Social support in the general population: standardization of the Oslo social support scale (OSSS-3)

Association between the hearing aid and mental health outcomes in people with hearing impairment: A case-control study among 28 European countries

BACKGROUND

Hearing loss affects over 1.5 billion individuals globally, with significant implications for mental health. This study investigates the association between hearing aid use and mental health outcomes, by particularly focusing on depression and unmet mental health needs (UMHN), across a diverse international sample.

METHODS

Utilizing data from the third wave of the European Health Interview Survey (EHIS), this study involved 17,660 participants with hearing impairment from 28 countries. The study examined the association between hearing aid use and mental health outcomes, including the likelihood of moderate and severe depression and UMHN due to lack of contact with general practitioners (GPs) and mental health specialists. Logistic regression models, adjusted for socio-demographic characteristics, health risk behaviours, and other relevant variables, were employed. Inverse probability weights were used to mitigate potential selection bias.

RESULTS

Hearing aid usage was associated with significantly lower likelihoods of moderate depression (Odds Ratio [OR] = 0.58, 95%CI = [0.54, 0.63]) and severe depression (OR = 0.61, 95%CI = [0.55, 0.69]), compared to non-usage. Hearing aid usage was also associated with reduced UMHN due to lack of GP contact for moderate (OR = 0.82, 95%CI = [0.75, 0.89]) and severe depression (OR = 0.75, 95%CI = [0.59, 0.95]). The depression risk reductions were greater among females and higher-educated subgroups but lower in individuals aged ≥65 years. Income level and rurality also impacted UMHN due to the lack of GP contact. No associations were found between hearing aids and UMHN due to the lack of mental health specialist contact.

CONCLUSIONS

Hearing aid adoption showed protective associations against mood disorders and lowered unmet primary mental healthcare needs. Tailoring intervention strategies to vulnerable sociodemographic profiles could optimize mental health benefits among those with hearing loss. Integrating hearing health services within mental healthcare delivery frameworks is vital amidst the rising global burden.

Short-term dynamics of loneliness and depressive symptoms: Gender differences in older adults

BACKGROUND

Previous research examining the relationship between loneliness and depressive symptoms often treated these constructs as static traits rather than dynamic states. The current study focused on the short-term, prospective link between loneliness and depressive symptoms, while also analyzing potential gender differences.

METHODS

We modeled panel data from seven bi-weekly assessments gathered in the FRequent health Assessment In Later life (FRAIL70+) study. At baseline, the sample size amounted to N = 426 community-dwelling older adults aged 70 years or older in Austria. The relationship between loneliness and depressive symptoms was analyzed using a latent change score modeling framework.

RESULTS

As regards depressive symptoms, women showed higher initial levels and more change across the three months than men. Loneliness did not considerably change across time for both sexes. Moreover, greater levels of loneliness at a given point in time were associated with an accelerated increase in depressive symptoms two weeks later in women but not in men.

CONCLUSION

Loneliness appeared to be a potential determinant of future increases in depressive symptoms. The varying effects observed between men and women suggest potential gender differences in short-term fluctuations of depressive symptoms and their underlying mechanisms.

Father-to-infant attachment and its associated factors during COVID-19 pandemic: a cross-sectional study

BACKGROUND

The attachment between father and infant is essential to a child's later development and well-being; yet, hardly any research has examined father-to-infant attachment during the outbreak of COVID-19. This study, therefore, aims to examine psychological, interpersonal, and health-related factors associated with father-to-infant attachment at 3-12 months postpartum during the pandemic.

METHOD

An online cross-sectional study was conducted between June and December 2021. A total of 775 fathers with at least one child aged 3-12 months were recruited. Participants completed measures of depression, COVID-19-related distress, relationship satisfaction, social support and other health-related factors including COVID-19 diagnosis and hospitalisation. Data on psycho-socio-demographic, obstetric, and COVID-19-related characteristics were also collected.

RESULTS

Findings demonstrated that paternal depression (β = -.33, p < .001); relationship satisfaction (β = .19, p < .001); COVID-19-related psychological distress (β = -.14, p < .001) and social support (β = .13, p < .001) had a significant effect on father-to-infant attachment. Fathers who were multiparous, had COVID-19 diagnosis, and hospitalised due to COVID-19 were more likely to report poorer father-to-infant attachment. Paternal depression was the most influential factor on father-to-infant attachment, which attenuated the strength of the relationships between marital status, prematurity, history of trauma, sleep quality, and father-to-infant attachment once included into the analyses. No significant associations between educational level, employment, socioeconomic status, delivery mode, and father-to-infant attachment were observed.

CONCLUSION

These findings highlight the critical role of paternal psychological well-being in establishing healthy father-to-infant attachment and the relevance of having satisfied interpersonal relationships in promoting this early relationship particularly during crises such as COVID-19 pandemic.

Resilience and social support as protective factors against suicidal ideation among tertiary students during COVID-19: a cross-sectional study

BACKGROUND

Suicidal ideation is a depression symptom which represents a key (cognitive) component of suicidality and plays an important role in suicide risk detection, intervention, and prevention. Despite existing research showing the importance of certain factors of depression symptoms and suicidal ideation, less is known about the interaction between the various risk and protective factors. The aim of the study was to examine whether living conditions characteristics and personal circumstances during the COVID-19 pandemic predicted the presence of depression symptoms and suicidal ideation among tertiary students and whether resilience and social support can mitigate the detrimental effects of difficult life circumstances.

METHOD

A large online cross-sectional study was conducted in March 2021 among 4,645 Slovenian tertiary students. Hierarchical multiple regression and hierarchical logistic regression methods were used to assess and compare the effect of life circumstances variables, as opposed to resilience and social support, on depression symptoms and suicidal ideation.

RESULTS

Female gender, single relationship status, living alone, a higher degree of household conflict, having a history of mental illness and chronic disease diagnosis were significant predictors of depression scores. All but gender were also predictors of suicidal ideation. Household conflict and a history of mental illness were the factors showing the strongest effect in both cases. On the other hand, social support and, in particular, resilience proved to be strong protective factors against depression symptoms and suicidal ideation. After accounting for one's resilience and social support, the explained variance in depression scores was more than doubled, while the harmful effect of household conflict and history of mental illness significantly decreased.

CONCLUSIONS

The findings stress the importance of one's resilience and social support and explain why some people manage to maintain mental well-being despite finding themselves in difficult life circumstances, which was the case for many tertiary students during the COVID-19 pandemic. These insights may inform preventive efforts against developing suicidal ideation and may be used as support for the design and implementation of interventions for improving resilience and social support from childhood onward.

A Complex Relationship between Quality of Life, Anxiety, and Depression among General Population during Second Year of COVID-19 Pandemic: A Population-Based Study

Background: The COVID-19 pandemic has had a significant impact on the global economy and public health, disrupting various aspects of daily life. Apart from its direct effects on physical health, it has also significantly affected the overall quality of life and mental health. This study employed a path analysis to explore the complex association among multiple factors associated with quality of life, anxiety, and depression in the general population of the Republic of Srpska during the pandemic's second year. Method: A cross-sectional study was conducted on a nationally representative sample (n = 1382) of the general population (adults aged 20+) during the second year of the COVID-19 pandemic in the Republic of Srpska, Bosnia, and Herzegovina. Assessment tools included the DASS-21 scale for depression, anxiety, and stress, along with the Brief COPE scale, Quality of Life Scale (QOLS), and Oslo Social Support Scale (OSSS-3). Sociodemographic factors and comorbidities were also assessed. Structural equation modeling was used to identify the direct and indirect links of various characteristics to quality of life, anxiety, and depression. Results: This study revealed a considerable prevalence of anxiety and depression symptoms (27.5% and 20.9%, respectively), with quality of life playing a significant mediating role. The constructed path model accounted for 33.1% of moderate to severe depression and 79.5% of anxiety. Negative coping was directly linked to anxiety and indirectly to depression via anxiety, while the absence of positive coping had both direct and indirect paths (through quality of life) on depression. Among variables that directly affected depression, anxiety had the highest effect. However, the bidirectional paths between anxiety and depression were also suggested by the model. Conclusions: Pandemic response strategies should be modified to effectively reduce the adverse effects on public mental health. Further research is necessary to assess the long-term effects of the pandemic on mental health and to analyze the contributing factors of anxiety and depression in the post-COVID period.

Prevalence of burnout and associated factors among midwives, 2023: institution-based cross-sectional study

Background

One of the main characteristics of the mental health condition known as burnout syndrome is an overwhelming feeling of physical and emotional tiredness, particularly with regard to one's work. Midwives are the group most prone to burnout because they work in emergency situations to save two lives at a time, share the stress of laboring women, and put in extra hours without enough payment. Besides this, there is little information on burnout among Ethiopian midwives.

Objectives

To assess burnout and associated factors among midwives working in public health facilities in West Arsi Zone, Ethiopia.

Methods and materials

A census method cross-sectional study was conducted among all 467 midwives working in public health facilities found in the West Arsi Zone, Ethiopia, from September 1 and 30, 2023. A pretested, validated face-to-face interviewer-administered structured questionnaire was used to collect data. Then, binary logistic regression was used for analysis. Bi-variable and multivariable logistic regression analyses were employed to identify factors associated with burnout. The level of statistical significance was declared at p < 0.05 with a 95% CI.

Results

Overall, the prevalence of burnout among midwives was 47.10% (95% CI: 42.55, 51.75%). Marital status not in union 2.03 (95% CI: 1.32-3.13), working more than 40 h per week 2.00 (95% CI: 1.29-3.08), conflict with their metron 2.33 (95% CI: 1.54-3.54), not satisfied with their current job 2.39 (95% CI: 1.56-3.66) and having depression symptoms 1.71 (95% CI: 1.06-2.74) were factors significantly associated with burnout.

Conclusion

This study found that in the study area, almost half of the midwives experienced burnout. Thus, it is recommended that midwives should develop respectful interactions with both their mentors and colleagues. Secondly, we suggest that zonal health offices set up systems that by shortening working hours and boost job satisfaction by creating conducive working environment, provide opportunities for career advancement and increase employee engagement.

Post-traumatic stress disorder and associated factors among inpatients at Eastern Command Referral Hospital in Dire Dawa, Eastern Ethiopia

Background

Post-traumatic stress disorder (PTSD) is characterized by heightened stress and anxiety after experiencing a traumatic event. While numerous studies have been conducted to investigate the magnitude and factors associated with PTSD, there is limited evidence available on specific study populations of military personnel.

Objective

The study aimed to determine the magnitude of post-traumatic stress disorder and associated factors among military personnel admitted to the Eastern Command Referral Hospital in Eastern Ethiopia from May 1 to 30, 2023.

Methods and materials

A cross-sectional study was carried out at an institution. Face-to-face interviews were conducted to collect data using the post-traumatic stress disorder military version checklist for the Diagnostic and Statistical Manual, Fifth Edition. Data were entered and analyzed using EpiData version 3.1 and STATA version 14. Descriptive statistics were employed to summarize the information. To investigate factors linked with outcome variables, bivariate and multivariate logistic regression analyses were conducted. The results were presented using odds ratios with 95% confidence intervals, with statistical significance given at a p-value of 0.05.

