Drug-Death Related Bereavement and Social Support

The loss of a close one to drug-related death (DRD) has been characterized as a form of stigmatized bereavement, and research has shown that there is a high risk of bereavement complications. Social support can be a buffer against bereavement complications, but because of stigma, DRD bereaved persons access to social support can be challenged. Based on data from a Norwegian sample of DRD bereaved persons (N = 252) the present study examines (1) bereaved persons' perceived access to different aspects of social support, and (2) the association between bereaved persons' experiences of societal stigma, own withdrawal, self-blame, and their perceptions of social support. Results show (1) that bereaved persons' access to contact with persons in the same situation is particularly low compared to other support aspects, and (2) that perceived stigma (4%) and own withdrawal (5%) predict variations in drug-related death bereaved persons' perception of social support.

First trans-diagnostic experiences with a novel micro-choice based concentrated group rehabilitation for patients with low back pain, long COVID, and type 2 diabetes: a pilot study

BACKGROUND

The health care is likely to break down unless we are able to increase the level of functioning for the growing number of patients with complex, chronic illnesses. Hence, novel high-capacity and cost-effective treatments with trans-diagnostic effects are warranted. In accordance with the protocol paper, we aimed to examine the acceptability, satisfaction, and effectiveness of an interdisciplinary micro-choice based concentrated group rehabilitation for patients with chronic low back pain, long COVID, and type 2 diabetes.

METHODS

Patients with low back pain > 4 months sick-leave, long COVID, or type 2 diabetes were included in this clinical trial with pre-post design and 3-month follow-up. The treatment consisted of three phases: (1) preparing for change, (2) the concentrated intervention for 3-4 days, and (3) integrating change into everyday life. Patients were taught and practiced how to monitor and target seemingly insignificant everyday micro-choices, in order to break the patterns where symptoms or habits contributed to decreased levels of functioning or increased health problems. The treatment was delivered to groups (max 10 people) with similar illnesses. Client Satisfaction Questionnaire (CSQ-8)) (1 week), Work and Social Adjustment Scale (WSAS), Brief Illness Perception Questionnaire (BIPQ), and self-rated health status (EQ-5D-5L) were registered at baseline and 3-month follow-up.

RESULTS

Of the 241 included participants (57% women, mean age 48 years, range 19-84), 99% completed the concentrated treatment. Treatment satisfaction was high with a 28.9 (3.2) mean CSQ-8-score. WSAS improved significantly from baseline to follow-up across diagnoses 20.59 (0.56) to 15.76 (0.56). BIPQ improved from: 22.30 (0.43) to 14.88 (0.47) and EQ-5D-5L: 0.715 (0.01) to 0.779 (0.01)), all P<0.001.

CONCLUSIONS

Across disorders, the novel approach was associated with high acceptability and clinically important improvements in functional levels, illness perception, and health status. As the concentrated micro-choice based treatment format might have the potential to change the way we deliver rehabilitation across diagnoses, we suggest to proceed with a controlled trial.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05234281.

A Novel Concentrated, Interdisciplinary Group Rehabilitation Program for Patients With Chronic Obstructive Pulmonary Disease: Protocol for a Nonrandomized Clinical Intervention Study

Background

Pulmonary rehabilitation has been demonstrated to be a highly effective treatment for people with chronic obstructive pulmonary disease (COPD). However, its availability is scarce worldwide, and new and innovative rehabilitation models are highly warranted. Recently, the group behind the present study published a protocol describing a novel concentrated, interdisciplinary group rehabilitation program for patients with chronic illnesses. The current paper describes an extension of this protocol to patients with COPD.

Objective

The objective of this study is to explore the acceptability of concentrated, interdisciplinary group pulmonary rehabilitation for patients with COPD. The intervention is expected to improve functional status and be highly acceptable to patients.

Methods

This study will include 50 patients aged over 40 years who fulfill the diagnostic criteria for COPD: a forced expiratory volume at the first second (FEV₁) <80% of expected and a FEV₁/forced vital capacity ratio below the lower limit of normal according to the Global Lung Function Initiative. An interdisciplinary team consisting of physicians, physiotherapists, psychologists, pharmacists, clinical nutritionists, and nurses will deliver the treatment to groups of 6 to 10 patients over 3 to 4 consecutive days with a 12-month follow-up. The intervention is divided into three distinct phases: (1) pretreatment preparation for change, (2) concentrated rehabilitation, where the patient is coached to focus on making health-promoting microchoices, and (3) integration of the changes into everyday living, aided by digital follow-up and 2 on-site clinical examinations. Statistical significance will be set at α=.05.

