Psychological distress mediated the effects of self-stigma on quality of life in opioid-dependent individuals: A cross-sectional study

A systematic review and meta-analysis of psychosocial interventions for persons with comorbid anxiety and substance use disorders

BACKGROUND & AIMS

Anxiety and substance use disorders are highly comorbid and represent two of the leading causes of disease burden globally. Psychosocial interventions are important treatment options for people with co-occurring anxiety and substance use (A-SUD). To date, few reviews have assessed the efficacy of psychosocial treatments for patients with A-SUD. This systematic review and meta-analysis aims to synthesize this literature and assess the efficacy of psychosocial interventions among patients with A-SUD.

METHODS

We searched all relevant records published until March 2023 in Medline, EMBASE, PsycINFO, CINAHL and Google Scholar. Two authors extracted and reconciled relevant data and assessed risk of bias. Random effects models were used to calculate effect sizes using Hedges' g for post treatment and follow-up time points. Main outcomes of the review were anxiety, alcohol use, and use of other substances. We examined effects on depression as a secondary outcome since it commonly co-occurs with A-SUD.

RESULTS

Psychosocial interventions for co-occurring A-SUD showed moderate effects on anxiety (g = 0.44), alcohol (Hedges' g = 0.29), and other substance use (g = 0.38) at post intervention. Large effects were observed on depression (g = 0.88) at post intervention with high heterogeneity. These effects were maintained at follow-up for anxiety (Hedges' g = 0.38), other substances (g = 0.44), and depression (g = 0.50). Moderation analyses for demographic factors, intervention characteristics, community level factors, anxiety reduction, and alcohol use reduction, were non-significant.

CONCLUSIONS

The current meta-analysis investigated the effects of psychosocial interventions on patients with anxiety and co-occurring SUD. The analyses indicated promising moderate-sized effects of treatment on anxiety, alcohol, all other drug use, and depression. The findings point to important avenues for psychosocial treatment while highlighting critical gaps in knowledge to be addressed in future research.

Somebody to Lean on: Understanding Self-Stigma and Willingness to Disclose in the Context of Addiction

Substance use self-stigma is a barrier to treatment and can negatively impact individuals' well-being and treatment engagement. Given the mixed findings in previous research and the limited specific investigation into the concept of self-stigma within the context of opioid misuse, examining factors associated with self-stigma in the context of opioid use disorder (OUD) is warranted. The current study examines the influence of individual-level factors (race, sex, urban/rural status, support group attendance) on self-stigma and willingness to disclose opioid use. Data for this study were from a larger study of OUD-related stigma among adults in Pennsylvania, U.S. The current study included participants who indicated a personal past or current history with OUD were included (n = 84). Exploratory factor analysis and multiple indicators, multiple causes (MIMIC) model were used to explore the associations between demographic factors (i.e., sex, age, race/ethnicity, urban/rural status), attendance at mutual support groups, and self-stigma factors. Results indicated that sex and attendance at mutual support groups significantly predicted levels of self-stigma. Women and individuals with no previous experience attending mutual support groups endorsed lower levels of self-stigma. Additionally, attendance at mutual support groups predicted willingness to self-disclose past and present opioid use. Individuals who reported no history of attending mutual support groups demonstrated less willingness to disclose past and present OUD use compared to participants who were support group attendees. The current research findings enhance the understanding of OUD-related self-stigma by examining its relationship with individual-level factors, disclosure, and attendance to mutual support groups. The results offer insights into the influence of sex and support group attendance on self-stigma and disclosure. These findings have significant clinical implications for developing future interventions and promoting health policy changes.

Stigma by association among alcohol and other drug and harm reduction workers: Implications for workplace outcomes

INTRODUCTION

The negative attitudes people hold towards those who use alcohol or other drugs (AOD) can also affect the people who work with this community, leading to lowered productivity and wellbeing. The impact of this stigma by association in the AOD and harm reduction sector is particularly significant because workers may have lived experience of AOD use and identify strongly with their client group. This study aimed to examine how stigma by association among health workers in the AOD/harm reduction sector relates to workplace outcomes. A secondary aim was to explore how lived experience influences experiences of stigma by association.

METHODS

The research used a cross-sectional survey design and data collection occurred in 2023. Australian AOD/harm reduction workers (n = 228) completed an online survey assessing stigma by association as well as various workplace outcomes measures.

RESULTS

Participants who reported experiencing more stigma by association experienced poorer workplace wellbeing, higher burnout and greater intentions to leave the AOD/harm reduction field. Experiences of stigma by association were unrelated to job satisfaction. Additional analyses revealed that participants with lived experience reported higher levels of job satisfaction and lowered intentions to leave the sector, but findings of stigma by association and its impacts on workplace outcomes did not differ from those without lived experience.

DISCUSSION AND CONCLUSIONS

Identifying staff experiences of stigma by association and developing support and advocacy mechanisms to address this is likely to be key to reducing these experiences and ultimately to increasing positive workplace outcomes for AOD and harm reduction staff.

