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Alqahtani JS, Arowosegbe A, Aldhahir AM, Alghamdi SM, Alqarni AA, Siraj RA, AlDraiwiesh IA, Alwafi H, Oyelade T. Prevalence and burden of loneliness in COPD: A systematic review and meta-analysis. Respir Med 2024; 233:107768. [PMID: 39142595 DOI: 10.1016/j.rmed.2024.107768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 08/05/2024] [Accepted: 08/10/2024] [Indexed: 08/16/2024]
Abstract
BACKGROUND Loneliness poses significant public health concerns on a global scale. Being alone and lacking social connections have been proven to impact prognosis and response to treatment in different diseases, including COPD. Yet, the prevalence and burden of loneliness on COPD outcomes remain unclear. METHODS Various relevant databases were systematically searched in March 2024. The quality of the studies included was assessed using a modified Newcastle-Ottawa Scale. The random effect model was used to compute the pooled prevalence and associated 95 % confidence intervals (95%CI) of loneliness and living alone in COPD patients. RESULTS After reviewing 256 studies, 11 studies, including 4644 COPD patients, met the inclusion criteria and were included in the systematic review. Of the included studies, 5/11 (45.5%) reported the prevalence of loneliness or lone living among COPD patients and were included in the meta-analysis. The prevalence of loneliness and lone living among COPD patients was 32% (95% CI = 16%-48%) and 29% (95% CI = 16%-41%), respectively. The Three-item UCLA loneliness scale was the most often used loneliness assessment tool (5/11, 45.5%). Loneliness and lone living were associated with poor outcomes, including emergency department visits, readmissions, depression, and reduced pulmonary rehabilitation response. CONCLUSION Despite one-third of COPD patients experiencing loneliness, researchers have not consistently documented its impact on COPD outcomes. More studies are needed to assess the impact of loneliness on COPD and how to mitigate the negative effects on patients' outcomes.
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Affiliation(s)
- Jaber S Alqahtani
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, 34313, Saudi Arabia.
| | - Abayomi Arowosegbe
- School of Arts & Creative Technologies, University of Bolton, Bolton, BL3 5AB, United Kingdom; Information School, University of Sheffield, Sheffield, S10 2SJ, United Kingdom
| | - Abdulelah M Aldhahir
- Respiratory Therapy Department, Faculty of Applied Medical Sciences, Jazan University, Jazan, 45142, Saudi Arabia
| | - Saeed M Alghamdi
- Respiratory Care Program, College of Applied Medical Sciences, Umm Al-Qura University, Makkah, 24382, Saudi Arabia
| | - Abdullah A Alqarni
- Department of Respiratory Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
| | - Rayan A Siraj
- Respiratory Therapy Department, King Faisal University, Al-Ahsa, 31982, Saudi Arabia
| | - Ibrahim A AlDraiwiesh
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dammam, 34313, Saudi Arabia
| | - Hassan Alwafi
- Faculty of Medicine, Umm Al Qura University, 21514, Mecca, Saudi Arabia
| | - Tope Oyelade
- UCL Division of Medicine, London, United Kingdom
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Floris G, Godar SC, Braccagni G, Piras IS, Ravens A, Zanda MT, Huentelman MJ, Bortolato M. The sinking platform test: a novel paradigm to measure persistence in animal models. Neuropsychopharmacology 2024; 49:1373-1382. [PMID: 38396257 PMCID: PMC11251282 DOI: 10.1038/s41386-024-01827-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/21/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024]
Abstract
Persistence is the propensity to maintain goal-directed actions despite adversities. While this temperamental trait is crucial to mitigate depression risk, its neurobiological foundations remain elusive. Developing behavioral tasks to capture persistence in animal models is crucial for understanding its molecular underpinnings. Here, we introduce the Sinking Platform Test (SPT), a novel high-throughput paradigm to measure persistence. Mice were trained to exit a water-filled tank by ascending onto a platform above water level. Throughout the training, mice were also occasionally exposed to "failure trials," during which an operator would submerge a platform right after the mouse climbed onto it, requiring the mouse to reach and ascend a newly introduced platform. Following training, mice were subjected to a 5-min test exclusively consisting of failure trials. Male and female mice exhibited comparable persistence, measured by the number of climbed platforms during the test. Furthermore, this index was increased by chronic administration of fluoxetine or imipramine; conversely, it was reduced by acute and chronic haloperidol. Notably, six weeks of social isolation reduced SPT performance, and this effect was rescued by imipramine treatment over the last two weeks. A 4-week regimen of voluntary wheel running also improved persistence in socially isolated mice. Finally, comparing transcriptomic profiles of the prefrontal cortex of mice with high and low SPT performance revealed significant enrichment of immediate-early genes known to shape susceptibility for chronic stress. These findings highlight the potential of SPT as a promising method to uncover the biological mechanisms of persistence and evaluate novel interventions to enhance this response.
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Affiliation(s)
- Gabriele Floris
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
- Center for Substance Abuse Research, Temple University, Philadelphia, PA, USA
- Department of Neural Sciences, Temple University, Philadelphia, PA, USA
| | - Sean C Godar
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Giulia Braccagni
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Ignazio S Piras
- Neurogenomics Division, Translational Genomics Research Institute (TGen), Phoenix, AZ, USA
| | - Alicia Ravens
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, UT, USA
| | - Mary T Zanda
- Department of Psychiatry, School of Medicine, Yale University, New Haven, CT, USA
| | - Matthew J Huentelman
- Neurogenomics Division, Translational Genomics Research Institute (TGen), Phoenix, AZ, USA
| | - Marco Bortolato
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Utah, Salt Lake City, UT, USA.
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Jesus MD, Ware D, Meanley S, Brennan-Ing M, Okafor CN, Shoptaw S, Haberlen S, Stosor V, Friedman MR, Plankey M. Disrupting the Path from Depression to Loneliness: Multilevel Resilience among Older Sexual Minority Men with and without HIV. AIDS Behav 2024:10.1007/s10461-024-04416-w. [PMID: 39046610 DOI: 10.1007/s10461-024-04416-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/05/2024] [Indexed: 07/25/2024]
Abstract
Existing studies examining resilience among sexual minority men (SMM) have been limited by only analyzing 1 level of resilience. We therefore investigated the impact of multiple levels of resilience on the bidirectional relationship between loneliness and depression symptoms among older SMM. Loneliness, depression symptoms, and multilevel resilience scores were collected across 3 time points (October 2016 to March 2017 [T1]; October 2017 to March 2018 [T2]; and October 2018 to March 2019 [T3]) among 1,264 SMM aged 40 years and older living with and without HIV. Longitudinal mediation models were used to test the mediating effect of the multilevel resilience factors at T2 on the bidirectional relationship between loneliness and depression symptoms, adjusting for sociodemographic covariates. The multilevel resilience factors were negatively associated with loneliness and depression symptoms at T1. The individual-level global resilience factor was associated with decreased odds of depression symptoms (odds ratio [OR] = 0.50; 95% CI, 0.32-0.78), while the interpersonal-level relationship confidence (OR = 0.43; 95% CI, 0.24-0.77) and reliability (OR = 0.36; 95% CI, 0.15-0.84) factors were associated with decreased odds of loneliness at T3. The total effect of loneliness at T1 on depressive symptoms at T3 was β = 0.20 (95% CI, 0.11-0.28) and was reduced to β = 0.08 (95% CI, -0.04 to 0.20) after the inclusion of the multilevel resilience factors. The total effect of depressive symptoms at T1 on loneliness at T3 was similar (β = 0.21; 95% CI, 0.13-0.28) with the direct effect of β = 0.01 (95% CI, -0.08 to 0.11) after the inclusion of the multilevel resilience factors. Regarding specific indirect effects, individual-level global resilience (depression symptoms at T3 only) as well as the interpersonal-level relationship reliability and confidence (loneliness at T3 model only) factors were statistically significant. Multilevel resilience factors mediated the bidirectional relationship between loneliness and depression symptoms. Mental health interventions should consider implementing resilience-informed strategies that mitigate depression symptoms and loneliness among older SMM.
