Unravelling the role of mind-body therapies in paediatric palliative care: A narrative review

AIM

Given the multifaceted nature of paediatric palliative care (PPC), integrative medicine and mind-body therapies, in particular, are increasingly used in this setting. However, to our knowledge, their use in PPC has never been specifically reviewed. Therefore, this work aims to provide a comprehensive overview of the application and possible beneficial effects of mind-body therapies in the PPC setting.

METHODS

Papers about the use of meditation and mindfulness, biofeedback, hypnosis, yoga, tai chi and qi gong, imagery, creative outlets, and art therapy in PPC were identified by browsing PubMed and CINHAL.

RESULTS

We found that the harmless nature of mind-body therapies has been extensively described, and available studies consistently show some benefits on the anxiety, stress, and quality of life of parents/caregivers and healthcare providers. However, well-grounded and robust evidence does not fully support the efficacy of mind-body therapies, especially in patients.

CONCLUSION

Considering the peculiarity of the PPC setting, we suggest that mind-body therapies should be further considered and properly investigated through larger controlled studies and according to the different populations of PPC children, as well as for parents, caregivers, and healthcare professionals.

Patients' Perceptions and Attitudes to the Use of Artificial Intelligence in Breast Cancer Diagnosis: A Narrative Review

Breast cancer remains the most prevalent cancer among women worldwide, necessitating advancements in diagnostic methods. The integration of artificial intelligence (AI) into mammography has shown promise in enhancing diagnostic accuracy. However, understanding patient perspectives, particularly considering the psychological impact of breast cancer diagnoses, is crucial. This narrative review synthesizes literature from 2000 to 2023 to examine breast cancer patients' attitudes towards AI in breast imaging, focusing on trust, acceptance, and demographic influences on these views. Methodologically, we employed a systematic literature search across databases such as PubMed, Embase, Medline, and Scopus, selecting studies that provided insights into patients' perceptions of AI in diagnostics. Our review included a sample of seven key studies after rigorous screening, reflecting varied patient trust and acceptance levels towards AI. Overall, we found a clear preference among patients for AI to augment rather than replace the diagnostic process, emphasizing the necessity of radiologists' expertise in conjunction with AI to enhance decision-making accuracy. This paper highlights the importance of aligning AI implementation in clinical settings with patient needs and expectations, emphasizing the need for human interaction in healthcare. Our findings advocate for a model where AI augments the diagnostic process, underlining the necessity for educational efforts to mitigate concerns and enhance patient trust in AI-enhanced diagnostics.

The patient's perspective on the burden of psoriasis: findings based on the ROCQ, an online survey

Psoriasis is a common chronic skin disease, with well-characterised impact on quality-of life, however, no information is available on the lifetime impact of psoriasis on patients' lives. This descriptive cross-sectional web-based survey of patients with psoriasis, recruited from an online patient community, was conducted in France in 2021. Established questionnaires (Major Life-Changing Decision Profile-MLCDP, Dermatology Life Quality Index-DLQI, Hospital Anxiety and Depression Scale [HADS]), CAGE and BRIEF-COPE) were administered together with specially created questions. In total, 301 adult patients (mean age: 46.9 years; 56% women; mean disease duration: 20.3 years) participated in the study. The MLCDP showed that a mean of 9.4 life-changing decision items were affected; the most frequently cited domains being social life (n=258; 85.7%) and physical activity (n=226; 75.1%). In addition, 183 participants (60.7%) declared at least moderate impact of their psoriasis on their quality of life (score ≥6), with a median DLQI score of 7 [IQR: 3-13]. Impact on activities of daily living, such as social life, physical activities and marital relationships, was reported by over 50% of participants. Moreover, 107 (35.5%) declared being satisfied and 66 (21.9%) very satisfied with care. Over 50% of participants reported stigma related to being considered to have a contagious disease (n=182) or being unhygienic (n=163) and undesirable (n=167). Finally, 104 participants (34.6%) presented with clinically relevant anxiety and 32 (10.6%) clinically relevant depression (score ≥11) based on the HADS. Psoriasis carries a high psychological burden and has a strong long-term impact on social functioning.

"It Bothered Me": The Mental Burden of COVID-19 Media Reports on Community-Dwelling Elderly People

Background and Objectives: Elderly people may have difficulties understanding the quality and quantity of information about the COVID-19 epidemic, which can put an additional mental strain on their health and well-being. The purpose of this study was to explore the processing of COVID-19 information among older people. Materials and Methods: A qualitative study was carried out in summer 2021. The sampling was based on the snowball method. This approach allowed us to communicate with the next potential participants relatively freely and without reservations. Two female researchers (both MD, PhD) conducted the interviews. All interviews were held in Serbian. The data were analyzed using qualitative content analysis. Results: The interviews were conducted with 13 participants (average age 71 years). The analysis of qualitative content suggested that four topics could be identified: (1) sources of information, (2) information interest and need, (3) reporting of information and (4) suggestions for better reporting. The participants were troubled by the excess of information, repetitive information about death tolls, unqualified people in media discussing the pandemic and inconsistent reporting. These features caused the participants to feel the psychological burden in processing all the pieces of information. Conclusions: The elderly people in Serbia followed mainstream media to get information about COVID-19; however, they perceived a variety of problems with reporting, which made the understanding of the information difficult and psychologically burdensome. These findings should be taken into consideration when delivering health-related information to elderly people.

Surgical Therapy of Congenital Nevi in the First Year of Life-Psychological Impact on Parents

BACKGROUND

The birth of a child with a congenital melanocytic nevus (CMN) can lead to distress in the parents. Surgical treatment of CMN can begin in infancy.

OBJECTIVES

To provide insight into the perspective of parents of children with CMN regarding their experienced psychological burden and motivation to undergo surgery as well as their satisfaction.

METHODS

Retrospective analysis of patient data of infants (< 1 year of age), who were surgically treated by power stretching for CMN using subcutaneous infiltration anesthesia (SIA) from 01/01/2020 to 08/31/2021. To evaluate the parent's motivation and psychological burden during the surgical treatment of their child, a questionnaire was designed to interview them in a standardized telephone-based interview.

RESULTS

Out of 45 interviewed parents, 62.2% indicated "severe" or "very severe" distress at the time of their child's birth. Distress was mostly reduced by information about diagnosis and treatment (n = 34) and treatment-progress (n = 27). Stigmatization was experienced by 35.6% of parents. 84,5% of parents were highly satisfied with early initiation of surgical therapy. 69% felt "very satisfied" or "satisfied" with the outcome of surgery. Motivation for surgical therapy was concern about malignant transformation of the, possible stigmatization of the child due to the nevus, while most of the parents (73.3%) mentioned both.

CONCLUSIONS

Surgical treatment of CMN by power stretching in SIA in infancy is associated with high levels of satisfaction among the children's parents. Early initiation of surgical therapy and education about the diagnosis can reduce the psychological burden of the parents and can prevent psychosocial problems in affected children.

Suicide rates among patients with first and second primary cancer

AIMS

With advancements in cancer treatments, the survival rates of patients with their first primary cancer (FPC) have increased, resulting in a rise in the number of patients with second primary cancer (SPC). However, there has been no assessment on the incidence of suicide among patients with SPC. This study assessed the occurrence of suicide among patients with SPC and compared them with that in patients with FPC.

METHODS

This was a retrospective, population-based cohort study that followed patients with FPC and SPC diagnosed from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) 17 registries database between 1 January 2000 and 31 December 2019.

RESULTS

For patients with SPC, an age of 85+ years at diagnosis was associated with a higher incidence of suicide death (HR, 1.727; 95% CI, 1.075-2.774), while the suicide death was not considerably different in the chemotherapy group (P > 0.05). Female genital system cancers (HR, 3.042; 95% CI, 1.819-6.361) accounted for the highest suicide death among patients with SPC. The suicide death distribution of patients with SPC over time indicated that suicide events mainly occurred within 5 to 15 years of diagnosis. Compared with patients with FPC, patients with SPC in general had a lower risk of suicide, but increased year by year.