Opioid Overdoses and Take-Home Naloxone Interventions: Ethnographic Evidence for Individual-Level Barriers to Treatment of Opioid Use Disorders in Rural Appalachia

Introduction: Research indicates that take-home naloxone (THN) is saving lives across rural Appalachia, but whether it also results in treatment for opioid use disorders (OUDs) remains unclear. This study involves a detailed qualitative analysis of interviews with 16 individuals who had overdosed on opioids 61 times to understand why a THN intervention does not routinely lead to OUD treatment. Methods: This study builds upon a one-year (2018) qualitative study on community responses to opioid overdose fatalities in four adjacent rural counties in Western Pennsylvania. Using a semi-structured interview guide, 16 individuals who had experienced one or more overdoses were interviewed. Using NVivo, the transcribed audio-recorded interviews were coded, and a thematic analysis of the coded text was conducted. Findings: Findings reveal that of the 29 overdoses that included a THN intervention, only eight resulted in treatment. The analysis derives five individual-level barriers to treatment: (1) opioid dependence, (2) denial/readiness, (3) opioid withdrawal fears, (4) incarceration concerns, and (5) stigma and shame. These barriers impeded treatment, even though all the interviewees knew of treatment programs, how to access them, and in some cases had undergone treatment previously. Discussion and Conclusion: findings indicate that there is evidence that the five barriers make entering treatment after a THN intervention challenging and seemingly insurmountable at times. Recommendations based on the findings include increasing efforts to reduce stigma of OUDs in the community, including self-stigma resulting from misusing opioids, increasing informational efforts about Good Samaritan Laws, and increasing familiarity with medication-assisted treatments for OUDS.

Leveraging neuroscience education to address stigma related to opioid use disorder in the community: a pilot study

Opioid use disorder (OUD) and overdose deaths are a public health crisis. One contributing factor is stigma towards people who use opioids. We developed and conducted a public-facing, half-day educational event designed to challenge misperceptions about OUD from a contemporary neuroscience perspective. Participants engaged with three different resources on the neurobiology of addiction, and, at the end of the event, they rated its effectiveness. We also collected and compared pre- and post-event composite OUD stigma scales. Participants rated our approach and the overall event as highly effective. Additionally, OUD stigma scores were lower immediately following the event, and this decrease was primarily driven by decreased internalized stigma. Here, we demonstrate an effective proof-of-concept that an accessible, public-facing, neuroscience education event may reduce OUD stigma in the community.

Psychosocial Correlates of Motivation for Abstinence Among People Who Used Drugs After Community Rehabilitation Treatment in China: A Structural Equation Modelling

Background

Enhancing abstinence motivation of drugs is an effective strategy for the rehabilitation of people who used drugs and prevention of drug use relapse. However, little is known about its risk and protective factors. This study aimed to examine the potential intrapersonal (ie, impulsivity, depression, anxiety, sleep quality) and interpersonal factors (ie, perceived social support) of abstinence motivation among people who completed the community rehabilitation treatment.

Methods

A total of 222 participants (mean age = 43; male = 89.2%) were recruited from eleven communities located in Wenzhou, China. Data were collected using a self-reported questionnaire in counselling room settings between April and June 2021.

Results

The proportions of participants with depression, anxiety, and poor sleep quality were 38.8%, 19.5%, and 21.2%, respectively. Age and family history of physical disease were significant background factors of abstinence motivation. Impulsivity, depressive symptoms, anxiety symptoms, and poor quality of sleep were negatively associated with abstinence motivation. Perceived social support from family and important others was positively associated with abstinence motivation. Structural equation modeling fitted the data well in which impulsivity and perceived social support were both associated with abstinence motivation indirectly through mental health problems.

Conclusion

The identified psychosocial factors should be addressed in community rehabilitation treatment and follow-up service to enhance abstinence motivation and the long-term effectiveness of the treatment.

Leveraging neuroscience education to address stigma related to opioid use disorder (OUD) in the community: A pilot study

Opioid use disorder (OUD) and overdose deaths are a public health crisis. One contributing factor is stigma towards people who use opioids. We developed and conducted a public-facing, half-day educational event designed to challenge misperceptions about OUD from a contemporary neuroscience perspective. Participants engaged with three different resources on the neurobiology of addiction; at the end of the event, they rated its effectiveness. We also collected and compared pre- and post-event composite OUD stigma scales. Participants rated our approach and the overall event as highly effective. Additionally, OUD stigma scores were lower immediately following the event, and this decrease was primarily driven by decreased internalized stigma. Here, we demonstrate an effective proof-of-concept that an accessible, public-facing, neuroscience education event may reduce OUD stigma in the community.