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Affiliation(s)
- Maria De Jesus
- Department of Environment, Development and Health, School of International Service and Center on Health, Risk, and Society, American University, 4400 Massachusetts Avenue NW, Washington, DC, 20016, USA.
| | - Deanna Ware
- Department of Medicine, Georgetown University Medical Center, Washington, DC, USA
| | - Steven Meanley
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, USA
| | - Mark Brennan-Ing
- Department of Geriatrics, Brookdale Center for Healthy Aging, City University of New York, New York City, NY, USA
| | - Chukwuemeka N Okafor
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, USA
| | - Steve Shoptaw
- Department of Family Medicine, University of California, Los Angeles, CA, USA
| | - Sabina Haberlen
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins, Baltimore, MD, USA
| | - Valentina Stosor
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - M Reuel Friedman
- Department of Infectious Diseases and Microbiology, School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - Michael Plankey
- Department of Medicine, Division of General Internal Medicine, Georgetown University, Washington, DC, USA
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Yuan M, He Y, Wang F, Wen X, Tong Y, Zhu D, Wang G, Su P. Multi-level factors associated with psychological resilience in the face of adverse childhood experiences among Chinese early adolescents. CHILD ABUSE & NEGLECT 2024; 153:106861. [PMID: 38797118 DOI: 10.1016/j.chiabu.2024.106861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 05/10/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) are pervasive and exert enduring negative effects on health throughout one's life. A better understanding of resilience among adolescents with ACEs exposure is crucial to enhance their mental health; however, comprehensive and multifaceted analyses of its associated factors are limited. OBJECTIVE This study aimed to investigate multi-level correlates of psychological resilience in Chinese early adolescents exposed to ACEs. PARTICIPANTS AND SETTING In a sample of 5724 middle school students, 65.5 % (n = 3749; 49.1 % females; Mage = 13.57, SD = 0.96) reported ACEs during their primary school period and were finally included in this study. METHOD Both linear regression and network models were conducted to explore correlates of capacity- and outcome-oriented resilience at the individual (i.e., five personality traits, emotional release, and loneliness), family (i.e., family support and relationships with the mother and father), and school levels (i.e., peer support, teacher support, and relationships with classmates and teachers). RESULTS Linear regression analysis revealed that all correlates were associated with capacity- (β ranged from -0.271 to 0.503, PFDR < 0.001 for all) and outcome-oriented resilience (β ranged from -0.516 to 0.229, PFDR < 0.001 for all). Similarly, network analysis revealed that neuroticism, conscientiousness, loneliness, emotional release, extraversion, and the relationship with the mother were directly associated with both capacity- (weights ranged from 0.029 to 0.179) and outcome-oriented resilience (weights ranged from 0.024 to 0.396). However, openness, peer and family support, and relationships with classmates and teachers were directly associated with capacity-oriented resilience (weights ranged from 0.020 to 0.201). CONCLUSIONS This study identified the shared and unique associated factors for capacity- and outcome-oriented resilience in the face of ACEs and demonstrated the complex interactions between these factors, which can guide tailored interventions to enhance resilience among Chinese early adolescents with ACEs exposure. Further longitudinal studies may endeavor to confirm our results.
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Affiliation(s)
- Mengyuan Yuan
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei 230032, Anhui, China
| | - Yuheng He
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei 230032, Anhui, China
| | - Fan Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei 230032, Anhui, China
| | - Xue Wen
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei 230032, Anhui, China
| | - Yingying Tong
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei 230032, Anhui, China
| | - Dongxue Zhu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei 230032, Anhui, China
| | - Gengfu Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei 230032, Anhui, China; Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei 230032, Anhui, China.
| | - Puyu Su
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No.81 Meishan Road, Hefei 230032, Anhui, China; Key Laboratory of Population Health Across Life Cycle, Anhui Medical University, Ministry of Education of the People's Republic of China, No 81 Meishan Road, Hefei 230032, Anhui, China; Anhui Provincial Key Laboratory of Population Health and Aristogenics, No 81 Meishan Road, Hefei 230032, Anhui, China.
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5
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Sanzo' S, Tizzoni F, Previtali SC, Berardinelli A, Nobile M, Molteni M, Manzoni M, Tarabelloni A, Russo A, Delle Fave A, D'Angelo MG. Psychosocial resources and psychopathology among persons with neuromuscular disorders during the COVID-19 pandemic. BMC Psychol 2024; 12:243. [PMID: 38685111 PMCID: PMC11059641 DOI: 10.1186/s40359-024-01742-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 04/21/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic substantially affected the lives of persons with inherited neuromuscular disorders (INMD), causing disruption in clinical and support services. While several studies have investigated mental health, distress and psychosocial resources in the general population during the pandemic, little is known about the experience of persons with INMD. METHODS This study was aimed to fill this gap by jointly investigating both psychopathological symptoms and psychosocial resources - specifically, resilience and perceived social support - among persons with INMD during the pandemic, taking into account demographic and clinical factors. Between April and December 2020, 59 participants with INMD (aged 15-59, 71.2% M) completed a questionnaire collecting demographic and clinical data, the Multidimensional Scale of Perceived Social Support, the Resilience Scale for Adults, and the Achenbach System of Empirically Based Assessment. RESULTS Overall, participants showed good levels of resilience and perceived social support. A minority of participants reported clinically relevant psychopathological symptoms, 28.81% for anxiety and depression. Most psychopathological symptoms were negatively correlated with resilience (-0.347 < r < - .420), but not significantly associated with social support. Consistent with previous studies, regression analyses highlighted that participants with Duchenne muscular dystrophy were more prone to report anxious and depressive symptoms (B = 1.748, p = .028, OR = 5.744), and participants with myotonic dystrophy, attention problems (B = 2.339, p = .006, OR = 10.376). Resilience emerged as a potential predictor of lower anxious-depressive symptoms (B=-1.264, p = .012, OR = 0.283). CONCLUSIONS The findings suggest the importance to investigate psychosocial resources in addition to psychopathology among persons with INMD, and to design interventions supporting resilience as a protective factor for mental health promotion.