Results

This study found that approximately 23.6% (95% CI = 19.9-27.8) of admitted military members fulfilled the diagnostic criteria for PTSD. Participants' history of mental illness [adjusted odds ratio (AOR) = 5.73, 95% CI = 2.66-12.31], family history of mental illness (AOR = 10.38, 95% CI = 5.36-20.10), current chewing of khat (AOR = 2.21, 95% CI = 1.13-4.32), physical trauma (AOR = 2.03, 95% CI = 1.00-4.13), moderate social support (AOR = 0.27, 95% CI = 0.1-4.53), strong social support (AOR = 0.09, 95% CI = 0.02-0.35), and severe depression (AOR = 2.06, 95% CI = 1.74-5.71) were factors significantly associated with post-traumatic stress disorder.

Conclusions

The magnitude of post-traumatic stress disorder is high among military personnel. Factors such as participants' history of mental illness, family history of mental illness, depression, lack of social support, current use of khat, and physical trauma are significantly associated with PTSD. It is crucial to identify and intervene early in individuals with these risk factors to address PTSD effectively.

Prevalence of depression and associated factors among obstetric care providers at public health facilities in the West Arsi Zone, Ethiopia: Cross-sectional study

BACKGROUND

Depression is a severe and treatable mental illness that significantly affects individuals' daily activities. Obstetric care providers are the most vulnerable group for depression because they work in an emergency to save two lives at a time, share the stress of women during labor, and are at great risk for contamination.

OBJECTIVES

To assess depression and associated factors among obstetric care providers working in public health facilities.

METHOD AND MATERIALS

A cross-sectional study was conducted among 423 obstetric care providers working in public health facilities found in the West Arsi Zone, Ethiopia, from June 1 to 30, 2023. Study participants were selected through a simple random sampling technique. A pretested, face-to-face interviewer-administered structured questionnaire was used to collect data. Bi-variable and multivariable logistic regression analyses were employed to identify factors associated with depression. The level of statistical significance was declared at P < 0.05 with a 95% CI.

CONCLUSIONS AND RESULTS

Overall, the prevalence of depression among obstetric care providers was 31.1% (95% CI: 26.6%, 35.5%). Marital status not in union (AOR = 2.86, 95%CI: 1.66, 4.94), working more than 40 hours per week (AOR = 2.21, 95%CI: 1.23, 3.75), current substance use (AOR = 2.73, 95%CI: 1.64, 4.56), not being satisfied with their job (AOR = 3.52, 95%CI: 2.05, 6.07) and having burnout symptoms (AOR = 5.11, 95%CI: 2.95, 8.83) were factors significantly associated with depression.

RECOMMENDATIONS

We recommend that health professionals take care of themselves and avoid substance use. We also recommended that stakeholders enhance job satisfaction and avoid burnout by implementing various programs, like raising wages for workers, increasing staff members, offering various benefits, and regularly monitoring issues that arise.

The long-term association between exposure to wartime bombing earlier in life and post-traumatic stress later in life among today's older Vietnamese population

This analysis examines the relationship between exposure to American wartime bombardments earlier in life and later-life PTSD among current surviving Vietnamese aged 59+. It also assesses whether the relationship varies by military status during the war - formal military, informal military, or civilian - and whether associations are explained by exposure to violence and malevolent conditions. Data link survey responses from the 2018 Vietnam Health and Aging Study to provincial-wide level bombing intensity using U.S. Department of Defense records from the Theater History of Operations Vietnam database. PTSD measured using nine items from the PTSD Checklist. Analyses employ multivariate logistic quantile regression. Findings examined for a sample of 2290 Vietnamese survivors and a subsample of 736 Vietnamese that moved at least once during wartime. Results show a robust and significant positive association between province-wide bombing intensity and later-life PTSD scores. Interaction effects indicate civilians have overall lower levels of PTSD than those that were in the formal or informal military, but the association between bombing and PTSD is stronger among civilians. Much of the association is a function of exposure to violence and less is a function of exposure to malevolent conditions. Findings confirm earlier studies that have shown severe deleterious impacts of war trauma, and arial bombardments particularly, on long-term psychological health, while extending extant literature to civilian populations living in Vietnam during intense aerial bombing episodes.

Awareness and Uptake of Pre-Exposure Prophylaxis (PrEP) for HIV Prevention Among Men who have Sex with Men in Nepal

Pre-exposure prophylaxis (PrEP) is a highly effective biomedical prevention strategy that remarkably reduces HIV transmission risk. Although PrEP has been available in Nepal since 2019, very little is known about PrEP use among MSM in Nepal. This study aimed to examine PrEP awareness and its use among Nepali MSM and the factors influencing its adoption. A cross-sectional survey was conducted among MSM in Nepal between October and December 2022 (N = 250). Bivariate analysis and logistic regression were performed to determine factors associated with awareness and use of PrEP. In the study population, 59.6% of participants were aware of PrEP, however, only 30.4% of them had utilized it. The odds of PrEP awareness were higher among participants who had completed high school or above (aOR = 4.1; 95% CI = 1.8-9.6), those with health insurance coverage (aOR = 6.9; 95% CI = 2.1-22.3) and had tested for HIV (aOR = 21.2; 95% CI = 8.3-53.9). Similarly, participants who identified as gay (aOR = 3.4; 95% CI = 1.4-8.4), had visited a doctor within the past 6 months (aOR = 2.9; 95% CI = 1.2-6.5), had previously tested for HIV (aOR = 12.3; 95% CI = 3.4-44.7), and had been diagnosed with sexually transmitted infections (aOR = 7.0; 95% CI = 2.5-19.5) were more likely to have used PrEP. Our results highlight the critical importance of healthcare providers engaging in providing care for MSM, including facilitating as well as discussions about PrEP. In addition, there is a pressing need for innovative strategies (e.g., peer educators, social media, online facilitating technologies) to disseminate PrEP knowledge and reduce stigma surrounding PrEP.

Validation of the Chinese version of the Oslo-3 Social Support Scale among nursing students: a study based on Classical Test Theory and Item Response Theory models

BACKGROUND

Nursing students are encountering a range of health issues. Assessing social support is a key component in most questionnaire surveys related to health status, aiming to investigate the relationships and mechanisms between health status and social support to enhance overall health. Therefore, it is essential to seek out appropriate instruments to evaluate social support for nursing students. The Oslo-3 Social Support Scale (OSSS-3) is a reliable and concise instrument for evaluating social support. To date, there have been no studies validating the OSSS-3 based on Item Response Theory (IRT) models. Also, an officially validated Chinese version has not been found. The current research intended to verify the Chinese version of the OSSS-3.

METHODS

The OSSS-3 was translated into Chinese and culturally adapted. Subsequently, the OSSS-3 was validated by employing the Classical Test Theory (CTT) and IRT models.

RESULTS

The split-half reliability was 0.622. The Cronbach's α coefficient was 0.687. The correlations between each item and total scores varied from 0.723 to 0.835. The retest coefficient was 0.907. The content validity index was 0.933. A single common factor was extracted and accounted for 61.559% of the variance. The item loading values on the single factor were between 0.743 and 0.814. The communalities were between 0.552 and 0.663. There was no variance between males and females (P = 0.055). The difference in scores between the top (30%) and bottom (30%) groups attained significance. IRT models results revealed that the discrimination parameters ranged from 1.39 to 2.33 and difficulty parameters increased monotonically.

CONCLUSION

The OSSS-3 demonstrates satisfying psychometric properties and is a proper instrument for measuring social support in Chinese nursing students.

Determinants of premenstrual dysphoric disorder and associated factors among regular undergraduate students at Hawassa University Southern, Ethiopia, 2023: institution-based cross-sectional study

BACKGROUND

Premenstrual dysphoric disorder (PMDD) is a condition causing severe emotional, physical, and behavioral symptoms before menstruation. It greatly hinders daily activities, affecting academic and interpersonal relationships. Attention is not given to premenstrual disorders among female students in higher education. As a result, students are susceptible to stress, and their academic success is influenced by various factors, including their menstrual cycle, and the long-term outcomes and consequences are poorly researched. Even though PMDD has a significant negative impact on student's academic achievement and success limited research has been conducted in low- and middle-income countries including Ethiopia, especially in the study setting. Therefore, a study is needed to assess premenstrual dysphoric disorder and associated factors among regular undergraduate students at Hawassa University.

METHODS

An institutional-based cross-sectional study was conducted among 374 regular undergraduate female students at Hawassa University, College of Medicine and Health Sciences. A self-administered structured premenstrual symptoms screening tool for adolescents was used to assess premenstrual dysphoric disorder. The collected data were loaded into a statistical package for the social science version 25 and analyzed using it. Both bivariate and multivariate logistic regression were used to identify factors associated with premenstrual dysphoric disorder. Each independent variable was entered separately into bivariate analysis, and a variable with a p-value less than 0.25 were included in the multivariate analysis to adjust the possible confounders. Statistically significant was declared at a 95% confidence interval when variable with a p-value less than 0.05 in the multivariate analysis with premenstrual dysphoric disorder.

RESULTS

The magnitude of premenstrual dysphoric disorder in this study was 62.6% (95% CI 57.4-67.5). Having severe premenstrual pain (AOR = 6.44;95%CI 1.02-40.73), having irregular menstrual cycle (AOR = 2.21; 95% CI 1.32-3.70), students who had poor social support (AOR = 5.10;95%CI, (2.76-12.92) and moderate social support (AOR = 4.93;95%CI (2.18-11.18), and students who used contraception (AOR = 3.76;95%CI, 2.21-6,40) were statistically significant factors with the outcome variable.

CONCLUSION

The prevalence of premenstrual dysphoric disorder was high as compared to other studies. There was a strong link between irregular menstrual cycle, severe menstrual pain (severe dysmenorrhea), poor social support, and contraception use with premenstrual dysphoric disorder. This needs early screening and intervention to prevent the complications and worsening of the symptoms that affect students' academic performance by the institution.

Mental health literacy and associated factors among traditional healers of Jimma town, southwest, Ethiopia 2020: a community based, cross-sectional study

Background

Traditional healers are in the front line to give the mental healthcare service in developing countries like Ethiopia. In Ethiopia, different studies were done focusing on the role of traditional medicine and perception of the community toward traditional medicine. However, there is paucity of studies, which shows the level of mental health literacy among traditional healers. Therefore, this study intended to mental health literacy level of traditional healers in Jimma town, Ethiopia.

Method

A community-based cross-sectional study design was employed among 310 participants. To select the participants from Jimma town, a stratified random sampling method was utilized from August 1 to September 30, 2020. The Mental Health Literacy Questionnaire was used to assess mental health literacy for assessment of mental health literacy among traditional healers. The collected data were coded and entered into EpiData version 4.6 and exported to SPSS version 25.0 for analysis. Bivariate and multivariable linear regression was used for data analysis.

Result

The finding of this study showed that the samples of traditional healers found in Jimma town scored a total mean of 95.91 ± 3.0025 for mental health literacy. Age [β = -0.052 (95% CI: -0.078, -0.026)], year of experience [β = 0.095 (95% CI: 0.067, 0.123)], family history of mental illness [β = 1.709 (95% CI: 0.543, 2.360)], history of professional help seeking on mental illness [β = 0.501 (95% CI: 0.715, 2.288)], history of getting information of mental illness on media [β = 0.941 (95% CI: 0.345, 1.538)], training on mental health [β = 2.213 (995% CI: 1.520, 2.906)], history of treating mental illness [β = 1.676 (95% CI: 0.808, 2.544)], and informal education [β = -1.664 (95% CI: -2.081, -1.247)] were factors significantly associated with MHL.