CONCLUSION

The risk of suicide was reduced in patients with SPC compared with patients with FPC, but increased year by year. Therefore, oncologists and related health professionals need to provide continuous psychological support to reduce the incidence of suicide. The highest suicide death was found among patients with female genital system cancer.

Stress experiences of healthcare assistants in family practice at the onset of the COVID-19 pandemic: a mixed methods study

Background

At the beginning of the pandemic in 2020, healthcare assistants in general practices were confronted with numerous new challenges. The aim of the study was to investigate the stress factors of healthcare assistants in March/April 2020 as well as in the further course of the pandemic in 2020.

Methods

From August to December 2020, 6,300 randomly selected healthcare assistants in four German states were invited to participate in the study. We performed a mixed methods design using semi-structured telephone interviews and a cross-sectional survey with quantitative and open questions. The feeling of psychological burden was assessed on a 6-point likert-scale. We defined stress factors and categorized them in patient, non-patient and organizational stress factors. The results of the three data sets were compared within a triangulation protocol.

Results

One thousand two hundred seventy-four surveys were analyzed and 28 interviews with 34 healthcare assistants were conducted. Of the participants, 29.5% reported experiences of a very high or high feeling of psychological burden in March/April 2020. Worries about the patients' health and an uncertainty around the new disease were among the patient-related stress factors. Non-patient-related stress factors were problems with the compatibility of work and family, and the fear of infecting relatives with COVID-19. Organizational efforts and dissatisfaction with governmental pandemic management were reported as organizational stress factors. Support from the employer and team cohesion were considered as important resources.

Discussion

It is necessary to reduce stress among healthcare assistants by improving their working conditions and to strengthen their resilience to ensure primary healthcare delivery in future health crises.

The Intricacies of Survivor's Guilt: Exploring Its Phenomenon Across Contexts

Survivor's guilt is the response to an event that some people experience when they survive a traumatic event or situation that others did not. This psychological phenomenon can be associated with post-traumatic stress disorder (PTSD), anxiety disorders, and complicated grief. Survivor's guilt is described as the manifestation of tension, distress, or solitude that is triggered by a celebration of life, references to the deceased, and expressions of sympathy. Survivor's guilt is difficult to treat, and the treatment will depend on the severity of the patient's symptoms and the individual's specific needs. This symptom is often overlooked, as it gets grouped into the broader recognized disorder of PTSD. It has been studied within various contexts, including instances of multiple causality, bereaved populations, and HIV-positive men.

Impact of Vitamin D Deficiency on Mental Health in University Students: A Cross-Sectional Study

Students pursuing a university education are vulnerable to psychological burdens such as depression, anxiety, and stress. The frequency of vitamin D deficiency, on the other hand, is extensively recognized worldwide, and vitamin D regulates various neurological pathways in the brain that control psychological function. Therefore, the goal of this cross-sectional study was to determine the relationship between vitamin D deficiency and psychological burden among university students in Riyadh, Saudi Arabia. During March-May 2021 in Riyadh, a cross-sectional comparative study survey was delivered to university students. The DASS-21 scale was used to determine the severity of the psychological burden. Both univariate and binomial regression analyses were conducted to analyze the level of significance and influence of several factors on the development of psychological burden. The data were analyzed with SPSS-IBM, and a p value of <0.05 was considered significant. Of the 480 students recruited for the study, 287 (59.79%) had a vitamin D deficiency. Significantly (p = 0.048), a high proportion of the vitamin D-deficient students attained a low or moderate GPA compared to the control cohort. The prevalence of depression, anxiety, and stress among the vitamin D-deficient students was 60.35%, 6.31%, and 75.08%, respectively, which was significantly (p < 0.05) different from the control group. The odds of developing depression (OR = 4.96; CI 2.22-6.78; p < 0.001), anxiety (OR = 3.87; CI 2.55-6.59; p < 0.001), and stress (OR = 4.77; CI 3.21-9.33; p < 0.001) were significantly higher in the vitamin D-deficient group. The research shows a strong association between psychological stress and vitamin D deficiency. To promote the mental health and psychological wellbeing of university students, it is critical to create awareness about the adequate consumption of vitamin D. Additionally, university students should be made aware of the likelihood of a loss in academic achievement owing to vitamin D deficiency, as well as the cascade effect of psychological burden.

The Psychological and Professional Burden Experienced by Nurses Who Worked in COVID-19 Clinics during the Pandemic: A Content Analysis

INTRODUCTION

Since the beginning of the pandemic, nurses have played a key role in providing care for COVID-19 patients. Infection risk and fear, use of personal protective equipment, and social isolation were related to high levels of stress and extreme psychological drain among front-line healthcare providers.

AIM

The aim of this study was to explore how front-line nurses experienced psychological and professional burdens during the coronavirus outbreak.

MATERIAL AND METHODS

The study used a qualitative research design. Semi-structured interviews were applied as the method of data collection. Ten nurses from COVID-19 wards and units of two general public hospitals participated in the study. A content analysis approach was employed to analyze the data.

RESULTS

Data analysis revealed two main categories, namely: (A) front-line experience "From fear to empowerment", and (B) caring and management "From powerlessness to adaptation". Eight sub-categories were developed and included within the corresponding main categories. The study's findings demonstrated that the pandemic caused significant psychological and professional strain on front-line nurses, with feelings of fear, anxiety, and uncertainty predominating. Nonetheless, the process of adaptation and adjustment brought about sentiments of self-actualization and empowerment.

CONCLUSIONS

A thorough understanding of the psychological and professional burden experienced by the front-line nurses is crucial to ensure that nurses receive appropriate support and that quality care is sustained under highly demanding healthcare conditions.

The SARS-CoV-2 pandemic causes a dysfunctional dietary behavior: A German cross-sectional study

Background: Since the COVID-19 pandemic has been affected our daily lives, the global population has been exposed to permanent concerns and thus might suffer from the psychological burden. It is well known that psychological burdens can affect dietary behavior. Aim: The impact of a psychological burden on people, and in particular on their dietary patterns was investigated in this nationawide cross-sectional study. Methods: 7525 participants responded to the questionnaire regarding the psychological burden concerning the COVID-19 pandemic and their current dietary structure with changes in the pattern and food amount (between November 2020 and March 2021). Results: A pandemic-related dysfunction of dietary behavior was found. Some participants reported restrictive (conscious) food intake and as well impulsive food intake, which can be described as dysfunctional eating behaviors. In particular, younger persons and individuals who claimed an increased psychological burden reported dysfunctional dietary behavior. Data clearly show that psychological burdens affect an individual's dietary behavior. Conclusion: Public health strategies have to be developed to support individuals at risk to improve coping strategies. The long-term aim should be avoiding the maintenance of dysfunctional dietary behavior.

Caregivers' Perspective on the Psychological Burden of Living with Children Affected by Sickle Cell Disease in Kinshasa, the Democratic Republic of Congo

There is limited information on knowledge, perceptions, and management of sickle cell disease (SCD) in Africa in general and in the Democratic Republic of the Congo (DRC) in particular. This study explored knowledge, perceptions, and burden of 26 parents/caregivers of children with SCD in three selected hospitals in Kinshasa, DRC. We conducted a focus group with in-depth interviews with parents/caregivers of children affected with SCD. Four themes were discussed, including knowledge and perceptions, diagnosis and management, society's perceptions, and the psychosocial burden and the quality of life of the family affected by SCD. The majority of participants/caregivers felt that society, in general, had negative perceptions of, attitudes toward, and knowledge about SCD. They reported that children with sickle cell are often marginalized, ignored, and excluded from society or school. They face a number of challenges related to care, management, financial difficulties, and a lack of psychological support. The results suggest the need to promote measures and strategies to improve knowledge and management of SCD in Kinshasa, DRC.