A randomized controlled trial to improve fathering among fathers with substance use disorders: Fathering in recovery intervention

In early recovery for substance use disorders (SUDs), fathers may experience a desire to become more active in their role as a parent but may need support in using effective parenting strategies. Parent management training programs may be effective for fathers in recovery from SUD as they have been shown to improve parenting knowledge, self-efficacy, parenting practices, and child behavior, as well as decrease parent substance use. Using the Parent Management Training-Oregon model, we adapted a video-based program for text delivery to fathers in their first year of recovery from SUD, the fathering in recovery (FIR) intervention. In this pilot study, we randomized 41 fathers to control or 6 weeks of video content and three brief coaching calls and assessed outcomes in the parenting, child, and substance domains at baseline, 6-week, and 4-month follow-ups. We found FIR was effective for improving parenting knowledge, fathering efficacy, and in reducing fathers' ineffective parenting. The intervention showed promise for reducing child behavior problems. While larger studies are needed to replicate and build on these FIR findings, our data suggest that FIR holds promise for improving the lives of fathers and their families affected by SUD. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Online gaming and its effect on academic performance of Bangladeshi university students: A cross-sectional study

Background and Aims

Due to the availability of more sophisticated cell phones with top-notch gaming functions, the present generation is more active. The available literature indicates that adolescents experience a variety of psychological issues, like low self-control brought on by an addiction to mobile games. Because of this, the aim of this study is to control the prevalence of, and factors that contribute to, online gaming addiction and its effects on academic performance in Bangladeshi university students.

Methods

Convenient sampling was adopted to collect primary data from 399 Bangladeshi university students utilizing a prestructured questionnaire. Descriptive statistics, the χ 2 test, binary logistic regression, and multinomial logistic regression were also used to accomplish the study's objective.

Results

According to this study, 62.7% of students play online games over 30 h every week. The findings also show that male students are more inclined than female students to show signs of addiction. Also, regular online gaming can result in long-term problems, and that factor including age, internet access, educational background, and frequency of play can influence the likelihood of these problems. The findings shows that a lower cumulative grade point average (CGPA), less physical activity, and less study time are associated with playing online games for at least 30 h per week. Moreover, the study found that playing online games, playing for long time, and skipping class can all have an adverse effect on a student's academic performance.

Conclusions

The authors recommend that the authorities set up a good entertainment environment and take into account the findings of this article to discourage students from playing online games. Furthermore, encouragement of extracurricular activities such as sports or other pursuits is also essential in assisting Bangladeshi students in overcoming their addiction to mobile games.

Identifying the most common barriers to opioid agonist treatment in an Australian setting

BACKGROUND

Opioid use disorder is a public health concern in Australia. Opioid agonist treatment (OAT) is effective at treating and minimising harm from opioid use disorder, yet is underused in Australia due to client barriers. Although these barriers have been reported, the barriers that are most important to clients is unclear. The aim of this paper was to determine the most important OAT barriers to Australian clients.

METHODS

A cross-sectional, self-completed survey was given to 204 opioid-dependent clients who attended needle and syringe sites in Australia. Participants were given 15 OAT barrier statements, which they answered using a 5-point Likert scale (1=strongly disagree, 2=disagree, 3=neutral, 4=agree and 5=strongly agree). The Likert scale data are presented using the count method and the mean Likert scores (for the whole sample and for subgroups).

RESULTS

The two methods determined that the four most important barriers to OAT were stigma, lack of support services, no flexibility and enjoy using opioids. Furthermore, those who used prescription opioids (compared with heroin) were female or non-binary (compared with male), were not currently using OAT (compared with current OAT), were younger (compared with older) and had high dependence scores (compared with low dependence scores) were impacted more by certain OAT barriers.

CONCLUSIONS

Policies around improving support services, reducing stigma and increasing flexibility would be beneficial to reduce barriers to OAT in Australia. Second, certain groups were more vulnerable to OAT barriers, emphasising the importance to better tailor opioid treatment programs to these specific populations to increase treatment engagement.

The eleven-item Alcohol, Smoking and Substance Involvement Screening Test (ASSIST-11): Cross-cultural psychometric evaluation across 42 countries

The Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) is an instrument to screen substance-use-related health risks. However, little is known whether the ASSIST could be further shortened while remaining psychometrically sound across different countries, languages, gender identities, and sexual-orientation-based groups. The study aimed to validate a shortened 11-item ASSIST (ASSIST-11). Using the International Sex Survey data, 82,243 participants (M age = 32.39 years) across 42 countries and 26 languages completed questions from the ASSIST-11 regarding gender identity, sexual orientation, and other information. Confirmatory factor analysis (CFA) and multigroup CFA (MGCFA) evaluated the ASSIST-11's structure and tested measurement invariance across groups. Cronbach's α and McDonald's ω were used to examine the internal consistency. Cohen's d and independent t-tests were used to examine known-group validity. The ASSIST-11 was unidimensional across countries, languages, age groups, gender identities (i.e., men, women, and gender-diverse individuals), and sexual orientations (i.e., heterosexual and sexual minority individuals). Cronbach's α was 0.63 and McDonald's ω was 0.68 for the ASSIST-11. Known-group validity was supported by Cohen's d (range between 0.23 and 0.40) with significant differences (p-values<0.001). The ASSIST-11 is a modified instrument with a unidimensional factor structure across different languages, age groups, countries, gender identities, and sexual orientations. The low internal consistency of the ASSIST-11 might be acceptable as it assesses a broad concept (i.e., use of several different substances). Healthcare providers and researchers may use the ASSIST-11 to quickly assess substance-use information from general populations and evaluate the need to follow up with more detailed questions about substance use.