Conclusion

The mental health literacy of traditional healers mean score is lower than the mean score of other studies. Age, year of experience, training on mental illness, family history, history of professional help seeking, history of treating mental illness, information on mental illness, and informal education are significantly associated with mental health literacy. Therefore, structured training is very important to improve their level of mental health literacy.

Factors associated with depression among war-affected population in Northeast, Ethiopia

BACKGROUND

Depression is the most common mental health outcome of exposure to war-related traumatic stressors. Due to inter-communal conflict, Dessie City residents have experienced prolonged armed conflict in 2021. This conflict leads to widespread violence, negative impact on mental health, and large-scale forced migration. However, the problem is not properly addressed in Ethiopia. Therefore, this study aimed to assess the prevalence and risk factors of depression in the war-affected area in Dessie City, Ethiopia.

METHOD

A cross-sectional study design was conducted among 785 participants in 2022. The study subjects were selected using a multi-stage cluster sampling technique. The outcome measures used in the study were validated with the Patient Health Questionnaire (PHQ-9). Data was entered using Epi-data version 3.1 and SPSS version 25 was used to analyze data. Bivariate and multivariable logistic regressions were done to identify factors related to depression. In multivariable logistic regression variables with a p-value less than 0.05 were considered significant and, adjusted OR (AOR) with 95% CI was used to present the strength of the association.

RESULT

The prevalence of depression among participants was found to be 24.5% (95% CI,21.7, 27.5). In multivariable analysis, post-traumatic stress disorder (AOR = 2.79, 95% CI 1.76-4.43), middle-perceived life threats (AOR = 8.25, 95% CI 2.47-17.49), low social support (AOR = 1.90, 95% CI 1.23-2.96) were variables significantly associated with depression.

CONCLUSION

This study found a high prevalence of depression among Dessie City residents. post-traumatic stress disorder, middle-perceived life threats, and low social support were associated with depression. Interventional strategies should be implemented to promote healing, resilience, and the overall well-being of individuals and communities. However, the findings underscore the need to address the current lack of mental health care resources in post-conflict populations.

Level of perceived social support, and associated factors, in combat-exposed (ex-)military personnel: a systematic review and meta-analysis

PURPOSE

Combat deployment increases exposure to potentially traumatic events. Perceived social support (PSS) may promote health and recovery from combat trauma. This systematic review and meta-analysis aimed to synthesize studies investigating the level of PSS and associated factors among (ex-)military personnel who served in the Iraq/Afghanistan conflicts.

METHODS

Five electronic databases were searched in August 2023 and searches were restricted to the beginning of the Iraq/Afghanistan conflicts in 2001. The search was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A quality assessment was carried out, and a meta-analysis and narrative synthesis were performed.

RESULTS

In total, 35 papers consisting of 19,073 participants were included. Of these, 31 studies were conducted in the United States (US) and 23 were cross-sectional. The pooled mean PSS score was 54.40 (95% CI: 51.78 to 57.01). Samples with probable post-traumatic stress disorder had a lower mean PSS score (44.40, 95% CI: 39.10 to 49.70). Approximately half of the included studies (n = 19) investigated mental health in relation to PSS, whilst only four explored physical health. The most frequently reported risk factors for low PSS included post-traumatic stress disorder, depression and anxiety, whilst post-traumatic growth and unit support were protective factors.

CONCLUSION

Higher levels of PSS were generally associated with more positive psychosocial and mental health-related outcomes following deployment. PSS should be targeted in psychosocial interventions and education programmes. Future research should investigate PSS in (ex-)military personnel across other countries and cultures, based on the lack of studies that focused on PSS in countries outside of the US.

Magnitude of self-harm and associated factors among postnatal mothers attending immunization clinics at public health facilities in Boneya Boshe Woreda, Western Ethiopia, 2023: institution-based cross-sectional study design

Background

Self-harm is a preventable, but a leading, cause of maternal morbidity and mortality all over the world, with a significant impact on healthcare systems.

Objective

To assess the magnitude of self-harm and associated factors among postnatal mothers attending immunization clinics.

Methods

An institution-based cross-sectional study was employed among postnatal mothers attending infant immunization clinics at public health facilities in Boneya Boshe Woreda, Western Ethiopia, 1 October to 30 October 2023. A pretested, face-to-face interviewer-administered structured questionnaire prepared by Kobo Toolbox was used to collect the data. Both bivariable and multivariable logistic regression analyses were done. The level of significance was declared at p-value <0.05 with a 95% CI.

Results

Among the 423 mothers enrolled in the study, 415 of them finally participated, at a response rate of 98.10%. The magnitude of self-harm was 12.53% (95% CI: 9.33, 15.73). Involvement of husband in maternity and child healthcare (AOR = 1.90; 95% CI: 1.12, 2.10), depression (AOR = 2.79; 95% CI: 2.14, 6.94), loneliness (AOR = 2.49; 95% CI: 1.15, 5.40), postpartum intimate partner violence (AOR = 2.15; 95% CI: 1.01, 4.54), average monthly income (AOR = 3.70; 95% CI: 2.17, 10.50), and postnatal care (AOR = 2.72; 95% CI: 1.28, 5.80) were significantly associated factors.

Conclusion and recommendations

The study sought a magnitude of self-harm that was slightly higher than the previous study conducted in the northern part of Ethiopia. Therefore, healthcare providers should focus on identified factors during postnatal care to overcome them. Similarly, the concerned body should develop an effective strategy based on the identified factors to pay attention to postnatal mothers.

The burden of psychological trauma and post-traumatic stress disorder among adults with congenital heart disease: PTSD in ACHD

Psychological trauma, symptoms of post-traumatic stress disorder (PTSD), and mental health conditions are common in adult congenital heart disease (ACHD). There is a gap in research examining PTSD in ACHD using the current Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) criteria in assessing patient characteristics and experiences with trauma-focused treatment. Surveys were offered to outpatients over a 6-month enrollment period to be completed by way of a QR code on their personal smart phone. Patient-reported items include a detailed medical and psychosocial history, the Oslo social support scale, adverse childhood experiences survey, and the PTSD checklist for DSM-5. Of 158 patients (77% moderate or complex heart disease) who provided complete data, a provisional diagnosis of PTSD was found in 48 patients (30%) using a PTSD checklist for DSM-5 cut-off score of ≥31. A positive PTSD screen was associated with younger age, nonwhite race, presence of heart failure, lower New York Heart Association functional class, lower linear quality of life score, lower Oslo social support scale score, an insecure caregiver relation, period of unemployment, emergency department visits, medication nonadherence, and coexisting mental health disorders. Complexity of heart disease and number of surgical and/or catheter-based interventions were not associated with PTSD, although having undergone no cardiac surgeries until adulthood (aged ≥18 years) was associated with a lower prevalence of PTSD. Those who screened positive for PTSD were more likely to report multiple traumatic events, including noncardiac traumatic events. Only 14 of 48 patients (29%) reported a known diagnosis of PTSD, although 44 patients (92%) reported having ever seen a mental health provider. A total of 18 patients (38%) reported currently having a mental health provider. A total of 30 patients (62%) had heard of at least 1 evidence-based trauma-informed therapy, and 14 (29%) had tried at least 1. In conclusion, using the DSM-5 criteria, we observed a high prevalence of potential PTSD in ACHD associated with several novel cardiac and psychosocial patient factors. Future longitudinal studies will be necessary to establish causality. Few patients with ACHD have been formally diagnosed with PTSD or have experience with evidence-based trauma-informed therapies.

Restore and Rebuild (R&R): a protocol for a phase 2, randomised control trial to compare R&R as a treatment for moral injury-related mental health difficulties in UK military veterans to treatment as usual

BACKGROUND

Exposure to potentially morally injurious events is increasingly recognised as a concern across a range of occupational groups, including UK military veterans. Moral injury-related mental health difficulties can be challenging for clinicians to treat and there is currently no validated treatment available for UK veterans. We developed Restore and Rebuild (R&R) as a treatment for UK veterans struggling with moral injury-related mental health difficulties. This trial aims to examine whether it is feasible to conduct a pilot randomised controlled trial (RCT) of R&R treatment compared with a treatment-as-usual (TAU) control group.

METHODS

We will use a feasibility single-blind, single-site RCT design. The target population will be UK military veterans with moral injury-related mental health difficulties. We will recruit N=46 veteran patients who will be randomly allocated to R&R (n=23) or TAU (n=23). Patients randomised to R&R will receive the 20-session one-to-one treatment, delivered online. Veterans allocated to TAU, as there are currently no manualised treatments for moral injury-related mental health problems available, will receive the one-to-one treatment (online) typically provided to veterans who enter the mental health service for moral injury-related mental health difficulties. We will collect outcome measures of moral injury, post-traumatic stress disorder (PTSD), alcohol misuse, common mental disorders and trauma memory at pretreatment baseline (before randomisation), end of treatment, 12 weeks and 24 weeks post-treatment. The primary outcome will be the proportion of patients who screen positive for PTSD and moral injury-related distress post-treatment.

ETHICS AND DISSEMINATION

This trial will establish whether R&R is feasible, well-tolerated and beneficial treatment for veterans with moral injury-related mental health difficulties. If so, the results of the trial will be widely disseminated and R&R may improve access to effective care for those who struggle following moral injury and reduce the associated negative consequences for veterans, their families and wider society.

TRIAL REGISTRATION NUMBER

ISRCTN99573523.

Prenatal depression among pregnant women attending public health facilities in Babile district, Eastern Ethiopia: a cross-sectional study

BACKGROUND

Depression during pregnancy is a significant health concern that can lead to a variety of short and long-term complications for mothers. Unfortunately, there is a lack of information available on the prevalence and predictors of prenatal depression in rural eastern Ethiopia. This study assessed prenatal depression and associated factors among pregnant women attending public health facilities in the Babile district, Eastern Ethiopia.

METHOD

An institution-based cross-sectional study was conducted among 329 pregnant women attending Babile District Public Health Facilities from November 1 to December 30, 2021. Bivariable and multivariable logistic regression were used to identify factors associated with prenatal depression. The adjusted odds ratio (AOR) with a 95% confidence interval was used to report the association, and the significance was declared at a p-value < 0.05.

RESULTS

The prevalence of prenatal depression was 33.1% (95% CI = 28.0%, 38.2%). A lower income (AOR = 3.85, 95% CI = 2.08, 7.13), contraceptive use (AOR = 0.53, 95% CI = 0.28, 0.98), unintended pregnancy (AOR = 2.24, 95% CI = 1.27, 3.98), history of depression (AOR = 5.09, 95% CI = 2.77, 9.35), poor social support (AOR = 5.08, 95% CI = 2.15, 11.99), and dissatisfied marriage (AOR = 2.37, 95% CI = 1.30, 4.33) were the factors associated with increased prenatal depression among pregnant women.

CONCLUSIONS

One in every three pregnant women in rural eastern Ethiopia had prenatal depression. Monthly income, contraceptive use, pregnancy intention, history of depression, social support, and marriage satisfaction status were the determinants of prenatal depression. Preventing unintended pregnancies by encouraging women to utilize modern contraceptive methods is essential for mitigating and controlling the risks and burdens of prenatal depression and its negative consequences.

