Psychological Resilience and Adverse Mental Health Issues in the Thai Population during the Coronavirus Disease 2019 Pandemic

Psychometric evaluation of the multidimensional Uraemic Pruritus in Dialysis patients (UP-Dial) scale: comparison of haemodialysis and peritoneal dialysis patients with chronic pruritus

BACKGROUND

High-quality patient-reported outcome (PRO) measures for dialysis patients with chronic pruritus are urgently needed. However, no known, well-validated multidimensional tools have been investigated to measure pruritus symptoms in dialysis patients.

OBJECTIVES

To examine the psychometric properties of a multidimensional tool of chronic pruritus, the Uraemic Pruritus in Dialysis patients (UP-Dial) 14-item scale, by comparing haemodialysis and peritoneal dialysis modality.

METHODS

This validation study used data from the Thai Renal Outcomes Research-Uraemic Pruritus, a prospective, multicentre, longitudinal study. Data for this study were collected from 1 February 2019 to 31 May 2022. The adult sample of 226 haemodialysis and 327 peritoneal dialysis patients fulfilled the criteria of chronic pruritus based on the International Forum for the Study of Itch. Psychometric properties of the UP-Dial included validity and reliability, as measured across haemodialysis and peritoneal dialysis patients. Patients completed a set of anchor-based measurement tools, including global itching, Dermatology Life Quality Index (DLQI), EuroQoL-5 dimension-5 level (EQ-5D-5L), Kidney Disease Quality of Life-36 (KDQOL-36), Pittsburgh Sleep Quality Index (PSQI), global fatigue, Somatic Symptom Scale-8 (SSS-8) and Patient Health Questionnaire-9 (PHQ-9).

RESULTS

From the patient's perspective, face validity was satisfactory for both dialysis samples. Psychometric analyses of the UP-Dial for each dialysis sample had good convergent validity. Spearman rho correlations indicate a positively strong correlation (0.73-0.74) with global itching, a positively moderate correlation (0.33-0.58) with DLQI, PSQI, global fatigue, SSS-8 and PHQ-9, and a negatively moderate correlation (-0.39 to -0.58) with EQ-5D-5L and KDQOL-36. The discriminant validity was satisfactory with a group of moderate and severe burden of pruritus for both dialysis samples. For scale reliability, the UP-Dial revealed excellent internal consistency (Cronbach's α = 0.89 and McDonald's ω = 0.90) and reproducibility (intraclass correlation 0.84-0.85) for both dialysis samples. Regarding psychometric properties, no statistically significant differences between dialysis samples were observed (all P > 0.05).

CONCLUSIONS

The findings reaffirm good measurement properties of the UP-Dial 14-item scale in haemodialysis and peritoneal dialysis patients with chronic pruritus. These suggest a transferability of the UP-Dial as a PRO measure in clinical trial and practice settings.

Psychological Resilience among Orang Asli Youths in Selangor during COVID-19 and Its Associated Factors

Background

Coronavirus disease (COVID-19) has affected everyone and stress-related mental health issues affect young people more than other groups, including marginalised populations. As a result of this pandemic, society is being urged to examine indigenous psychological resilience, especially among Orang Asli (OA) communities in Malaysia. Hence, this study aims to identify factors associated with psychological resilience among OA youths of Kampung Orang Asli (KOA) in Gombak during the COVID-19 pandemic.

Method

A cross-sectional study comprising OA communities was conducted between January 2022 and September 2022 in the Gombak District, Selangor. A self-administered online questionnaire using Google Forms and a self-administered printed questionnaire was used to collect data from youths aged 18 years old-24 years old. The Malay version of Conner-Davidson Resilience Scale-25 (CD-RISC-25) was used to assess psychological resilience. Data analysis was performed using SPSS version 28.0, and multiple linear regression analyses were conducted to evaluate the associated factors and their significance level.

Result

A total of 158 participants were involved in this study. The mean score for psychological resilience was estimated at 69.28 (SD = 14.52). The social relationships domain recorded the highest mean score for quality of life (71.54, SD = 13.72). Meanwhile, the total mean score for self-esteem fell into the high-level category (35.77, SD = 4.94), and the domain of relationship and family dynamics under family environment scored the highest mean score of 18.83 (SD = 2.89). Psychological resilience was associated with youths of KOA Batu 12 (β = -14.274, P < 0.05), KOA Ulu Batu (β = -17.789, P < 0.05), less than four siblings (β = -6.495, P < 0.05), owner of residential property (β = -7.543, P < 0.05), high self-esteem (β = 0.612, P < 0.05) and good relationship and family dynamic (β = 1.391, P < 0.05).

Conclusion

Developing interventions aimed at psychological resilience determinants may assist OA youths in coping with future threats.

Mental health and resilience quotient of patients in primary care units during the widespread COVID-19 pandemic in Thailand: a cross-sectional study

BACKGROUND

The coronavirus disease 2019 pandemic impacted both the physical and mental health of individuals. The resilience quotient (RQ) is an important factor that decreases mental health problems. This study aimed to explore mental health problems and RQ in patients who visit Primary Care Units (PCU).