Longitudinal Associations Between Sluggish Cognitive Tempo and Academic Achievement in Adolescents: A Mediated Moderation Model

Sluggish cognitive tempo (SCT) was initially studied in the context of attention deficit hyperactivity disorder (ADHD), but is now recognized as a distinct disorder. Despite the growing recognition of SCT, its impact on academic achievement among adolescents remains controversial, even when controlling for the level of ADHD. This may be due to the influence of other factors such as learning engagement and emotional distress. To address this gap, we conducted a longitudinal study with a sample of 782 Chinese senior high school students, measuring their SCT, learning engagement, and emotional distress at Grade 10 (Time1, T1) to predict their academic achievement evaluated based on final exams scores five months later (Time2, T2). Results showed that learning engagement mediated the negative relationship between SCT and later academic achievement. Additionally, individuals with high SCT showed less impact by emotional distress on learning engagement. These findings may shed light on the complex interplay between SCT, emotional distress and learning engagement in shaping academic achievement, underscoring the potential adaptive function of SCT as a coping strategy for managing emotional challenges.

Preventing comorbidity between distress and suicidality: a network analysis

Suicidality among individuals between 10 and 35 years of age may be poised to exert massive burdens on society through decreased economic productivity and increased incidence of chronic physical conditions in the individuals' later years, thereby necessitating early prevention of suicide. While research suggests that the pathway to suicidality may begin from episodes of psychological distress, such pathway may involve complex interplays between intermediary psychiatric symptoms and external stimuli that are not easily delineated through conventional means. This study applies the network approach to psychopathology to elucidate this complexity. Comorbidity between psychological distress and suicidality in 1968 community-dwelling individuals is analyzed with regularized partial correlation networks to identify their bridge symptoms and links. Temporal relationships between symptoms are analyzed through temporal symptom network formed from 453 individuals who completed subsequent follow-up surveys. Network analysis shows that feelings of hopelessness and the presence of suicidal ideation are the strongest bridge symptoms in the comorbidity symptom network, and form the only prominent link that bridges psychological distress and suicidality. Effects of sleep troubles, anxiety, and poor social relationships on suicidal ideation appear to be mediated by hopelessness. The same observations hold among individuals with and without diagnoses of psychiatric disorders, as well as young people (10-24 year-olds) and young adults (25-35 year-olds). The edge between hopelessness and suicidal ideation remains the strongest bridge link after controlling for effects of symptoms from the previous time point. Findings here provide an evidence base for both professional training in caregiving professions as well as gatekeeper training in community members to emphasize more on how to effectively recognize hopelessness, and instill hope, in young people and young adults for various types of distress.

Using mindfulness-based stress reduction group therapy to reduce perceived stress of vulnerable women in south of Iran

Provision of educational and health services to vulnerable women in drop-in centers can reduce their traumas. Mindfulness-Based Stress Reduction (MBSR) group therapy is a psychological intervention to reduce perceived stress these women. This quasi-experimental study aimed to evaluate the effectiveness of MBSR group therapy in the perceived stress of 63 vulnerable women who referred to two drop-in centers in southeastern Iran. The participants were assigned into the intervention (n = 30) and control (n = 33) groups. The intervention group members were required to attend the MBSR intervention held in eight 90-minute sessions. Perceived Stress Scale (PSS) was administered to collect data before and one month after the MBSR. Based on the findings, the pre-test scores of perceived stress were not significantly different between the intervention (38.16 ± 6.04) and control (39.06 ± 5.30) groups (t = -0.62, p = 0.53). However, the perceived stress scores reduced significantly in the intervention group (30.20 ± 2.89) than the control group scores (37.96 ± 4.18) in the posttest (t = -8.35, P = 0.001). Given the significant reduction of perceived stress in participants after attending the MBSR group therapy, expert counselors, psychologists, and psychiatrists are recommended to conduct this therapy to reduce perceived stress in vulnerable women.

Psychological distress and quality of life among Opioid Agonist Treatment service users with a history of injecting and non-injecting drug use: A cross-sectional study in Kathmandu, Nepal

BACKGROUND

Opioid use disorder is a serious public health problem in Nepal. People who use opioids often experience psychological distress and poor quality of life. Opioid agonist Treatment (OAT) is central in managing opioid dependence. This study aimed to examine factors associated with quality of life and serious psychological distress among OAT service users in the Kathmandu Valley, Nepal and compare those who had injected opioids prior to OAT and those who had not.

METHODS

A cross-sectional study with 231 was conducted using a semi-structured questionnaire, the Nepalese versions of the Kessler 6 psychological distress scale and World Health Organization Quality of Life scale (WHOQOL-BREF). Bivariate and multivariate analyses were undertaken to examine factors associated with quality of life and serious psychological distress.

RESULTS

Most participants were males (92%) and about half had injected opioids before initiating OAT. Serious psychological distress in the past four weeks was significantly more prevalent among participants with a history of injecting (32.2%) than those who did not inject (15.9%). In the adjusted linear regression model, those who had history of injecting were likely to have lower physical quality of life compared to non-injectors. Those self-reporting a past history of mental illness were more than seven times and those with medical comorbidity twice more likely to have serious psychological distress over last four weeks. Lower socioeconomic status and a history of self-reported mental illness in the past were found to be significantly associated with lower quality of life on all four domains.