Coping Self-Efficacy and Its Relationship with Psychological Morbidity after Genetic Test Result Disclosure: Results from Cancer-Unaffected BRCA1/2 Mutation Carriers

Women who are found to carry a BRCA1/2 pathogenic variant experience psychological distress due to an increased risk of breast and ovarian cancer. They may decide between different preventive options. In this secondary analysis of data collected alongside a larger randomized controlled trial, we are looking at 130 newly found BRCA1/2 pathogenic variant carriers and how their coping self-efficacy immediately after genetic test result disclosure is related to their psychological burden and status of preventive decision making. Participants received the Coping Self-Efficacy Scale, the Hospital Anxiety and Depression Scale, the Impact of Event Scale, the Decisional Conflict Scale, and the Stage of Decision-Making Scale after positive genetic test result disclosure. We found that women with higher coping self-efficacy showed fewer symptoms of anxiety or depression and were less affected by receiving the genetic test result in terms of post-traumatic stress. However, coping self-efficacy had no relationship with any decision-related criteria, such as decisional conflict or stage of decision making. This shows that despite its buffering capacity on psychological burden, possessing coping self-efficacy does not lead to more decisiveness in preference-sensitive decisions.

Understanding the Association between Red Blood Cell Transfusion Utilization and Humanistic and Economic Burden in Patients with β-Thalassemia from the Patients' Perspective

We assessed the humanistic and economic burden of chronic red blood cell (RBC) transfusions on patients with β-thalassemia. This cross-sectional, US-based study included adults (≥18 years) who self-reported a β-thalassemia physician diagnosis and had received ≥1 RBC transfusion in the past 6 months. The outcomes included the Functional Assessment of Cancer Therapy-Anemia (FACT-An), Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and ad hoc questions about treatment experience, side effects, direct/indirect costs, and psychological burden. Overall, 100 patients completed the survey, of whom 70% experienced "moderate" to "extremely high" burden due to RBC transfusions, 81% reported iron overload, 42% reported compromised social lives. The mean FACT-An score was 132 (higher score indicates better outcomes; 0-188). Mean scores were 33/52 for fatigue and 20/28 for anemia symptoms in the previous 7 days. Health-related quality of life (HRQoL) temporarily improved after RBC transfusion, although patients continued to experience mild-to-severe depression and anxiety, substantial direct costs, compromised employment, and suboptimal quality of life. Over 6 months, patients dedicated a mean of 173 h to transfusion requirements and incurred out-of-pocket costs of USD 2239 for transfusions and USD 896 for additional care costs. These findings highlight the need for new treatment options to improve patient HRQoL and economic outcomes.

Role of polycystic ovarian syndrome in developing psychological burden in Saudi Arabian females: A case control study

It is well known that polycystic ovarian syndrome (PCOS) may elevate psychological problems in patients, but there is a scarcity of the studies among Saudi Arabian population. This research was designed to investigate the influence of PCOS on the development of psychological load in terms of depression, anxiety, and stress in comparison to normal women who have no PCOS. Further, a correlation of psychological distress in PCOS females was done with their educational level. This is case-control research carried out in one of Riyadh's multispecialty hospitals. In the PCOS patients and control groups (each with 84 samples), samples were collected using convenience sampling and a simple random approach, respectively. The psychological burden was determined using DASS-21. The data obtained were analyzed using SPSS-IBM 25. Most participants (52.9%) were between the ages of 26 and 35 and had a university education (68.4%). A significantly higher percentage of PCOS patients (P = 0.001) had irregular menses, hirsutism, infertility, and acne in comparison to the mothers without PCOS. There was a significantly higher possibility of depression (P = 0.003), anxiety (P = 0.016), and stress (P = 0.001) among PCOS patients than in control subjects. Among the psychological domain tested in the study, the risk of developing stress (odds ratio, OR = 8.32) was high when compared to depression (OR = 3.12) and anxiety (OR = 2.127) in PCOS patients. Furthermore, when compared to PCOS females with less education, a significantly lower number of university-educated PCOS females developed depression. The study demonstrates a high prevalence of psychological burden among the PCOS population. Higher education has been shown to help in alleviating depression in PCOS females. Meeting PCOS women's psychological needs will improve their overall health status.

Psychological empowerment and job satisfaction in nurses: A systematic review and meta-analysis

Background

Psychological empowerment is generally understood to be associated with job satisfaction among nurses. However, recently published literature has questioned this association.

Objective

We aimed to systematically investigate through a meta-analysis the association of psychological empowerment with job satisfaction among nurses.

Methods

PubMed, Medline, Cochrane Library, PsycInfo, and Embase were used to search targeted studies from conception to 20 January 2022. The correlation coefficients of each study were extracted and converted into Fisher's Z. Finally, pooled r was calculated by Fisher's Z and standard error (SE).

Results

A total of 28 studies encompassing 27 articles with 7,664 registered nurses were included. The pooled correlation coefficient between psychological empowerment and job satisfaction was 0.55. Subgroup analyses were conducted according to ethnicity, and the correlation in the Asian participants (P < 0.01) was significantly stronger (P < 0.05) than that of the Caucasian nurses (P < 0.01).

Conclusions

Psychological empowerment is strongly correlated to job satisfaction for registered nurses, especially among those from Asian countries. Interventions designed for psychological empowerment could be one of the strategies to promote the retention of nurses. Nonetheless, additional future studies are essential for more investigations.

Fear of Death during COVID-19 Does Not Explain Post-Infection Depression Symptoms beyond Reported Symptoms during the Infection in COVID-19 Survivors

The COVID-19 pandemic poses an unprecedented global burden to the general population and, in particular, to individuals who have been infected with SARS-CoV-2. In the context of the discussion about "post COVID-19", the aim of the study was to advance research on mental health and long-term consequences after COVID-19. In total, 214 COVID-19 survivors (female: 54.2%; hospitalized: 36.7%) participated in the repeated cross-sectional assessment. In addition to demographic data, mental and somatic symptoms, fear of death at the time of infection, and depressive (PHQ-8) and generalized anxiety symptoms (GAD-7) were assessed. Results showed an increased prevalence of depressive symptoms and symptoms of generalized anxiety compared to observations in the general population prior to the COVID-19 pandemic. Psychological symptoms of depression and reported levels of fear of death during the SARS-CoV-2 infection showed a negative association with the time interval since COVID-19 diagnosis. Furthermore, although fear of death during the acute COVID-19 was related to depression and generalized anxiety, this association was predominantly explained by the presence of mental and somatic symptoms. In conclusion, initial fear of death does not impact mental health beyond the overall symptom burden. Furthermore, depressive symptoms appear to vanish across time since infection.

[Survey in Hyogo Prefecture on the Current Status of Pharmacists in Home Health Care and Exploration of Factors Causing Psychological Burden]

There is a need for pharmacists to be actively involved in home healthcare through a wide range of collaboration in healthcare and welfare. However, insufficient evidence is available to search for factors that prevent pharmacists from being proactive in home healthcare. In this study, we conducted an extensive questionnaire survey among pharmacists engaged in home pharmacy work who belong to the Hyogo Pharmaceutical Society regarding the current status of pharmacists' work in home medical care and their psychological burden; we also explored the factors that may hinder the future development of home medical care. As a result, 925 (44%) valid responses were obtained, and seven factors- "current multidisciplinary cooperation", "relationships with patients and their families", "emotional burden for home healthcare", "attitude toward patients", "ideal of multidisciplinary cooperation", "anxiety about aggressive intervention", and "anxiety about talking to and dealing with patients"- were extracted. Furthermore, it was suggested that pharmacists' mental burden and anxiety are closely related to their successful experiences in building relationships with patients and patients' families as well as with multidisciplinary cooperation in home healthcare. Therefore, to train pharmacists to be actively involved in home healthcare, it is important not only to impart knowledge and skills but also for them to gain experience practicing their contributions as pharmacists in the field of home healthcare with multiple professions, patients, and patients' families.

