The measurement of body-mind-spirit well-being toward multidimensionality and transcultural applicability

Associations between patterns of social support and perinatal mental health among Chinese mother: the mediating role of social trust

This study aims to explore the correlation between different social support patterns and perinatal mental health, and the mediating role of social trust in this. A cross-sectional survey was conducted in Jiangsu, China, with a sample size of 1705 pregnant respondents. Latent class analysis (LCA) was utilized to identify various social support patterns, while a multiple regression model was employed to analyze the mediating effect of social trust on the relationship between social support patterns and perinatal mental health. The study found four distinct social support patterns among the respondents: primary relationship-centric support, overall weak support, primary-secondary relationship-balanced support, and overall strong support. In the relationship between social support patterns and perinatal mental health, social trust played both a partial and full mediating role. The findings indicate that a social support system that enhances maternal trust and promotes honest disclosure of symptoms can effectively promote perinatal mental health.

Serial multiple mediation of perceived professional healthcare support and social structural factors in the relationship between care-seeking behavior and perinatal mental health in Chinese mothers

BACKGROUND

In previous studies, it has been observed that mother's perinatal mental health (PMH) problems can be improved by engaging in appropriate health care-seeking behaviors. However, the exact mechanism that influences the relationship between these two factors is still not fully understood. This cross-sectional study aims to examine the serial multiple mediating effects of perceived professional healthcare support (PPHS) and social structural factors on the association between care-seeking behavior and PMH.

METHODS

The cross-sectional study evaluated 1705 Chinese mothers (pregnancy 12 to 41 weeks) through questionnaires from October 2021 to November 2022. These mothers were selected from three hospitals in Wuxi, with an annual delivery volume of at least 5000. We conducted a structural equation model (SEM) analysis to examine the multiple mediating effect of PPHS and social structural factors (social stigma or social trust) between care-seeking behavior and PMH. After analyzing the results of the SEM, we used bootstrapping to further test the mediating effect.

RESULTS

Among the 1705 Chinese mothers surveyed, 636 (37.3%) sought help from professionals. It was observed that more women tended to seek professional help during the early stages of pregnancy (12 to 28 weeks) compared to the later stages (28 to 41 weeks) (t = 1.47, p < 0.05). The results of the SEM analysis indicated that the mother's care-seeking behavior did not have a significant direct effect on PMH. However, it was identified as a crucial distal variable, with its significant effect being fully mediated by PPHS and social structural factors. The mediation effect of PPHS and social stigma on the pathway from care-seeking behavior to PMH was found to be 92.9% (direct effect = 0.002; indirect effect = 0.026). Additionally, the mediating effect of stigma contributed to 21.9% of the association between care-seeking behavior and PPHS (direct effect = 0.405; indirect effect = 0.114). Similarly, the mediation effect of PPHS and social trust on the pathway from care-seeking behavior to PMH was 73.3% (direct effect = 0.008; indirect effect = 0.022). Moreover, the mediating effect of social trust contributed to 22.0% of the association between care-seeking behavior and PPHS (direct effect = 0.407; indirect effect = 0.115). The proposed model showed a good fit with the collected data.

CONCLUSION

This study examines the serial multiple mediation effect, in which PPHS and social structural factors mediate the relationship between PMH and professional care-seeking behavior. We suggest three levels of intervention: implementing mental health in all policies, providing training for healthcare providers, and establishing healthcare channels with easily accessible information.

Group-based active artistic interventions for adults with primary anxiety and depression: a systematic review

OBJECTIVES

This systematic review examined the potential benefit of all group-based performing arts interventions for primary anxiety and/or depression.

SETTING

Scholarly literature from any country or countries globally.

DATA SOURCES

Three key bibliographic databases, Google Scholar and relevant citation chasing.

PRIMARY AND SECONDARY OUTCOME MEASURES

Depression and/or anxiety symptom severity, well-being, quality of life, functional communication or social participation.

RESULTS

Database searches returned a total of 63 678 records, of which 56 059 remained following dededuplication. From these database searches, a total of 153 records proceeded to full-text screening. These were supplemented by 18 additional unique full-text screening records from Google Scholar searches and citation chasing (12% of total). From a total of 171 records at the full-text screening stage, 12 publications (7%) were eligible for inclusion in this systematic review, each reporting on a separate study. Published from 2004 to 2021, these studies involved a total of 669 participants with anxiety and/or depression from nine countries and covered five broad artistic modalities: dance, music therapy, art therapy, martial arts and theatre. Dance was the most studied artistic modality (five studies), while there were three studies on art therapy, two on music therapy and one each on martial arts and theatre. The evidence was clearest for a benefit of arts therapies on depression and/or anxiety symptoms.

CONCLUSIONS

This systematic review addresses all group-based active arts interventions in a focused population of primary anxiety and/or depression. The evidence suggests that the arts may be a useful therapeutic medium in this population. However, a substantial limitation of the evidence base is the lack of studies directly comparing different artistic modalities. Moreover, not all artistic modalities were assessed for all outcome domains. Therefore, it is not currently possible to determine which artistic modalities are most beneficial for which specific outcomes.

Increased neurocardiological interplay after mindfulness meditation: a brain oscillation-based approach

Background

Brain oscillations facilitate interaction within the brain network and between the brain and heart activities, and the alpha wave, as a prominent brain oscillation, plays a major role in these coherent activities. We hypothesize that mindfully breathing can make the brain and heart activities more coherent in terms of increased connectivity between the electroencephalogram (EEG) and electrocardiogram (ECG) signals.

Methods

Eleven participants (28-52 years) attended 8 weeks of Mindfulness Based Stress Reduction (MBSR) training. EEG and ECG data of two states of mindful breathing and rest, both eye-closed, were recorded before and after the training. EEGLAB was used to analyze the alpha band (8-12 Hz) power, alpha peak frequency (APF), peak power and coherence. FMRIB toolbox was used to extract the ECG data. Heart coherence (HC) and heartbeat evoked potential (HEP) were calculated for further correlation analysis.

