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Rea KE, Cushman GK, Westbrook AL, Reed B. Trajectories of psychological stress in youth across the first year of inflammatory bowel disease diagnosis. J Psychosom Res 2023; 165:111143. [PMID: 36628854 PMCID: PMC9892289 DOI: 10.1016/j.jpsychores.2022.111143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 12/28/2022] [Accepted: 12/29/2022] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Youth newly diagnosed with inflammatory bowel diseases (IBD) may be physically impacted by their disease and experience increased psychological stress. Stress is known to relate to greater reported IBD symptoms, but little is known about the longitudinal experience of stress and clinical symptoms of youth newly diagnosed with IBD. METHODS Fifty-seven children (Mage = 14.26, range 8-17 years) diagnosed with IBD completed measures assessing psychological stress (PROMIS Psychological Stress Experiences), depressive symptoms (Children's Depression Inventory-2), and clinical disease symptoms (Self-Report Disease Activity) within 45 days of diagnosis and at 6-month and 1-year follow-ups. Group-based trajectory modeling was used to describe trajectory patterns of psychological stress over the first year of diagnosis and logistic regression identified predictors of group membership. RESULTS Two distinct groups of psychological stress trajectories were identified: 1) low prevalence over the first year of diagnosis (51%) and 2) moderate and increasing prevalence (49%). Membership in the moderate and increasing psychological stress group was associated with female sex and greater IBD symptoms at diagnosis. CONCLUSION Findings suggest roughly half of youth newly diagnosed with IBD would likely benefit from multidisciplinary assessment and intervention to promote adaptive stress management, given moderate and increasing stress levels. Future research is needed to evaluate specific intervention techniques most helpful to youth with IBD.
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Affiliation(s)
- Kelly E Rea
- University of Georgia, Department of Psychology, Athens, Georgia, United States
| | - Grace K Cushman
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island, United States
| | - Adrianna L Westbrook
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University, Atlanta, Georgia, United States
| | - Bonney Reed
- Emory University Department of Pediatrics and Children's Healthcare of Atlanta, Atlanta, Georgia, United States.
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Haglund K, King AL, Bekhet AK, Garnier-Villarreal M, Olson K, Atshan R, Ortiz A, de Los Santos J, Belknap RA. Learning a Healthy Rhythm: An Intervention to Increase Children's Resources for Stress Management. West J Nurs Res 2023; 45:46-54. [PMID: 35610951 DOI: 10.1177/01939459221099362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article describes a pilot test of a community engaged, culturally relevant, arts-based intervention. The purpose was to increase children's personal protective buffering resources. Protective buffering resources help children cope with stressful stimuli, reduce activation of their systemic stress response, mitigate allostatic load, and promote optimal health. The "Learning a Healthy Rhythm" intervention included a stress management component and an ongoing Afro-Latino percussion program for 18 children ages 9-11. The stress management component included educational content about stress, self-assessment of stress symptoms, and stress management techniques. A mixed-method intervention evaluation design was used. Qualitative data, quantitative data, and biometrics including hair cortisol were collected. Six intervention parameters were evaluated: effectiveness, fidelity, feasibility, acceptability, necessity, and safety. Positive results were obtained for all parameters. Reduction in physiological and subjective measures of stress was evident. This stress management intervention was well-received and supported by participants.
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Affiliation(s)
- Kristin Haglund
- College of Nursing, Marquette University, Milwaukee, WI, USA.,Froedtert & Medical College of Wisconsin, Milwaukee, WI, USA
| | - Amanda L King
- College of Nursing, Marquette University, Milwaukee, WI, USA.,Neuro-Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda MD, USA
| | - Abir K Bekhet
- College of Nursing, Marquette University, Milwaukee, WI, USA
| | - Mauricio Garnier-Villarreal
- College of Nursing, Marquette University, Milwaukee, WI, USA.,Department of Sociology, Vrije University, Amsterdam, Netherlands
| | - Karen Olson
- College of Nursing, Marquette University, Milwaukee, WI, USA.,Hennepin Healthcare, Minneapolis, MN, USA
| | - Rasha Atshan
- Department of Mathematical and Statistical Sciences, Marquette University, Milwaukee, WI, USA.,Center for International Blood and Marrow Transplant Research, Medical College of Wisconsin, Milwaukee WI, USA
| | - Angela Ortiz
- College of Nursing, Marquette University, Milwaukee, WI, USA.,NorthShore University Health System, Evanston, IL, USA
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Benheim TS, Dalal M, Holcomb JM, Dutta A, Hosker D, Jellinek MS, Murphy JM. Back to Basics: Lifestyle Interventions for Adolescent Depression. Harv Rev Psychiatry 2022; 30:283-302. [PMID: 36103683 DOI: 10.1097/HRP.0000000000000343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
LEARNING OBJECTIVES After completing this activity, practitioners will be better able to:• Discuss and better understand the recently adopted screening standards for adolescents with depression and the potential advantages of using "lifestyle medicine"• Set up a process for providing effective interventions for the increased number of patients with adolescent depression• Design or update their toolbox of treatment options for adolescents with depression based on the new literature and increased demand. ABSTRACT Recently adopted quality standards recommend that pediatricians screen adolescents for depression and that they document follow-up plans for those who screen positive. As a result of these new recommendations, pediatricians and other pediatric providers, as well as psychiatrists and other mental health professionals, may face an increasing number of referrals and a growing need for effective interventions for adolescent depression. Given the widely acknowledged scarcity of traditional mental health resources, the current study reviewed the rapidly expanding array of evidence-based, but nontraditional, interventions applicable to outpatient pediatric and mental health care settings. Many of these interventions come from a lifestyle medicine framework. Lifestyle medicine interventions are congruent with the cultures of pediatrics and outpatient psychiatry, and offer additional evidence-based tools for providers managing adolescent depression. These interventions can be implemented individually or within group or community settings, and may be used in conjunction with more common interventions such as psychotherapy or psychotropic medications.