CONCLUSION

Those who had history of injecting were younger, had frequent quit attempts, higher medical comorbidity, lower socioeconomic status and remained longer in OAT services. Alongside OAT, the complex and entangled needs of service users, especially those with a history of injecting drugs, need to be addressed to improve quality of life and lessen psychological distress.

Temporal associations between problematic use of the internet and self-stigma among people with substance use disorders: A cross-lagged model across one year

Self-stigma is a common experience for people with substance use disorders (SUDs). Understanding factors associated with self-stigma may aid in intervention development. This study investigated the reciprocal relationship between three types of problematic use of the internet [PUI; i.e. problematic use of social media (PUSM), problematic smartphone use (PSPU), and problematic gaming (PG)] and self-stigma among people with SUDs. This longitudinal study involved five waves of a survey given to individuals with SUDs in Taiwan. A total of 319 participants (85% male), with a mean age of 42.2 years (SD = 8.9), were recruited. The Smartphone Application-Based Addiction Scale, Bergen Social Media Addiction Scale, Internet Gaming Disorder-Short Form, and Self-Stigma Scale-Short Form were used. No significant associations between PUI and self-stigma were found in early waves (i.e., Waves 1 and 2). The earliest significant finding was identified between Wave 2 PSPU (smartphone) and Wave 3 self-stigma. Additionally, Wave 3 PSPU (smartphone) and PG (gaming) were associated with Wave 4 self-stigma, and Wave 4 PSPU (smartphone), PG (gaming), and PUSM (social media) were associated with Wave 5 self-stigma. Therefore, all three types of PUI (internet) may elevate self-stigma at different time points for individuals with SUDs. However, the reciprocal effects between self-stigma and PUI (internet) only occurred in PUSM (social media) at a later stage (i.e., from Wave 4 to Wave 5). In conclusion, people with SUDs who have PUI (internet) are at increased likelihood of developing more self-stigma, which may then increase subsequent PUSM (social media), forming a vicious cycle.

Patient-centered quality measurement for opioid use disorder: Development of a taxonomy to address gaps in research and practice

Background: Evidence-based treatment is provided infrequently and inconsistently to patients with opioid use disorder (OUD). Treatment guidelines call for high-quality, patient-centered care that meets individual preferences and needs, but it is unclear whether current quality measures address individualized aspects of care and whether measures of patient-centered OUD care are supported by evidence. Methods: We conducted an environmental scan of OUD care quality to (1) evaluate patient-centeredness in current OUD quality measures endorsed by national agencies and in national OUD treatment guidelines; and (2) review literature evidence for patient-centered care in OUD diagnosis and management, including gaps in current guidelines, performance data, and quality measures. We then synthesized these findings to develop a new quality measurement taxonomy that incorporates patient-centered aspects of care and identifies priority areas for future research and quality measure development. Results: Across 31 endorsed OUD quality measures, only two measures of patient experience incorporated patient preferences and needs, while national guidelines emphasized providing patient-centered care. Among 689 articles reviewed, evidence varied for practices of patient-centered care. Many practices were supported by guidelines and substantial evidence, while others lacked evidence despite guideline support. Our synthesis of findings resulted in EQuIITable Care, a taxonomy comprised of six classifications: (1) patient Experience and engagement, (2) Quality of life; (3) Identification of patient risks; (4) Interventions to mitigate patient risks; (5) Treatment; and (6) Care coordination and navigation. Conclusions: Current quality measurement for OUD lacks patient-centeredness. EQuIITable Care for OUD provides a roadmap to develop measures of patient-centered care for OUD.

Prevalence and correlates of self-stigma in Post-Traumatic Stress Disorder (PTSD)

Background

Self-stigma refers to the internalisation of negative societal views and stereotypes. Self-stigma has been well-characterised in the context of mental disorders such as schizophrenia but has received little attention in relation to post-traumatic stress disorder (PTSD).

Objective

This work aimed to determine the prevalence of self-stigma in a sample of adults with PTSD and to establish factors associated with the internalisation of stigma in this population.

Method

Participants were 194 adults (mean age 46.07 (SD = 12.39); 64.4% female; 96.6% white Caucasian; residing in the UK), who self-reported a diagnosis of PTSD and currently screened positive for the disorder according to the PTSD Checklist for DSM-5 (PCL-5). Structured interviews and validated self-report questionnaires were used to ascertain clinical and sociodemographic information for analysis.

Results

The prevalence of self-stigma measured by the Internalized Stigma of Mental Illness Scale (ISMIS) was 41.2% (95% CI 34.24-48.22). There was no evidence of an association between self-stigma and gender (β = -2.975 (95% CI -7.046-1.097) p = .151), age (β = 0.007 (95% CI -0.152-0.165) p = .953), sexual trauma (β = 0.904 (95% CI -3.668-5.476) p = .697), military trauma (β = -0.571 (95% CI -4.027-7.287) p = .571). Self-stigma was associated with lower income and higher levels of anxiety (β = 5.722 (95% CI 2.922-8.522) p = <.001), depression (β = 6.937 (95% CI 4.287-9.588) p = <.000), and traumatic stress symptoms (β = 3.880 (95% CI 1.401-6.359) p = .002).