Age-related shifts in mental health determinants from a deprived area in the European Union: informing the national healthy aging program of Hungary

Mental disorders are among the leading causes of disability worldwide, disproportionately affecting older people. This study aims to assess the mental health of elderly individuals living in a deprived region of Hungary, and to identify and estimate the weight of different determinants of mental health across different age groups. A cross-sectional study was conducted with randomly selected samples of individuals (n = 860) aged 18 years and older in Northeast Hungary. The World Health Organization Well-Being Index (WHO-5), the single-item Life Satisfaction Scale, and the 12-item General Health Questionnaire (GHQ-12) were used to measure mental health of the participants. Multiple linear regression analysis was performed to measure the association between sociodemographic and health-related variables and mental health. Overall, the mean WHO-5 score was 69.2 ± 18.1 and it showed a significant decrease by age (p < 0.001), with the lowest score observed in aged 75 years and above (p < 0.001). The mean life satisfaction score was 7.5 ± 1.9 and it showed a significant decreasing trend over the life course (p < 0.001). The highest level of psychological distress as assessed by GHQ-12 was observed in the group aged 75 years or older (11.5 ± 6.0, p < 0.001). Multiple linear regression indicated that self-reported financial status, social support, sense of control over their health, activity limitation and pain intensity were the most important determinants of mental health among older adults. Interventions to improve the mental health of older adults should focus on the positive impact of social support, the reduction of financial insecurity and the use of effective pain relief medications.

A pragmatic randomized clinical trial of multilevel interventions to improve adherence to lung cancer screening (The Larch Study): Study protocol

BACKGROUND

In real-world settings, low adherence to lung cancer screening (LCS) diminishes population-level benefits of reducing lung cancer mortality. We describe the Larch Study protocol, which tests the effectiveness of two patient-centered interventions (Patient Voices Video and Stepped Reminders) designed to address barriers and improve annual LCS adherence.

METHODS

The Larch Study is a pragmatic randomized clinical trial conducted within Kaiser Permanente Washington. Eligible patients (target n = 1606) are aged 50-78 years with an index low-dose CT (LDCT) of the chest with negative or benign findings. With a 2 × 2 factorial-design, patients are individually randomized to 1 of 4 arms: video only, reminders only, both video and reminders, or usual care. The Patient Voices video addresses patient education needs by normalizing LCS, reminding patients when LCS is due, and encouraging social support. Stepped Reminders prompts primary care physicians to order patient's repeat screening LDCT and patients to schedule their scan. Intervention delivery is embedded within routine healthcare, facilitated by shared electronic health record components. Primary outcome is adherence to national LCS clinical guidelines, defined as repeat LDCT within 9-15 months. Patient-reported outcomes are measured via survey (knowledge of LCS, perception of stigma) approximately 8 weeks after index LDCT. Our mixed-methods formative evaluation includes process data, collected during the trial, and interviews with trial participants and stakeholders.

DISCUSSION

Results will fill an important scientific gap on multilevel interventions to increase annual LCS adherence and provide opportunities for spread and scale to other healthcare settings.

REGISTRATION

Trial is registered at clinicaltrials.gov (#NCT05747443).

Poor sleep quality and associated factors among adult chronic kidney disease patients

Background

Poor sleep quality is a common concern in chronic kidney disease (CKD) patients, which can accelerate the progression of chronic renal disease and negatively impact their health-related quality of life, potentially leading to greater morbidity and mortality rates. It can also have an effect on the immune system, cognitive function, and emotional well-being of CKD patients. Furthermore, poor sleep quality may contribute to drug noncompliance and decreased participation in the entire treatment plan. Nonetheless, no research has been undertaken in Ethiopia on the prevalence of poor sleep quality and its associated factors among CKD patients.

Objective

This study aimed to assess the prevalence of poor quality of sleep and associated factors among chronic kidney disease patients at the University of Gondar Comprehensive Specialized and Felege Hiwot Referral Hospitals in 2020.

Methods

A cross-sectional study design was implemented at the University of Gondar Comprehensive Specialized and Felege Hiwot Referral Hospitals between February and April 2020. The study participants were chosen through systematic random sampling techniques. The Pittsburgh Sleep Quality Index (PSQI), a validated assessment tool, was utilized to measure sleep quality. A PSQI total score > 5 was used as an indicator of poor sleep quality. Subsequently, the data obtained were entered into Epi Data version 3.0 and then transferred to STATA 14 for analysis. Both bivariable and multivariable binary logistic regression analyses were performed to recognize factors associated with poor sleep quality. In the multivariable logistic regression analysis, variables demonstrating a p-value of ≤0.05 were considered statistically associated to poor sleep quality.

Results

In this study, 424 CKD patients were included. Among screened CKD patients, 42.9% tested positive for poor sleep quality with a 95% CI (38 to 47%). Independent predictors of poor sleep quality among CKD patients were common mental disorder [AOR = 1.8, 95% CI (1.19-2.89)], anemia [AOR = 2.7, 95% CI (1.71-4.36)], declined eGFR between 60 and 89.9 [AOR = 1.6; 95% CI (2.28-5.54)], 30-59.9 [AOR = 2.6, 95% CI (1.53-4.43)], and ≤ 30 [AOR = 3.8, 95% CI (1.17-12.61)], age > 50 years [AOR = 1.7(1.11-2.69)] and duration of disease 2.9 [AOR = 2.9, 95% CI (1.77-4.90)].

Conclusion

In our study, almost 1 out of 2 CKD patients assessed for poor sleep quality tested positive. It was noted that poor sleep quality was more frequent among CKD patients with common mental disorders, anemia, decreased eGFR levels, individuals aged over 50 years, and those with a longer duration of the disease. Consequently, it's advised to regularly screen these CKD patients for poor sleep quality.

Miracle friends and miracle money in California: a mixed-methods experiment of social support and guaranteed income for people experiencing homelessness

BACKGROUND

This paper describes the protocols for a randomized controlled trial using a parallel-group trial design that includes an intervention designed to address social isolation and loneliness among people experiencing homelessness known as Miracle Friends and an intervention that combines Miracles Friends with an economic poverty-reduction intervention known as Miracle Money. Miracle Friends pairs an unhoused person with a volunteer "phone buddy." Miracle Money provides guaranteed basic income of $750 per month for 1 year to Miracle Friends participants. The study will examine whether either intervention reduces social isolation or homelessness compared to a waitlist control group.

METHODS

Unhoused individuals who expressed interest in the Miracle Friends program were randomized to either receive the intervention or be placed on a waitlist for Miracle Friends. Among those randomized to receive the Miracle Friends intervention, randomization also determined whether they would be offered Miracle Money. The possibility of receiving basic income was only disclosed to study participants if they were randomly selected and participated in the Miracle Friends program. All study participants, regardless of assignment, were surveyed every 3 months for 15 months.

RESULTS

Of 760 unhoused individuals enrolled in the study, 256 were randomized to receive Miracle Friends, 267 were randomized to receive Miracle Money, and 237 were randomized to the waitlist control group. In the two intervention groups, 360 of 523 unhoused individuals were initially matched to a phone buddy. Of the 191 study participants in the Miracle Money group who had been initially matched to a volunteer phone buddy, 103 were deemed to be participating in the program and began receiving monthly income.

DISCUSSION

This randomized controlled trial will determine whether innovative interventions involving volunteer phone support and basic income reduce social isolation and improve housing outcomes for people experiencing homelessness. Although we enrolled unhoused individuals who initially expressed interest in the Miracle Friends program, the study team could not reach approximately 30% of individuals referred to the study. This may reflect the general lack of stability in the lives of people who are unhoused or limitations in the appeal of such a program to some portion of the unhoused population.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05408884 (first submitted on May 26, 2022).

Comorbid depression among adults with heart failure in Ethiopia: a hospital-based cross-sectional study

BACKGROUND

Depression is a common comorbidity in adults with heart failure. It is associated with poor clinical outcomes, including decreased health-related quality of life and increased morbidity and mortality. There is a lack of data concerning the extent of this issue in Ethiopia. Consequently, this study aimed to assess the prevalence of comorbid depression and associated factors among adults living with heart failure in Ethiopia.

METHODS

A hospital-based cross-sectional study was conducted at the cardiac outpatient clinics of two selected specialist public hospitals in Addis Ababa, Ethiopia: St. Paul's Hospital Millennium Medical College and St. Peter Specialized Hospital. An interviewer-administered questionnaire was used to collect data from 383 adults with heart failure who attended the clinics and met the inclusion criteria. Depression was measured using the Patient Health Questionnaire (PHQ-9). A binary logistic regression model was fitted to identify factors associated with depression. All statistical analyses were conducted using STATA version 17 software.

RESULTS

The mean age of the participants was 55 years. On average, participants had moderate depression, as indicated by the mean PHQ-9 score of 11.02 ± 6.14, and 217 (56.6%, 95%CI 51.53-61.68) had comorbid depression. Significant associations with depression were observed among participants who were female (AOR: 2.31, 95%CI:1.30-4.08), had comorbid diabetes mellitus (AOR: 3.16, 95%CI: 1.47-6.82), were classified as New York Heart Association (NYHA) class IV (AOR: 3.59, 95%CI: 1.05-12.30), reported poor levels of social support (AOR: 6.04, 95%CI: 2.97-12.32), and took more than five medications per day (AOR: 5.26, 95%CI: 2.72-10.18).

CONCLUSIONS

This study indicates that over half of all adults with heart failure in Ethiopia have comorbid depression, influenced by several factors. The findings have significant implications in terms of treatment outcomes and quality of life. More research in the area, including interventional and qualitative studies, and consideration of multifaceted approaches, such as psychosocial interventions, are needed to reduce the burden of comorbid depression in this population.

Fear of childbirth and its associated factors among pregnant women in Dejen Woreda, East Gojjam Zone, Northwest Ethiopia: a community-based cross-sectional study

Fears of delivery are the uncertainty and worry experienced before, during, and following labor. It hurts women's health and affects 5-40% of all moms globally. If not recognized, it could cause expectant mothers to feel alone and unsupported. Studies on this subject, however, are scarce at the woreda level. Therefore, this study amis to assess the prevalence and associated factors of fear of childbirth among pregnant women in Dejen Woreda, East Gojjam Zone, Northwest Ethiopia. A community-based cross-sectional study was conducted among 575 pregnant women selected by Cluster Sapling from December 15 to December 25, 2022. Data were gathered using a structured questionnaire that was presented by an interviewer. Data were entered using Epi-data version 3.1 and analyzed using SPSS Version 23 statistical software. Descriptive statistics and inferential statistics were done, and ordinary logistic regression was used to examine the associated factor for fear of childbirth. Finally, a P-value < 0.05 was used to determine statistical significance. Among the 575 pregnant women supposed to have participated, 560 agreed and participated in the survey, with a response rate of 97.4%. This study showed that 133(23.8%; CI 20.4-26.8) of the study participants had low fear of childbirth, 67(12%; CI (9.3-14.8 moderate, 217 (38.8%; CI 34.6-42.7) high, 143 (25.5%; CI 21.8-29.1) severe fear of childbirth. Having maternal age 18-24 (adjusted odds ratio/AOR = 1.6; 95% CI (1.1-2.3), p-value = -0.08), occupation daily laborer and other (AOR = 0.3,95%; CI 0.3, 0-74; p-value = 0.004),gestational age in third trimester (AOR = 1.9,95%; CI 1.1-3.4), p-value = 0.022) showed significant factor for a fear of childbirth. Maternal age, occupation, and third-trimester pregnancy were found to be significantly associated with fear of childbirth. Women should engage in special attention to keep them healthy by consistent monitoring during pregnancy. Healthcare providers should identify pregnant women with high fear of childbirth early, offer cognitive behavioral therapy, support psychological and physical well-being, provide early age and preventive measures, and use uniform instruments for assessing women's anxiety, promoting systematic reviews and longitudinal studies.