Results

After 8 weeks of MBSR training, the correlation between APF and HC increased significantly in the middle frontal region and bilateral temporal regions. The correlation between alpha coherence and heart coherence had similar changes, while alpha peak power did not reflect such changes. In contrast, spectrum analysis alone did not show difference before and after MBSR training.

Conclusion

The brain works in rhythmic oscillation, and this rhythmic connection becomes more coherent with cardiac activity after 8 weeks of MBSR training. Individual APF is relatively stable and its interplay with cardiac activity may be a more sensitive index than power spectrum by monitoring the brain-heart connection. This preliminary study has important implications for the neuroscientific measurement of meditative practice.

What Could Highly Engaged Workers Gain From Mental Health Promotion Programs?: An Exploratory Analysis of Secondary Outcomes of Brief Daily Workplace Well-being Programs

OBJECTIVE

The current study aims to examine the effects of mental health programs on well-being among highly engaged workers.

METHODS

Participants were randomly allocated to body-mind-spiritual or peer support program. Of the whole sample, we examined participants' work engagement and positive affect from the highest quarter and the lowest quarter of work engagement at baseline. Measures were taken at baseline and 1-month intervals during 3-month programs and 3-month follow-up.

RESULTS

The programs had decreasing effects on work engagement in the HWE subgroup. There is an increasing trend of positive affect on the HWE group only in the body-mind-spiritual program. The trajectories of work engagement in the HWE group moved toward a moderate level.

CONCLUSION

Our results suggest that the work engagement's decrease in the HWE group could be a sign of recovery and relaxation.

The Effects of a Mindfulness-Based Family Psychoeducation Intervention for the Caregivers of Young Adults with First-Episode Psychosis: A Randomized Controlled Trial

OBJECTIVE

In this study, we investigated the effects of a mindfulness-based family psychoeducation (MBFPE) program on the mental-health outcomes of both caregivers and young adults with first-episode psychosis with an onset in the past three years through a multi-site randomized controlled trial. We also studied the outcomes of three potential mediating effects of interpersonal mindfulness, expressed emotions, and non-attachment on the program.

METHOD

We randomly assigned 65 caregivers of young adults with psychosis to MBFPE (n = 33) or an ordinary family psychoeducation (FPE) program (n = 32); among them, 18 young adults in recovery also participated in the evaluation of outcomes.

RESULTS

Intent-to-treat analyses were conducted. No significant time × group interaction effects of MBFPE and FPE programs were found in any of the caregivers' outcomes. However, the young adults with psychosis reported higher levels of recovery after the MBFPE program than after the ordinary FPE program (F = 8.268, p = 0.012, d = 1.484). They also reported a larger reduction in over-involvement of their caregivers (F = 4.846, p = 0.044, d = 1.136), showing that MBFPE had a superior effect to FPE in promoting recovery and reducing over-involvement.

CONCLUSIONS

A brief psychoeducation program may not reduce the burden on or improve the mental-health outcome of caregivers of individuals with recent-onset psychosis. However, integrating mindfulness into a conventional family psychoeducation program may reduce the expressed emotions of caregivers, especially over-involvement. Further studies should explore how psychoeducation programs can reduce the impact of psychosis on family through sustainable effects in terms of reducing their burden and expressed emotions, using a rigorous study and adequate sample size.

Study protocol of guided mobile-based perinatal mindfulness intervention (GMBPMI) - a randomized controlled trial

Background

Psychological distress is a common occurrence among women during the perinatal period. Maternal psychological distress (MPS) can also have a negative influence on neonatal outcomes such as infant health, child development or mother-child interaction. Hence, interventions to improve mental wellbeing during this period are vital. Mindfulness based intervention (MBI) has been found to be effective in reducing psychological distress. Delivery of MBI via the internet, making it accessible and inexpensive, is showing a promising positive effect in reducing psychological distress. A randomized control trial with sufficient power is required to confirm its positive effect among pregnant women. The positive effects of MBI have been found to be associated with heart rate variability (HRV) biofeedback; however, the efficacy of MBI on HRV has been rarely studied among pregnant women. Also, the potential association of HRV with MBI and psychological wellbeing needs further examination. This research aims to test the effectiveness of guided mobile-based perinatal mindfulness intervention (GMBPMI) among pregnant women experiencing psychological distress during the pre- and post-natal period, as well as examining the efficacy of GMBPMI on HRV.

Method

This study is a randomized controlled trial that follows a parallel design. Consenting pregnant women in their second trimester (between 12^th and 20^th week gestation) will be randomly assigned to an intervention group (GMBPMI) or a control group (psychoeducation). The intended sample size is 198, with 99 participants in each group. Three levels of outcomes will be measured at baseline, post intervention in both the intervention and control groups, and at 36-week gestation and five-week postpartum. The primary outcomes include maternal psychological stress, mindfulness and positive appraisal HRV. Secondary outcomes are psychological and physical wellbeing. Tertiary outcomes include obstetric and neonatal outcomes, and social support. Analyses will follow an intention-to-treat method and repeated measures MANOVA will be conducted to compare changes in primary and secondary outcomes. A series of mixed-effects models will be fitted to assess the mediation effects.

Discussion

This trial expects to increase understanding of GMBPMI on HRV and psychological wellbeing for pregnant women, with extended support in both pre-and post-natal periods. The study could also potentially provide evidence for delivery of cost-effective and accessible services to pregnant women.

Trial registration

ClinicalTrials.gov: NCT04876014, registered on 30 March 2021. Protocol Version 1.0., 10 May 2021.

Comprehensive well-being scale: development and validation among Chinese in recovery of mental illness in Hong Kong

Background

Given the absence of a brief scale that reconciles and encompasses different conceptual definitions of well-being (physical, psychological, social and spiritual), the present research aimed at developing and validating a Comprehensive Well-Being Scale (CWBS) that encompasses these different conceptual definition and extend the definition of well-being to transcendental well-being among individuals in recovery of mental illness. The present research focuses on testing the scale among people in recovery of mental illness so that a brief and theoretically comprehensive scale would be available for mental health organization to evaluate the well-being of service users, and to develop and evaluate well-being related services.