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Affiliation(s)
- Silvia Sanzo'
- Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy
| | - Federica Tizzoni
- Child Psychopathology Unit, Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - Stefano C Previtali
- Neuromuscular Repair Unit, Inspe and Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Angela Berardinelli
- Child and Adolescence Neurology Unit, National Neurological Institute C. Mondino Foundation IRCCS, Pavia, Italy
| | - Maria Nobile
- Child Psychopathology Unit, Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Italy.
| | - Massimo Molteni
- Child Psychopathology Unit, Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - Martina Manzoni
- Child Psychopathology Unit, Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - Arianna Tarabelloni
- Child Psychopathology Unit, Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - Annamaria Russo
- Unit of Rehabilitation of Rare Diseases of the Central and Peripheral Nervous System, Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Italy
| | - Antonella Delle Fave
- Department of Pathophysiology and Transplantation, University of Milano, Milan, Italy
| | - Maria Grazia D'Angelo
- Unit of Rehabilitation of Rare Diseases of the Central and Peripheral Nervous System, Scientific Institute IRCCS Eugenio Medea, Bosisio Parini, Italy
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Li L, Carrino L, Reinhard E, Avendano M. Has the UK Campaign to End Loneliness Reduced Loneliness and Improved Mental Health in Older Age? A Difference-in-Differences Design. Am J Geriatr Psychiatry 2024; 32:358-372. [PMID: 37978020 DOI: 10.1016/j.jagp.2023.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/06/2023] [Accepted: 10/07/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVE To estimate the impact of the UK nationwide campaign to End loneliness on loneliness and mental health outcomes among older people in England. DESIGN Quasi-experimental design, namely, a difference-in-differences approach. SETTING Local authorities across England. PARTICIPANTS Older adults aged 65 and over participating in waves 4-8 (2008-2017) of the English Longitudinal Study of Aging (ELSA) and waves 1-9 (2009-2019) of the UK Household Longitudinal Study (UKHLS). MAIN OUTCOME MEASURES Loneliness was measured through the UCLA Loneliness scale. A social isolation scale with components of household composition, social contact and participation was constructed. Mental health was measured by The Centre for Epidemiological Studies of Depression (CES-D) score, the General Health Questionnaire (GHQ-12) score, and the Short-Form-12 Mental Component Summary (SF-12 MCS) score. RESULTS There was no evidence of change in loneliness scores over the study period. Difference-in-differences estimates suggest that explicitly developed and implemented antiloneliness strategies led to no change in loneliness scores (estimate = 0.044, SE = 0.085), social isolation caseness (estimate = 0.038, SE = 0.020) or levels of depressive symptoms (estimate = 0.130, SE = 0.165). Heterogeneity analyses indicate that antiloneliness strategies produced little impact on loneliness or mental health overall, despite small reductions in loneliness and increases in social engagement among well-educated and higher-income older adults. The results were robust to various sensitivity and robustness analyses. CONCLUSIONS Antiloneliness strategies implemented by local authorities have not generated a significant change in loneliness or mental health in older adults in England. Generating changes in loneliness in the older population might require longer periods of exposure, larger scope of intervention or more targeted strategies.
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Affiliation(s)
- Liming Li
- Department of Global Health & Social Medicine (LL, LC, ER, MA), King's College London, London, UK; Department of Sociology (LL), University of Cambridge, Cambridge, UK.
| | - Ludovico Carrino
- Department of Global Health & Social Medicine (LL, LC, ER, MA), King's College London, London, UK; Department of Economics (LC), Business, Mathematics and Statistics, University of Trieste, Trieste, Italy
| | - Erica Reinhard
- Department of Global Health & Social Medicine (LL, LC, ER, MA), King's College London, London, UK
| | - Mauricio Avendano
- Department of Global Health & Social Medicine (LL, LC, ER, MA), King's College London, London, UK; Department of Epidemiology and Health Systems (MA), Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
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7
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Standal MI, Hjemdal O, Foldal VS, Aasdahl L, Hagen R, Fors EA, Anyan F. Measuring Resilience in Long-term Sick-listed Individuals: Validation of the Resilience Scale for Adults. JOURNAL OF OCCUPATIONAL REHABILITATION 2023; 33:713-722. [PMID: 36971989 PMCID: PMC10684425 DOI: 10.1007/s10926-023-10100-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
Return to work from long-term sick leave is influenced by personal and social factors, which can be measured by resilience, a construct that describe healthy adaptation against adversity. This study aimed to validate the validity and psychometric properties of the resilience scale for adults in a sample of long-term sick-listed individuals, and to investigate measurement invariance when compared with a university student sample. Confirmatory factor analysis was used on a sick-listed sample (n = 687) to identify the scale?s factor structure, and comparison with a university student sample (n = 241) was utilized to determine measurement invariance. Results show that a slightly modified factor structure, in accordance with previous research, achieved acceptable fit in the sick-listed sample, while comparisons with the student sample supported measurement invariance. This means that the study to a large degree support the factor structure of the resilience scale for adults in long-term sick-listed. Furthermore, the results indicate that the scale is similarly understood among long-term sick-listed as in a previously validated student sample. Thus, the resilience scale for adults can be a valid and reliable measure of protective factors in the long-term sickness absence and return to work context, and the subscale and total score can be interpreted similarly in long-term sick-listed as in other populations.
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Affiliation(s)
- Martin Inge Standal
- Faculty of Medicine and Health Sciences, Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
- NTNU Social Research, Trondheim, Norway.
| | - Odin Hjemdal
- Faculty of Social and Educational Sciences, Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Vegard Stolsmo Foldal
- Faculty of Medicine and Health Sciences, Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Lene Aasdahl
- Faculty of Medicine and Health Sciences, Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Unicare Helsefort Rehabilitation Centre, Rissa, Norway
| | - Roger Hagen
- Faculty of Social and Educational Sciences, Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Faculty of Social Sciences, Department of Psychology, University of Oslo, Oslo, Norway
- Modum Bad Research Institute, Vikersund, Norway
| | - Egil A Fors
- Faculty of Medicine and Health Sciences, Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Frederick Anyan
- Faculty of Social and Educational Sciences, Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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8
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Zhang X, Brown AM, Rhubart DC. Can Resilience Buffer the Effects of Loneliness on Mental Distress Among Working-Age Adults in the United States During the COVID-19 Pandemic? A Latent Moderated Structural Modeling Analysis. Int J Behav Med 2023; 30:790-800. [PMID: 36631701 PMCID: PMC9838440 DOI: 10.1007/s12529-022-10151-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND The profound health consequences of loneliness are well-established. However, less is known about the protective factors which may alleviate the effects of loneliness on mental health especially among working-age adults amidst the COVID-19 pandemic. We draw on the social ecology of resilience and examine whether resilience factors can buffer the effects of loneliness on mental distress. METHODS Data came from the National Well-being Survey-a national study of a demographically representative sample of U.S. working-age adults (N = 4014). We used (a) structural equation models with latent variables to examine the main effects of loneliness, psychological resilience, and perceived social support on mental distress, and (b) latent moderated structural equations to estimate the latent interaction effects. RESULTS Results revealed that (a) loneliness was positively associated with mental distress and psychological resilience was negatively related to mental distress, and (b) psychological resilience and perceived social support moderated the strength of the relationship between loneliness and mental distress. CONCLUSIONS Our study highlights the importance of psychological resilience and perceived social support as two protective factors in the relationship between loneliness and mental distress. Given that loneliness significantly predicts worse mental and physical health and higher mortality, identifying protective factors that might disrupt these connections is vital. As such, public health efforts to strengthen and expand familial and community social support networks and foster psychological resilience are urgently needed to support mental health among working-age adults during additional waves of the pandemic or future similar stressors.