Results

The recruitment period will last from April 2022 until June 2023.

Conclusions

If successful, this highly novel rehabilitation format might change the way we deliver care for patients with COPD, leading to substantial societal and socioeconomic gains. The study will expand knowledge on the concentrated treatment format as a rehabilitation model for people with COPD.

Trial Registration

ClinicalTrials.gov NCT05234281; https://clinicaltrials.gov/ct2/show/NCT05234281

International Registered Report Identifier (IRRID)

PRR1-10.2196/40700

Concentrated transdiagnostic and cross-disciplinary group treatment for patients with depression and with anxiety: a pilot study

BACKGROUND

A number of treatment approaches have shown efficacy for depression and/or anxiety, yet there is a paucity of research on potentially cost-effective concentrated approaches. Based on our previous experience with concentrated treatment in disorders such as Obsessive-Compulsive Disorder and chronic fatigue, we proposed that this novel approach could be useful for other conditions, including depression and/or anxiety. As a pre-requisite for a future randomized controlled trial, the aim of this study was to investigate the acceptability, satisfaction and effectiveness of a transdiagnostic, interdisciplinary group treatment delivered during 5 consecutive days to groups of 6-10 patients with depression and/or anxiety.

METHODS

This was a non-randomized clinical intervention pilot study in line with a published protocol. Forty-two consecutively referred patients, aged 19-47 (mean age 31.7, SD = 8.12) were included and completed treatment. All had a severity of their problems that entitled them to care in the specialist public mental health care. Self-reported age when the symptoms became a problem was 20.9 years. Mean number of prior treatment courses was 2.77 (SD = 2.19; range 0-8). Acceptability was defined as the proportion of eligible patients who accepted and completed the treatment. Satisfaction was evaluated by Client Satisfaction Questionnaire-8. Secondary objectives were to assess the treatment effectiveness by questionnaires at pre-treatment, seven days post-treatment and three months follow-up.

RESULTS

The treatment was highly acceptable (91.3% accepted, all completed), and patients were highly satisfied with the treatment, including the amount. Functional impairment, as measured by Work and Social Adjustment Scale (WSAS) improved significantly (p < .0005) from "severe" (mean 25.4 SD = 6.59) to "less severe" (mean 13.37, SD = 9.43) at 3 months follow-up. Using the Generalized Anxiety Disorder Scale (GAD-7) and the Patient Health Questionnaire (PHQ-9), the effect sizes at 3 months follow-up were 1.21 for anxiety and 1.3 for depression. More than 80% reported reduced utilization of mental health care, and 67% had not used, or had used the family doctor less, for anxiety or depression. 52% had not used, or had reduced, medication for their disorder.

CONCLUSIONS

The concentrated, interdisciplinary treatment approach yielded promising results. Long-term follow up is warranted.

TRIAL REGISTRATION

This study is registered in Clinical Trials, identifier NCT05234281 and approval date 09/02/2022.

Evaluation of Novel Concentrated Interdisciplinary Group Rehabilitation for Patients With Chronic Illnesses: Protocol for a Nonrandomized Clinical Intervention Study

BACKGROUND

An aging population with a growing burden of chronic complex illnesses will seriously challenge the public health care system. Consequently, novel and efficacious treatment approaches are highly warranted. Based on our experiences with concentrated treatment formats for other health challenges, we developed a highly concentrated interdisciplinary group rehabilitation approach for chronic illnesses.

OBJECTIVE

We aim to explore the acceptability of the intervention and describe potential changes in functional impairment at follow-up.

METHODS

The cornerstones of the intervention are as follows: (1) prepare the patient for change prior to treatment, (2) focus on health promoting microchoices instead of symptoms, and (3) expect the patient to integrate the changes in everyday living with limited hands-on follow-up. The intervention will be delivered to patients with highly diverse primary symptoms, namely patients with low back pain, post-COVID-19 symptoms, anxiety and depression, and type 2 diabetes.