Methods

A 56-item preliminary well-being scale was developed by a professional panel. In Study 1, 300 mental health service users in Hong Kong were recruited. Twenty items were selected through principal component analysis to form the CWBS. In Study 2, another sample of 300 service users was recruited. Confirmatory factor analysis was done to confirm a two-factor structure. Validity of the scale was also examined.

Results

The CWBS yielded good internal consistency (Cronbach’s alphas = .79–.91). The finding supported a two-factor structure, namely Intrapersonal Well-Being, and Transpersonal Well-Being, χ² (169) = 335.61, p < .001, CFI = .90, RMSEA = .06, SRMR = .06.

Conclusions

The CWBS established concurrent and construct validity in assessing well-being among Chinese in recovery of mental illness in Hong Kong. It provided theoretical and practical implications for measuring well-being. Theoretically, it extended the concept of well-being to encompass transcendental well-being in model of recovery among individuals recovery from mental illness. Practically, it provided a tool for evaluation of well-being and service development in mental health organization.

A systematic review and meta-analysis of effects of psychosocial interventions on spiritual well-being in adults with cancer

Objective

Spiritual well-being (SpWb) is an important dimension of health-related quality of life for many cancer patients. Accordingly, an increasing number of psychosocial intervention studies have included SpWb as a study endpoint, and may improve SpWb even if not designed explicitly to do so. This meta-analysis of randomized controlled trials (RCTs) evaluated effects of psychosocial interventions on SpWb in adults with cancer and tested potential moderators of intervention effects.

Methods

Six literature databases were systematically searched to identify RCTs of psychosocial interventions in which SpWb was an outcome. Doctoral-level rater pairs extracted data using Covidence following Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Standard meta-analytic techniques were applied, including meta-regression with robust variance estimation and risk-of-bias sensitivity analysis.

Results

Forty-one RCTs were identified, encompassing 88 treatment effects among 3883 survivors. Interventions were associated with significant improvements in SpWb (g = 0.22, 95% CI [0.14, 0.29], p < 0.0001). Studies assessing the FACIT-Sp demonstrated larger effect sizes than did those using other measures of SpWb (g = 0.25, 95% CI [0.17, 0.34], vs. g = 0.10, 95% CI [-0.02, 0.23], p = 0.03]. No other intervention, clinical, or demographic characteristics significantly moderated effect size.

Conclusions

Psychosocial interventions are associated with small-to-medium-sized effects on SpWb among cancer survivors. Future research should focus on conceptually coherent interventions explicitly targeting SpWb and evaluate interventions in samples that are diverse with respect to race and ethnicity, sex and cancer type.

Systematic Review of Mind-Body Interventions to Treat Myalgic Encephalomyelitis/Chronic Fatigue Syndrome

Background and Objectives: Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) is a chronic condition distinguished by disabling fatigue associated with post-exertional malaise, as well as changes to sleep, autonomic functioning, and cognition. Mind-body interventions (MBIs) utilize the ongoing interaction between the mind and body to improve health and wellbeing. Purpose: To systematically review studies using MBIs for the treatment of ME/CFS symptoms. Materials and Methods: MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane CENTRAL were searched (inception to September 2020). Interventional studies on adults diagnosed with ME/CFS, using one of the MBIs in comparison with any placebo, standard of care treatment or waitlist control, and measuring outcomes relevant to the signs and symptoms of ME/CFS and quality of life were assessed for inclusion. Characteristics and findings of the included studies were summarized using a descriptive approach. Results: 12 out of 382 retrieved references were included. Seven studies were randomized controlled trials (RCTs) with one including three reports (1 RCT, 2 single-arms); others were single-arm trials. Interventions included mindfulness-based stress reduction, mindfulness-based cognitive therapy, relaxation, Qigong, cognitive-behavioral stress management, acceptance and commitment therapy and isometric yoga. The outcomes measured most often were fatigue severity, anxiety/depression, and quality of life. Fatigue severity and symptoms of anxiety/depression were improved in nine and eight studies respectively, and three studies found that MBIs improved quality of life. Conclusions: Fatigue severity, anxiety/depression and physical and mental functioning were shown to be improved in patients receiving MBIs. However, small sample sizes, heterogeneous diagnostic criteria, and a high risk of bias may challenge this result. Further research using standardized outcomes would help advance the field.

Effects of Mindfulness-Based Stress Reduction on Health and Social Care Education: a Cohort-Controlled Study

Objectives

Mindfulness practice has been recommended as part of health and social care education and training because of its potential benefits in fostering clinical skills and attitudes, increasing self-care, and reducing the effect of stress in education and occupation. The objectives of this study were to evaluate the effects of a mindfulness-based stress reduction (MBSR) program on stress, physical distress, job burnout, work engagement, and empathy for health and social care education.

Methods

Students (N = 124) from postgraduate programs in social work, counseling, and family therapy were recruited. Sixty-four students participated in an 8-week MBSR program as an elective course. Sixty students were recruited from other elective courses in the same cohort as control group participants. All participants completed self-report assessments.

Results

The results suggested that MBSR was associated with significant improvements in perceived efficacy and vigor and significant reductions in physical distress, total job burnout, emotional exhaustion, and depersonalization of clients compared with the control group.

Conclusions

This study contributes to the growing body of literature highlighting the potential use of mindfulness practice to improve students' personal well-being and professional growth in health and social care education. Mindfulness practice should be further promoted in health and social care education and training.

Effects of Qigong Exercise on Physical and Psychological Health among African Americans

Interventions are needed to address physical and psychological health in middle-aged and older African Americans (AAs). The purpose of this pilot study was to evaluate the feasibility and potential benefits of an eight-week Qigong exercise on physical ability and function, balance, frailty, depression and anxiety, and spiritual well-being in AAs using a single-group design. Fifteen AAs with a mean age of 64 years received Qigong exercise over 16 semi-weekly, one-hour sessions. The majority were female (93.3%) and college-level educated (53.3%). Repeat chair stands, physical function, and spiritual well-being improved significantly (p < .05) with effect sizes ranging from .45 to .87. Over 52% of participants showed improved depression scores, fast gait speed, and standing balance. Nearly 42% demonstrated some frailty improvement over baseline. No adverse events were reported. Qigong exercise potentially improves the physical ability and function, and spiritual well-being of AAs and needs further testing in a randomized clinical trial.