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Affiliation(s)
- Xiaoyan Zhang
- Department of Human Development and Family Science, Falk College of Sport and Human Dynamics, Syracuse University, Syracuse, USA.
| | - Austin McNeill Brown
- Lerner Center for Public Health Promotion, Maxwell School of Citizenship and Public Affairs, Syracuse University, Syracuse, USA
| | - Danielle C Rhubart
- Department of Biobehavioral Health, The Pennsylvania State University, State College, USA
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Balki E, Hayes N, Holland C. The Indirect Impact of Educational Attainment as a Distal Resource for Older Adults on Loneliness, Social Isolation, Psychological Resilience, and Technology Use During the COVID-19 Pandemic: Cross-Sectional Quantitative Study. JMIR Aging 2023; 6:e47729. [PMID: 37999938 DOI: 10.2196/47729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/11/2023] [Accepted: 10/10/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND During the COVID-19 pandemic, government-mandated social distancing prevented the spread of the disease but potentially exacerbated social isolation and loneliness for older people, especially those already vulnerable to isolation. Older adults may have been able to draw from their personal resources such as psychological resilience (PR) and technology use (TU) to combat such effects. Educational attainment (EA) or early-life EA may potentially shape later-life personal resources and their impact on the effects of the pandemic lockdown on outcomes such as loneliness. The developmental adaptation model allows for the supposition that social isolation, TU, and PR may be affected by early EA in older adults. OBJECTIVE This study examined the indirect impact of EA on pandemic-linked loneliness in a sample of older adults. The developmental adaptation model was used as the conceptual framework to view EA as a distal influence on loneliness, social isolation, PR, and TU. We hypothesized that EA would predict TU and PR and have a moderating impact on social isolation and loneliness. We also hypothesized that PR and TU would mediate the effect of EA on loneliness. METHODS This was a cross-sectional observational study, in which data were gathered from 92 older adults aged ≥65 years in the United Kingdom from March 2020 to June 2021, when the country was under various pandemic-linked social mobility restrictions. The data captured demographic information including age, gender, ethnicity, and the highest degree of education achieved. The University of California Los Angeles Loneliness Scale, Connor-Davidson Resilience Scale, Lubben Social Network Index, and Technology Experience Questionnaire were used as standardized measures. Pearson correlation, moderation, and mediation regression analyses were conducted to investigate the hypotheses. RESULTS We found a higher prevalence of loneliness in older adults than in prepandemic norms. EA was correlated with greater TU and PR and moderated the impact of social isolation on loneliness. PR mediated and TU partially mediated the relationship between EA and loneliness. CONCLUSIONS Early-life EA was confirmed as a distal resource for older adults and played an indirect role in affecting loneliness levels during the pandemic. It has an impact on present-day personal resources, such as PR and TU, which affect loneliness and also moderate the impact of social isolation on loneliness. Policymakers should be aware that older adults with low levels of EA may be more vulnerable to the harmful impacts of loneliness when isolated by choice.
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Affiliation(s)
- Eric Balki
- Department of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Niall Hayes
- The Directorate, Nottingham Trent University, Nottingham, United Kingdom
| | - Carol Holland
- Department of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
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10
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Lie SØ, Wisting L, Stedal K, Rø Ø, Friborg O. Stressful life events and resilience in individuals with and without a history of eating disorders: a latent class analysis. J Eat Disord 2023; 11:184. [PMID: 37845712 PMCID: PMC10577902 DOI: 10.1186/s40337-023-00907-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 10/04/2023] [Indexed: 10/18/2023] Open
Abstract
BACKGROUND Eating disorders (EDs) are associated with a range of stressful life events, but few have investigated protective factors that may affect these associations. The current study used mixture modelling to describe typologies in life stress exposure and availability of protective resources in individuals with and without eating disorders (EDs). METHODS A case - control sample (n = 916) completed measures of stressful life events, resilience protective factors, emotion regulation, and symptoms of EDs, depression and anxiety. We conducted latent class analyses to identify subgroups of stress exposure and profile analyses of emotional regulation and resilience. The resulting two latent variables were combined to explore effects on ED status and symptomatology, depression, and anxiety as distal outcome variables. RESULTS We identified four classes of stressful life events (generally low, some abuse/bullying, sexual/emotional assaults, and high adversity). For protective resources, we identified six profiles that ranged from low to higher levels of protection with variations in social/family resources. The latent protection variable contributed more strongly to the distal outcomes than the latent stress variable, but did not moderate the latent stress and distal outcome variable relationships. Profiles characterized by lower protective resources included higher proportions of individuals with a lifetime ED, and were associated with higher scores on all symptom measures. CONCLUSIONS Intra- and interpersonal protective resources were strongly associated with lifetime EDs and current mental health symptom burden after accounting for stressful event exposure, suggesting protective factors may be useful to target in the clinical treatment of patients with ED.
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Affiliation(s)
- Selma Øverland Lie
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956, 0424, Nydalen, Oslo, Norway.
| | - Line Wisting
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956, 0424, Nydalen, Oslo, Norway
| | - Kristin Stedal
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956, 0424, Nydalen, Oslo, Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956, 0424, Nydalen, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Oddgeir Friborg
- Faculty of Health Sciences Department of Psychology, UiT - The Arctic University of Norway, Tromsø, Norway
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11
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Balki E, Hayes N, Holland C. Loneliness and older adults: psychological resilience and technology use during the COVID-19 pandemic-a cross sectional study. FRONTIERS IN AGING 2023; 4:1184386. [PMID: 37434741 PMCID: PMC10331608 DOI: 10.3389/fragi.2023.1184386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 06/12/2023] [Indexed: 07/13/2023]
Abstract
Introduction: This study investigated how psychological resilience influenced greater technology use among older adults, and whether they moderated the impact of social isolation on loneliness during the COVID-19 pandemic. We also explored whether technology mediates the impact of psychological resilience on loneliness. To explain the relationship between variables, the research drew upon the socio-emotional selective theory, which posits the notion that older adults are more focused on current and emotionally important relationships and goals concerning emotional regulation goals such as psychological well-being. Methods: Using a cross-sectional observational design, data were collected from 92 residents aged 65 to 89 in England from March 2020 to June 2021. Participants completed the Connor-Davidson Resilience Scale, Technology Experience Questionnaire, UCLA Loneliness Scale, and Lubben Social Network Index. Pearson correlation, mediation and moderation analyses were conducted to investigate the hypotheses. Results: Most participants experienced moderate to severe levels of loneliness, displaying higher levels than pre-pandemic. Psychological resilience predicted greater technology use, and lower levels of loneliness. Technology was found to mediate the relationship between psychological resilience and loneliness. Neither technology use, nor psychological resilience was found to moderate the impact of social isolation on loneliness. Discussion: Findings suggested that strategies directed towards screening older adults for psychological resilience levels and low technology experience may help identify those most at risk for adapting poorly when exposed to stressors in situations like the Covid-19 pandemic. Early interventions can be initiated to increase psychological resilience and technology use, including empirical interventions, that may help decrease loneliness, especially in times of elevated risks for loneliness.
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Affiliation(s)
- Eric Balki
- Centre for Ageing Research, Division of Health Research, Lancaster University, Lancaster, United Kingdom
| | - Niall Hayes
- The Directorate, Nottingham Trent University, Nottingham, United Kingdom
| | - Carol Holland
- Centre for Ageing Research, Division of Health Research, Lancaster University, Lancaster, United Kingdom
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12
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Zhang K, Burr JA, Mutchler JE, Lu J. Online engagement, resilience, and loneliness among older people during the COVID-19 pandemic. Soc Sci Med 2023; 329:116026. [PMID: 37354867 DOI: 10.1016/j.socscimed.2023.116026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND AND OBJECTIVES The COVID-19 pandemic exacerbated the public health concerns of social isolation and loneliness for older people who are vulnerable due to their health conditions and more restrictive social measures. However studies revealed that many older adults demonstrated high resilience and remained emotionally stable during the pandemic, particularly those who had a broad engagement with online technology that could compensate for their isolation. Yet, little empirical research has examined explicitly the association between online engagement and loneliness among older adults, and the role resilience played in this relationship during the pandemic. This study contributed to the literature by addressing these research gaps. RESEARCH DESIGN AND METHODS This study investigated the relationships between online engagement (sum of involvement in 31 online activities), resilience (sum of positive experiences and personal growth during COVID-19) and loneliness (mean of 11-items from the revised version of the UCLA loneliness scale) among community-dwelling older people (aged 60+), using national survey data from the 2020 Health and Retirement Study (HRS) collected during the COVID-19 pandemic (N = 3,552). RESULTS AND CONCLUSION Online engagement was negatively associated with levels of loneliness (β = -0.080, 95% CI [-0.118, -0.047]), and this association was partially mediated by levels of resilience (β = -0.023, 95% CI [-0.031, -0.016]. The findings suggested that a broad integration of online technology into daily-life may have helped older people combat loneliness during the pandemic, and resilience could be one important mechanism that linked this association.
