. Aims Monitoring the psychological effects and prevalence among high- and middle-school students. Settings and Design This study is cross-sectional, carried online. Methods and Materials The survey was conducted by publishing an online questionnaire between May 14, 2020 and June 14, 2020, which included inquiries about socio-demographic data, the conditions of home confinement, activities carried out during confinement, and medical history and sleep patterns. To assess depressive disorder, anxiety disorders, and stress, the survey employed the "DSRS-c," "SCARED," and "PSS10" scales, respectively. Statistical Analysis Used Data were received on Google forms coded by Excel 2010 and analyzed by IBM SPSS Statistics 22. Results Out of the 689 participants, 73.7% were females; the mean age was 16.08 years (standard deviation 1.48). 94.8% of subjects reported changes in sleep habits, and 41.4% of adolescents had high levels of depressive symptoms, while 50.7% had high levels of anxiety symptoms. Several factors were significantly associated with anxiety and depressive symptoms, including being a girl (P = 0.000), being a high-school student (P = 0.011), economic struggles during the pandemic (P = 0.003), doubting the necessity of home confinement (P = 0.000), spending over 3 hours a day on social networks and video games (P = 0.000), dropping out of remote learning (P = 0.000), having a psychiatric history (P = 0.000), having chronic illnesses in the family (P = 0.002), and changes in sleep habits (P = 0.000). Conclusions The study found high prevalence of depression, anxiety, and stress symptoms among students during the pandemic, emphasizing the need for mental health awareness and support.
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Affiliation(s)
- Hind Moumni
- Department of Psychiatry, University Hospital Mohammed VI, Oujda, Faculty of Medicine and Pharmacy Oujda, University Mohammed the First, Oujda, Morocco
| | - Fatima Elghazouani
- Materno-Infantile and Mental Health Research Laboratory, Faculty of Medicine and Pharmacy Oujda, University Mohammed the First, Oujda, Morocco
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Szaszkó B, Schmid RR, Pomper U, Maiworm M, Laiber S, Tschenett H, Nater UM, Ansorge U. The influence of hatha yoga on stress, anxiety, and suppression: A randomized controlled trial. Acta Psychol (Amst) 2023; 241:104075. [PMID: 37931334 DOI: 10.1016/j.actpsy.2023.104075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 10/30/2023] [Indexed: 11/08/2023] Open
Abstract
Engaging in yoga may mitigate stress and anxiety in individuals while potentially enhancing one's capacity to manage distractions. Our research aimed to explore the relation between these two outcomes: Can an eight-week yoga program foster distraction suppression, thereby reducing stress and discomfort? To answer this question, we used Hatha Yoga, the most commonly practiced form of yoga. We tested if the intervention improved participants' ability to suppress distractions and selectively decrease self-reported stress and stress reactivity. In Addition, we investigated whether such an intervention would increase participants' mindfulness. Our study included 98 healthy yoga novices between 18 and 40 years who were randomly assigned to either an experimental or a waitlist condition, with each participant completing pre- and post-intervention assessments, including questionnaires, as well as electrophysiological and behavioral measures. After eight weeks of yoga practice, significant reductions in self-reported stress and stress reactivity levels, as well as increased mindfulness, were observed among those participating in the intervention relative to those in the waitlist control group. There were, however, no significant changes in state or trait anxiety due to the intervention. Changes in stress measures could not be explained by changes in participants' ability to suppress distractors, which was not affected by the intervention. Overall, our findings suggest that regular participation in Hatha Yoga can improve mental health outcomes without impacting cognitive functioning directly related to distractor suppression. CLINICAL TRIAL REGISTRATION NUMBER: NCT05232422.
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Affiliation(s)
- Bence Szaszkó
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Liebiggasse 5, 1010 Vienna, Austria.
| | - Rebecca Rosa Schmid
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Liebiggasse 5, 1010 Vienna, Austria
| | - Ulrich Pomper
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Liebiggasse 5, 1010 Vienna, Austria
| | - Mira Maiworm
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Liebiggasse 5, 1010 Vienna, Austria
| | - Sophia Laiber
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Liebiggasse 5, 1010 Vienna, Austria
| | - Hannah Tschenett
- Department of Clinical and Health Psychology, University of Vienna, Liebiggasse 5, 1010 Vienna, Austria; University Research Platform "The Stress of Life - Processes and Mechanisms Underlying Everyday Life Stress", University of Vienna, Liebiggasse 5, 1010 Vienna, Austria
| | - Urs Markus Nater
- Department of Clinical and Health Psychology, University of Vienna, Liebiggasse 5, 1010 Vienna, Austria; University Research Platform "The Stress of Life - Processes and Mechanisms Underlying Everyday Life Stress", University of Vienna, Liebiggasse 5, 1010 Vienna, Austria
| | - Ulrich Ansorge
- Department of Cognition, Emotion, and Methods in Psychology, University of Vienna, Liebiggasse 5, 1010 Vienna, Austria; Vienna Cognitive Science Hub, University of Vienna, Kolingasse 14-16, 1090 Vienna, Austria; Research Platform Mediatised Lifeworlds, University of Vienna, Spitalgasse 2-4, 1090 Vienna, Austria
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50
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Scullion R, Icke K, Tissen-Diabaté T, Adam D, Ortiz M, Witt CM, Brinkhaus B, Stöckigt B. Self-care strategies for medical students: an uncontrolled mixed-methods evaluation of a mind-body-medicine group course. BMC MEDICAL EDUCATION 2023; 23:816. [PMID: 37907897 PMCID: PMC10617184 DOI: 10.1186/s12909-023-04745-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 10/04/2023] [Indexed: 11/02/2023]
Abstract
BACKGROUND High stress during medical education and its detrimental effects on student health is well documented. This exploratory evaluation study assesses a 10-week Mind-Body-Medicine student course, created to promote student self-care at Charité Universitätsmedizin Berlin, Germany. METHODS During 2012-2019, uncontrolled quantitative and qualitative data were gathered from 112 student participants. Outcomes including changes in perceived stress (PSS), mindfulness (FMI/MAAS), self-reflection (GRAS), self-efficacy (GSE), empathy (SPF), and health-related quality of life (SF-12) were measured between the first (T0) and last sessions (T1). Qualitative data were obtained in focus groups at course completion and triangulated with quantitative data. RESULTS Quantitative outcomes showed decreases in perceived stress and increased self-efficacy, mindfulness, self-reflection, and empathy. In focus groups, students reported greater abilities to self-regulate stressful experiences, personal growth and new insights into integrative medicine. Triangulation grounded these effects of MBM practice in its social context, creating an interdependent dynamic between experiences of self and others. CONCLUSION After completing an MBM course, students reported reduced perceived stress, increased self-efficacy, mindfulness, empathy and positive engagement with integrative concepts of doctor-patient relationships. Further research with larger randomized confirmatory studies is needed to validate these benefits.
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Affiliation(s)
- Raphael Scullion
- Institute of Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Katja Icke
- Institute of Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Tatjana Tissen-Diabaté
- Institute of Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Daniela Adam
- Department of Pediatric Oncology/Hematology, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Miriam Ortiz
- Institute of Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Claudia M Witt
- Institute for Complementary and Integrative Medicine, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Benno Brinkhaus
- Institute of Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Barbara Stöckigt
- Institute of Social Medicine, Epidemiology and Health Economics, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
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