Study Protocol of Brief Daily Body-Mind-Spirit Practice for Sustainable Emotional Capacity and Work Engagement for Community Mental Health Workers: A Multi-Site Randomized Controlled Trial

Background

Given the emotional demanding nature of social services, we developed a brief daily body-mind-spirit (BMS) program and successfully piloted it with workers at elderly services. The proposed study focuses on community mental health workers who are often under chronic stress and vulnerable to burnout.

Methods

The study aims to evaluate the program for fostering sustainable emotional capacity and work engagement for community mental health workers. A multi-site randomized controlled trial design is adopted. All the 24 the Integrated Community Centre for Mental Wellness (ICCMW of Hong Kong will be approached to join this program. Assuming conservatively, 60% ICCWM (14 centers) will respond and participate. At each site, a pair of intervention and control groups will be run. The targeted total sample size is 224. To investigate the course of changes in burnout and engagement, each group will last 6 months, including 3-month intervention and 3-month follow-up. Measures will be taken at monthly intervals.

Discussion

In light of literature and the pilot trial’s findings, participants in the Brief Daily BMS intervention group are expected to have a reduced burnout level and a narrowing of range in work engagement during the 3 months intervention. And within the 3 months post-intervention period, a rebound of burnout level and a widening of range in work engagement are expected to be observed in the same group of participants. Hopefully, this study will contribute to the deeper understanding of burnout and work engagement, and shed light on sustainable intervention for emotionally demanding workplaces.

Clinical Trial Registration

The trial has been registered in the Clinical Trials Centre of the University of Hong Kong. HKUCTR-2763 Registered 27 December 2019 – Retrospectively registered, http://www.hkuctr.com/Study/Show/eb930d24e2c647afb7a922055163f24b.

Examining the Moderating Role of Patient Enablement on the Relationship Between Health Anxiety and Psychosomatic Distress: A Cross-Sectional Study at a Traditional Chinese Medicine Outpatient Clinic in Hong Kong

Background

Little research effort has been devoted to examining the role of patient enablement in alleviating health anxiety in primary care. In this study, we examined the role of patient enablement as a moderator in the relationship between health anxiety, psychological distress, and treatment seeking in traditional Chinese medicine (TCM).

Methods

The participants were 634 patients of a government-subsidized Chinese medicine outpatient clinic in Hong Kong. They were asked to complete a series of questionnaires on patient enablement, health anxiety, anxiety, depression, physical distress, annual clinic visits, and service satisfaction and provided various demographic details. Descriptive statistics, correlations, and general linear models were used to analyze the data.

Results

We found that patient enablement correlated positively with service satisfaction. Patient enablement also interacted significantly with health anxiety in affecting indices of psychological distress (depression, anxiety) and treatment seeking (annual visits). Among highly enabled patients, the positive association between health anxiety and indices of psychological distress was weakened, and they also showed more health anxiety-driven treatment seeking as measured by annual clinic visits.

Conclusion

These findings suggest a moderating mechanism by which patient enablement weakens the relationship between health anxiety on psychological well-being and increases treatment-seeking behavior in TCM. Practitioners are encouraged to provide sufficient information to patients to foster self-care and disease self-management using complementary and alternative medicine (CAM).

The effectiveness of acupressure in the management of depressive symptoms and in improving quality of life in older people living in the community: a randomised sham-controlled trial

Objective: The primary aim of the current trial was to assess the clinical effectiveness of acupressure in the management of depression in elderly people compared to patients receiving sham acupressure or standard care alone.Methods: Randomized sham-controlled trial of acupressure, sham acupressure and standard care alone in older patients with depression living in the community. Patients with a score>/=8 in the Geriatric Depression Scale were recruited for this study. Intervention/sham treatments were provided four times/week for three months. Assessments related to depressive symptoms (primary outcome), well-being, resilience, spirituality and quality of life domains were carried out at baseline, end of the intervention and three-months after the intervention.Results: 118 patients were randomized to intervention (n = 40), sham (n = 40) or control arm (n = 38), with 84 patients providing final analysis data. Significant reduction in mean score of depressive symptoms was found in the acupressure group (from 10.6 (sd = 0.03) to 7.7 (sd = 0.07), p < 0.001 at end of intervention and 8.7 (sd = 0.8), p = 0.002 at follow-up) and the sham acupressure group (from 10.5 (sd = 0.3) to 8.4 (sd = 0.8), p = 0.005) at end of intervention and 8.4 (sd = 0.8), p = 0.006 at follow-up but not in the control group (from 10.8 to 9.9, p = 0.20). Resilience (p = 0.02) and spirituality (p = 0.02) were also improved in the intervention group at the end of intervention assessment but this change was not sustained at follow-up. Mind-body-spirit well-being and social functioning were improved both at the end of intervention and follow-up in the experimental as well as sham group. The sham group showed additional improvements in daily functioning and environmental quality of life.Conclusions: Although acupressure improved outcomes, a placebo effect was evident. Acupressure may be an effective approach to manage depression in elderly patients, but more evidence is needed in the future before it can be recommended for practice as well as more clear elucidation of any placebo effects.

Promising effect of a family rugby programme for children with ADHD: Promoting parent-child relationship and perceptual change on child's behaviors

BACKGROUND AND PURPOSE

This study explored the effectiveness of a family-based rugby programme to improve the parent-child relationship for children with ADHD and their parents.

MATERIALS AND METHODS

A total of 17 Chinese families (12 fathers and 13 mothers) of children (in early primary grades) with ADHD participated in this study. Mixed methods, including questionnaires, parent focus groups, parental reflective journals, and interviews with children, were adopted.