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Affiliation(s)
- Kunyu Zhang
- Department of Gerontology, McCormack Graduate School of Policy and Global Studies University of Massachusetts, Boston, MA, 02125, USA.
| | - Jeffrey A Burr
- Department of Gerontology, McCormack Graduate School of Policy and Global Studies University of Massachusetts, Boston, MA, 02125, USA.
| | - Jan E Mutchler
- Department of Gerontology, McCormack Graduate School of Policy and Global Studies University of Massachusetts, Boston, MA, 02125, USA.
| | - Jiehua Lu
- Department of Sociology, Center for Healthy Aging and Development Studies, Peking University, Beijing, 100871, China.
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13
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Kıllı NE, Bakır ÇN, Canbaz AA, Karabulut K, Mutlu A, Karataşlı Ş, Tekin S, Kayı İ. Resilience during the COVID-19 pandemic among people living with HIV: A cross-sectional study. Int J STD AIDS 2023:9564624231156202. [PMID: 36820627 PMCID: PMC9950817 DOI: 10.1177/09564624231156202] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND This study aims to investigate the factors shaping resilience during the COVID-19 pandemic among people living with HIV (PLWH). METHODS A total of 341 participants were included in this cross-sectional study. The online survey included scales of resilience, depression & anxiety, loneliness, social support, COVID-19 fear, stress, and sociodemographic information. RESULTS Logistic regression test results showed loneliness (OR = 2.548, 95% CI = 1.251, 5.189), social support (OR = 2.217, 95% CI = 1.148, 4.279), income (OR = 2.581, 95% CI = 1.217, 5.472), sexual orientation (OR = 2.707, 95% CI = 1.004, 7.300), age (OR = 1.044, 95% CI = 1.006, 1.083) and COVID-19 fear (OR = 0.891, 95% CI = 0.840, 0.944) were statistically significant factors associated with resilience among PLWH. CONCLUSION In conclusion, reducing COVID-19 fear by providing the correct information about the COVID-19 pandemic, fortifying the level of social support satisfaction, as well as minimising the level of loneliness have the potential to improve psychological resilience among PLWH.
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Affiliation(s)
- Nesrin Ecem Kıllı
- School of Medicine, Koç University, İstanbul, Turkey,Nesrin Ecem Kıllı, School of Medicine, Koç University, Rumelifeneri Campus, Rumelifeneri Way, İstanbul 34450, Turkey.
| | | | | | | | - Ali Mutlu
- School of Medicine, Koç University, İstanbul, Turkey
| | | | - Süda Tekin
- Department of Clinical Microbiology and Infectious Diseases, Koç University School of Medicine, İstanbul, Turkey
| | - İlker Kayı
- Department of Public Health, Koç University School of Medicine, İstanbul, Turkey
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14
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Yan HY, Lin HR. Resilience in Stroke Patients: A Concept Analysis. Healthcare (Basel) 2022; 10:2281. [PMID: 36421605 PMCID: PMC9691242 DOI: 10.3390/healthcare10112281] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 11/02/2022] [Accepted: 11/11/2022] [Indexed: 05/01/2024] Open
Abstract
(1) Background: Resilience enables individuals to develop positive coping strategies when faced with adversity. However, knowledge on resilience in stroke patients remains limited, and resilience assessment methods continue to be debated. (2) Aim: To perform a concept analysis of resilience in stroke patients. (3) Methods: The Walker and Avant approach to concept analysis was adopted. Searches were performed in the PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System Online (MEDLINE), and Chinese Electronic Periodical Services (CEPS) databases and grey literature using the keywords "stroke patient", "resilience", and "concept analysis". (4) Results: The defining attributes of resilience in stroke patients were classified into internal personality traits and external environmental support. Antecedents included physical, mental, and familial and social impairments caused by the disease, and the consequences were good adaptation, which included active cooperation with rehabilitation activities, positive thinking, goal setting, and harboring hope for the future. (5) Conclusion: Resilience is of a diverse and complex nature. Optimism and positivity, problem-solving ability, and familial and social support may assist in re-adjusting or restoring the balance between physical and mental health when a stroke patient faces adversity. Key factors affecting resilience in stroke patients should be further investigated in future research to assist in the development of effective interventional treatment measures.
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Affiliation(s)
- Huey-Yeu Yan
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City 112303, Taiwan
- Department of Nursing, University of Kang Ning, Taipei City 114311, Taiwan
| | - Hung-Ru Lin
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei City 112303, Taiwan
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15
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Pineda CN, Naz MP, Ortiz A, Ouano EL, Padua NP, Paronable JJ, Pelayo JM, Regalado MC, Torres GCS. Resilience, Social Support, Loneliness and Quality of Life during COVID-19 Pandemic: A Structural Equation Model. Nurse Educ Pract 2022; 64:103419. [PMID: 35952471 PMCID: PMC9301165 DOI: 10.1016/j.nepr.2022.103419] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/28/2022] [Accepted: 07/18/2022] [Indexed: 11/26/2022]
Abstract
AIM To determine the parsimonious model of the interrelationships of personal resilience, social support, loneliness and quality of life (QoL) and to identify the mediating effect of loneliness among nursing students amidst the pandemic. BACKGROUND The coronavirus 2019 (COVID-19) pandemic led to control measures which increased loneliness among students due to disrupted social connections and sudden shift to virtual learning. During these changes, resilience and social support can significantly influence how learners deal with pandemic-related stresses thus, minimizing loneliness and enhancing QoL. Although studies posited the influence of resilience and social support with loneliness and QoL, these were conducted prior the COVID-19 pandemic wherein loneliness and feelings of isolation play a crucial part. DESIGN Correlational, theory testing using covariance-based structural equation modeling METHODS: A total of 550 nursing students from a comprehensive university in Manila, Philippines were recruited from September to October 2021 and answered four standardized, validated scales. RESULTS A good and parsimonious model (x2/df = 2.84, RMSEA = 0.058, GFI = 0.999, CFI = 0.999, PNFI = 0.048) highlighted the mediating effect of loneliness between social support, personal resilience and QoL. While personal resilience positively influenced the physical and psychological domains of QoL, social support positively affected the social relationships and environmental domains. Loneliness was a strong, negative predictor of the psychological and social domains of QoL and had a moderate, negative effect on the physical domain. Personal resilience also mediated the influence of social support on loneliness and QoL. CONCLUSION Social support and personal resilience positively affected QoL, while loneliness had a negative effect. Through the mediation of loneliness, the effects of social support on QoL decreases. However, the mediation of resilience further decreases loneliness and improves QoL. The presented model assists nurse educators and administrators in developing strategies to enhance social support, resilience and QoL among students while mitigating the negative effects loneliness during the pandemic. TWEETABLE ABSTRACT Loneliness and Resilience are mediators of student nurses' quality of life during COVID-19 pandemic. Social support is the common predictor.
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Affiliation(s)
| | - Moira Pauline Naz
- College of Nursing, University of Santo Tomas, España, Manila 1015, Philippines.
| | - Annedel Ortiz
- College of Nursing, University of Santo Tomas, España, Manila 1015, Philippines.
| | - Ella Louisse Ouano
- College of Nursing, University of Santo Tomas, España, Manila 1015, Philippines.
| | | | - Jaime Jr Paronable
- College of Nursing, University of Santo Tomas, España, Manila 1015, Philippines.
| | - Janella Mae Pelayo
- College of Nursing, University of Santo Tomas, España, Manila 1015, Philippines.
| | | | - Gian Carlo S Torres
- College of Nursing, University of Santo Tomas, España, Manila 1015, Philippines.