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Bentley TGK, Seeber C, Hightower E, Mackenzie B, Wilson R, Velazquez A, Cheng A, Arce NN, Lorenz KA. Slow-Breathing Curriculum for Stress Reduction in High School Students: Lessons Learned From a Feasibility Pilot. Front Rehabilit Sci 2022; 3:864079. [PMID: 36189008 PMCID: PMC9397716 DOI: 10.3389/fresc.2022.864079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 05/26/2022] [Indexed: 11/13/2022]
Abstract
Purpose Nearly one in three US adolescents meet the criteria for anxiety, an issue that has worsened with the COVID-19 pandemic. We developed a video-based slow diaphragmatic breathing stress-reduction curriculum for high school students and evaluated its feasibility, tolerability, and preliminary effectiveness. Methods This cluster-randomized feasibility pilot compared 5-min slow diaphragmatic breathing for 5 weeks with treatment-as-usual control among four 12th-grade public high school classes. Students individually participated after school during COVID-19-related hybrid teaching, with slow diaphragmatic breathing three times/week and breath science education once/week. Feasibility was based on completion of breathing exercises, breath science education, and preliminary effectiveness assessments, and ease/tolerability was based on qualitative assessments. Preliminary effectiveness was measured with the State-Trait Anxiety Inventory (STAI) and a timed-exhale carbon dioxide tolerance test (CO2TT) of physiological stress response. Descriptive statistics and repeated analysis of variance were performed to quantify and compare outcomes between time periods. Human subjects research approval was granted through Western IRB–Copernicus Group (WCG IRB) [ClinicalTrials.gov, Identifier: NCT05266833.] Results Forty-three students consented to participate. Breath practice compliance ranged from 29 to 83% across classes and weeks, and decreased on average over the 5 weeks. Compliance with the breath science videos ranged from 43 to 86%, and that with the weekly STAI-State and CO2TT measures varied from 36 to 86%. Compliance with ease/tolerability assessments ranged from 0 to 60%. Preliminary effectiveness assessments' compliance varied across classes from 83 to 89% during baseline, and 29 to 72% at follow-up. The curriculum was rated as somewhat-to-definitely useful/beneficial, and definitely-to-very easy/tolerable. Students reported enjoying the diaphragmatic breathing, CO2TT, and breath science education; some found the extended exhales challenging and the curriculum and assessments time-consuming. Preliminary effectiveness analyses indicated no significant changes in STAI or CO2TT from baseline to followup or from before to after breathing exercises (p > 0.05 for all). Conclusions Implementation of this 5-week slow breathing curriculum was feasible and tolerable to this cohort. Compliance, tolerability, and effectiveness may be improved with in-class participation. Future research on simple and accessible slow-breathing exercises is warranted to address today's adolescent stress-management crisis. Trial Registration ClinicalTrials.gov, Identifier: NCT05266833
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Affiliation(s)
- Tanya G. K. Bentley
- The Health and Human Performance Foundation, Los Angeles, CA, United States
- *Correspondence: Tanya G. K. Bentley
| | | | - Emily Hightower
- The Health and Human Performance Foundation, Los Angeles, CA, United States
| | - Brian Mackenzie
- The Health and Human Performance Foundation, Los Angeles, CA, United States
| | - Rob Wilson
- The Health and Human Performance Foundation, Los Angeles, CA, United States
| | - Aly Velazquez
- The Health and Human Performance Foundation, Los Angeles, CA, United States
- Department of Kinesiology, San Francisco State University, San Francisco, CA, United States
| | - Anna Cheng
- The Health and Human Performance Foundation, Los Angeles, CA, United States
| | - Nicholas N. Arce
- The Health and Human Performance Foundation, Los Angeles, CA, United States
| | - Kent A. Lorenz
- Department of Kinesiology, San Francisco State University, San Francisco, CA, United States
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Freire T, Santana G, Vieira A, Barbosa B. Adolescer in Time of COVID-19's Pandemic: Rationale and Construction Process of a Digital Intervention to Promote Adolescents' Positive Development. Int J Environ Res Public Health 2022; 19:ijerph19052536. [PMID: 35270229 PMCID: PMC8909284 DOI: 10.3390/ijerph19052536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 02/18/2022] [Accepted: 02/19/2022] [Indexed: 11/16/2022]
Abstract