Quality of Life and Psychological Burden of Parents of Children, Adolescents, and Young Adults with Type 1 Diabetes: A Cross-Sectional Study during the Lockdown Period of COVID-19

The current study aimed to investigate how parents of children, adolescents, and young adults with DM1 perceived quality of life and psychological burden during the lockdown period of COVID-19. A cross-sectional study was carried out on 110 parents in Greece in spring 2021. Perceived quality of life was measured using the Parent Diabetes Distress Scale, and psychological burden was measured using the Spielberger State/Trait Anxiety Inventory, and both were assessed with correlational analysis. Overall, 79.1% of the parents were females ,while the mean age of all was 44.4 years (±5.8). PDDS was found to be moderate (mean 2.42 ± 0.76): 63.6% of respondents had moderate/high distress. The highest mean score was for Teen Management Distress and the lowest for Healthcare Team (3.02 vs. 1.49, p < 0.001). STAI was found to be moderate to high, with a higher mean score for state versus trait anxiety (49.8 vs. 48.0, p = 0.006). Increased distress or poorer parents’ quality of life was related with the highest number of hyperglycemic episodes (β = 0.25, p = 0.002), the fewest hypoglycemic episodes (β = −0.18, p = 0.024), and the highest parental trait anxiety (β = 0.04, p < 0.001). Parents were found with moderate-to-high distress and anxiety, and their correlation also shows that there is an urgent need for suitable education of parents on managing the disease to improve quality of life and eliminate health risks to all involved.

Examining the Impact of COVID-19 Experiences on Reported Psychological Burden Increase in Older Persons: The Effects of Illness Severity and Social Proximity

Previous findings have provided indications that experience of COVID-19 illness of self and other affect mental health unfavorably. However, prior studies do not satisfactorily differentiate according to severity of COVID-19 illness or social proximity, which are both hypothesized to be relevant factors for increased psychological burden. This study provides an in-depth examination of the impact of Covid-19 experience of self and other on mental health, considering illness severity as well as proximity to the infected person (self, close and distant network). It used data on an older population (50+ years) from 28 European countries (n > 40 000 persons) surveyed in summer of 2021 using the Survey of Health and Retirement in Europe (SHARE). Aside from bivariate analyses, a logistic regression model was computed to test the effects of illness severity by personal proximity over and above other stressors of life in the pandemic. Severity of illness was shown to be a contributor to psychological burden increase with the strongest effects among persons who reported own illness experiences or experiences in the close network. Regression analysis confirmed the impact of severe Covid-19 experience in self, close and distant relations. Moreover, even a less severe course impacted burden unfavorably when experienced in the own person and more distant relations. These results prove troubling. Psychological burden is impacted by infection, with experiences in self or close persons being strongest, while even 'lighter' experiences in the distant network also have an unfavorable effect, emphasizing the need to gain control of the present pandemic.

Should psychological distress be listed as a surgical indication for indeterminate pulmonary nodules: protocol for a prospective cohort study in real-world settings

BACKGROUND

Pulmonary nodules (PNs) are documented in up to 30% of computed tomography (CT) reports. PNs of indeterminate nature (IPN) have been reported to be associated with increased psychological distress and deterioration of the quality of life. Despite lack of solid evidence, severe anxiety or depression has been proposed to be one of the surgical indications in expert consensus for IPN management. So far, there is no established criterion to guide the decision-making process, or to ensure evidence-based management. This study aims to evaluate whether psychological distress could be a surgical indication for IPN, and to establish an evidence-based distress threshold for necessary surgical intervention.

METHODS

This prospective observational study in real-world setting will involve an expected sample size of 1,253 IPN patients from the thoracic clinic of Guangdong Provincial People's Hospital. Web-based questionnaires powered by Wen Juan Xing (WJX) platform will be delivered to the patients for baseline data collection and psychological screening. Based on our pilot study, a total of 376 IPN patients with abnormal or borderline abnormal psychological states, as assessed by the Hospital Anxiety and Depression Scale (HADS), will be followed for 1 year before proceeding to the final analysis. The planned study period is from Jan 1, 2021, to Sept 30, 2022, and will entail two HADS assessments at baseline and follow-up. Sleep quality and indicators of healthcare-seeking behavior, such as the number of unplanned clinic visits or CT scans per year, will be used as anchors of psychological state. Patients who undergo surgical resection against the follow-up plan will be enrolled into a surgical group (expected n=94), while those who adhere to their plan will be automatically classified as a follow-up group after 1-year follow-up (expected n=282). Statistical measures such as independent-samples t-test and receiver operating characteristics (ROC) analysis will be used to assess the difference in psychological changes between the groups, and to generate an optimal threshold alerting surgical need. A Chi-square test or nonparametric test will be used to compare the baseline characteristics. Contributors to psychological burden and their effect sizes will be evaluated using general linear regression.

DISCUSSION

To date, data on the psychological benefits of surgical resection of IPN remains scanty. Evidence-based procedure of patient selection using appropriate psychological screening tools is crucial in improving the quality of care and preventing overtreatment. This protocol describes the rationale and methodology to address this unmet clinical need using real-world data, aiming to bridge the gap between clinical guidelines and real-world practice.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04857333. Registered April 23, 2021.

Urinary incontinence and health burden of female patients in China: Subtypes, symptom severity and related factors

AIM

Urinary incontinence (UI) causes long-term physical and psychological suffering to patients. Risk factors for different UI subtypes and symptom severity are still unclear, as well as their associations. We aimed to examine the potential influencing factors of UI episodes, UI severity and UI subtypes, and the associations among them.

METHODS

A total of 611 women were recruited in Shantou, China. Clinical and demographic data were collected through electronic medical records, measurements and self-reports. UI diagnosis, subtypes and symptom severity were confirmed according to international uniform standards. The health burden of UI was evaluated by the Incontinence Impact Questionnaire. Multivariate logistic and linear regression models were carried out to examine the potential risk factors and associations among UI subtypes, symptom severity, and health burdens.

RESULTS

Age, body mass index, comorbidity, lower urinary tract symptoms and constipation were associated with UI episodes and UI severity. Mixed UI patients had worse severity than urgency UI and stress UI, especially in leak times/week and daily life obstructing. Mixed UI patients also had higher health burdens, including mental health burdens, than urgency UI and stress UI patients. UI severity was positively associated with higher health burdens (β = 0.46, 95% CI 0.34-0.60), especially in physical activities, travel and social relationship burden (β = 0.61, 95% CI 0.40-0.85; β = 0.55, 95% CI 0.19-0.76; β = 0.65, 95% CI 0.38-0.91; respectively).

CONCLUSIONS

Age, body mass index, comorbidity, somnipathy and constipation were associated with UI episodes and symptom severity. Mixed UI showed the highest symptoms severity and health burdens. Worse UI severity increased the patient's physical health burden, but was not obvious for mental health burden. Geriatr Gerontol Int 2022; 22: 219-226.

Evaluating the physical, psychosocial and ergonomic burden of lead aprons among Jordanian interventionists: a nationwide study

Objectives. This study assessed the physical and psychological burden of lead apron use on Jordanian interventionists and investigated the attitudes and knowledge of interventional personnel toward ergonomic guidelines and practices. Methods. A cross-sectional investigation of a randomly sampled Jordanian cohort of interventional personnel was conducted using a self-administered questionnaire.