METHODS

A cross-sectional study was conducted on participants aged 18 to 60 years who visited the PCU of Songklanagarind Hospital from May 1, 2022, to June 31, 2022. Participants completed a self-administered questionnaire on baseline characteristics and the Primary Care Assessment, Personal Resource Questionnaire, satisfaction with life scale, Thai RQ, PHQ-9, and GAD-7, and the results were analyzed by descriptive, logistic regression, and Spearman's rank correlation.

RESULTS

Among the 216 participants, 72.2% were female, and the median age was 39 (24,51) years old. Most of them had normal RQ levels (61.1%). Of these, 4.2% and 12.1% exhibited moderate to high levels of depression and anxiety, respectively. This study found that sex (OOR 1.93; 95% CI 1.01-3.74), age (OOR 1.03; 95% CI 1.01-1.06), moderate and high social support levels (OOR 9.51; 95% CI 3.36-28.85), and a high life satisfaction level (OOR 4.67; 95%CI 1.75-13.25) were associated with RQ. Moreover, the results showed that ≥ 3 times visiting PCU (β 1.73; 95% CI 0.39-3.08), BMI (β 0.13; 95% CI 0.04-0.23) and experiencing stressful events (β 2.34; 95% CI 1.32-3.36) were positively associated with depression. Finally, experiencing stressful events (OR 4.1; 95% CI 1.09-15.47) significantly affected anxiety, however, moderate and high life satisfaction levels acted as a protective factor against anxiety (OR 0.19; 95% CI 0.07-0.54 and OR 0.03; 95% CI 0.01-0.16, respectively).

CONCLUSION

Although there were a few patients with moderate to severe levels of depression and anxiety, most of them had normal RQ levels. However, there were some patients with low RQ levels which correlated to a high risk of psychiatric diseases such as depression and anxiety. Healthcare providers should focus on interventions that enhance resilience in both proactive and defensive strategies to reduce negative mental problems during these formidable times.

Resilience, Perceived Stress from Adapted Medical Education Related to Depression among Medical Students during the COVID-19 Pandemic

The COVID-19 pandemic disrupted several routine teaching methods in clinical settings which causing psychological distress among medical students. This study aims to explore the association of perceived stress related to the adapted medical education, resilience, and depression among medical students at a medical school in northern Thailand during the COVID-19 outbreak. A total of 437 medical students were recruited in January 2022. Data were obtained using self-administered online questionnaires, including demographic data, perceived challenges in learning online classes, the Resilience Inventory (RI-9), and the Patient Health Questionnaire 9 (PHQ-9). Binary logistic regression analysis was employed to explore factors associated with depression (PHQ-9 ≥ 9). A total of 27% of the participants were identified as having depression. Logistic regression revealed that the presence of previous psychiatric conditions (ß = 2.80, p < 0.05), stress from lack of in-person contact with peers (ß = 1.48, p < 0.05), stress from lack of in-person communication with teachers (ß = 1.49, p < 0.05), and level of resilience (ß = 0.88, p < 0.001) were independently associated factors for depression among medical students. Level of resilience was negatively correlated with depressive symptoms (r = −0.436, p < 0.001). The rate of depression among medical students was higher during the pandemic. Resilience was associated with depression. Strengthening resilience might have an important implication for depression among medical students.

Health-Promoting Behaviors among Older Adults with Noncommunicable Diseases in Rural and Urban Areas during the New Normal Post-COVID-19 Era: A Structural Equation Modeling Analysis

This study aimed to develop and test a causal relationship among perceived self-efficacy (PSE), health literacy (HL), access to COVID-19 preventive material (ACPM), social networks (SN), and health-promoting behaviors (HPBs). Multistage stratified random sampling was used to recruit 250 older adults with noncommunicable diseases (NCDs) from Thai urban and rural communities. The data were collected with self-reported questionnaires. Data analyses used descriptive statistics and structural equation modeling. The results indicated that participants in urban communities had higher PSE, ACPM, HL, SN, and HPBs than rural participants. The fitness parameters of the modified model (χ2 = 71.936, df = 58, p-value = 0.103, χ2/df = 1.240; root mean square error of approximation (RMSEA) = 0.031; standardized root mean square residual (SRMR) = 0.042; goodness of fit index (GFI) = 0.964; normed-fit index (NFI) = 0.964; comparative fit index (CFI) = 0.993) indicated its suitability as the research model. HPBs were directly positively influenced by PSE (β = 0.40, p < 0.001), ACPM (β = 0.24, p < 0.001), HL (β = 0.19, p < 0.01), and SN (β = 0.01, p < 0.05). Therefore, taking all predicting variables together could explain 81.0% of the variance in HPBs. Multidisciplinary healthcare teams could use these findings to establish proper interventions or healthcare activities to increase HPBs among older adults, particularly in this era of the “new normal”.