Prevalence of major depressive disorder and its associated factors among adult patients with neurolathyrism in Dawunt District, Ethiopia; 2022: community-based cross-sectional study

INTRODUCTION

Major Depressive Disorder (MDD) is one of the commonest mental disorders affecting more than 250 million people globally. Patients with chronic illnesses had higher risks for developing MDD than the general population. Neurolathyrism is a chronic illness characterized by lifelong incurable spastic paralysis of lower extremities; causing permanent disability. It is highly prevalent in Dawunt district, Ethiopia; with a point prevalence of 2.4%. Despite this, there were no previous studies assessing the prevalence of MDD among patients with neurolathyrism in Ethiopia.

OBJECTIVE

To assess the prevalence of MDD and to identify its associated factors among patients with neurolathyrism in Dawunt district, Ethiopia.

METHODS

A community based cross-sectional study was conducted on 260 samples in Dawunt district from February 01 to March 30/ 2021. Multistage sampling technique was used to select study participants. The patient Health Questionnaire-9 (PHQ-9) depression screening tool was used to diagnose MDD. PHQ-9 is a standardized depression screening tool and a PHQ-9 score of ≥ 10 has a sensitivity and specificity of 88.0% [95% CI (83.0-92.0%)] and 85.0% [95% CI (82.0-88.0%)] for screening MDD. Data were collected by interview; entered to EpiData version 4.2.0; exported to SPSS version 25.0 for analysis; descriptive statistics and binary logistic regression model were used; AOR with 95% CI was used to interpret the associations; and finally results were presented by texts, charts, graphs, and tables.

RESULTS

A total of 256 adult patients with neurolathyrism were participated; and the prevalence of MDD was found to be 38.7%. Being female [AOR = 3.00; 95% CI (1.15, 7.84)], living alone [AOR = 2.77; 95% CI (1.02-7.53)], being on neurolathyrism stage-3 [AOR = 3.22; 95% CI (1.09, 9.54)] or stage-4 [AOR = 4.00; 95% CI (1.28, 12.48)], stigma [AOR = 2.69; 95% CI (1.34, 5.39)], and lack of social/ family support [AOR = 3.61; 95% CI (1.80, 7.24)] were found to have statistically significant association with an increased odds of MDD; while regular exercise and ever formal counselling were found to have statistically significant association with a decreased odds of MDD.

CONCLUSION

The prevalence of MDD among neurolathyrism patients in Dawunt district was high. Lack of social support, stigma, not getting formal counselling, and not involving in regular exercise were modifiable risk factors. Therefore, social support, reducing stigma, formal counselling, and encouraging regular exercise might help to reduce the burden of MDD among neurolathyrism patients.

Post-COVID-19 syndrome, who at risk and why: an insight from Qatar 2022

Background

Despite the recovery from the COVID-19 pandemic, many people experience post-COVID-19 syndrome, which negatively impacts their health and function. This condition has become a significant public health problem that requires immediate attention.

Objective

To study the prevalence, clinical characteristics, and predictors of post-COVID-19 Syndrome in Qatar during 2022.

Methods

An analytic cross-sectional study was conducted among COVID-19 confirmed cases from January 2022 to July 2022 in Qatar. A simple random sample was employed to include (n = 588) participants from the list of cases and invited to participate in a telephone survey. The World Health Organization's standard case definition for PCS was adopted.

Results

Out of 368, the prevalence of post-COVID-19 syndrome was 43.2% (n = 159). Most PCS cases were females (67.9%; n = 108), married (73.6%; n = 117), and university and higher educational level (83.6%; n = 133). However, 78.7% (n = 125) reported poor to moderate levels of social support. Only 30.2% (n = 48) of PCS patients had a history of chronic diseases, and 5.7% (n = 9) required hospital admission during acute illness. Among PCS cases, the most commonly reported symptoms were fatigue (75.5%), followed by anxiety (49.1%), forgetfulness (46.5%), mood alteration (45.3%), and general weakness (39.6%). The logistic regression revealed that female gender (AOR: 2.58 95%CI: 1.58-4.225, p < 0.0001), university and high educational level (AOR: 2.2, 95%CI: 1.256-3.98, p < 0.006), poor level of social support (AOR: 2.45; 95%CI: 1.55-4.13; p < 0.002), were significant predictors for PCS.

Conclusion

Post-COVID-19 syndrome may go under-recognized. More efforts are needed to raise awareness and mobilize the resources to respond to this ongoing public health problem.

Postnatal depression in British mothers of African and Caribbean origin: a randomised controlled trial of learning through play plus culturally adapted cognitive behaviour therapy compared with psychoeducation

Background

One in every three women worldwide experiences postnatal depression after childbirth, with long-term negative consequences on their children. The mainstream mental healthcare provision for British mothers of African/Caribbean origin is mostly unsuccessful due to a lack of culturally appropriate care.

Methods

The study adopts a mixed-methods randomised controlled trial (RCT) design. A 12-session (60 minutes each) of online Learning Through Play plus Culturally adapted Cognitive Behaviour Therapy (LTP+CaCBT) intervention was employed for treating postnatal depression in comparison with psychoeducation (PE). Participants aged 19-53 were screened for depression using the Patient Health Questionnaire (PHQ-9). N=130 participants who scored >5 on PHQ-9 were randomised into LTP+CaCBT (n=65) or PE (n=65) groups. N=12 focus groups (LTP+CaCBT, n=6; PE, n=6) and n=15 individual interviews (LTP+CaCBT, n=8; PE, n=7) were conducted, transcribed verbatim and analysed.

Results

Satisfaction with intervention (LTP+CaCBT, 72.9%; PE, 65.2%); retention rates (LTP+CaCBT, 91%; PE, 71%); reduction in postnatal depression was higher in LTP+CaCBT on PHQ-9 Md=1.00 with z= -4.046; compared to PE, Md=1.00 with z= -1.504. Both groups showed reduced levels of anxiety on GAD-7 with no significant difference. Emerging themes from the qualitative findings showed increased positive moods, reduced worries about parenting difficulties and the facilitative role of remote intervention.

Conclusions

LTP+CaCBT intervention is culturally appropriate and acceptable and reduces postnatal depression in British mothers of African/Caribbean origin. A fully powered RCT is recommended to evaluate the clinical and cost-effectiveness of LTP+CaCBT, including the child's outcomes compared with routine treatment as usual.

Clinical trial registration

www.ClinicalTrials.gov, identifier NCT04820920.

Suicidal ideation and associated factors among pregnant women attending antenatal care at public hospitals of Harari regional state, eastern Ethiopia: A cross-sectional study

BACKGROUND

Suicide is a global issue. It is the third responsible for death among the reproductive age group. Pregnancy is a complicated event and crucial in the life of a woman with considerable physiological, hormonal changes, social, and mental changes. However, third-world countries like Ethiopia have not been investigated well. Therefore, the study planned to assess the magnitude and factors associated with suicidal ideation. Furthermore, it will identify the role of hyperemesis gravidarum on suicidal ideation.

METHOD

A Cross-sectional study was employed for 543 pregnant participants attending antenatal care at Hiwot Fana Specialized University Hospital and Jugal General Hospital, Harari regional state, eastern Ethiopia from June 1 to August 1, 2022. The recruited participants were selected by systematic random sampling method. Suicide was assessed using Composite International Diagnostic by interview methods data collection. Epi data and STATA version 14.1 were used for data entry and analysis respectively. Candidate variables were entered into a multivariate logistic regression then those variables that have p-value < 0.05 were considered as significantly associated.

RESULTS

The magnitude of suicidal ideation in this study was found to be 11.15% at (95% CI: 8.75-14.11). Regarding the associated factor, unwanted pregnancy (AOR = 3.39: at 95% CI = 1.58-7.27), Hyperemesis gravidarum (AOR = 3.65: at 95% CI = 1.81-7.34), having depressive symptoms (AOR = 2.79: at 95% CI = 1.49-5.23), having anxiety symptoms (AOR = 3.37; at 95% CI = 1.69-6.68), experiencing intimate partner violence (AOR = 2.88: at 95% CI = 1.11-7.46), and having stress (AOR = 3.46; at 95% CI = 1.75-6.86) were significantly associated variable with suicidal ideation among pregnant women.

CONCLUSION AND RECOMMENDATION

This study revealed that suicidal ideation is common among pregnant women. Regarding the associated factors unwanted pregnancy, hyperemesis gravidarum, having depressive and anxiety symptoms, experiencing intimate partner violence, and stress were significantly associated with suicidal ideation. Thus, giving awareness and early screening and interferences for antenatal suicide should be warranted.

Combining mHealth Technology and Pharmacotherapy to Improve Mental Health Outcomes and Reduce Human Rights Abuses in West Africa: Intervention Field Trial

Background

In West Africa, healers greatly outnumber trained mental health professionals. People with serious mental illness (SMI) are often seen by healers in "prayer camps" where they may also experience human rights abuses. We developed "M&M," an 8-week-long dual-pronged intervention involving (1) a smartphone-delivered toolkit designed to expose healers to brief psychosocial interventions and encourage them to preserve human rights (M-Healer app), and (2) a visiting nurse who provides medications to their patients (Mobile Nurse).

Objective

We examined the feasibility, acceptability, safety, and preliminary effectiveness of the M&M intervention in real-world prayer camp settings.

Methods

We conducted a single-arm field trial of M&M with people with SMI and healers at a prayer camp in Ghana. Healers were provided smartphones with M-Healer installed and were trained by practice facilitators to use the digital toolkit. In parallel, a study nurse visited their prayer camp to administer medications to their patients. Clinical assessors administered study measures to participants with SMI at pretreatment (baseline), midtreatment (4 weeks) and post treatment (8 weeks).

Results

Seventeen participants were enrolled and most (n=15, 88.3%) were retained. Participants had an average age of 44.3 (SD 13.9) years and 59% (n=10) of them were male. Fourteen (82%) participants had a diagnosis of schizophrenia and 2 (18%) were diagnosed with bipolar disorder. Four healers were trained to use M-Healer. On average, they self-initiated app use 31.9 (SD 28.9) times per week. Healers watched an average of 19.1 (SD 21.2) videos, responded to 1.5 (SD 2.4) prompts, and used the app for 5.3 (SD 2.7) days weekly. Pre-post analyses revealed a significant and clinically meaningful reduction in psychiatric symptom severity (Brief Psychiatric Rating Scale score range 52.3 to 30.9; Brief Symptom Inventory score range 76.4 to 27.9), psychological distress (Talbieh Brief Distress Inventory score range 37.7 to 16.9), shame (Other as Shamer Scale score range 41.9 to 28.5), and stigma (Brief Internalized Stigma of Mental Illness Scale score range 11.8 to 10.3). We recorded a significant reduction in days chained (1.6 to 0.5) and a promising trend for reduction in the days of forced fasting (2.6 to 0.0, P=.06). We did not identify significant pre-post changes in patient-reported working alliance with healers (Working Alliance Inventory), depressive symptom severity (Patient Health Questionnaire-9), quality of life (Lehman Quality of Life Interview for the Mentally Ill), beliefs about medication (Beliefs about Medications Questionnaire-General Harm subscale), or other human rights abuses. No major side effects, health and safety violations, or serious adverse events occurred over the course of the trial.