RESULTS

Quantitative data suggested a trend of parental perceptual change on their children's ADHD behaviors. Thematic analysis on the qualitative data further suggested the family rugby programme served as "a family play context" that helped promote parent-child relationship for the Chinese children with ADHD and their parents. Participating children experienced "a different self" and better self-control when playing rugby.

CONCLUSION

There is a promising effect of the use of rugby as an alternative family-based approach for children with ADHD and their parents.

Structural Model for Estimating the Influence of Healthy Lifestyle on Episodic Memory in Adults with Subjective Memory Complaints

The aim of this study is to examine the relationships between a healthy lifestyle and episodic memory among adults with subjective memory complaints (SMCs). We proposed a structure equation model to study the association between a healthy lifestyle and episodic memory with an investigation covering 309 participants over 50 years old with SMCs. The model showed a good fit after being adjusted (p = 0.054, goodness of fit index = 0.981, adjusted goodness of fit index = 0.956, comparative fit index = 0.981, and root mean square error of approximation = 0.049): a healthy lifestyle has a direct positive effect on episodic memory among adults with SMCs (β = 0.60). The research model provides possible guidelines for medical staff to prevent the cognitive function decline in the risk population of Alzheimer's disease.

A Brief Mindfulness-Based Family Psychoeducation Intervention for Chinese Young Adults With First Episode Psychosis: A Study Protocol

Family psychoeducation (FPE) has been recommended as a major component in the treatment of psychosis. Many previous studies have implemented an intensive program design that often only emphasized improvements in patients' illness outcomes but the benefits for caregivers were limited. There have been calls for a time-limited but cost-effective FPE program to mitigate the looming reality of the suffering of people with psychosis and their families. A Brief Mindfulness-Based Family Psychoeducation for psychosis program is developed to reduce caregivers' burden and promote young adult's recovery. A randomized controlled trial will be conducted to compare this intervention with an ordinary FPE intervention. Both arms will involve six sessions, with a total contact time of 12 h. 300 caregivers of young adults who have experienced first episode psychosis within last 3 years will be recruited. Program effectiveness will be assessed by comparing outcomes measuring the caregivers' burden, mental health symptoms, positive well-being, and the young adult's mental health symptoms during the study and at 9-month post-randomization. The role of expressed emotions, interpersonal mindfulness, and non-attachment in mediating these outcomes will be explored. An additional qualitative approach Photovoice is selected to explore the complex family experiences and the benefits of mindfulness from the caregivers' personal perspectives. Trial Registration: The trial is registered with the United States Clinical Trials Registry (ClinicalTrials.gov): NCT03688009.

Comparing the Differences in Health of Body, Mental, and Spirit Among Category 3 and 4 Controlled Drug Users, Nursing Students, and Psychology Students

Drug abuse adversely affects the health of populations in many counties and contributes immensely to social issues. Schedule III and IV controlled drug abuse is popular in young adults. Medical education is one of the most stressful academic fields for students. The aim of this study was to compare the health differences in body, mind, and spirit among Schedule III and IV controlled drugs users, nursing students, and psychology students. This study uses a cross-sectional comparative study on a convenience sample. Four hundred eleven participants were recruited from three different samples that include Schedule III and IV controlled drug users (n = 211), nursing students (n = 100), and psychology students (n = 100), all from either a drug abuse prevention center or two universities in Southern Taiwan. Relying on the Health of Body, Mind and Spirit Scale, a linear regression model was used to identify the health differences among drug users, nursing students, and psychology students. The results show that drug users scored higher on the physical subscale (ß = -.249, p < .001), the mental subscale (ß = -.120, p < .05), the spiritual subscale (ß = -.154, p < .01), and the Health of Body, Mind and Spirit Scale (ß = -.210, p < .001) than psychology students. The nursing students scored higher on the mental subscale (ß = .146, p < .01) than drug users did. These results could help health staff and instructors understand the differences and improve the physical, mental, and spiritual health among Schedule III and IV controlled drug users, nursing students, and psychology students. Furthermore, future study could further investigate the factors that may affect physical, mental, and spiritual health.

Major Depression in Chinese Medicine Outpatients with Stagnation Syndrome: Prevalence and the Impairments in Well-Being

Stagnation syndrome, a diagnostic entity in traditional Chinese medicine (TCM), has been long regarded as the TCM counterpart of major depression in Western medicine. The study investigated the prevalence of major depression among stagnation syndrome patients and evaluated their well-being and functioning outcomes. In total, 117 patients diagnosed with stagnation syndrome were measured using Stagnation Scale, the Patient Health Questionnaire-9 (PHQ-9), and the Body-Mind-Spirit Well-Being Inventory. Results indicate major depression among stagnation syndrome patients was characterized by a high co-occurrence rate and worse physical, mental, and functional outcomes. More than one-quarter (26.5%) of the patients met the DSM-V diagnostic criteria for major depression and over half (53%) exceeded the PHQ-9 cutoff (score above 10) for moderate/severe depression symptoms. The wellness of the stagnation syndrome patients was worse (M = 298.2, SD = 66.5) than that of the general population (M = 360.9, SD = 79.9), with a large Cohen's d value of 0.9. The “wellness outlook” of the depressed stagnation syndrome patients appeared grimmer (M = 252.3, SD = 52.2). The correlation between stagnation and depression was higher for affective symptoms than somatic symptoms. Physical distress did not mediate the relationship between stagnation and daily functioning. These might suggest that stagnation syndrome and major depression may share some similar psychological mechanisms.

A Brief Body-Mind-Spirit Group Therapy for Chinese Medicine Stagnation Syndrome: A Randomized Controlled Trial

BACKGROUND

Stagnation syndrome, a diagnostic entity in traditional Chinese medicine (TCM), is characterized by mind-body obstruction-like symptoms. Although TCM has long-established symptom-relief treatments, a comprehensive mind-body intervention was called for.

PURPOSE

The study evaluated the efficacy of a six-session body-mind-spirit (BMS) group therapy for persons with stagnation syndrome.