Results. A nationwide sample of 130 practitioners with a mean 9.3 ± 8.1 years of experience in interventional procedures participated. Practitioners were aware of their apron's weight but not of its lead equivalence (71.5%). More than 60% of respondents complained of back pain. While 66.9% did not develop musculoskeletal pathologies, 64.3% of those with already established musculoskeletal pathologies experienced worse pain due to apron usage. Despite believing in the effect of lead aprons on muscular strain and work performance, 78.5% adhere to its usage. In terms of ergonomics, only 39.2% were aware of ergonomic guidelines; however, 90.0% believe that ergonomic practices are essential as 49.2% have experienced discomfort due to bad ergonomics. In terms of psychological burden, anxiety and depression were suggested in 16.4 and 21.6% of the sample.

Conclusion. Jordanian interventionists portray positive attitudes toward lead aprons; nevertheless, their awareness of ergonomic practices warrants the implementation of evidenced-based interventions.

Psychological Impact of the COVID-19 Pandemic on Children and Adolescents With and Without Mental Disorders

Background: The previous and current studies highlight the psychological distress caused by coronavirus disease 2019 (COVID-19)-associated restrictions among the general population, especially among children and adolescents; however, few studies have examined children and adolescents with a mental disorder. The current study aimed to explore whether youth with mental disorders show a higher pandemic-associated psychological burden than healthy children and adolescents and to determine which psychiatric diagnoses are particularly associated with a higher distress level. Methods: In this study, 144 children and adolescents between the ages of 6 and 18 years with a mental disorder and 48 children and adolescents within the same age range without a mental disorder, and their caregivers, completed questionnaires assessing the pandemic-associated trauma symptoms (the Child Report of Post-Traumatic Symptoms [CROPS] and the Parents Report of Post-Traumatic Symptoms [PROPS]). Additionally, we asked specific questions about the pandemic-associated stress factors, such as financial problems, prolonged screen times, or loneliness. Results: Children and adolescents with a mental illness showed a significantly higher psychological burden than their mentally healthy peers. Female gender was a risk factor for a higher self-reported psychological burden, and younger age was associated with a more extensive parent-reported psychological burden. The patients with a depressive disorder showed significantly higher levels of psychological distress associated with the COVID-19 pandemic than the patients with an attention deficit and/or a conduct disorder. Conclusions: Children and adolescents with a mental illness, particularly, female children and individuals with a depressive disorder, are at an increased risk of suffering from pandemic-associated psychological distress. Adequate mental health care options, such as telepsychiatry, are indispensable.

Hitting Close to Home: The Effect of COVID-19 Illness in the Social Environment on Psychological Burden in Older Adults

This study examines the impact of COVID-19 experience of infection in the individual's social environment on psychological burden controlling for a broad range of factors using data on an older population (50+ years). Based on the empirical evidence of preexisting studies, it is hypothesized that psychological burden will increase concurrent to the severity of COVID-19 experience (tested positive, hospitalized, and death) independent of the other stressors resulting from the pandemic, such as a subjective sense of uncertainty or financial burden. Data of the Survey of Health, Aging and Retirement in EUROPE, and a European cross-national panel study were used to examine this hypothesis. Besides Chi2 test and Spearman's rho, a logistic regression model was constructed to test the hypothesized model. The study confirms that there is significantly higher risk for psychological burden by heightened COVID-19 severity in the social environment independent of multiple also significantly influential variables depicting stressors to everyday life of older people during the pandemic. The results point to the importance of multiple factors (social, financial, health, and sociodemographic) which have significantly affected the psychological condition of the individual during the past year. Conclusively, the results illustrate the dilemma that infection and illness in the social circle, as well as countermeasures (social distancing), have negative consequences for our mental health.

Psychological Burden During the COVID-19 Pandemic in Germany

After the first COVID-19 case was diagnosed in Germany, various measures limiting contact between people were introduced across the country. The implementation of these measures varied between jurisdictions and potentially had a negative impact on the psychological well-being of many people. However, the prevalence, severity, and type of symptoms of psychological burden has not been documented in detail. In the current study, we analysed various self-reported symptoms of psychological burden in a German sample. The dataset was collected between April 8th and June 1st, 2020, through an online survey measuring psychological burden using the ICD-10-symptom rating scale. More than 2,000 individuals responded to the survey, with a total of 1,459 complete datasets. Data was then sampled to compare (1) the new data to an existing demographically comparable reference dataset including a total of 2,512 participants who did not undergo any kind of contact restrictions or other pandemic measurements, and (2) psychological burden in two different German states. In line with recent observations from Germany, Italy, China, Austria and Turkey, we found a high prevalence of depressive symptoms in comparison to the reference sample. Furthermore, we found a high prevalence of eating disorder and compulsion symptoms. Especially younger adults and women reported a higher symptom severity compared to other groups during our measurement period. However, no difference between the two states in psychological burden was found.

Higher Levels of Psychological Burden and Alterations in Personality Functioning in Crohn's Disease and Ulcerative Colitis

Aims: Is there evidence for increased psychological distress and alterations in personality functioning in patients with Crohn’s disease (CD) and ulcerative colitis (UC) compared to healthy controls (HCs)?

Background: In patients with CD and UC, perceived stress is closely associated with changes in disease activity. The stress response is influenced by psychological burden and personality functioning, but only little is known about these factors in inflammatory bowel diseases (IBD).

Study: A total of 62 patients with an endoscopic ensured CD/UC without remission (n = 31 per group) and 31 HC were included. Patients with an active CD/UC and HC were individually matched (n = 93, 31 per group) for age, sex, education, and disease activity. Depression and anxiety were assessed to evaluate the effect of psychological burden (Patient Health Questionnaire-9/PHQ-9, Generalized Anxiety Disorder-7/GAD-7). Personality functioning was measured by validated questionnaires for psychodynamic structural characteristics, mentalization, and attachment (Operationalized Psychodynamic Diagnosis-Structure Questionnaire/OPD-SQ, Mentalization Questionnaire/MZQ, and Experiences in Close Relationships scale/ECR-RD 12).

Results: Levels of depression and anxiety were higher in CD/UC patients than in HC with large effect sizes. Comparing personality functioning in CD/UC with HC, psychodynamic structural characteristics differed between CD/UC and HC with medium effect sizes, with structural differences occurring primarily in the domain of self-perception and regulation. Only minor differences were found regarding mentalization and attachment. CD and UC differed only with small effect sizes.

Conclusion: Our data show that compared to HC, patients with CD/UC are characterized by a higher level of psychological burden and structural alterations in the domain of self.

Preoperative Psychological Burdens in Patients with Vestibular Schwannoma

OBJECTIVE

To assess preoperative psychological burden in patients with vestibular schwannoma (VS).

METHODS

A total of 100 patients undergoing VS resection between September 2019 and June 2020 completed preoperative psychological screening. The Hospital Anxiety and Depression Scale (HADS) was applied the day before surgery, and a score >14 was considered clinically important. Univariate and multivariate logistic regression analyzes were used to identify risk factors associated with increased preoperative psychological stress.

RESULTS

Of the 100 patients who underwent VS resection, 44% were male, with a mean age of 45.9 years. Twenty-two (22%) had HADS scores >14. For the univariate analysis, risk factors associated with elevated psychological burden included time since diagnosis, number of symptoms, headache, vertigo, and nausea and/or vomiting. In the regression analysis, the number of symptoms and greater time from diagnosis to treatment correlated with higher preoperative psychological stress.

CONCLUSION

Nearly 1 in 4 patients with VS experienced clinically significant emotional burden preoperatively. Number of symptoms and greater time from diagnosis to treatment contributed to this psychological burden.

Assessment of the Psychological Burden Among Family Caregivers of People Living with Alzheimer's Disease Using the Zarit Burden Interview

BACKGROUND

In China, family caregivers play a major role in caring for people living with Alzheimer's disease (PLWAD), but little is known about the burden this creates.

OBJECTIVE

This study aimed to investigate the burden among family caregivers of PLWAD and the factors influenced it.