RESULTS

Recruitment started between August 2020 and January 2021 (according to the illness category). For initial 3-month results, recruitment is expected to be completed by the end of 2021.

CONCLUSIONS

If successful, this study may have a substantial impact on the treatment of low back pain, post-COVID-19 symptoms, anxiety and depression, and type 2 diabetes, which together constitute a major socioeconomic cost. Further, the study may widen the evidence base for the use of the concentrated treatment format in a diverse group of medical conditions.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/32216.

Mental Health During Naval Deployment: The Protective Role of Family Support

INTRODUCTION

Minor mental health problems among service members deployed in combat areas are relatively common, but social support is a protective factor. With the advent of digital communication, as well as more frequent family separations, a stable family support system may be more important than before. In this exploratory study, we aimed to test the relationship between perceived family support and the development of minor psychiatric symptoms during a 4-month naval counter piracy mission in the Gulf of Aden.

MATERIALS AND METHODS

We measured minor mental health problems with the general health questionnaire 12 (GHQ-12) and family support at three intervals, 3 weeks before deployment, 2 months into the mission, and at the end of deployment. We used mixed multilevel regression analysis to analyze the main effects of family support and time, as well as their interaction. All analyses were controlled for military rank.

RESULTS

We found that minor psychiatric symptoms increased at both midway (B = 0.51, P < 0.05) and toward the end of the mission (B = 0.72, P < 0.01). The results also showed that receiving more family support is associated with fewer psychiatric symptoms (B = -0.87, P < 0.01). Family support also moderated the development of symptoms toward the end of the mission (B = -0.73, P < 0.01). The buffering effect was such that service members with a high degree of family support experienced no increase in minor psychiatric symptoms during the deployment.

CONCLUSIONS

The results indicate that naval deployment is associated with a small increase in minor mental health problems and that having a high degree of family support buffers this effect. Efforts to increase support among military families may positively influence the wellbeing of naval sailors during combat missions.

Lean on Me: A Scoping Review of the Essence of Workplace Support Among Child Welfare Workers

Child welfare workers (CWWs) often work under conditions similar in nature to workers within safety critical organizations (SCOs). This is because most of their work surrounds child neglect, securing homes for foster children, haphazard, and intricate cases, among other things, and where making wrong decisions, inattention to details, and the likes could lead to adverse consequences especially for the kids within their care. Research has shown that employees who experience support at work often report less stress symptoms, burnout, and a host of other negative workplace experiences. Experience of support at work has also been found to boost employees' retention, job satisfaction, and productivity. Despite this development, research exploring the essence of workplace support among CWW is very scarce in the literature, and we know very little about the type of workplace support and their influence on a host of workplace outcomes, especially the negative ones like secondary traumatic stress, aggression, and violence toward CWWs. The purpose of the current scoping review was to uncover what is known about workplace support and their relationship with workplace outcomes among CWWs. The authors explored four databases and identified 55 primary studies investigating workplace support and workplace outcomes among CWWs in the review. Studies mostly framed support under three main support types of coworker/peer support, social/organizational/management support, and supervisor/leadership support. Findings showed that workplace support has a positive impact on workplace variables like job satisfaction, engagement, commitment, and reduces the risk of turnover, burnout, and other negative workplace variables. The review highlights possible directions for future research.

Dispositional resilience in treatment-seeking patients with obsessive-compulsive disorder and its association with treatment outcome

There is a lack of research on the relation between obsessive-compulsive disorder (OCD) and resilience. Dispositional resilience, as described and defined in literature on hardiness, consists of three facets, namely beliefs about having control in everyday living, having a sense of purpose or commitment, and a positive attitude toward challenges. This study explores associations between dispositional resilience (measured with the Dispositional Resilience Scale (DRS-15-R)), symptom severity, and treatment outcome in a sample of 89 patients treated with concentrated exposure therapy (cET), and compares the findings with scores from two reference groups (students and soldiers). The patient group had significantly lower resilience scores than the two reference groups. Weak correlations were observed between dispositional resilience and OCD symptoms. Differences in dispositional resilience were weakly related to remission status at follow-up (odds ratio of 1.11). Furthermore, resilience improved from pre- to post-treatment (Cohen's d of 0.65). Our results imply that patients' initial resilience score does not hinder nor facilitate treatment effects to a great extent in this format of ERP treatment.