METHOD

A 2-arm randomized controlled trial design was adopted. The control group received a parallel general TCM instruction course. Both groups completed a pretest (T0), posttest (T1), and 2-month follow-up assessment (T2). The measures included self-report scales on stagnation, depression, anxiety, physical distress, daily functioning, and positive and negative affect; the other measure was of salivary cortisol, a biological marker of stress.

RESULTS

Data on 111 adults with stagnation syndrome were included in the analysis. Completion rates were high (over 87%) for both the intervention and control groups. Repeated-measures multivariate MANOVA revealed a significant combined effect with large effect size (eta-squared = 0.42). Repeated-measures ANOVA further revealed that the intervention group showed significant improvements in stagnation, the primary outcome, with medium effect size (eta-squared = 0.11). The intervention group also showed significant improvements in depression, physical distress, everyday functioning, and negative affect (eta-squared = 0.06 to 0.13). Post hoc analysis revealed that the intervention group showed significant improvements over the control group in cortisol level at 2-month follow-up assessment (T0 versus T2) with small effect size (eta-squared = 0.05), but not at posttest (T0 versus T1).

CONCLUSIONS

Overall, the findings indicate that our brief BMS group therapy intervention for stagnation syndrome is efficacious. Moreover, the intervention resulted in a number of substantial improvements in the physical and mental health domains.

Effects of clay art therapy on adults outpatients with major depressive disorder: A randomized controlled trial

BACKGROUND

Depression has become a critical global health problem, affecting millions of people. Cost-effective nonpharmacological treatment in community settings has been proposed to complement medical treatment. Short-term clay art therapy (CAT) is an alternative treatment that promotes the enhancement of various aspects of mental health for depressed individuals.

METHODS

One-hundred and six adults with depression were randomized into a CAT group or visual art (VA) control group for six 2.5-h weekly sessions. Intervention effects were measured using the Beck Depression Inventory, 12-Item General Health Questionnaire (Chinese version), Body-Mind-Spirit Well-Being Inventory, and 20-Item Toronto Alexithymia Scale (Chinese version) at baseline, immediately postintervention (T1), and 3-weeks postintervention (T2).

RESULT

Multivariate analysis of covariance results indicated a more significant time × group effect for CAT than for VA on depressive signs, general health, and body-mind-spirit well-being (all p<0.05). Significant within-groups changes were observed in these three aspects after treatment and at T2 (all p<0.001) and in alexithymia at T2 (p<0.01) in the CAT group, but the change was nonsignificant in the VA group at T1 and T2.

LIMITATIONS

The homogeneity of the participants affected the generalizability of the study findings. The short-term postintervention follow-up (3 weeks) presented difficulties in demonstrating the long-term effects of CAT.

CONCLUSIONS

CAT can aid emotion regulation and benefit various aspects of mental health in adults. The short duration of the intervention suggests additional application value in treating depression. Further investigation is warranted regarding the potential effect of CAT on alleviating physical symptoms and improving social function.

Active Interest Mentorship for Soon-to-Retire People: A Self-Sustaining Retirement Preparation Program

Retirement is a major life transition that often leads to maladjustments and mental health hazards. In this study, we developed an innovative retirement preparation program, the Active Interest Mentorship Scheme (AIMS), which utilized active interest development as a positive entry point through which to engage soon-to-retire people. Each retiree received a 1-year mentorship 6 months before retirement. Adopting a quasi-experimental design, the study aimed to evaluate the efficacy of the AIMS in protecting retirees' well-being. The well-being status of 161 retirees was assessed at 4-month intervals. Measures included self-esteem, life satisfaction, positive affect, depression, anxiety, and somatic symptoms. Serial trend analysis revealed a general improvement in well-being at 4 months after mentorship, followed by a mark reversion in some variables at 2 months after retirement. Upon completion of the program, participants generally returned to a level of well-being that was comparable with or better than preretirement levels. The first 2 months after retirement appeared to be the most distressing. The findings support the efficacy, as well as feasibility of the innovative retirement preparation program.

Addressing holistic health and work empowerment through a body-mind-spirit intervention program among helping professionals in continuous education: A pilot study

To examine the effectiveness of a body-mind-spirit (BMS) intervention program in improving the holistic well-being and work empowerment among helping professionals in continuous education. Forty-four helping professionals, who were in their first-year part-time postgraduate study, participated in the present study. All participants attended a 3-day BMS intervention program which emphasized a holistic approach to health and well-being. Ratings on their levels of physical distress, daily functioning, affect, spirituality, and psychological empowerment at work were compared before and immediately after the intervention. Participants reported significantly lower levels of negative affect and physical distress, and were less spiritually disoriented after the intervention. Enhanced levels of daily functioning, positive affect, spiritual resilience, and tranquility were also reported. Results also suggested that participants were empowered at work, and specifically felt more able to make an impact on work outcomes. The 3-day BMS intervention program produced a positive and measurable effect on participants' holistic well-being and empowerment at work. Educators in related fields could incorporate holistic practices into the curriculum to better prepare the future practitioners, leading to better outcomes both to the professionals themselves and their clients or patients.

From Body to Mind and Spirit: Qigong Exercise for Bereaved Persons with Chronic Fatigue Syndrome-Like Illness

Bereavement may bring negative impacts on the mind, body, and spiritual well-being of grieving persons. Some bereaved persons with chronic fatigue syndrome- (CFS-) illness experience a dual burden of distress. This study investigated the effects of bereavement on CFS-like illness by comparing bereaved and nonbereaved participants. It also adopted a random group design to investigate the effectiveness of Qigong on improving the well-being of bereaved participants. The Qigong intervention comprised 10 group sessions delivered twice a week for 5 weeks and home-practice for at least three times a week lasting 15–30 minutes each. The participants' fatigue, anxiety, and depression, quality of life (QoL), and spiritual well-being were measured at baseline and 3 months after treatment. The bereaved participants experienced significantly greater mental fatigue (16.09 versus 14.44, p = 0.017) and lower physical QoL (34.02 versus 37.17, p = 0.011) than their nonbereaved counterparts. After 3 months, the mental fatigue (−8 versus −4, p = 0.010) and physical fatigue (−10 versus −5, p = 0.007) experienced by intervention group had declined significantly, and improvements on their spirituality (14 versus −2, p = 0.013) and psychological QoL (8.91 versus 0.69, p = 0.002) scores exceeded those of the control group.