METHODS

Family caregivers of PLWAD were recruited from a hospital in China from January 2018 to July 2018. All data were collected online using the Chinese version of the Zarit Burden Interview (ZBI), and the participants' sociodemographic and caregiving details were obtained. T-tests and Kruskal-Wallis H (K) tests were used to compare ZBI scores between groups. Factors related to the caregiver psychological burden were analyzed using multiple linear regression analysis.

RESULTS

A total of 300 participants were assessed, of which 213 (71.00%) were female. More than half of the caregivers were the patient's daughter (51.0%, n = 153). The average ZBI score of the caregivers was 43.05 (13.42). The level of burden was influenced by age, the relationship of the caregiver to the patient, the severity of AD, the caregiver's retirement status, the income level of the caregiver, and the caring time. Regression analysis showed that retired caregivers were more likely to have higher levels of burden and that burden increased with AD severity.

CONCLUSION

Most family caregivers of PLWAD have a considerable caregiver psychological burden. The findings increase the understanding of factors that influence family caregiver burden, and pave the way for potential interventions, such as social support and caregiver empowerment, to reduce their burden.

Psychological Burden and Experiences Following Exposure to COVID-19: A Qualitative and Quantitative Study of Chinese Medical Student Volunteers

Background: During the COVID-19 pandemic, some medical students devoted themselves to volunteer activities, but it was the first time that they had been exposed to such an infectious disease and they might have experienced fear in the face of the epidemic. We aimed to conduct a timely assessment of the psychological burden and experience on medical student volunteers during the COVID-19 pandemic. Methods: We used the 21-item Depression Anxiety Stress Scales to survey the psychology burden of students in April 2020. Semi-structured interviews were conducted with nine medical students who signed up for volunteer activities in Chinese from February to April 2020. Quantitative and qualitative methods were used to analyze the data. Results: The detection of depression, anxiety and stress of medical student volunteers were 26.8%, 20.2% and 11.1%, respectively. The volunteer's negative emotions were more pronounced before work and diminished gradually. Most participants expressed no concern about being infected themselves, but worry about family infection. Participant's motivations for volunteering were primarily their duties as medical students and encouragement from their families/teachers. The vast majority of medical students said they would be willing to work as medical assistants again and this experience would not affect their career choice. Conclusions: Chinese medical student volunteers tended to show negative emotions at the beginning of their work, and then gradually declined, while positive emotions emerged. Most medical students were willing to volunteer as medical assistants when their country needed them due to their sense of responsibility as medical students. This study on the psychological and experiential aspects were derived from Chinese medical student volunteers and might have a significant impact on future public health emergencies in similar settings.

Hospital Preparedness, Resilience, and Psychological Burden Among Clinical Nurses in Addressing the COVID-19 Crisis in Riyadh, Saudi Arabia

In the continuous effort to minimize the devastating effects of coronavirus disease (COVID-19) and to curb the spread of the disease, hospital preparedness and resilience play significant roles in the psychological well-being of clinical nurses given that their work demands immediate action to adapt and adjust to stressors. Thus, this study investigates the hospital preparedness, psychological burden, and resilience of clinical nurses in addressing COVID-19 in Riyadh, Saudi Arabia. A total of 281 clinical nurses participated in the survey from April 2020 to June 2020. Results show that clinical nurses perceived a high self-assessed COVID-19 hospital preparedness (49.65, SD = 2.30); high self-assessed nurses' resilience (4.03, SD = 0.36); and most have normal levels of depression, anxiety, and stress. The variables were predicted to be statistically significant (F_18,262 = 4.14, p = 0.001) and accounted for 16.8% of the variance in the nurses' perception of hospital preparedness (R² = 0.221; adjusted R² = 0.168). The regression analysis was statistically significant (F_30,250 = 6.71, p = 0.001) and accounted for 38% of the variance in nurses' resilience (R² = 0.446, Adjusted R² = 0.380). The predictors of depression, anxiety, and stress show that the overall relationship was statistically significant at (F_23,257 = 6.71, p < 0.001), (F_23,257 = 6.675, p 0.000), and (F_23,257 = 6.692, p 0.000) with 31.9% of the variance (R² = 0.375, Adjusted R² = 0.319), 31.8% of the variance (R² = 0.374, Adjusted R² = 0.318), and 31.9 % of the variance (R² = 0.375, Adjusted R² = 0.319), respectively. The findings of this study helps in improving the continuing education program, psychological support, and mental health program to ensure that the needs of clinical nurses are addressed during the outbreak of a disease.

Feasibility, Acceptability, and Preliminary Efficacy of Dignity Therapy in Patients With Early Stage Dementia and Their Family. A Pilot Randomized Controlled Trial

Purpose: Dementia is the major cause for disability and dependence in older people and associated with considerable psychological burden. The aim of this study was to determine the feasibility, acceptability and preliminary efficacy of Dignity Therapy, a brief psychotherapeutic intervention to enhance dignity and reduce psychological burden, in patients with early stage dementia and in their families or close friends. Materials and methods: In this randomized, waitinglist-controlled clinical trial a total of 54 patients with new diagnosis of early stage dementia and 54 study partners (spouses: n = 37; relatives: n = 14; close friends: n = 3) were randomly assigned to immediate treatment (n = 28) or delayed treatment (n = 26) after 3 months waiting. The main outcomes were feasibility: proportion of screened and invited patients who consented participation; Acceptability: number of drop-outs, and satisfaction with treatment; Efficacy: psychological burden (Hospital Anxiety and Depression Scale-HADS), quality of life (WHOQOL-Bref), and sense of dignity (Patient Dignity Inventory-PDI). Results: In total 38.6% of all eligible patients (n = 140) consented and were enrolled. Along the study six participants (11.1%) dropped out. Patients' satisfaction with the treatment was high and with no significant difference between the groups. HADS scores were significantly lower in both groups at the 3-months follow-up (immediate group: mean difference = -2.69, SE = 0.85, P = 0.003; delayed group: mean difference = -1.97, SE = 0.89, P = 0.031). There was no significant group by time interaction effect (F = 0.71; df = 2, 70.3; P = 0.50). PDI scores only decreased significantly (i.e., improvement of dignity) in the immediate group (mean difference = -6.56, SE = 1.63, P < 0.001; delayed group: mean difference = -3.01, SE = 1.69, P = 0.081), but the group by time interaction effect was not statistically significant (F = 2.29; df = 1, 46.8; P = 0.14). Quality of life improved in some respects by the treatment, but the immediate and the delayed group did not differ significantly over time. After pooling patients' data of both groups, Dignity Therapy resulted in significant improvements in almost all outcome measures. Patients' family members/close friends reported high satisfaction with the intervention. Conclusions: Our findings suggest that Dignity Therapy is feasible and highly accepted in patients with early stage dementia. Patients reported significant improvements, however, there was no significant effect of the intervention in the immediate treatment group compared to the delayed group.

Psychological burden of healthcare professionals in Germany during the acute phase of the COVID-19 pandemic: differences and similarities in the international context

BACKGROUND

Healthcare professionals (HPs) are the key figures to keep up the healthcare system during the COVID-19 pandemic and thus are one of the most vulnerable groups in this. To this point, the extent of this psychological burden, especially in Europe and Germany, remains unclear. This is the first study investigating German HPs after the COVID-19 outbreak.

METHODS

We performed an online-based cross-sectional study after the COVID-19 outbreak in Germany (10-31 March 2020). In total, 2224 HPs (physicians n = 492, nursing staff n = 1511, paramedics n = 221) and 10 639 non-healthcare professionals (nHPs) were assessed including generalized anxiety (Generalized Anxiety Disorder-7), depression (Patient Health Questionnaire-2), current health status (EQ-5D-3L), COVID-19-related fear, subjective level of information regarding COVID-19.

RESULTS

HPs showed less generalized anxiety, depression and COVID-19-related fear and higher health status and subjective level of information regarding COVID-19 than the nHPs. Within the HP groups, nursing staff were the most psychologically burdened. Subjective levels of information regarding COVID-19 correlated negatively with generalized anxiety levels across all groups. Among HPs, nursing staff showed the highest and paramedics the lowest generalized anxiety levels.

