Cognitive behavioral therapy for frequent attenders in primary care

Efficacy of internet-based emotion-focused cognitive behavior therapy (IECBT) in improving stress and anxiety of women with suspected fetal malformation: A randomized controlled trial

BACKGROUND AND OBJECTIVES

Anxiety is prevalent among pregnant women with suspected fetal malformation. Hence, this study aimed to assess the effectiveness of IECBT in alleviating pregnancy-specific stress and anxiety in anxious women with suspected fetal malformation.

METHODS

A randomized four-arm parallel-group controlled trial was conducted involving 140 pregnant women displaying anxiety symptoms before 20 weeks of gestation and suspected fetal malformation. Participants were randomly allocated into four groups, each consisting of 35 women: IECBT alone, IECBT with booster sessions, IECBT with spouse participation, and IECBT combined with spouse participation and booster sessions. The IECBT intervention comprised six 50-min therapist-led sessions for women, with an additional 20-min session for men in the IECBT with spouse participation group. Those in the IECBT with booster sessions groups received six monthly 50-min sessions post-intervention until delivery. Five questionnaires-Spielberger's State Anxiety, Pregnancy-Specific Stress, Uncertainty Intolerance, and Emotion Regulation-were administered before the trial, upon completion of the 6-week intervention, and at 3-month and 6-month post-trial follow-ups.

RESULTS

The IECBT interventions led to significant improvements in anxiety symptoms, pregnancy-specific stress, uncertainty intolerance, and emotional regulation after therapy, with these improvements sustained at the 3-month and 6-month post-treatment assessments. However, no superiority was observed among the four IECBT models across the three measurement intervals-post-trial, 3-month, and 6-month follow-ups regarding outcome improvement. Additionally, participants expressed high satisfaction levels with all IECBT approaches, with no significant differences noted among the four groups.

LIMITATION

IECBT with spouse participation and IECBT with booster sessions were not therapist-guided, results might stem from the masculism culture of the population and their low responsibility and assistance in solving pregnant women's problems, especially during pregnancy, the lack of long-term follow-up of treatment effectiveness and postnatal psychological outcomes with or without fetal malformation.

CONCLUSIONS

The findings suggest that the four models of IECBT improved anxiety, stress, uncertainty, and dysregulated emotions in women with suspected fetal malformation, and such improvements remained stable up to six months after the intervention.

Hospitalized Women Have Anxiety and Worse Mental Health Scores than Men

This study aimed to assess the levels of anxiety, depression, and quality of life in hospitalized men and women using the Hospital Anxiety and Depression Scale (HADS), Beck's Anxiety Inventory (BAI), and Short Form-36 Health Survey Questionnaire (SF-36). 60 patients of both sexes were recruited from at the outpatient department of the Hospital Universitário de Vassouras (HUV). The HADS-Anxiety (HADS-A) and BAI questionnaires were used to assess anxiety; the HADS-Depression (HADS-D) questionnaire to assess levels of depression, and the SF-36 to assess the quality of life. The results indicated that hospitalized women had higher levels of anxiety when compared to men. No difference was observed in the levels of depression between men and women. Regarding quality of life, women showed more deterioration in general and mental health compared to men. Thus, the findings suggest that hospitalized women have higher levels of anxiety when compared to men and that this increase can lead to worse general and mental health. Professionals should be aware of possible psychological changes in hospitalized women as they can affect the overall quality of life.

Risk factors for the frequent attendance of older patients at community health service centers in China: a cross-sectional study based on stratified sampling

Background

This study aimed to investigate the characteristics of frequent attenders (FAs) among older patients in Shanghai, China, and explore the associated factors.

Methods

This cross-sectional study was conducted in six community health service centers in Shanghai, China, from August to December 2018 based on stratified sampling. On the basis of our preliminary study, FAs were defined as those attending at least four consultations in a month. A self-administered questionnaire was used to collect the clinicodemographic data of the participants. Social support, pain severity, depression, and anxiety were evaluated using the Social Support Revalued Scale, six-point Behavioral Rating Scale, Patient Health Questionnaire–9, and Generalized Anxiety Disorder Scale, respectively.

Results

This study included 619 patients aged > 60 years. Among these patients, 155 (25%) were FAs to a community health service center, 366 (59.1%) had 1 or 2 chronic diseases, 179 (28.9%) had ≥3 chronic diseases, 313 (50.4%) opted for a family doctor service, and 537 (86.8%) chose a community health service center for the first consultation. The following were identified as independent risk factors for frequent attendance: widowed status, unmarried status, the presence of > 3 chronic diseases, first consultation at a community health service center, high medical expenses, frequent attendance of the spouses, long-term medication, the use of both traditional Chinese and Western medicine services, and depression.

Conclusions

This study summarizes the characteristics of older FAs to community health service centers in China and identifies 10 risk factors significantly associated with frequent attendance.