Conclusions

The M&M intervention proved to be feasible, acceptable, safe, and clinically promising. Preliminary findings suggest that the M-Healer toolkit may have shifted healers' behaviors at the prayer camp so that they commit fewer human rights abuses.

Associations Between Healthy Behaviors and Persistently Favorable Self-Rated Health in a Longitudinal Population-Based Study in Switzerland

BACKGROUND

Self-rated health is a subjective yet valuable indicator of overall health status, influenced by various factors including physical, psychological, and socio-economic elements. Self-rated health could be telling and used by primary care physicians to evaluate overall present and predictive health.

DESIGN

This study investigates the longitudinal evolution of self-rated health in Switzerland during the COVID-19 pandemic, focusing on the association of persistently favorable self-rated health with various predictors.

PARTICIPANTS

This study based on the Specchio cohort, a population-based digital study in Geneva Switzerland, involved participants completing questionnaires from 2021 to 2023.

MAIN MEASURES

Self-rated health was assessed alongside factors like physical and mental health, socio-economic status, and lifestyle behaviors.

KEY RESULTS

The study included 7006 participants in 2021, and 3888 participants who answered all three follow-ups (2021, 2022, and 2023). At baseline, 34.9% of individuals reported very good, 54.6% reported good, 9.6% reported average, and 1.0% reported poor to very poor self-rated health. Overall, 29.1% had a worsening in their self-rated health between 2021 and 2023. A subset of participants (12.1%) maintained very good self-rated health throughout, demonstrating persistently favorable self-rated health during the COVID-19 pandemic. Positive health behaviors were associated with persistently favorable self-rated health (exercise aOR 1.13 [1.03-1.24]; healthy diet aOR 2.14 [1.70-2.68]; less screen time aOR 1.28 [1.03-1.58]; and better sleep quality aOR 2.48 [2.02-3.04]). Mental health and social support also played significant roles.

CONCLUSION

The study underscores the significance of healthy lifestyle choices and social support in maintaining favorable self-rated health, particularly during challenging times like the COVID-19 pandemic. Primary care physicians should focus on promoting these factors, integrating these actions in their routine consultations, and advising patients to undertake in socially engaging activities to improve overall health perceptions and outcomes.

Common mental disorders and associated factors among adult chronic kidney disease patients attending referral hospitals in Amhara Regional State

Common mental disorders (CMDs) are a wide term that includes disorders like depression, anxiety, and somatic manifestations. Chronic kidney disease (CKD) patients are at high risk of developing a common mental disorders, which leads to a lower survival rate, poor clinical outcome, longer hospitalization, increased health-care utilization, difficulty adhering to medications, an increased risk of initiation of dialysis, poor quality of life, and an increased risk of mortality. However, there is limited study done related to common mental disorders and associated factors among chronic kidney disease patients in Ethiopia. This study aimed to assess the prevalence of common mental disorders and associated factors among chronic kidney disease patients attending referral hospitals in Amhara Regional State. An institution-based cross-sectional study design was conducted at the University of Gondar Comprehensive Specialized and Felege Hiwot Referral Hospitals from January to April 2020. The study participants were selected using systematic random sampling techniques. Common mental disorders were assessed using the Self-Reporting Questionnaire-Falk Institute (SRQ-F) tool. Data were entered into Epi Data Version 3.0 then exported into STATA 14 for analysis. Both bivariable and multi-variable binary logistic regressions were done to identify factors associated with common mental disorders. In multivariable logistic regression analysis, variables with a p-value of ≤ 0.05 were declared as a statistically associated with common mental disorders. In this study, 424 CKD patients were included, with a response rate of 100%. Among screened CKD patients, 40.8% was positive for common mental disorders, with a 95% CI (36-45%). Independent predictors of common mental disorders among CKD patients were poor social support [(AOR 3.1, 95% CI (1.67-5.77)], family history of mental disorders, [AOR 3.6, 95% CI (1.12-11.8)], comorbidity [AOR 1.7, 95% CI (1.03-2.78)], being female [AOR 2.69, 95% CI (1.72-4.20)], and duration of CKD (AOR 3.5; 95% CI (2.28-5.54). Two out of five CKD patients screened for CMDs were found to be positive. Common mental disorders were more common among CKD patients with poor social support, a family history of mental disorders, comorbidity, being female, and the duration of CKD. Therefore, screening CKD patients for common mental disorders is recommended.

The role of a community conversation intervention in reducing stigma related to lower limb lymphoedema in Northern Ethiopia

BACKGROUND

Stigma related to lower-limb lymphoedema poses a major psychosocial burden to affected persons and acts as a barrier to them accessing morbidity management and disability prevention (MMDP) services. Community Conversation (CC), which actively engages community members and disseminates health information amongst them, is believed to break the vicious cycle of stigma by enhancing disease-related health literacy at the community level.

METHODS

A quasi-experimental study was conducted in Northern Ethiopia to assess the role of the CC intervention in reducing stigma. In two control districts, a comprehensive and holistic MMDP care package was implemented that included physical health, mental health and psychosocial interventions, whilst in the intervention district the CC intervention was added to the MMDP care package. A total of 289 persons affected by lymphoedema and 1659 community members without lymphoedema were included in the study.

RESULTS

Over the course of the intervention, in all sites, community members' knowledge about the causes of lymphoedema increased, and perceived social distance and stigmatizing attitudes towards people with lymphoedema decreased in the community, whilst experienced and internalized stigma decreased amongst affected persons. There were no significant changes for perceived social support. However, the changes were greater in the control sites overall, i.e. those districts in which the holistic care package was implemented without CC.

CONCLUSION

The findings suggest that the CC intervention provides no additional stigma reduction when used alongside a holistic MMDP care package. Provision of comprehensive and holistic MMDP services may be adequate and appropriate to tackle stigma related to lower-limb lymphoedema in a resource-constrained setting like Ethiopia.

Identification of health-related problems in youth: a mixed methods feasibility study evaluating the Youth Health Report System

BACKGROUND

Because poor health in youth risk affecting their entry in adulthood, improved methods for their early identification are needed. Health and welfare technology is widely accepted by youth populations, presenting a potential method for identifying their health problems. However, healthcare technology must be evidence-based. Specifically, feasibility studies contribute valuable information prior to more complex effects-based research. The current study assessed the process, resource, management, and scientific feasibility of the Youth Health Report System prototype, developed within a youth health clinic context in advance of an intervention study.

METHODS

This mixed-methods feasibility study was conducted in a clinical setting. The process, resource, management, and scientific feasibility of the Youth Health Report System were investigated, as recommended in the literature. Participants were youth aged 16-23 years old, attending a youth health clinic, and healthcare professionals from three clinics. The youth participants used their smart phones to respond to Youth Health Report System health questions and healthcare professionals used their computer to access the results and for registration system entries. Qualitative data were collected from interviews with healthcare professionals, which were described with thematic analysis. Youth participants' quantitative Youth Health Report System data were analyzed for descriptive statistics.

RESULTS

Feasibility analysis of qualitative data from interviews with 11 healthcare professionals resulted in three themes: We expected it could be hard; Information and routines helped but time was an issue; and The electronic case report form was valuable in the health assessment. Qualitative data were collected from the Youth Health Report System. A total of 54 youth participants completed the evaluation questionnaire, and healthcare professionals retrieved information from, and made post-appointment system entries. Quantitative results revealed few missing items and acceptable data variability. An assessment template of merged qualitative and quantitative data guided a consensus discussion among the researchers, resulting in acceptable feasibility.

CONCLUSIONS

The process-, resource-, management-, and scientific feasibility aspects were acceptable, with some modifications, strengthening the potential for a successful Youth Health Report System intervention study.

Perceived social support and characteristics of social networks of families with children with special healthcare needs following the COVID-19 pandemic

Background

Children with special healthcare needs (CSHCN) require more support than the average of their peers. Support systems for CSHCN were particularly affected by pandemic control measures. Perceived social support is a resource for health and wellbeing for CSHCN and their families. Associations of social support, mental health and socioeconomic status (SES) have been described. This study aims to (1) assess perceived social support in families with and without CSHCN; (2) describe structure and types of social networks of families with and without CSHCN; and (3) explore associations between perceived social support, disease complexity, child and caregiver mental health, and SES.

Methods

This is the third of a sequential series of cross-sectional online surveys conducted among caregivers of children ≤ 18 years in Germany since the beginning of the COVID-19 pandemic, administered between 1st December 2022 and 10 March 2023. The Brief Social Support Scale (BS6) assessed perceived social support. Child and parental mental health were assessed using the Strengths and Difficulties Questionnaire (SDQ) and WHO-5 Wellbeing index. The CSHCN-Screener identified CSHCN. Descriptive statistics and linear regression modeling assessed associations between perceived social support, parent-reported child mental health problems, disease complexity, caregiver mental wellbeing and SES.

Results

The final sample included 381 participants, among them 76.6% (n = 292) CSHCN. 46.2% (n = 176) of caregivers reported moderate, i.e., at least occasional social support. Social support was largely provided by informal social networks consisting of partners, relatives and neighbors/friends. Linear regression modeling revealed associations of lower perceived social support with higher disease complexity of the child, lower caregiver mental wellbeing, lower SES and increasing caregiver age.

Conclusion

The results of this study describe inequalities in perceived social support according to disease complexity of the child, caregiver mental health and socioeconomic status. They highlight the importance of social support and support networks as a resource for wellbeing of caregivers and CSHCN. Moving on from the COVID-19 pandemic, recovery strategies should focus on low-threshold interventions based in the community to improve social support for families with CSHCN and actively involve caregivers in identifying needs and co-creating new approaches.

Longitudinal assessment of psychological distress and its determinants in a sample of firefighters based in Montreal, Canada

Introduction

Firefighters face elevated risks of common mental health issues, with distress rates estimated at around 30%, surpassing those of many other occupational groups. While exposure to potentially traumatic events (PTEs) is a well-recognized risk factor, existing research acknowledges the need for a broader perspective encompassing multidimensional factors within the realm of occupational stress. Furthermore, this body of evidence heavily relies on cross-sectional studies. This study adopts an intensive longitudinal approach to assess psychological distress and its determinants among firefighters.

Methods

Participants were recruited from 67 fire stations in Montreal, Canada, meeting specific criteria: full-time employment, smartphone ownership, and recent exposure to at least one PTE, or first responder status. Subjects underwent a telephone interview and were directed to use an app to report depressive, post-traumatic, and generalized anxiety symptoms every 2 weeks, along with work-related stressors, social support, and coping styles. Analyses involved 274 participants, distinguishing between those exceeding clinical thresholds in at least one distress measure (the "distressed" subgroup) and those deemed "resilient." The duration and onset of distress were computed for the distressed group, and linear mixed models were employed to evaluate determinants for each psychological distress variable.

Results

Clinical psychological distress was observed in 20.7% of participants, marked by depressive, post-traumatic, and anxiety symptoms, often within the first 4-week reference period. Contextual factors (operational climate, social support, solitude) and individual factors (coping style, solitude and lifetime traumatic events in private life) exhibited more significant impacts on psychological distress than professional pressures within the firefighters' work environment.