Conclusions

The results indicate that self-stigma may be a significant issue among people with a diagnosis of PTSD. Further work is needed to understand the long-term impact and to develop interventions to address the internalisation of stigma in this population.

HIGHLIGHTS

The prevalence of self-stigma among a sample of participants with PTSD was 41.2%.There was no evidence of an association between self-stigma and gender, age or sexual / military trauma.Self-stigma was associated with lower income and higher levels of anxiety, depression, and traumatic stress symptoms.

The Prevalence of Post-traumatic Stress Disorder Symptoms, Sleep Problems, and Psychological Distress Among COVID-19 Frontline Healthcare Workers in Taiwan

The adverse effect of COVID-19 pandemic among individuals has been very disturbing especially among healthcare workers. This study aims to examine the prevalence of post-traumatic stress disorder (PTSD) symptoms, sleep problems, and psychological distress among COVID-19 frontline healthcare workers in Taiwan. Hence, a total of 500 frontline healthcare workers were recruited to participate in this cross-sectional study. They responded to measures on fear of COVID-19, depression, anxiety, stress, insomnia, PTSD, perceived stigma, and self-stigma. The results indicated a prevalence rate of 15.4% for PTSD symptoms, 44.6% for insomnia, 25.6% for depressive symptoms, 30.6% for anxiety symptoms, and 23.4% for stress among the participants. There were significantly positive interrelationships between all these variables. Anxiety symptoms and fear of COVID-19 predicted PTSD whereas symptoms of anxiety, fear of COVID-19, and stress predicted insomnia. The prevalence rates of the psychological problems reveal a worrying view of mental health challenges among Taiwanese frontline healthcare workers. Anxiety symptoms and fear of COVID-19 are the common predictive factors of PTSD and sleep problems suggesting that mental healthcare services for them may help prevent future occurrence of psychological problems by allaying fears of healthcare workers. Therefore, there should be mental healthcare services for healthcare workers during the COVID-19 pandemic.

Perceived stigma and associated factors among adults with problematic substance use in Northwest Ethiopia

Background

Substance use-related problems including cigarette smoking and alcohol use are among leading preventable risk factors for premature death. However, people with these problems did not get the appropriate treatment they need. Stigma against substance use could be the potential barrier for people with problematic substance use to seek professional help. Therefore, the objective of this study was to investigate magnitude and associated factors of perceived stigma towards problematic substance use.

Methods

A total of 2400 participants were screened using the Cut down, Annoyed, Guilty, and Eye-opener (CAGE) Adapted to Include Drugs (CAGE-AID) questionnaire. We found 540 participants screened positive for problematic substance use (alcohol, hashish, tobacco and khat) and interviewed them for perceived stigma using Perceived Stigma of Substance Abuse Scale (PSAS). Logistic regression was used to examine associated factors with perceived stigma.

Results

Three hundred forty-five (63.9%) participants reported perceived stigma above the mean value of Perceived Stigma of Substance Abuse Scale (PSAS). Variables positively associated with perceived stigma were lower wealth and joblessness, history of separation from family members before age of 18 years, poly-substance misuse and awareness about economic crisis of substance use.

Conclusion

Approximately, three in five people with problematic substance use perceived having been stigmatized by others. Health planning for problematic substance use should focus on stigma.

Relationships of Family Emotional Support and Negative Family Interactions with the Quality of Life among Chinese People with Mental Illness and the Mediating Effect of Internalized Stigma

This study aimed to investigate the relationships of family emotional support and negative family interactions with the quality of life among Chinese people with mental illness. Furthermore, it examined the mediating role of internalized stigma in these relationships. One hundred and twenty-five Chinese adults with mental illness were recruited from community mental health service centers in Hong Kong. The results show that both family emotional support and negative family interactions were related to the quality of life. Negative family interactions had a stronger effect on the quality of life compared to family emotional support. Internalized stigma partially mediated the relationship between negative family interactions and the quality of life. These findings suggest that, for Chinese people with mental illness, interventions aimed at promoting quality of life should consider enhancing family emotional support and reducing negative family interactions. In addition, mental health service providers could consider using family approaches to address internalized stigma in the effort of improving the quality of life for their service users.

Prevalence and underlying factors of mobile game addiction among university students in Bangladesh

BACKGROUND

Nowadays, the youth are more engaging with their more advanced smartphones having high-quality graphics and gaming features. However, existing literature depicts that adolescents suffer from several forms of psychological problems including mental health, depression, loneliness, insomnia and low self-control due to mobile game addiction. Therefore, this study aims to find the prevalence and motivating factors for mobile game addiction among university students of Bangladesh.

METHODS

A cross-sectional survey was carried out to collect the required information from 1125 students of three universities in Bangladesh. Descriptive statistics, χ² test and ordinal regression model are employed to meet the objective of this study.

RESULTS

The findings reveal that male students are more likely to show addictive behaviours than their counterparts in the context of mobile game addiction. The results depict that loneliness, duration of using smartphones and playing mobile games, and source of entertainment are the main cause of mobile addiction. Also, more than half of the respondents (54.3%) are severely addicted to mobile games who were influenced by friends and YouTube gamers to play games. Moreover, students are suffering from several physical problems such as headaches, eye discomfort, blurry vision and ear discomfort.