CONCLUSIONS

In the context of COVID-19, German HPs seem to be less psychological burdened than nHPs, and also less burdened compared with existing international data.

Is Quarantine for COVID-19 Pandemic Associated with Psychological Burden in Primary Ciliary Dyskinesia?

Background: Information on psychological impact of COVID-19 quarantine in primary ciliary dyskinesia (PCD), a chronic disorder with recurrent pulmonary exacerbations, is lacking. Psychological well-being was prospectively assessed during COVID-19 lockdown in Italy in a PCD population. Methods: we recruited 27 PCD patients and 27 healthy controls. To assess psychological well-being, psychological general well-being index and parenting stress index-short questionnaires were administered to participants ≥15 years-old and to mothers of participants <15 years-old, respectively. The PCD exacerbations since outbreak onset and frequency of quarantine weekly chest physiotherapy were compared to the same period of 2019. Outcomes: 70% of PCD mothers and 90% of PCD patients did not show parental stress levels or distress levels, respectively, and these groups showed no significant difference in stress compared to controls. The PCD pulmonary exacerbations occurred less frequently and weekly chest physiotherapy sessions significantly increased compared to the same period during 2019 (p < 0.05). Interpretation: During COVID-19 quarantine, a PCD population showed psychological well-being. Low exacerbation rate, explained by lower infectious exposure or improved compliance to chest physiotherapy, likely contributed to psychological well-being. Evaluating psychological burden and parental stress is a valuable tool for measuring the emotional impact of PCD and improving PCD medical care.

Effects of Internet Hospital Consultations on Psychological Burdens and Disease Knowledge During the Early Outbreak of COVID-19 in China: Cross-Sectional Survey Study

Background

Coronavirus disease (COVID-19) has become a global threat to human health. Internet hospitals have emerged as a critical technology to bring epidemic-related web-based services and medical support to the public. However, only a few very recent scientific literature reports have explored the effects of internet hospitals on psychological burden and disease knowledge in major public health emergencies such as the COVID-19 pandemic.

Objective

The aim of this study was to explore the role of internet hospitals in relieving psychological burden and increasing disease knowledge during the early outbreak of the COVID-19 pandemic.

Methods

This survey was conducted from January 26 to February 1, 2020, during the early outbreak of COVID-19 in China. The platform used for the consultation was the WeChat public account of our hospital. To participate in the study, the patient was required to answer a list of questions to exclude the possibility of COVID-19 infection and confirm their willingness to participate voluntarily. Next, the participant was directed to complete the self-report questionnaire. After the internet consultation, the participant was directed to complete the self-report questionnaire again. The questionnaire included sections on general information, the General Health Questionnaire-28 (GHQ-28), and the participant’s worries, disease knowledge, and need for hospital treatment.

Results

The total number of internet consultations was 4120. The consultation topics mainly included respiratory symptoms such as cough, expectoration, and fever (2489/4120, 60.4%) and disease knowledge, anxiety, and fear (1023/4120, 24.8%). A total of 1530 people filled out the questionnaires before and after the internet consultation. Of these people, 1398/1530 (91.4%) experienced psychological stress before the internet consultation, which significantly decreased after consultation (260/1530, 17.0%) (χ²₁=1704.8, P<.001). There was no significant difference in the number of people who expressed concern about the COVID-19 pandemic before and after the internet consultation (χ²₁=0.7, P=.43). However, the degree of concern after the internet consultation was significantly alleviated (t₂₆₉₉=90.638, P<.001). The main worries before and after consultation were the dangers posed by the disease and the risk of infection of family members. The scores of the self-assessment risk after the internet consultation were significantly lower than those before consultation (t₃₀₅₈=95.694, P<.001). After the consultation, the participants’ knowledge of the symptoms, transmission routes, and preventive measures of COVID-19 was significantly higher than before the consultation (t₃₀₅₈=–106.105, –80.456, and –152.605, respectively; all P<.001). The hospital treatment need score after the internet consultation decreased from 3.3 (SD 1.2) to 1.6 (SD 0.8), and the difference was statistically significant (t₃₀₅₈=45.765, P<.001).

Conclusions

During the early outbreak of COVID-19, internet hospitals could help relieve psychological burdens and increase disease awareness through timely and rapid spread of knowledge regarding COVID-19 prevention and control. Internet hospitals should be an important aspect of a new medical model in public health emergency systems.

The emotional impact of surveillance programs for pancreatic cancer on high-risk individuals: A prospective analysis

OBJECTIVE

Literature shows that emotional status can influence participation in screening/surveillance programs, and that screening/surveillance programs may alter the psychological well-being of subjects examined. This study aims to assess if participating in a surveillance program for pancreatic cancer early detection is associated with abnormal levels of psychological distress in high-risk individuals (HRIs), compared to the general population.

METHODS

Fifty-four HRIs participating in a magnetic resonance cholangiopancreatography (MRCP)-based surveillance program completed several psychological assessment questionnaires, investigating global functioning, self-efficacy, perceived stress, coping abilities, and social support. The questionnaires were administered by a clinical psychologist after the MRCP but before the subjects were informed about the results of the scans. The HRIs were subjects with strong familiarity of pancreatic cancer and/or carriers of known genetic mutations related to cancer susceptibility. The psychological assessment was made at the time of the first examination.

RESULTS

The population was characterized by an overall good psychological status. Scoring of our sample was comparable to the general population norms. The HRIs showed decent global functioning, high self-efficacy levels, low perceived stress in the last month prior to examination, efficient emotion-focused coping strategies, and an adequate social support system. The younger subjects' subpopulation only revealed higher levels of stress.

CONCLUSIONS

From a psychological point of view, an MRCP-based pancreatic cancer annual surveillance seemed not to influence the HRIs' psychological well-being, unless in young people. Further studies are needed to better establish if there are any changes in distress levels over time and how emotional status influences participation in surveillance programs.

Characterization of pre-transplant psychosocial burden in an integrated national islet transplant program

The psychological burden experienced by people with diabetes prior to islet transplantation is recognized but has not been studied comprehensively, especially in relation to glycemia. Therefore, we conducted a rigorous pre-operative psychosocial profile of UK islet transplant recipients, and compared groups with higher/lower HbA1 c to test the null hypothesis that pre-transplant hypoglycemia awareness and psychosocial burden would not be related to baseline HbA1 c in this high-risk cohort. Pre-transplant, recipients (n = 44) completed validated hypoglycemia awareness questionnaires and generic/diabetes-specific measures of psychological traits and states. Scores were compared in groups, dichotomized by HbA1 c (≤8% versus >8%). Participants were aged (mean±SD) 53 ± 10 years; 64% were women; with HbA1 c 8.3 ± 1.7%. Median rate of severe hypoglycemia over the preceding 12 months was 13 events/person-year and 90% had impaired awareness of hypoglycemia (Gold/Clarke score ≥4). Participants had elevated fear of hypoglycemia (HFS-II Worry), impaired diabetes-specific quality of life (DQoL) and low generic health status (SF-36; EQ-5D). One quarter reported scores indicating likely anxiety/depression (HAD). Dispositional optimism (LOT-R) and generalized self-efficacy (GSE) were within published 'norms.' Despite negative perceptions of diabetes (including low personal control), participants were confident that islet transplantation would help (BIPQ). Hypoglycemia awareness and psychosocial profile were comparable in lower (n = 24) and higher (n = 20) HbA1 c groups. Islet transplant candidates report sub-optimal generic psychological states (anxiety/depressive symptoms), health status and diabetes-specific psychological states (fear of hypoglycemia, diabetes-specific quality of life). While their generic psychological traits (optimism, self-efficacy) are comparable with the general population, they are highly optimistic about forthcoming transplant. HbA1 c is not a proxy measure of psychosocial burden, which requires the use of validated questionnaires to systematically identify those who may benefit most from psychological assessment and support.