The coronavirus pandemic has severely impacted children's and adolescents' lives due to policies and regulations implemented to slow the virus from spreading, which led to a loss of routine, structure, academic support, and social contacts. Literature also reports a lack of outdoor activity, inappropriate diet, and disruption of sleeping habits as affecting children's and adolescents' lifestyles and well-being. Remarkably, these consequent psychological, behavioral, and emotional changes can compromise their self-esteem, sense of self-efficacy, and self-concept, affecting their immune systems. These maladaptive coping strategies and associated effects may emerge as a failure to access some of the sources of support that might help them cope. Facing this crisis, we aimed at promoting well-being, growth, and the positive development of Portuguese adolescents through an intervention focused on positive coping strategies. We developed "Adolescer in time of COVID-19-A good practices Guide for adolescents in social distancing" as a digital document to be quickly disseminated online, answering the emergent needs of Portuguese youth between 13 and 18 years old during the COVID-19 pandemic. In this article, we present the rationale and process of construction of this intervention while living within a quarantine period, considering the restrictive measures adopted at the time.
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Nelson S, Burns M, Logan D. The Clinical Utility of a Brief Psychological Stress Measure (Patient-Reported Outcomes Measurement Information System) in Youth with Chronic Pain. Pain Med 2021; 22:91-99. [PMID: 32914177 DOI: 10.1093/pm/pnaa263] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To preliminarily examine the psychometric properties (i.e., internal consistency reliability, construct validity) and clinical utility of the Patient-Reported Outcomes Measurement Information System (PROMIS) psychological stress experiences scale in a sample of youth with chronic pain. METHODS Participant data were gathered from an institutional review board (IRB) approved clinical data registry. One hundred sixty-eight children and adolescents (age: mean = 14.97, SD = 2.78) with chronic pain presenting to a tertiary pain treatment clinic were included in the data set. Internal consistency estimates (i.e., Cronbach's alpha), bivariate correlations, and confirmatory factor analyses were performed to preliminarily examine reliability and validity. Multivariate regression analyses were performed to examine the associations between PROMIS psychological stress and pain-related and psychosocial outcomes. RESULTS Confirmatory factor analysis and correlational results indicated that the PROMIS psychological stress experiences scale shows promising reliability and validity in the current sample of youth with chronic pain. Additionally, the results indicated that almost 50% of youth with chronic pain report "high" or "very high" stress (T ≥ 60) and significantly higher rates of stress when compared with national validation samples (P < 0.001). The results also indicated that the PROMIS psychological stress experiences scale was significantly associated with both pain-related and psychosocial outcomes (all P <0.01). CONCLUSIONS The PROMIS psychological stress experiences scale shows promising psychometric properties in youth with pediatric pain and may be useful in assessing for psychological impairment. Future research should further examine the use of this brief measure to assess psychological stress in medical clinics as a way to enhance intervention and prevention efforts in these youth.
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Affiliation(s)
- Sarah Nelson
- Division of Pain Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Maureen Burns
- Division of Pain Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Deirdre Logan
- Division of Pain Medicine, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Jaramillo-Quintanar D, Cruz-Albarran IA, Guzman-Sandoval VM, Morales-Hernandez LA. Smart Sensor Based on Biofeedback to Measure Child Relaxation in Out-of-Home Care. Sensors (Basel) 2020; 20:s20154194. [PMID: 32731523 PMCID: PMC7435878 DOI: 10.3390/s20154194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/19/2020] [Accepted: 07/20/2020] [Indexed: 12/28/2022]
Abstract
Children from out-of-home care are a vulnerable population that faces high stress and anxiety levels due to stressful experiences, such as being abused, being raped, and violence. This problem could have negative effects on their bio-psycho-social well-being if they are not provided with comprehensive psychological treatment. Numerous methods have been developed to help them relax, but there are no current approaches for assessing the relaxation level they reach. Based on this, a novel smart sensor that can evaluate the level of relaxation a child experiences is developed in this paper. It evaluates changes in thermal biomarkers (forehead, right and left cheek, chin, and maxillary) and heart rate (HR). Then, through a k-nearest neighbors (K-NN) intelligent classifier, four possible levels of relaxation can be obtained: no-relax, low-relax, relax, and very-relax. Additionally, an application (called i-CARE) for anxiety management, which is based on biofeedback diaphragmatic breathing, guided imagery, and video games, is evaluated. After testing the developed smart sensor, an 89.7% accuracy is obtained. The smart sensor used provides a reliable measurement of relaxation levels and the i-CARE application is effective for anxiety management, both of which are focused on children exposed to out-of-home care conditions.