Discussion

This study reports lower rates of psychological distress than previous research, possibly attributable to sample differences. It highlights that reported symptoms often represent a combined and transient layer of distress rather than diagnosable mental disorders. Additionally, determinants analysis underscores the importance of interpersonal relationships and coping mechanisms for mental health prevention interventions within this worker group. The findings carry implications for the development of prevention and support programs for firefighters and similar emergency workers.

Health-related quality of life of postpartum women and associated factors in Dendi district, West Shoa Zone, Oromia Region, Ethiopia: a community-based cross-sectional study

BACKGROUND

Promoting a favorable experience of postpartum care has become increasingly emphasized over recent years. Despite the fact that maternal health care services have improved over the years, postnatal care service utilization is generally low and the health-related quality of life of postpartum women remains overlooked. Furthermore, the health-related quality of life of postpartum women is not well studied. Therefore, this study aimed to assess the health-related quality of life of postpartum women and associated factors in Dendi district, West Shoa Zone, Oromia, Region, Ethiopia.

METHODS

A community-based cross-sectional study was conducted among 429 participants. A multistage stratified sampling procedure was used to select the sampling unit and simple random sampling technique was employed to select the study participants from 23 August 2022 to 16 November 2022. A pre-tested standard structured questionnaire was used to collect the data. Data were entered using Epi-Data 3.1 and then exported to Statistical package for social science version 26. Binary logistic regression analysis was computed at p-value < 0.25 were considered candidates for multivariable logistic regression. Adjusted Odds Ratios (AOR) with 95% confidence interval and statistical significance was declared at a p-value < 0.05.

RESULTS

The study revealed that 73.7% (95% CI: 69.4-77.7) had a low level of health-related quality-of-life with a mean of 44.02 (SD ± 10.4). Urban residing [AOR = 0.27, 95% CI: (0.10-0.74)], no education [AOR = 3.44, 95% CI (1.35-8.74)], received at least four antenatal contact [AOR = 0.56, 95% CI (0.33-0.95)], received at least one postnatal care [AOR = 0.30, 95% CI (0.14-0.62)], poor social support [AOR = 2.23, 95% CI: (1.025-4.893)], having postpartum depression [AOR = 2.99, 95% CI: (1.52-5.56)], cesarean delivery [AOR = 3.18, 95% CI: (1.09-9.26)], and lowest household assets [AOR = 5.68, 95% CI: (2.74-11.76)] were significant associations with low health-related quality of life of postpartum women.

CONCLUSIONS

The health-related quality of life among postpartum women was very low. Postpartum women with low socio-economic status and inadequate maternal health service utilization had a low health-related quality of life. Promoting women's education and postnatal care services is needed to improve the health-related quality of life of postpartum women.

Prevalence of physical inactivity and associated factors among older adults in Gondar town, Northwest Ethiopia: a community-based cross-sectional study

INTRODUCTION

Older adults are increasing in number in both developed and developing countries. However, as the world's aging population grows, the burden of diseases among older people also increases. Despite this, co-occurring health problems due to physical inactivity in older adults have become a concern, and physical inactivity can be caused by different conditions. As a result, for older adults to have better health outcomes, early diagnosis of physical activity status and prevention of non-communicable diseases are crucial. There is a lack of data on the prevalence and associated factors of physical inactivity among older adults that is scarce in sub-Saharan Africa, particularly in the study area, Ethiopia. Therefore, this study aimed to assess the prevalence and associated factors of physical inactivity among older adults in Gondar town, Northwest Ethiopia, in 2022.

METHODS

A community-based cross-sectional study was conducted from April 1st to June 30th, 2022, in Gondar town, Northwest Ethiopia. The data was collected by the Global Physical Activity Questionnaire, Volume 2 through face-to-face interviews among 838 participants. Data were entered into Epinfo version 7.1, then exported and analysed using the Statistical Package of Social Science version 25. A binary logistic regression model was performed to identify factors associated with physical inactivity. The result was considered statistically significant based on an adjusted odds ratio of 95% and a p-value less than 0.05.

RESULT

The prevalence of physical inactivity was 65.6% (95% CI: 62.1-68.9). Being female (AOR: 3.053, 95% CI:1.487-6.267), age group > = 80 (AOR: 4.082, 95% CI:1.234-13.497), primary school level (AOR: 3.020, 95% CI:1.433-6.367), no formal education (AOR: 8.573, 95% CI:2.843-25.847), unemployed (AOR: 10.273, 95% CI:5.628-18.753), and symptoms of depression (AOR: 7.152, 95% CI: 4.786-17.965) were significantly associated with physical inactivity.

CONCLUSION

Physical inactivity was relatively high among older adults in Gondar town. Being female, older age, having low levels of education, being unemployed, and having depression symptoms were associated with physical inactivity. We suggest promoting the health benefits of physical activity among females by reducing their burden, older age groups, and unemployed older adults, and avoiding depression among individuals.

Assessing the efficacy of a resilience training intervention for long-term improvements in well-being and resilience

This article has two aims: (1) to assess the impacts of a novel training intervention for individual well-being and (2) to measure the trajectory of resilience over the training period dependent on reported significant life events. Using a randomised controlled trial with a diverse German sample with the majority drawn from a student population, we measure the effects of the intervention to provide insight into its impacts and act as a proof of concept for the training. We find that the training intervention boosts resilience and other related well-being measures with a high effect size in comparison with a control group and compared with existing resilience training studies.

Test anxiety and its determinants among health sciences students at Mattu University: a cross-sectional study

Background

Test anxiety is a particular type of anxiety that is marked by physical, cognitive, and behavioural symptoms when taking and performing tests. It is defined as "severe stress" before, during, and after exams and other assessments. Test anxiety could cause poor academic performance and increase dropout rates. This study aimed to determine the levels of test anxiety and its determinants among health sciences students at Mattu University.

Methods

An institution-based cross-sectional study was conducted among 421 selected students from June 1 to June 30, 2021. The study utilized the Westside Test Anxiety, the Oslo Social Support Scale, the Rosenberg Self-esteem Scale, and the Kessler Scale to assess test anxiety, social support, self-esteem, and psychological distress, respectively. The collected data were entered into EpiData version 3.1 and then exported to STATA version 14.0 for analysis. A linear regression model was used to determine factors associated with test anxiety. The multiple regression assumptions were checked for each variable. Statistically significant effects were assumed for a p-value of less than 0.05 at a 95% confidence interval in the multiple linear regression analysis.

Results

A total of 416 (99%) participants were completed out of the 420 questionnaires administered. The mean score of test anxiety among participants was 25.3 (SD: ±5.51). Tobacco use (β: 1.028; 95% CI: 0.709-1.347), khat chewing (β: 0.115; 95% CI: 0.038-0.192), self-esteem (β: -0.049; 95% CI: -0.062-(-0.036)), psychological distress (β: 0.022; 95% CI: 0.017-0.027), and physical activity (β: -0.162; 95% CI: -0.224-(-0.099)) were shown to have a significant association with test anxiety.

Conclusion

Test anxiety was common in the study area. Current substance use (tobacco use and khat chewing) and psychological distress were discovered to be factors that exacerbated test anxiety, whereas self-esteem and physical activity were discovered to be factors that alleviated test anxiety. Therefore, students and stakeholders need to work to discourage those factors that increase test anxiety while promoting factors that alleviate it.

Diabetes-related distress and its associated factors among people with type 2 diabetes in Southeast Ethiopia: a cross-sectional study

BACKGROUND

Diabetes-related distress lowers the motivation for self-care, often leading to lowered physical and emotional well-being, poor diabetes control, poor medication adherence and increased mortality among individuals with diabetes.

OBJECTIVE

To assess factors associated with diabetes-related distress among people living with type 2 diabetes in Southeast Ethiopia.

DESIGN

Institution-based cross-sectional study was conducted.

SETTING

Six diabetic follow-up care units at public hospitals in Southeast Ethiopia.

PARTICIPANTS

All adult people living with type 2 diabetes from the diabetic follow-up clinic.

THE MAIN OUTCOME MEASURES

Diabetes Distress Scale-17 questionnaire was used to assess diabetes-related distress.

RESULTS

Out of the total 871 study participants intended, 856 participated in the study with a response rate of 98.3%. The findings showed that about 53.9% (95% CI 50.4% to 57.2%) of the patients have diabetes-related distress. Physical activity (adjusted OR, AOR 2.22; 95% CI 1.36 to 3.63), social support (AOR 4.41; 95% CI 1.62 to 12.03), glycaemic control (AOR 2.36; 95% CI 1.35 to 4.12) and other comorbidities (AOR 3.94; 95% CI 2.01 to 7.73) were factors that significantly associated with diabetes-related distress at p<0.05.

CONCLUSION

This study demonstrated that more than half of the participants had diabetes-related distress. Therefore, the identified factors of diabetes-related distress need to be a concern for health institutions and clinicians in the management of people living with type 2 diabetes.

Depressive disorder, bipolar disorder, and associated factors among adults, in the Eastern part of Ethiopia

BACKGROUND

Depressive disorder is one of the severe and common mental illnesses in the general population. Bipolar disorder is a severe, persistent mental illness associated with significant morbidity and mortality. However, there is a paucity of data on the prevalence of depressive disorder, and bipolar disorder in our study area.

OBJECTIVE

This study aimed to assess the prevalence of depressive and bipolar disorders among adults in Kersa, Haramaya, and Harar Health and Demographic Surveillance Sites in Eastern Ethiopia.

METHODS

A community-based cross-sectional study was conducted among 1,416 participants. A multi-stage sampling was employed to select the participants. DSM-5 diagnostic criteria was used to assess depressive disorder and bipolar disorder. Data was collected using a standard questionnaire. Data were entered into Epi-Data 3.1 and analyzed using SPSS version 26. Both binary and multivariate logistic regression analyses were done. Those with a p-value < 0.05 in the final model were considered statistically significant.

RESULTS

The overall prevalence of depressive and bipolar disorders among our study participants was 6.7% (95% CI: 5.40, 8.20) and 2.1% (95% CI: (1.40, 3.00), respectively. The independent predictors of depressive disorder included a family history of mental illness, chronic medical illnesses, unemployment, low educational status, divorced or widowed, poor social support, and current alcohol use or khat chewing. Single, males, divorced or widowed, and current consumers of alcohol were independent predictors for bipolar disorder.

CONCLUSIONS AND RECOMMENDATION

The results of our investigation showed that bipolar illness and depression were significant public health issues. It was shown that although bipolar disorder is highly prevalent in the society, depression is a widespread concern. As a result, it is imperative that the relevant body grow and enhance the provision of mental health services. Furthermore, research on the effects and burdens of bipolar disorder in the community is required.

Internet-based transdiagnostic treatment for emotional disorders in Arabic- and Farsi-speaking refugees: study protocol of a randomized controlled trial

BACKGROUND

Refugee populations have an increased risk for mental disorders, such as depression, anxiety, and posttraumatic stress disorders. Comorbidity is common. At the same time, refugees face multiple barriers to accessing mental health treatment. Only a minority of them receive adequate help. The planned trial evaluates a low-threshold, transdiagnostic Internet-based treatment. The trial aims at establishing its efficacy and cost-effectiveness compared with no treatment.