They have got the blues: patient's mood- and disease activity-related psychological burden of rheumatoid arthritis on caregivers

Objective: Rheumatoid arthritis (RA), as a long-lasting disease, not only affects the musculoskeletal health but also deteriorates the psychological well-being of the patient. What about their caregivers? There exist a limited number of studies on this issue. The objectives of the present study were (i) to evaluate the psychological health among caregivers of RA patients and (ii) to determine the confounding factors playing role on their psychological status. Methods: Fifty-three RA patients and their caregivers were included in this cross-sectional study. Disease activity was assessed by using the disease activity score 28 based on C-reactive protein (DAS28-CRP) and rheumatoid arthritis disease activity index-5 (RADAI-5), while disability was evaluated by disability of the arm, shoulder, and hand (DASH) questionnaire. Psychological status was tested by Beck's depression and anxiety inventories (BDI and BAI). Results: A total of 53 patients with RA were included in the study. Caregivers' depression score was weakly correlated with disease activity variables including DAS28-CRP, RADAI and DASH scores (rs = .304, rs = .392 and rs = .301, respectively); and moderately correlated with patients' depression score and caregivers' comorbidity (rs = .407 and rs = .451, respectively). Conclusions: The psychological impact of RA on caregivers appears to be associated with patients' mood, disease activity and upper extremity functionality.

Psychological Burden in Female, Iraqi Refugees Who Suffered Extreme Violence by the "Islamic State": The Perspective of Care Providers

Introduction: A large number of refugees suffer from mental disorders such as post-traumatic stress disorder (PTSD). In the context of a special quota project, 1100 Yazidi women from Northern Iraq who had suffered extreme violence by the so-called Islamic State (IS) were brought to Germany to receive specialized treatment. This study aims to investigate the psychological burden and trauma-related symptoms of these female IS-victims from the perspectives of their care providers. Material and methods: Care providers with various professional backgrounds (N = 96) were asked to complete a self-developed questionnaire on a Likert-type scale ranging from 1 (very low) to 7 (very high) analyzing the psychological burden and trauma-related symptoms of the IS-traumatized women since their arrival in Germany. We controlled for potential confounders, namely the care providers' personal experiences of trauma and flight, by using chi-square tests. Results: The mean psychological burden for the whole period in Germany as perceived by care providers was M = 5.51 (SD = 0.94). As the main factors of distress the care providers reported: worries about family members in Iraq (M = 6.69; SD = 0.69), worries about relatives' possibilities to be granted asylum in Germany (M = 6.62; SD = 0.68), and uncertainties regarding their future (M = 5.89; SD = 1.02). The most prominent trauma-related psychological symptoms were nightmares (M = 6.43; SD = 0.54). The care providers reported that somatic complaints have been present among the refugees in the following manifestation: pain (M = 6.24; SD = 1.08), gastrointestinal complaints (M = 4.62; SD = 1.62), and dizziness (M = 4.40; SD = 1.59). The care providers' personal experiences of trauma and flight had no significant influence on their response behavior. Discussion: Care providers working with IS-traumatized female refugees evaluate the psychological burden and trauma-related somatic and psychological symptom loads of their clients as very high. The results of this study provide important information about the perceptions of care providers working in a refugee-services context and may provide insights for the progression of specialized treatment programs and interventions for highly traumatized refugees and culture-sensitive training programs for their care providers.

The Fukushima Daiichi Nuclear Power Plant accident and school bullying of affected children and adolescents: the need for continuous radiation education

The health threats of radiation-release incidents are diverse and long term. In addition to direct radiation effects, it is imperative to manage the indirect effects of radiation such as stigma, prejudice and broader mental health impacts. Six years after the Fukushima Daiichi Nuclear Power Plant accident of March 2011, bullying caused by stigma and prejudice toward evacuees, including children, has become a social problem in Japan. This phenomenon may be associated with the fact that knowledge about radiation has still not reached the general public, and to a potential lack of motivation among Japanese citizens to learn about radiation and bullying. Continuous and sustained education regarding radiation is warranted in order to enhance the general knowledge level about the effects of radiation in Japan after the Fukushima Daiichi Nuclear Power Plant accident, and this education will become an important reference for education after future nuclear disasters.

Psychological burden on patients with cancer of unknown primary: from onset of symptoms to initial treatment

OBJECTIVE

Supportive care is a critical issue especially for patients with cancer of unknown primary since they often face serious situations, continuing to seek for relevant diagnosis and treatment with the primary sites unknown. However, there are only few research reports on this subject. The aim of this study was to clarify the experience on patients with cancer of unknown primary until they have their initial treatment and to obtain suggestions of supportive care for them.

METHODS

A qualitative study using semi-structured interviews regarding the experience on patients with cancer of unknown primary was conducted.

RESULTS

Data of the experience of the nine patients with cancer of unknown primary until their initial treatment were collected by semi-structured interviews. Patients' speech at interviews recorded in verbatim reports was assigned with 545 codes, 102 subcategories and 38 categories. Experience of the patients with cancer of unknown primary was categorized into five phases: Phase 1: period of making self-judgment on symptoms; Phase 2: period of suspecting serious disease, and seeking for appropriate medical treatment; Phase 3: period of searching for cause of disease while having painful symptoms and anxiety; Phase 4: period of having fear for death, frustration with unknown cause and denial of unknown state; Phase 5: period of struggling but being determined to face disease.

CONCLUSIONS

Experience of patients with cancer of unknown primary from onset of symptoms to their initial treatment was categorized into five phases, mainly manifesting their psychological burden. These findings will warrant for the future study of supportive care for patients with cancer of unknown primary.

AB150. The impact of intravaginal ejaculatory latency time and erectile function on anxiety and depression in the four types of premature ejaculation: a large cross-sectional study in a Chinese population

Aim

The aim of this study was to evaluate the impact of intravaginal ejaculation latency time (IELT) and erectile function on anxiety and depression among patients with PE in general and according to the four types of PE.

Methods

Between September 2011 and September 2012, we conducted a cross-sectional study in the Anhui province of China. We enrolled 4,000 men aged over 18 years, each of whom had been in a stable, monogamous, heterosexual relationship with the same partner for at least 6 months.

Main outcome measurements

Self-estimated IELT, the international index of erectile function-5 (IIEF-5) and the Zung self-rating anxiety and depression scales (SAS/SDS) were used to measure PE, erectile dysfunction (ED), anxiety, and depression, respectively, among the entire study population.

Results

Of the 3,016 men evaluated, 25.80% complained of PE. Distribution of the four types of PE among men with PE was as follows: LPE, 12.34%; APE, 18.77%; NVPE, 44.09%; PLED, 24.81%. Men with PE presented lower IIEF-5 scores and higher SAS and SDS scores vs. men without PE (P<0.001 for all). Similar findings were observed in men with APE when compared with other PE syndromes. After adjustment for age in men with PE, IELT was negatively associated with SAS and SDS scores (SAS, adjusted r=–0.42, P<0.001; SDS, adjusted r=–0.45, P<0.001). IIEF-5 score was negatively associated with SAS and SDS scores (SAS, adjusted r=–0.54, P<0.001; SDS, adjusted r=–0.50, P<0.001). These negative relationships were strongest in men with PLED (IELT vs. SAS: adjusted r=–0.63, P<0.001; IELT vs. SDS, adjusted r=–0.60, P<0.001; IIEF-5 vs. SAS: adjusted r=–0.57, P<0.001; IELT vs. SDS, adjusted r=–0.55, P<0.001).

Conclusions

APE patients reported higher rates of ED, anxiety, and depression than men with other types of PE. The negative relationships between IELT/IIEF-5 and SAS/SDS were strongest in men with PLED.