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Affiliation(s)
- Daniel Jaramillo-Quintanar
- Mechatronics, Engineering Faculty, Campus San Juan del Rio, University Autonomous of Queretaro, San Juan del Rio, Queretaro 76803, Mexico; (D.J.-Q.); (I.A.C.-A.)
| | - Irving A. Cruz-Albarran
- Mechatronics, Engineering Faculty, Campus San Juan del Rio, University Autonomous of Queretaro, San Juan del Rio, Queretaro 76803, Mexico; (D.J.-Q.); (I.A.C.-A.)
| | | | - Luis A. Morales-Hernandez
- Mechatronics, Engineering Faculty, Campus San Juan del Rio, University Autonomous of Queretaro, San Juan del Rio, Queretaro 76803, Mexico; (D.J.-Q.); (I.A.C.-A.)
- Correspondence:
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Jonsson K, Peterson M. Peak expiratory flow rate and thoracic mobility in people with fibromyalgia. A cross sectional study. Scand J Pain 2019; 19:755-763. [PMID: 31343985 DOI: 10.1515/sjpain-2019-0044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/19/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND AIMS Fibromyalgia (FM) is characterized by chronic widespread pain and affects approximately 1-3% of the general population. Respiratory function has not been given much consideration in people with FM. Few studies have been published concerning FM and respiratory function and conflicting data still exist. The aim of this study was to compare differences in forced expiration, but also to investigate chest expansion, spinal mobility and segmental pain intensity between a group with fibromyalgia and healthy controls. METHODS Forty-one women with diagnosed FM based on American College of Rheumatology 1990 criteria and forty-one controls without pain matched for age and gender participated in this cross-sectional study. For evaluation of forced expiration, a Wright peak expiratory flow rate meter was used. A tape measure was used to measure the mobility of the thorax at maximum inhalation and exhalation known as chest expansion. Spinal mobility was measured with the Cervico-thoracic ratio method. The spinal mobility was measured as range of motion from C7 to 15 cm below in flexion and manual palpation was conducted between C7-T5. For differences in pain intensity a palpation-index was defined for each level, respectively; C7-T1, T1-2, T2-3, T3-4 and T4-5 by calculating the mean value for the four different palpation points for each motion segment. A combined measure of expiration and thoracic mobility (expiratory/inspiratory ratio) was calculated by dividing peak expiratory flow rate (L/min) with chest expansion (cm). Statistical analyses included descriptive statistics to describe subjects and controls, means and standard deviation to compare differences between groups and student-t and Chi-square (χ2) tests, using SPSS 22 software. Confidence interval was set to 95%. RESULTS In the FM group 17 had the diagnosis for more than 5 years and 24 less than 5 years. The FM group demonstrated significantly lower forced expiration (p < 0.018), less thoracic expansion (p < 0.001), reduced spinal mobility (p < 0.029), higher expiratory-inspiratory ratio value (p < 0.001) and increased palpation pain over C7-T5 (p < 0.001) compared to healthy controls. There were more smokers in the FM group (n = 9) compared to the controls (n = 5) though this difference was not statistically significant (p < 0.24) and excluding the few smokers yielded similar result. No significant correlations for manual palpation, chest expansion, peak expiratory flow rate and spinal mobility were found in the FM group. CONCLUSIONS Women with FM demonstrated significantly lower forced expiration and thoracic mobility compared to healthy controls. IMPLICATIONS The results of this study point to a plausible restriction of respiratory function which in turn may have effect on physical endurance and work capacity in people with FM.
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Affiliation(s)
- Kent Jonsson
- Department of Geriatric and Rehabilitation Medicine, Nykoping Hospital, Nykoping, Sweden.,Department of Public Health and Caring Sciences, Section of Family Medicine, Uppsala University, Uppsala, Sweden
| | - Magnus Peterson
- Department of Public Health and Caring Sciences, Section of Family Medicine, Uppsala University, Uppsala, Sweden.,Samariterhemmet Academic Primary Health Care Centre, Region Uppsala, Sweden
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