Psychometric properties of the stagnation scale in medication overuse headache patients

Background

Medication-overuse headache (MOH) is often comorbid with emotional disturbances, contributing to poorer outcomes. The aims of the present study were to assess the psychometric properties of the Stagnation Scale in a sample of MOH patients, and to compare two factor models: a three-factor model reported in previous studies and a proposed bi-factor model.

Methods

Consecutive adult outpatients (N = 310) admitted to the Regional Referral Headache Centre of the Sant’Andrea Hospital in Rome (Italy) were administered the Stagnation Scale and two questionnaires measuring depression and perceived disability.

Results

The original three-factor model demonstrated an adequate fit to the data (χ²₁₀₁ = 238.70; p < 0.001; Root Mean Square Error of Approximation [RMSEA] = 0.07; 90% CI of RMSEA = 0.06 / 0.08; Comparative Fit Index [CFI] = 0.98; Weighted Root Mean Square Residual [WRMR] = 0.75). However, the bi-factor model had a comparable or even better fit, with a RMSEA of 0.05 (90% CI: 0.04 / 0.07), providing strong evidence for an absolute fit to the data (χ²₈₈ = 161.43; p < 0.001; RMSEA = 0.05; 90% CI of RMSEA = 0.04 / 0.07; CFI = 0.99; WRMR = 0.56). The stagnation general factor and all the group factors correlated significantly and positively with convergent measures.

Conclusions

There is support for the use of the Stagnation Scale in MOH patients, with the goal of better understanding the role of psychological factors in the evolution and course of the disorder.

Factor structure of the Chinese version of the Meaning in Life Questionnaire among Hong Kong Chinese caregivers

This study examines the factor structure of the Chinese version of the Meaning in Life Questionnaire (C-MLQ) in a sample of Hong Kong Chinese caregivers of patients with chronic illness (N = 223). Confirmatory factor analysis was performed to examine the factor structure. Findings confirm that, identical to the original version, C-MLQ showed the same two-factor structure: Presence and Search. Correlation between Presence and Search was found to be positive and moderate (r = .47). This study establishes empirically the same factor structure as the original version of MLQ among caregivers in Hong Kong. The relationship between Presence and Meaning is discussed in the contexts of Chinese culture and caregiving. Results suggest caregivers' continuing need for meaning in life. Medical social workers may help caregivers to integrate their caregiving experience with their sense of meaning in life and search for meaning in life to sustain their caregiving role.

Conceptualizing mind, body, spirit interconnections through, and beyond, spiritual healing practices

CONTEXT

Although research is increasingly exploring the concept of the mind, body, spirit (MBS) and its relevance to health and well-being, it remains difficult to precisely define it.

OBJECTIVE

This research aims to explore indigenous and non-indigenous spiritual healers' conceptualizations of MBS and consider implications for theory and practice.

DESIGN AND SETTING

A total of 12 spiritual healers from Aotearoa/New Zealand participated in a semi-structured interview about their healing practices.

INTERVENTION

The research interview asked participants to discuss how they conceptualized the mind, body, spirit in their work.

MAIN OUTCOME MEASURES

The data were analyzed using interpretative data analysis.

RESULTS

Transcripts of the interviews were analyzed using interpretative phenomenological analysis, which led to the identification of three major themes: MBS interconnections of healing, impacts on the mind and the body, and spiritual aspects of healing. These results are discussed in terms of their implications for concepts of healing and conceptualizations of MBS.

Incorporating spirituality in psychosocial group intervention for women undergoing in vitro fertilization: a prospective randomized controlled study

OBJECTIVES

This study examined the efficacy of a group intervention, the Integrative Body-Mind-Spirit (I-BMS) intervention, which aims at improving the psychosocial and spiritual well-being of Chinese women undergoing their first IVF treatment cycle.

DESIGN

The I-BMS intervention facilitates the search of meaning of life in the context of family and childbearing, as well as the letting go of high IVF expectations. A randomized controlled study of 339 women undergoing first IVF treatment cycle in a local Hong Kong hospital was conducted (intervention: n= 172; no-intervention control: n= 167).

METHODS

Assessments of anxiety, perceived importance of childbearing, and spiritual well-being were made at randomization (T(0) ), on the day starting ovarian stimulations (T(1)), and on the day undertaking embryo transfer (T(2)).

RESULTS

Comparing T(0) and T(2), interaction analyses showed women who had received the intervention reported lower levels of physical distress, anxiety, and disorientation. They reported being more tranquil and satisfied with their marriage, and saw childbearing as less important compared to women in the control group.

CONCLUSIONS

These findings suggest that I-BMS intervention was successful at improving the psychosocial and spiritual well-being of women undergoing their first IVF treatment cycle. This study highlights the importance of providing integrative fertility treatment that incorporates psychosocial and spiritual dimensions.

Confirmatory factor analysis of the stagnation scale--a traditional Chinese medicine construct operationalized for mental health practice

Background

Traditional Chinese medicine stagnation (“yu”) syndrome is characterized by a cluster of mind/body obstruction-like symptoms. Previous studies have operationalized the concept as a psychological construct through scale development, producing a three-factor 16-item inventory with good psychometric properties.

Purpose

The study aimed to further validate the Stagnation Scale by confirmatory factor analysis (CFA) and examine self-appraisal of stagnation as an illness.

Method

A cross-sectional questionnaire survey was conducted on a random community sample of 755 adults recruited by cluster sampling in Hong Kong.

Results

CFA revealed a good fit of the three-factor model (CFI = .95; RMSEA = .077; SRMR = .043). ROC analysis suggested a cutoff score at 50 on stagnation total score for predicting self-appraisal of an illness condition, with false positive and negative rates at 25.8% and 23.3%, respectively. Overall, 6.2% participants self-appraised to suffer stagnation symptoms to a degree of an illness, and for it, 1.9% participants intended to seek treatment. Stagnation showed positive correlations with physical distress, depression, and anxiety (r = .59–.76, p < .01) and negative correlation with age (r = −.22, p < .01).