METHODS

N = 131 treatment-seeking Arabic- or Farsi-speaking patients, meeting diagnostic criteria for a depressive, anxiety, and/or posttraumatic stress disorder will be randomized to either the intervention or the waitlist control group. The intervention group receives an Internet-based treatment with weekly written guidance provided by Arabic- or Farsi-speaking professionals. The treatment is based on the Common Elements Treatment Approach (CETA), is tailored to the individual patient, and takes 6-16 weeks. The control group will wait for 3 months and then receive the Internet-based treatment.

DISCUSSION

The planned trial will result in an estimate of the efficacy of a low-threshold and scalable treatment option for the most common mental disorders in refugees.

TRIAL REGISTRATION

German Registry for Clinical Trials DRKS00024154. Registered on February 1, 2021.

Psychosocial distress and associated factors among adult cancer patients at oncology: a case of Ethiopia

Background

Psychosocial distress is a chronic burden for cancer survivors, which impacts both their quality of life and their oncologic prognosis. Although the national cancer prevention and control program in Ethiopia has made efforts in cancer prevention, control, and management by implementing the national cancer control plan 2016-2020, there was no enough evidence about psychosocial distress among adult cancer patients. So, it is critical to understand the magnitude of psychosocial distress and the factors that contribute to it.

Objective

The purpose of this study was to assess the prevalence of psychosocial distress and associated factors among adult cancer patients at oncology units in the Amhara regional state, Ethiopia. 2022.

Methods

A multicenter institution-based cross-sectional study was conducted among a sample of 605 adult cancer patients from 30 April to 22 June 2022. A systematic random sampling technique was employed to select the study units. In addition, data were collected through interviewers administered questionnaires by using the validated and pretested tools. Distress was assessed using the Questionnaire on Stress in Cancer Patients Revised 10. Both bivariable and multivariable logistic regression was used to describe the association between dependent and independent variables. Independent variable with p < 0.25 in the bivariable logistic regression analyses were entered into multivariable logistic regression model. Variables with p < 0.05 in the multivariable logistic regression analyses were considered as statistically significant associated factors of psychosocial distress.

Result

A total of 593 adult cancer patients took part in this study with mean age of 46.86 ± 14.5 years. The overall prevalence of psychosocial distress was 63.74%. Variables such as being female [AOR = 1.98, 95% confidence interval (CI): 1.24-3.17], patients who lives in rural areas (AOR = 2.3, 95% CI: 1.49-3.54), community-based health insurance utilization (AOR = 0.34, 95% CI: 0.23-0.51), patients on chemotherapy treatment (AOR = 2.72, 95% CI: 1.38-5.39), patients with comorbidity (AOR = 3.2, 95% CI: 1.67-6.10), and symptom burdens such as severe fatigue (AOR = 1.65, 95% CI:1.09-2.39) and severe nausea (AOR = 2.07, 95% CI: 1.43-3.00) were statistically associated with psychosocial distress.

Conclusion and recommendation

In general, the findings of this study showed a relatively high magnitude in which around two-thirds of patients experienced psychosocial distress. It is better to establish and enforce the integration and coordination of psychosocial oncology service programs at national level with parallel guidelines and policies.

Treatment-seeking behavior and barriers to mental health service utilization for depressive symptoms and hazardous drinking: The role of religious and traditional healers in mental healthcare of Northwest Ethiopia

Understanding mental healthcare seeking and associated factors is essential for planning mental health services. This study aimed to assess treatment seeking and barriers to care for depressive symptoms and hazardous drinking in a community sample of Northwest Ethiopia. A cross-sectional study was conducted to screen 1,728 participants for depressive symptoms (n = 414) and hazardous drinking (n = 155). Participants were asked whether they had sought mental healthcare. We also assessed the barriers to seeking mental healthcare. Logistic regression was used to identify associated factors. Among people with depressive symptoms, 14.3%, 15.5%, and 19.6% sought treatment from healthcare settings, non-healthcare settings, or any sources, respectively. Religious places (39.5%) were the most helpful treatment sources. People with low levels of internalized stigma (adj OR = 3.00 [1.41, 6.42]) and positive attitudes towards mental illness (adj OR = 2.84 [1.33, 6.07]) were nearly threefold more likely to seek depression treatment. No participants with hazardous drinking sought treatment from healthcare settings, and only 1.3% had sought help from families/friends. Over 97% of participants with depressive symptoms and hazardous drinking reported at least one barrier to treatment-seeking from a healthcare setting. Religious and traditional healers were as important as healthcare settings for treatment-seeking.

A mixed-methods evaluation of the impacts of an online Carer wellbeing and connection program

Objective

To evaluate a facilitated, 90-min session, delivered for four weeks, Online Carer Wellbeing and Connection Program in Victoria, Australia.

Methods

One hundred and three carers took part in the evaluation. Eighty-six completed both pre- and post-program surveys evaluating program impacts on psychological distress, perceived loneliness, and social support. Qualitative interviews were conducted (n = 76) post-program for experiential data.

Findings

Paired samples t-tests showed significant decreases between pre- and post-program for psychological distress (M = 25.10, SD = 7.08; M = 22.00, SD = 6.57; t(85) = 4.88, p = 0.000), perceived loneliness (M = 6.69, SD = 1.89; M = 6.14, SD = 1.76; t(85) = 3.45, p = 0.000) and perceived social support (M = 8.31, SD = 2.48; M = 8.83, SD = 2.21; t(85) = -2.54, p = 0.013). Thematic analysis identified positive experiences and the mechanisms of action (or the ingredients for program success) as: 1. Delivery by a trained facilitator; 2. Provision of respite for person being cared for during meetings; 3. Technical assistance; 4. Online modality; 5. Inclusivity; 6. Diversity of experience; 7. Shared understanding; 8. Safety; 9. Emotional release; 10. Reflection, and; 11. Self-care practices.

Innovation

A model illustrating the mechanisms of action based on the findings of the mixed-methods evaluation is presented to support wider implementation and translation.

Conclusion

The online program effectively reduced psychological distress and loneliness and improved carer wellbeing.

The influence of social support on sleep and fatigue level among patients receiving hemodialysis in Saudi Arabia: a cross-sectional correlational design

Background

Patients on hemodialysis (HD) are more likely to experience sleep problems and fatigue that may affect their health outcomes. Management of these patients with social support may improve their sleep quality and fatigue as well as their health.

Aim

This study aimed to assess the influence of social support on sleep quality and fatigue levels among HD patients.

Methods

A cross-correlational study was conducted among 260 conveniently sampled HD patients from four dialysis centers in Hail and Al-Qassim cities of Saudi Arabia from Jun 2022 to January 2023. Besides sociodemographic data, the Pittsburgh Sleep Quality Index (PSQI), the Multidimensional Assessment of Fatigue (MAF) and the Oslo Social Support Scale (OSSS-3) were used to assess sleep quality, fatigue levels and social support, respectively. Chi-square test was used to determine the association between categorical variables, while Pearson's correlation coefficient was used to test the correlation between sleep quality, fatigue, and social support.

Results

Poor sleep and high fatigue were significantly higher in older patients compared to younger patients (p <0.001), while strong social support was significantly lower in older patients than younger and middle-aged ones (p = 0.001). On the other hand, poor sleep and high fatigue were significantly higher in males than females (p = 0.022 and p <0.001, respectively), while strong social support was significantly higher in females than males (p <0.001). Married patients showed significantly poorer sleep than single ones (p = 0.019), but single patients received significantly stronger social support. Retired patients showed significantly poorer sleep, higher fatigue and weaker social support than other groups (p <0.001). There was a significant negative correlation between fatigue and sleep quality among HD patients, where patients with more fatigue had poorer sleep (r = -0.510, p <0.001). A significant positive correlation was found between social support and sleep quality, where patients with stronger social support had more normal sleep (r = 0.415, p <0.001). However, a significant negative correlation was found between social support and fatigue, where patients with stronger social support had lower levels of fatigue (r = -0.479, p <0.001).

Conclusion

Saudi patients on HD who have stronger social support have better sleep quality and reduced fatigue levels than those with less social support. There is a need to design and implement intervention studies with structured social support programs, and to evaluate their effectiveness on improving sleep and reducing fatigue among HD patients.

Adherence to Clinical Practice Guidelines for Non-ST Elevation Acute Coronary Syndrome in the Emergency Department: Exploring the Role of Social, Healthcare-system, and Clinical Determinants

OBJECTIVES

The aim of this study was to assess adherence to the European Society of Cardiology 2020 non-ST elevation acute coronary syndrome (NST-ACS) guidelines, identify factors affecting this compliance, and explore the link between adherence and adverse cardiac outcomes.

METHODS

This prospective cohort study was conducted in a tertiary-level academic hospital between January 2022 and January 2023. Patients diagnosed with NST-ACS in the emergency department (ED) were included. The primary outcome measured was the rate of adherence to the guidelines, and secondary outcomes were factors affecting this adherence in the ED and its association with 28-day adverse cardiac outcomes.

RESULTS

Of the 298 patients included, guideline adherence was achieved in 32.2% in the ED. The highest compliance was observed in performing a 12-lead electrocardiogram (ECG) within 10 minutes (99.7%), while the lowest was found for obtaining additional right and posterior ECG leads when ongoing ischemia was suspected (42.3%). Factors associated with better adherence included the experience level of the treating physician, the presence of cardiac-quality chest pain, initial ischemic ECG findings, higher initial troponin levels, and advanced history, electrocardiogram, age, risk factors, and troponin score and Charlson comorbidity index. Complete guideline adherence over 28 days was achieved in 19.1% of patients and was found to be significantly associated with lower rates of adverse cardiac outcomes.

CONCLUSIONS

Adherence to NST-ACS guidelines was generally low but was associated with improved patient outcomes. This study highlighted the importance of various factors associated with guideline adherence. Future research should explore further barriers to guideline adherence and develop targeted interventions.

The Relative Role of Family Affluence and Social Support on Depression and Self-Esteem among Adolescents in Nigeria: a Cross-Sectional Study

OBJECTIVES

To assess the relative importance of social support and family affluence in depression and self-esteem among adolescents in Calabar, Nigeria.

METHODS

This cross-sectional study was conducted among adolescent students in Calabar, Nigeria. Using stratified random sampling, 332 students were selected for participation. The Family Affluence Scale (FAS), Oslo Social Support Scale (OSS), Becks Depression Inventory (BDI) and Rosenberg Self-Esteem Inventory (RSES) were administered. To facilitate comparisons, the sample was divided into four groups: those with low OSS and low FAS scores, those with low OSS and high FAS scores, those with high OSS and low FAS scores, and those with high scores in both OSS and FAS. Groups were compared using the Kruskal-Wallis Test. Linear regression analysis was conducted to determine the predictors of depression and self-esteem. All analyses were performed using IBM SPSS version 21.

RESULTS

Respondents with low levels of social support, irrespective of family affluence, had significantly higher depression scores and significantly lower self-esteem scores (P< 0.05). In linear regression analyses, social support (95%CI [-1.35,-0.58]) and female gender (95%CI [1.49,5.29]) emerged as predictors of depression, while social support (95%CI [0.25,0.64]) and age (95%CI [-0.79,-0.11]) emerged as predictors of self-esteem. Affluence did not predict depression or self-esteem.

CONCLUSIONS

Social support is of greater relative importance in depression and self-esteem in our study. In developing nations with lean resources, enhanced social support might buffer against the effect of low socio-economic status on mental health.