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Examining Differences, Relationships, and Predictors for Loneliness in an Adult Population: The Roles of Personal Characteristics, Place of Residence, Leisure Activities, Mental Health, and Social Outcomes. SOCIAL SCIENCES 2022. [DOI: 10.3390/socsci11090425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Loneliness is associated with poor mental and social outcomes globally. The literature suggests an association between loneliness and personal characteristics, place of residence, and leisure activities. However, the current literature has produced inconsistent findings and has focused largely on older adults. This study is one of the first to examine the differences, relationships, and predictors of loneliness in an adult population, and the roles of personal characteristics, place of residence, leisure activities, mental health, and social outcomes. A cross-sectional online survey was undertaken. A sample of 155 adults responded, with a mean age of 34.5 years (SD = 13.2), and with 54.1% identifying as female. An analysis revealed experiences of loneliness across the sample. In addition, age was moderately associated with loneliness, while psychological distress, depressive symptoms, and social networks were significantly associated with loneliness. Depressive symptoms were a positive predictor for loneliness, and social networks were a negative predictor for loneliness. This study has confirmed findings from previous research and provided new information on loneliness, which can guide future research and interventions to prevent or support people who suffer from loneliness.
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17
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Investigation of Loneliness and Social Support in Patients with Eating Disorders: A Case-Control Study. PSYCHIATRY INTERNATIONAL 2022. [DOI: 10.3390/psychiatryint3020012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Loneliness and, to a lesser degree, social support are considered under-researched topics in the literature on eating disorders (ED). This study attempted to expand the relevant body of research by examining loneliness in combination with social support in ED patients and in healthy controls (HC). Binge-eating problems, emotional eating, resilience, anxiety, and depression symptoms were also assessed. Thirty-two patients with ED and twenty-nine HC completed the following measures: UCLA Loneliness Scale, Social Support Questionnaire—Short Form, Binge Eating Scale, Emotional Eating Scale, Connor–Davidson Resilience Scale, Hospital Anxiety and Depression Scale, and the Eating Disorder Examination Questionnaire. Eating-disorder patients showed higher levels of loneliness and lower levels of social support—both in terms of perceived availability and satisfaction—than HC. Anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) subgroups did not differ significantly on either of these variables. In ED patients, loneliness was only correlated with Social Support Satisfaction (negatively) and depressive symptomatology (positively). Patients with ED appear to be lonelier and less satisfied with their social support compared to HC. We found similar levels of loneliness and social support between AN, BN, and BED sufferers. Decreased social support satisfaction and elevated symptoms of depression could account for ED patients’ high levels of loneliness.
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18
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Hathaway CA, Bloomer AM, Oswald LB, Siegel EM, Peoples AR, Ulrich CM, Penedo FJ, Tworoger SS, Gonzalez BD. Factors associated with self-reported social isolation among patients with cancer during the COVID-19 pandemic. Health Psychol 2022; 41:311-318. [PMID: 35324248 PMCID: PMC9053063 DOI: 10.1037/hea0001172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE We aimed to identify patient-level demographic and behavioral characteristics associated with higher social isolation among patients with cancer throughout the coronavirus disease 2019 (COVID-19) pandemic. METHOD Moffitt Cancer Center patients seen on or after January 1, 2015, had a last known alive vital status, a valid e-mail address, and were 18-89 years old, were emailed a survey regarding social isolation. We collected information on age, sex, race, ethnicity, marital status, smoking, self-reported cancer diagnosis, cancer treatment, and perceived life changes due to the COVID-19 pandemic. We calculated a COVID-19 risk mitigation score by summing the frequency of risk mitigation behaviors (e.g., mask wearing). Social isolation was assessed with the self-reported Patient-Reported Outcomes Measurement Information System (PROMIS) Social Isolation Short Form. Logistic regression models compared characteristics of participants reporting higher versus lower social isolation (T-scores >60 vs. ≤60). RESULTS Most participants (N = 9,579) were female (59.2%), White (93.0%), and non-Hispanic (92.5%). Participants at greater odds of higher social isolation were younger (per 10 years decrease odds ratio [OR] = 1.36, 95% confidence interval, CI [1.30, 1.43]), female (vs. male OR = 1.54, 95% CI [1.36, 1.74]), unmarried (vs. married OR = 1.83, 95% CI [1.62, 2.08]), current smokers (vs. never OR = 2.38, 95% CI [1.88, 3.00]), reporting more risk mitigation behaviors (per 1 SD; OR = 1.33, 95% CI [1.24, 1.42]), and more perceived life changes (vs. little/no change; OR = 2.64, 95% CI [2.08, 3.35]). CONCLUSIONS We identified younger age, females, unmarried, current smokers, more risk mitigation behaviors, and more perceived life changes increased odds of social isolation for patients with cancer during the COVID-19 pandemic. This can inform identification of patients with cancer at higher risk of social isolation for targeted mitigation strategies. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | - Amanda M. Bloomer
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Laura B. Oswald
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
| | - Erin M. Siegel
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Anita R. Peoples
- Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Cornelia M. Ulrich
- Huntsman Cancer Institute, Salt Lake City, Utah
- Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Frank J. Penedo
- Departments of Psychology and Medicine, University of Miami, Coral Gables, FL, USA
| | - Shelley S. Tworoger
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Brian D. Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, USA
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19
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Can Rehabilitation in Nature Improve Self-Perceived Interpersonal Problems? A Matched-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063622. [PMID: 35329308 PMCID: PMC8949583 DOI: 10.3390/ijerph19063622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/02/2022] [Accepted: 03/17/2022] [Indexed: 11/21/2022]
Abstract
Self-perceived interpersonal problems are of central concern for researchers and individuals; they are at the basis of psychopathology and cause for subjective distress. In this study, we examine whether a group-based rehabilitation program in nature may reduce self-perceived interpersonal problems in a heterogeneous group of men declining participation in traditional rehabilitation offers. The intervention consisted of weekly meetings in nature, taking place over the course of nine weeks. Through a matched-control study including 114 participants in the intervention group and 39 in a treatment as usual group participating in traditional rehabilitation offers, we found that there was no statistically significant development in self-perceived interpersonal problems in the nature-based rehabilitation offer. Though promising with regards to a number of mental challenges, including relational challenges, nature-based group-rehabilitation may require a more elaborate and thoroughgoing intervention, including e.g., a therapist and more time to be an effective intervention against interpersonal problems. We conclude that perhaps due to the fundamental aspect of self-perceived interpersonal problems, exposure to nature, and being in a group of men in a similar situation for the duration that this intervention lasted, may not be enough to address such underlying perceptions of self.
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Associations Between Outcome Resilience and Sociodemographic Factors, Childhood Trauma, Personality Dimensions and Self-Rated Health in Middle-Aged Adults. Int J Behav Med 2022; 29:796-806. [PMID: 35246825 DOI: 10.1007/s12529-022-10061-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND We examined how sociodemographic factors, childhood trauma, personality dimensions, and self-rated health were associated with outcome resilience and how different stressors influenced depressive symptoms. METHODS An outcome resilience score for 213 adults was derived by means of a residualization approach. Associations between outcome resilience and sociodemographic and personality factors were evaluated using linear regression. In addition, associations between log-transformed depressive symptoms and the stressors were analyzed using multiple linear regression. A Pearson correlation coefficient between self-rated health and outcome resilience was also computed. RESULTS Higher neuroticism was negatively and higher conscientiousness was positively associated with outcome resilience. Better self-rated health was associated with higher outcome resilience. Somatic disease events and onset of chronic mental disorders were associated with more depressive symptoms. CONCLUSIONS Outcome resilience was significantly related to neuroticism, conscientiousness, and self-rated health. Strong associations between depressive symptoms and the stressors somatic disease event, and chronic mental disorder were observed.