CONCLUSION

Considering the findings of this paper, the authors suggest that the authorities should consider this immediately and arrange a positive entertainment environment to prevent students from mobile games. Furthermore, it is necessary to encourage students to participate in sports or other extracurricular activities that may be helpful to lessen mobile game addiction among students in Bangladesh.

Large and non-specific somatic disease burdens among ageing, long-term opioid maintenance treatment patients

Objectives

To describe and explore somatic disease burdens of ageing long-term patients in opioid maintenance treatment (OMT), a unique population emerging in countries offering OMT as a long-term treatment.

Methods

We used data from the Norwegian Cohort of Patient in Opioid Maintenance Treatment and Other Drug Treatment Study (NorComt). 156 patients enrolled for at least three of the past five years provided data during structured interviews, including on chronic conditions, somatic treatment received, mental distress (SCL-25), and treatment satisfaction. A somatic disease burden was calculated from a list measuring the recent severity of 16 somatic complaints. A hierarchical multiple linear regression analysis identified correlates of somatic disease burden.

Results

Over half of patients reported at least seven somatic complaints. Reported somatic disease burden was associated with higher mental distress, more chronic conditions, fewer years in OMT, and treatment dissatisfaction. Age was unrelated, and there were few gender differences. These five variables explained 43.6% of the variance in disease burden.

Conclusion

Long-term OMT patients experience a large range of somatic complaints, and at non-acute levels. As OMT secures longevity for opioid-dependent persons, the clinical focus must be adjusted from acute to chronic care. Providers must address how to optimize health and quality of life while in treatment, as treatment may last for many years.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13011-020-00311-4.

Measurement invariance and psychometric properties of Perceived Stigma toward People who use Substances (PSPS) among three types of substance use disorders: Heroin, amphetamine, and alcohol

BACKGROUND

The 8-item self-report Perceived Stigma toward Substance Users Scale (PSAS) is a commonly used instrument to assess stigma for people with substance use disorders. This study aimed to develop and validate the Taiwan version of the PSAS entitled Perceived Stigma toward People who use Substances - Taiwan version (PSPS-TV) among individuals with substance use disorders.

METHODS

Patients with substance use disorders (N = 300; mean age = 45.22; 255 males) completed the PSPS-TV, Self-Stigma Scale-Short (SSS-S), Taiwan Depression Questionnaire (TDQ), and Rosenberg Self-Esteem Scale (RSES). Confirmatory factor analysis was used to test the construct validity and the measurement invariance of the PSPS-TV. Concurrent validity was tested using the correlations between PSPS-TV and SSS-S, TDQ, and RSES scores.

RESULTS

The confirmatory factor analysis supported the construct validity and measurement invariance of the PSPS-TV. SSS-S scores explained 13 %, TDQ scores explained 10 % and RSES scores explained 17 % of the PSPS-TV score variance with moderate standardized coefficients (0.38, 0.32 and -0.42, respectively; all p < 0.001).

CONCLUSIONS

The PSPS-TV is an appropriate instrument to assess perceived stigma for individuals residing in Taiwan who have substance use disorders. Taiwan healthcare providers may thus consider using the PSPS-TV to assess perceived stigma relating to substance use in Taiwan.

Impact of Recreational and Medicinal Cannabinoids on Quality of Life and Occupation: A Scoping Review

IMPORTANCE

Cannabinoids are at the center of much interest and controversy within health care and society. However, minimal research has investigated the impact of cannabinoids on quality of life (QoL) and occupation.

OBJECTIVE

The literature suggests that cannabinoids may have therapeutic potential, although the available research is limited. A scoping review was conducted to address the gap in the literature regarding the impact of recreational and medicinal cannabinoids on QoL and occupational engagement.

DATA SOURCES

Databases searched included Ovid and CINAHL; sources derived from a manual search of reference lists were also used. Of the 691 articles that were identified, 22 articles met the inclusion and exclusion criteria.

STUDY SELECTION AND DATA COLLECTION

This scoping review was conducted in accordance with Arksey and O'Malley's five stages. Inclusion criteria included English language, clear focus or description on the impact of nonsynthetic cannabinoids on QoL and occupation, and published between January 2011 and May 2019. Exclusion criteria included minors, single case studies, animal studies, antineoplastic articles, and articles that only discussed or investigated effects of synthetic cannabinoids.

FINDINGS

The findings were inconclusive, and the primary research that emerged from the literature investigated the effects of cannabinoids on pain management, sleep, appetite, and other physiological functions in both recreational and medicinal users.

CONCLUSIONS AND RELEVANCE

The findings derived from the literature raised more questions, and further research is warranted. Occupational therapy practitioners have an opportunity to use their knowledge and skills to address the impact of cannabinoids on occupational engagement and QoL.

WHAT THIS ARTICLE ADDS

Practitioners have the opportunity to provide education regarding cannabis use and monitor how it affects occupational engagement and QoL for both recreational and medicinal users.