The effect of hardiness on symptoms of insomnia during a naval mission

BACKGROUND

Sleep is increasingly being recognised as important for the health and well-being of sailors. The aim of the current study is to investigate the relationship between hardiness and reported insomnia-symptoms in a maritime military setting during a 4-month counter piracy naval mission in the Gulf of Aden.

MATERIALS AND METHODS

A sample of 281 officers, sailors, and enlisted personnel were measured on levels of hardiness before the mission. The participants were split into low and high hardiness groups based on the group level mean. Insomnia-symptoms were measured before, midway and at the end of the mission.

RESULTS

The results showed a significant main effect of time and a significant main effect of hardiness. The crew experienced the most insomnia symptoms in the middle of the mission and the high hardy group experienced less insomnia symptoms, in total, during the mission. There was also found a significant interaction effect of time and hardiness. The high hardiness group experienced less insomnia symptoms before and towards the end of the mission.

CONCLUSIONS

The results indicate that high levels of hardiness may be a protective factor between the stressors of a naval mission and symptoms of insomnia.

Does psychological capital moderate the relationship between worries about accidents and sleepiness?

The present study investigated psychological capital (PsyCap) as a protective factor in the relationship between worries about accidents and sleepiness among seafarers. The hypothesis that strong PsyCap weakens the relationship between worries about accidents and sleepiness was tested in a cross-sectional sample of 397 maritime workers. In contrast to expectations, the findings indicated a reverse buffering effect in that PsyCap only had a protective impact on sleepiness when worries about accidents were low. For workers that were highly worried, a strong PsyCap was associated with increased levels of sleepiness. The established associations remained consistent after controlling for workers' years of experience as seafarers, and their ratings of psychological safety climate. An interpretation of this finding is that seafarers with high levels of PsyCap will be attentive when the threat level is serious, but will not be bothered when exposed to everyday strain and hassles associated with their work situation.

Psychological hardiness predicts neuroimmunological responses to stress

Psychological hardiness characterizes people who remain healthy under psychosocial stress. The present exploratory study investigates possible links between hardiness and several immune and neuroendocrine markers: IL-6, IL-12, IL-4, IL-10, & neuropeptide-Y. A total of 21 Norwegian navy cadets were studied in the context of a highly stressful military field exercise. Blood samples were collected midway, and again late in the exercise when stress levels were highest. Psychological hardiness (including commitment, control, and challenge) was measured two days before the exercise. While all subjects scored high in hardiness, some were high only in commitment and control, but relatively low in challenge. These "unbalanced" hardiness subjects were also more stress reactive, showing suppressed proinflammatory cytokines (IL-12), increased anti-inflammatory cytokines (IL-4, IL-10), and lower neuropeptide-Y levels as compared to the hardiness-balanced group. This study thus shows that being high in hardiness with a balanced profile is linked to more moderate and healthy immune and neuroendocrine responses to stress.

The Role of Psychological Capital in Perception of Safety Climate Among Air Traffic Controllers

Previous research has shown that psychological capital (PsyCap) is associated with desired employee behavioral and performance outcomes. Extending previous research, we examine, in two studies, if the PsyCap of Norwegian air traffic controllers is related to their perceptions of safety climate. Based on bootstrapping procedures, results from Study 1 ( N = 77) and Study 2 ( N = 38) revealed that PsyCap was positively correlated with safety climate. In Study 1, PsyCap explained 31% of the variance in safety climate. Controlling for mediating effects of positive and negative emotions in Study 2, PsyCap explained 15.5% of the variance. These results provide first-time empirical evidence linking PsyCap to safety climate in safety critical organizations.

Psychometric properties of the revised Norwegian dispositional resilience (hardiness) scale

In the 30 years that have elapsed since it was first introduced, the concept of hardiness has continued to attract the attention and interest of researchers from all over the world. The purpose of this study was to examine the reliability and factor structure of a revised Norwegian hardiness scale (Dispositional Resilience Scale 15; DRS-15). Using exploratory and confirmatory factor analytic strategies with a large sample of working adults (N = 7,280), support was found for a hierarchical structure comprising a general hardiness dimension and three sub-dimensions (commitment, control, and challenge). Overall, the results support the reliability and validity of the revised DRS-15 and underscore the importance of examining the psychometric properties and cultural appropriateness of translated scales.