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21
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Montoro-Fernández E, Cárdenas-Gutiérrez AR, Bernal-Guerrero A. Entrepreneurial Resilience: A Case Study on University Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2589. [PMID: 35270281 PMCID: PMC8910058 DOI: 10.3390/ijerph19052589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 02/16/2022] [Accepted: 02/21/2022] [Indexed: 12/04/2022]
Abstract
Entrepreneurial resilience refers to the capacity to face, overcome and project oneself after suffering life events with a negative impact. Emerging adulthood and the characteristics of university life facilitate the occurrence of stressful situations that can affect well-being. The aim of this phenomenological research is to explore the strategic components of entrepreneurial resilience and how young university students have shaped their entrepreneurial resilience after experiencing negative life events. The present research is a multiple case study that was developed through a mixed methodology. The methodological sequence was quantitative and qualitative, with priority given to the qualitative phase of the research. Ten university students with high levels of resilience were interviewed. The data were analysed using thematic analysis. The results indicate that resilience is built through intrapersonal and exopersonal processes. These processes make up a set of strategic dimensions related to entrepreneurial behaviour that are used for the construction of personal projects.
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Affiliation(s)
- Elisabet Montoro-Fernández
- Department of Communication and Education, Faculty of Social and Human Sciences, University Loyola Andalucía, 41704 Seville, Spain
| | - Antonio Ramón Cárdenas-Gutiérrez
- Department of Theory and History of Education and Social Pedagogy, Faculty of Education Sciences, Seville University, 41013 Seville, Spain; (A.R.C.-G.); (A.B.-G.)
| | - Antonio Bernal-Guerrero
- Department of Theory and History of Education and Social Pedagogy, Faculty of Education Sciences, Seville University, 41013 Seville, Spain; (A.R.C.-G.); (A.B.-G.)
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22
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Öztürk A, Kundakçı N. Loneliness, Perceived Social Support, and Psychological Resilience as Predictors of Internet Addiction: A Cross-Sectional Study with a Sample of Turkish Undergraduates. PSYCHIAT CLIN PSYCH 2021; 31:449-456. [PMID: 38765644 PMCID: PMC11079665 DOI: 10.5152/pcp.2021.21115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 10/28/2021] [Indexed: 05/22/2024] Open
Abstract
Background This article examined the perceived social support, psychological resilience, and loneliness as predictors of internet addiction among university undergraduate students in Turkey. Methods Participants were 1028 university students (408 males and 620 females) from state university in Turkey. Measuring tools included the Descriptive Information Form, Internet Addiction Scale, Multidimensional Perceived Social Support Scale, UCLA Loneliness Scale, and Brief Resilience Scale. Results According to the findings of the study, positive correlation between internet addiction and perceived social support (r = 0.078, P < .01) and loneliness (r = 0.525, P < .001) shows a significant relationship. There was a significant and inverse relationship between psychological resilience and internet addiction (r = -0.498, P < .001). It was found that perceived social support, loneliness, and psychological resilience explained 34% of the total variance in internet addiction. Regression analysis showed that perceived social support (β = 0.061, P < .01), loneliness (β = 0.574, P < .001), and psychological resilience (β = -1.128 P < .001) significantly predicted internet addiction. Regression analysis revealed that psychological resilience negatively predicted internet addiction, while perceived social support and loneliness positively predicted internet addiction. Conclusion : Based on the findings, improving students' psychological resilience can be an effective way to reduce internet addiction behavior. Additionally, social activities and relevant measures should be planned to increase students' awareness of internet addiction, reduce their feelings of loneliness, and encourage them to establish positive interpersonal relationships.
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Affiliation(s)
- Ayfer Öztürk
- Department of Psychiatric Nursing, Bartin University Faculty of Health Sciences, Bartin, Turkey
| | - Necla Kundakçı
- Department of Psychiatric Nursing, Bartin State Hospital, Bartin Turkey
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Alsubheen SA, Oliveira A, Habash R, Goldstein R, Brooks D. Systematic review of psychometric properties and cross-cultural adaptation of the University of California and Los Angeles loneliness scale in adults. CURRENT PSYCHOLOGY 2021; 42:1-15. [PMID: 34785877 PMCID: PMC8586628 DOI: 10.1007/s12144-021-02494-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 12/30/2022]
Abstract
This systematic review assessed the psychometric properties and the cross-cultural adaptation of the University of California and Los Angeles Loneliness scale (UCLA-LS) in adults. A systematic search of four electronic databases (PubMed, EMBASE, Scopus, and PsycINFO) was conducted from inception until March 2021. We followed the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines for data extraction and evidence synthesis. Eighty-one studies assessed the validity and reliability of the UCLA-LS, translated into many languages, and applied across several countries/societies. Three versions of the 20-item and nine short versions of the UCLA-LS with 3 to 20 questions were identified. High-quality evidence supported the internal structure of the UCLAs: 4, 6, 7 and 10, while low-to moderate-quality evidence supported the construct validity of the UCLAs: 3, 4, 6, 8, 16 and 20. Moderate-quality evidence supported the test-retest reliability of version 3 UCLA-20 with excellent interclass coefficients values of 0.76-0.93. The UCLAs: 4, 6, 7 and 10 had the most robust internal structure and may therefore be the most useful for informing clinicians and social psychologists engaged in assisting those with loneliness. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s12144-021-02494-w.
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Affiliation(s)
- Sanaa A. Alsubheen
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, IAHS Building Room 430, Hamilton, ON L8S 1C7 Canada
| | - Ana Oliveira
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, IAHS Building Room 430, Hamilton, ON L8S 1C7 Canada
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON Canada
- Lab3R – Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Aveiro, Portugal
- Institute for Biomedicine (iBiMED), University of Aveiro, Aveiro, Portugal
| | - Razanne Habash
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON Canada
| | - Roger Goldstein
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON Canada
- Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Dina Brooks
- School of Rehabilitation Science, McMaster University, 1400 Main Street West, IAHS Building Room 430, Hamilton, ON L8S 1C7 Canada
- Department of Respiratory Medicine, West Park Healthcare Centre, Toronto, ON Canada
- Department of Physical Therapy and Rehabilitation Science, University of Toronto, Toronto, ON Canada
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24
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Nowland R, Thomson G, McNally L, Smith T, Whittaker K. Experiencing loneliness in parenthood: a scoping review. Perspect Public Health 2021; 141:214-225. [PMID: 34286652 PMCID: PMC8580382 DOI: 10.1177/17579139211018243] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS Chronic loneliness is experienced by around a third of parents, but there is no comprehensive review into how, why and which parents experience loneliness. This scoping review aimed to provide insight into what is already known about parental loneliness and give directions for further applied and methodological research. METHODS Searches for peer-reviewed articles were undertaken in six databases: PsycINFO, Medline, CINAHL, Embase, Web of Science and Scopus, during May 2019 to February 2020. We searched for English studies which examined loneliness experienced during parenthood, including studies that involved parents with children under 16 years and living at home and excluding studies on pregnancy, childbirth or postbirth hospital care. RESULTS From 2566 studies retrieved, 133 were included for analysis. Most studies (n = 80) examined the experience of loneliness in specific groups of parents, for example, teenage parents, parents of a disabled child. Other studies examined theoretical issues (n = 6) or health and wellbeing impacts on parents (n = 16) and their offspring (n = 17). There were 14 intervention studies with parents that measured loneliness as an outcome. Insights indicate that parental loneliness may be different to loneliness experienced in other cohorts. There is evidence that parental loneliness has direct and intergenerational impacts on parent and child mental health. Some parents (e.g. with children with chronic illness or disability, immigrant or ethnic minority parents) also appear to be at increased risk of loneliness although evidence is not conclusive. CONCLUSION This work has identified key gaps with further international, comparative and conceptual research needed.