Tobacco use disorder: Prevalence, associated factors and its influence on quality of life among patients on methadone assisted treatment

Background and Objectives: Smoking is the primary cause of preventable death and is highly prevalent among patients on methadone assisted treatment (MAT). This study aims to assess the prevalence of tobacco use disorder (TUD) among patients on MAT, the factors associated with TUD, and to examine the association between TUD and quality of life.Methods: A total of 171 male patients receiving MAT in two Malaysian government hospitals were assessed for TUD, levels of nicotine dependence, relevant associated factors and quality of life using DSM-5 criteria, Fagerström Test for Nicotine Dependence (FTND), Opiate Treatment Index (OTI), Mini-International Neuropsychiatric Interview (M.I.N.I.) and World Health Organization Quality of Life (WHOQOL)-BREF.Results: The prevalence of TUD was 81.3%. Being employed was significantly associated with having a TUD. Among the patients with TUD, the mean FTND score was 3.8 (SD ± 2.0). Being younger, having poorer social function, and presence of current opioid dependence were significantly correlated with higher FTND scores. There was no significant difference in the quality of life between patients with and without TUD. Following multiple linear regression analysis, being unmarried and poor health status were the two factors that significantly predicted a lower quality of life in all four domains of WHOQOL-BREF.Conclusions: Given the high prevalence of TUD among methadone-assisted patients, smoking cessation treatment should be integrated into the MAT program in Malaysia. Also, addressing patients' marital and health issues during MAT can be instrumental in improving their quality of life.

Psychological Quality of Life in People with Physical Disability: The Effect of Internalized Stigma, Collective Action and Resilience

PURPOSE

The main objective of this study was to examine the role of social identification, collective action and resilience in reducing the negative consequences of internalized stigma on the psychological quality of life of people with physical disability using path analysis. We propose a model with two paths: the first through social identification and collective action and the second via resilience.

METHOD

A total of 288 Spanish people with physical disability aged between 18 and 82 years (46.4% males; mean [SD] of age = 45.1 [12.3] responded to the questionnaire. Data were collected for three months through an online survey.

RESULTS

The tested model adequately fit the data. We found that the relationship between internalized stigma and the psychological quality of life of people with physical disability was mediated by resilience. However, neither social identification nor collective action mediated the association between internalized stigma and quality of life among our participants.

CONCLUSIONS

The results confirmed the negative association between internalized stigma and quality of life in the population with physical disability. The results show that some interactive processes, such as resilience, may contribute to decreasing the negative effects of internalized stigma. In contrast, no effects of identification with the group or collective action intention were found.

Psychological Pathway from Obesity-Related Stigma to Depression via Internalized Stigma and Self-Esteem among Adolescents in Taiwan

The objective of this research was to examine the pathway from public stigma, to perceived stigma, to depression in adolescents via internalized stigma. Adolescents in grade 7 through 9 from a junior high school in Changhua County in Taiwan completed self-administered surveys from March to July in 2018. Adolescents were asked questions regarding depressive symptoms, obesity-related perceived stigma, and internalized stigma. Structural equation modeling was used to fit the pathway model. The pathway was first analyzed with the full sample and then stratified by actual and perceived weight status. Our final analytic sample consisted of 464 adolescents. The pathway model suggested an acceptable model fit. Perceived weight stigma (PWS) was significantly associated with internalized stigma regardless of actual or self-perceived weight status. Internalized stigma was significantly associated with anxiety for both actual (β = 0.186) and self-perceived nonoverweight (non-OW) participants (β = 0.170) but not for overweight (OW) participants (neither actual nor self-perceived). For OW adolescents, perceived weight stigma was associated with anxiety. However, the internalization process did not exist. It may be that the influence of perceived weight stigma is larger than internalized stigma on anxiety. It may also be that the level of internalization was not yet high enough to result in anxiety.

Self-Esteem Mediates the Relationships Between Social Support, Subjective Well-Being, and Perceived Discrimination in Chinese People With Physical Disability

Background: Disabilities have a negative effect on mental health and individuals with such conditions are especially susceptible to mental disorders. Previous research has established that in normal population, social support is significantly correlated with subjective well-being (SWB) through mediating variables; however the internal mechanism underlying this in people with physical disability remains unclear. This study aims to examine whether self-esteem and perceived discrimination play a mediating role in the relationship between social support and SWB in a sample of people with physical disability in China. Methods: A total of 210 people with physical disability of Chinese ethnicity were recruited to complete a series of questionnaires. This included the Chinese Social Support Rating Scale (CSSRS), Rosenberg Self-esteem Scale (RSES), Disability Discrimination Perception Questionnaire (DDPQ), and the Chinese Happiness Inventory (CHI). Path analysis was implemented on the data. Results: The model showed excellent fit to data: χ 2 = 2.314, p > 0.05; root-mean-square error of approximation (RMSEA) = 0.079; standardized root-mean residual (SRMR) = 0.035; comparative fit index (CFI) = 0.989; and Tucker-Lewis index (TLI) = 0.936. The results showed that self-esteem significantly mediated the relationship between social support and SWB, and perceived discrimination in people with physical disability. However, there is no mediating effect of perceived discrimination between social support and SWB. Conclusion: These findings demonstrate that self-esteem may be a critical resource in mediating the relationships between social support, SWB, and perceived discrimination in people with physical disability.