Conclusion

The Stagnation Scale appeared to be robust in factorial and construct validity. With prevalence of illness by self-appraisal at 6.2% and intention for treatment at 1.9%, stagnation is a fairly common condition associated with treatment-seeking behaviors.

Symptoms catastrophizing versus social hypervigilance in irritable bowel syndrome patients

Western studies have revealed that symptoms catastrophizing (SC), a self-focused illness coping pattern, mediates poorer health outcomes in irritable bowel syndrome (IBS) patients. In light of the collective orientation of Chinese culture, an others-focused illness coping pattern named "symptoms-related social hypervigilance" (SSH) was constructed and explored together with SC in the current study. A cross-sectional questionnaire survey with 309 IBS patients recruited by 100% consecutive sampling was conducted. Exploratory factor analysis on the SSH scale provided a 9-item 3-factor solution. The three factors were 1) Anticipating negative perceptions from others; 2) Hiding symptoms in social situations; and 3) Assuming responsibility for total symptoms control. SC showed partial mediator properties between IBS symptoms severity and lowered health-related quality of life. Whereas SSH did not show similar mediating effects, it was associated with 'proactive' illness behaviors which, if excessive, can lead to relentless pursuit of total symptoms elimination.

Health promotion lifestyle profile-II: Chinese version short form

AIM

This paper is a report of an examination of the validity and reliability of the Chinese version of the Health Promoting Lifestyle Profile.

BACKGROUND

The Health Promotion Lifestyle Profile, a well-known instrument measuring health promotion lifestyle behaviours and developed by Walker in 1987 and later refined, has been translated into several languages. The original Chinese translated version, based on Walker's 48-item 1987 version, detected six dimensions of health promotion lifestyle behaviours. The 52-item revised Health Promotion Lifestyle Profile-II has not been tested for Mandarin-speakers.

METHOD

After the English version of the Health Promotion Lifestyle Profile-II was translated into Chinese using established forward-backward translation procedures, the psychometric properties of the translated version were determined with 331 Taiwanese Mandarin-speaking adults. Data were collected from August 2007 to July 2008 at outpatient clinics for health screening in Southern Taiwan. The psychometric properties of the instrument were evaluated, including the internal consistency, test-retest reliability, item analysis and factor analysis.

RESULTS

Neither Walker's original 6-factor model nor a forced 6-factor solution of the 52 items of the Health Promotion Lifestyle Profile-II was supported. Parallel analysis suggested that five factors be retained, with the 5-factor solution statistically and conceptually satisfactory. The 5-factor Chinese version of the Health Promoting Lifestyle Profile explained 53% of the variance in healthy lifestyles. Thirty items were retained for the Chinese version of the Health Promoting Lifestyle Profile.

DISCUSSION

Deletion of 22 items from the Health Promotion Lifestyle Profile-II did not impair the ability of the Chinese version of the Health Promoting Lifestyle Profile to measure a healthy lifestyle among a sample of Taiwanese adults. The data support the fact that lifestyle is influenced by culture.

An Exploration of the Burnout Situation on Teachers in Two Schools in Macau

To explore the burnout situation of teachers in two schools in Macau and to investigate any differences made of demographic characteristics. The relation of burnout on social problem solving and holistic health of teachers is also studied. A self reported questionnaire with the Chinese Maslach Burnout Inventory (C-MBI), Chinese Social Problem Solving Inventory (C-SPSI) and the Body-Mind-Spirit Well-Being Inventory (BMSWBI) were used. Totally 138 teachers participated in the study. With Hong Kong data as a reference, Macau teachers scored in the average range of burnout in emotional exhaustion and depersonalization but scored in the low range of burnout in personal accomplishment. Significance differences were found in some dimensions of burnout in age, marital status, teaching experiences, education background and satisfaction with income. Both C-SPSI and BMSWBI were found to be significantly negative correlated with emotional exhaustion and depersonalization and positive correlated with personal achievement. The findings identified those with greater degree of burnout, to whom more attention should be paid. The study also contributed to the limited literature on the quality of life of teachers in Macau. Finally, the findings added on the data base for comparison internationally among the Chinese population.

A study on the efficacy of body-mind-spirit group therapy for patients with breast cancer

AIMS AND OBJECTIVES

This study aims to understand the effects of culturally enriched body-mind-spirit group therapy on anxiety, depression and holistic well-being among women with breast cancer and to examine patients' views on what aspects of group therapy worked to enhance their health.

DESIGN

The study was designed using multiple methods, which consisted of a randomised controlled trial and a focus group interview.

METHODS

A total of 16 subjects in the control group received the standard care of a physician's treatment at the outpatient department. In addition to standard care, 12 subjects in the experimental group received 10 sessions of weekly body-mind-spirit group therapy for 180 minutes each. This therapy integrates concepts and practices of traditional Chinese medicine and Western medicine (e.g. positive psychology and forgiveness therapy). The subjects in the experimental group were invited to participate in a focus group interview regarding their perceptions of the change mechanisms that occurred in group therapy.

RESULTS

The results of analysis of covariance indicated that after a two-month trial, there was a similarity between the experimental and control groups in reducing the scores of Beck depression inventory and increasing the scores of body-mind-spirit well-being. However, subjects in the experimental group had a better reduction of the scores of state anxiety inventory than subjects in the control group. The qualitative analysis yielded eight domains: (i) imparting of information, (ii) interpersonal learning, (iii) catharsis, (iv) universality, (v) group cohesiveness, (vi) altruism, (vii) instillation of hope and (viii) existential factors. These domains illustrate how the therapeutic effects of group therapy worked to reduce patients' anxiety.

CONCLUSION

The culturally sensitive body-mind-spirit group therapy reduced anxiety among outpatients with breast cancer.

RELEVANCE TO CLINICAL PRACTICE

The involvement of mental health nurses in providing group therapy for cancer patients could enhance the quality of care in psycho-ontological nursing.