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Affiliation(s)
- R Nowland
- School of Community Health and Midwifery, University of Central Lancashire Brooke Building, Preston PR2 1HE, UK
| | - G Thomson
- University of Central Lancashire, Preston, UK
| | - L McNally
- University of Central Lancashire, Preston, UK
| | - T Smith
- University of Central Lancashire, Preston, UK
| | - K Whittaker
- University of Central Lancashire, Preston, UK
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25
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Pascual-Leone A, Bartres-Faz D. Human Brain Resilience: A Call to Action. Ann Neurol 2021; 90:336-349. [PMID: 34219268 DOI: 10.1002/ana.26157] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 07/03/2021] [Accepted: 07/03/2021] [Indexed: 01/01/2023]
Abstract
At present, resilience refers to a highly heterogeneous concept with ill-defined determinants, mechanisms, and outcomes. This call for action argues for the need to define resilience as a person-centered multidimensional metric, informed by a dynamic lifespan perspective and combining observational and interventional experimental studies to identify specific neural markers and correlated behavioral measures. The coronavirus disease 2019 (COVID-19) pandemic highlights the urgent need of such an effort with the ultimate goal of defining a new vital sign, an individual index of resilience, as a life-long metric with the capacity to predict an individual's risk for disability in the face of a stressor, insult, injury, or disease. ANN NEUROL 2021.
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Affiliation(s)
- Alvaro Pascual-Leone
- Department of Neurology, Harvard Medical School, Hinda and Arthur Marcus Institute for Aging Research and Deanna and Sidney Wolk Center for Memory Health at Hebrew SeniorLife, Boston, MA, USA.,Institut Guttmann de Neurorehabilitació, Guttmann Brain Health Institute, Barcelona, Spain
| | - David Bartres-Faz
- Institut Guttmann de Neurorehabilitació, Guttmann Brain Health Institute, Barcelona, Spain.,Department de Medicina, Facultat de Medicina i Ciències de la Salut - Campus Clínic, Universitat de Barcelona, Barcelona, Spain
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26
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Mau M, Nielsen DS, Jakobsen IS, Klausen SH, Roessler KK. Mental movements: How long-distance walking influences reflection processes among middle-age and older adults. Scand J Psychol 2021; 62:365-373. [PMID: 33719040 DOI: 10.1111/sjop.12721] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 01/29/2021] [Indexed: 12/20/2022]
Abstract
By providing a distinctive room for reflection, long-distance walks can help people similar to professional counselling. To understand reflection processes' influence on mental health, a framework focusing on personal transformations, specifically through the concept of liminality, can be used. Through nine semi-structured interviews with middle-aged and older long-distance walkers, this study answers the following question: How do middle-aged and older adults experience long-distance walking, and how do their experiences influence their reflective process? Four themes emerged during the analysis: (1) overcoming strain and achieving a sense of capability; (2) simplicity in obligations and having the time to pursue emotionally difficult experiences; (3) solitariness and reflection on oneself; and (4) calmness and embracing thoughts. These findings illustrate how going on long-distance walks may be similar to entering a liminal, or transformational, space. The findings show how long-distance walks can be helpful, or perhaps even therapeutic, in situations where personal transformation is required.
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Affiliation(s)
- Martin Mau
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,Health, Social Work and Welfare Research, UCL University College, Odense, Denmark.,Health Sciences Research Centre, UCL University College, Odense, Denmark
| | - Dorthe S Nielsen
- Migrant Health Clinic, Odense University Hospital, Odense, Denmark.,Department of Geriatric Medicine, Odense University Hospital, Odense, Denmark
| | - Ida Skytte Jakobsen
- Health, Social Work and Welfare Research, UCL University College, Odense, Denmark
| | - Søren H Klausen
- Department for the Study of Culture, University of Southern, Odense, Denmark
| | - Kirsten K Roessler
- Department of Psychology, University of Southern Denmark, Odense, Denmark
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Chernova A, Frajo-Apor B, Pardeller S, Tutzer F, Plattner B, Haring C, Holzner B, Kemmler G, Marksteiner J, Miller C, Schmidt M, Sperner-Unterweger B, Hofer A. The Mediating Role of Resilience and Extraversion on Psychological Distress and Loneliness Among the General Population of Tyrol, Austria Between the First and the Second Wave of the COVID-19 Pandemic. Front Psychiatry 2021; 12:766261. [PMID: 34777068 PMCID: PMC8578839 DOI: 10.3389/fpsyt.2021.766261] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 09/27/2021] [Indexed: 01/16/2023] Open
Abstract
Background: During the first 3 weeks of the COVID-19 pandemic, the federal state of Tyrol, Austria had one of the strictest curfews in Austria and worldwide. The aim of the current study was to investigate the assumingly protective role of resilience and extraversion and its impact on mental health following such an uncertain and unpredictable situation. Methods: Between the first and the second wave of the pandemic, adult residents of Tyrol were invited to participate in an online survey. Next to the assessment of sociodemographic and COVID-19-related variables the Brief-Symptom-Checklist, the Three-Item Loneliness Scale, the Resilience Scaled, and the Big Five Inventory were used to assess psychological distress, loneliness, resilience, and extraversion. Mediation analysis was used to investigate the role of resilience and extraversion in the context of age-, sex-, and partnership- related differences in psychological distress and loneliness. Results: One hundred and forty-five participants took part in the survey (68.2% female). Overall, psychological distress and severe loneliness were more often detected in women and singles. They also were less resilient, while men and singles presented with a lower degree of extraversion. Study participants under the age of 30 experienced severe loneliness more frequently than older people, whereas psychological distress, resilience, and extraversion were comparable between age groups. Resilience significantly mediated the relationship between both study participants' sex and partnership situation on one hand and psychological distress and severe loneliness on the other. In addition, extraversion significantly mediated the relationship between participants' partnership situation and psychological distress. Discussion: Our findings suggest that women, singles, and young people may be particularly affected by the measures and sequelae of the COVID-19 pandemic. Interventions promoting resilience and extraversion among these groups are urgently needed to foster mental health. Ideally, they can be utilized at home in case of renewed mobility restrictions or quarantine in the future.
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Affiliation(s)
- Anna Chernova
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Beatrice Frajo-Apor
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Silvia Pardeller
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Franziska Tutzer
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Barbara Plattner
- Department of Psychiatry, Sanitary Agency of South Tyrol, General Hospital of Bolzano, Bolzano, Italy
| | - Christian Haring
- Department of Psychiatry and Psychotherapy B, State Hospital Hall in Tyrol, Hall in Tyrol, Austria
| | - Bernhard Holzner
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Georg Kemmler
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Josef Marksteiner
- Department of Psychiatry and Psychotherapy A, State Hospital Hall in Tyrol, Hall in Tyrol, Austria
| | - Carl Miller
- Department of Psychiatry, County Hospital Kufstein, Kufstein, Austria
| | - Martin Schmidt
- Department of Psychiatry, County Hospital Lienz, Lienz, Austria
| | - Barbara Sperner-Unterweger
- Division of Psychiatry II, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
| | - Alex Hofer
- Division of Psychiatry I, Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University Innsbruck, Innsbruck, Austria
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