The relationship between trust in primary healthcare providers among patients with diabetes and levels of depression and anxiety

Investigating the Relationship Between Disaster Preparedness Knowledge, Disaster Related Stress, and Post-Disaster Depression Among Students and Faculty in Higher Education

The worldwide prevalence of disasters exposes students, staff, and faculty at colleges and universities to multiple disasters, potentially impacting their mental health. This study investigates the influence of cumulative disaster-related stressors on depression among 1,497 higher education participants. Results from modified Poisson regression analyses reveal that individuals exposed to cumulative stressors (COVID-19 and Hurricane Sandy) have a higher prevalence of depression (PR 4.20; 95% CI: 1.45-6.12) compared to those without such exposure. The relationship was confounded when disaster preparedness knowledge factors (specifically, medication and grocery delivery knowledge) were added to the model (PR 3.75; 95% CI: 1.36-5.47). These results underscore the importance of integrating disaster preparedness knowledge into mental health interventions for the higher education community. Adapting interventions based on individual preparedness knowledge levels, especially for students and staff, can be a critical strategy in mitigating the impact of disasters on mental health in higher education settings.

A qualitative study of preoperative anxiety in orthognathic patients: The patient perspective

INTRODUCTION

Increased preoperative anxiety may have an adverse impact on the patient experience. This qualitative study therefore aimed to explore those factors affecting anxiety in the approach to orthognathic surgery.

METHODS

A total of 28 orthognathic patients who had completed their presurgical orthodontic treatment and were within 8 weeks before their surgery underwent one-to-one in-depth interviews. The interviews explored their experience in the preoperative period, with the focus on aspects relating to anxiety. Interviews were audio-recorded and transcribed verbatim, and data were then analyzed using a thematic framework approach.

RESULTS

Eight themes and associated subthemes were identified. The first theme related to time and described the approach to the surgery and the transience of the side effects. The second theme discussed control and how the need for control may affect anxiety; the third focused on fear related to the surgery and the element of "the unknown." The fourth theme highlighted the importance of trust between patients and clinicians, whilst the fifth focused on information and its delivery, which was crucial for managing uncertainty. The sixth theme centered on expectations about the surgery and the patient's ability to cope, and the seventh discussed coping strategies that were effective in alleviating anxiety. The final theme focused on the benefits of a strong, effective support system in reducing anxiety. No distinct typologies emerged from the data. Recommendations for consideration by clinicians are presented.

CONCLUSIONS

The findings provide a novel insight into the multifactorial nature of preoperative anxiety in orthognathic patients and also highlight the important role of the clinical team in creating a supportive environment to help reduce patient anxiety.

Moderating effect for illness uncertainty on the relationship of depressive and anxiety symptoms among patients with type 1 diabetes in Taif region, Saudi Arabia

Background

Illness uncertainty was found to be associated with the development of depressive and anxiety symptoms among patients with type 1 diabetes and chronic illness in general. However, the moderating effect of illness uncertainty was not examined in sufficient depth. The current study evaluates how the path from diabetes distress to depression and anxiety is mediated by illness uncertainty, ambiguity, symptoms and course predictability, and illness complexity.

Method

Descriptive cross-sectional survey of a large-scale sample of patients living with type one diabetes in Saudi Arabia. We utilized structural equation modelling mediation analysis to examine the effect of illness uncertainty and its subcategories (illness-related ambiguity, symptoms and course predictability, and illness complexity) on depressive and anxiety symptoms.

Results

The current survey analyzed data pertaining to (n = 536) type one diabetes patients. Mean Mishel Uncertainty of Illness Scale score was 80.8 points (Cronbach's α = 0.91) signifying moderate uncertainty among our patients. Diabetes-related uncertainty was associated with marriage (t = 3.337, P = 0.0009937), diabetes complications (t = 5.257, P < 0.00001), pain (r = 0.2247, P < 0.00001), and children count (correlation coefficient r = 0.195, P < 0.00001). The prevalence of depression was (n = 367, 68.5%) and for anxiety was (n = 173, 30.3%). Illness uncertainty correlated with depressive (r = 0.2484, P < 0.00001) and anxiety (r = 0.2548, P < 0.00001) symptoms' scores. Illness uncertainty exerted a partial moderating effect on both anxiety (β = 0.060, P < 0.001) and depressive symptoms (β =0.056, P < 0.001). We observed a partial moderating effect for diabetes-related ambiguity and diabetes-related symptom unpredictability in terms of depressive and anxiety symptoms. However, for diabetes-related course unpredictability, the moderating effect was significant only for anxiety. Diabetes-related complexity did not exert a significant moderating effect on either depressive or anxiety symptoms.

Discussion

We confirmed high levels of depression and anxiety among patients with type one diabetes in Saudi Arabia. Our findings suggest that illness uncertainty affects both diabetes-related distress and depression constructs and is likely to be affected by them.

User Satisfaction with Primary Health Care Rehabilitation Services in a South African Metropolitan District

Rehabilitation services are critical to improve health outcomes, particularly at community level within primary healthcare settings. As groups with an interest in the health system, rehabilitation service users' and caregivers' involvement in various aspects of health system strengthening is important for healthcare planning and evaluation. This study aimed to explore rehabilitation service users' perceptions of the rehabilitation services and their effect on their functioning in the Johannesburg Metropolitan District. A qualitative study was conducted using purposive sampling of participants attending rehabilitation at nine provincially funded clinics. Semi-structured interviews were conducted, and data were analysed using reflexive thematic analysis. The findings revealed the theme of happy with rehabilitation services and five associated categories, namely (1) service provider actions, (2) service organisation, (3) service user actions, (4) service access, and (5) service outcomes. The participants expressed overall satisfaction with their experiences of rehabilitation services, highlighting the importance of effective communication, patient-centred care, strong therapeutic relationships, and active patient engagement to achieve positive outcomes. This study provides the evidence for maintaining and extending rehabilitation at the PHC level in support of the health policy changes proposed for South Africa.

Conceptualizing and Measuring Trust, Mistrust, and Distrust: Implications for Advancing Health Equity and Building Trustworthiness

Trust is vital to public confidence in health and science, yet there is no consensus on the most useful way to conceptualize, define, measure, or intervene on trust and its related constructs (e.g., mistrust, distrust, and trustworthiness). In this review, we synthesize literature from this wide-ranging field that has conceptual roots in racism, marginalization, and other forms of oppression. We summarize key definitions and conceptual frameworks and offer guidance to scholars aiming to measure these constructs. We also review how trust-related constructs are associated with health outcomes, describe interventions in this field, and provide recommendations for building trust and institutional trustworthiness and advancing health equity. We ultimately call for future efforts to focus on improving the trustworthiness of public health professionals, scientists, health care providers, and systems instead of aiming to increase trust in these entities as they currently exist and behave.

Mental health and resilience quotient of patients in primary care units during the widespread COVID-19 pandemic in Thailand: a cross-sectional study

BACKGROUND

The coronavirus disease 2019 pandemic impacted both the physical and mental health of individuals. The resilience quotient (RQ) is an important factor that decreases mental health problems. This study aimed to explore mental health problems and RQ in patients who visit Primary Care Units (PCU).

METHODS

A cross-sectional study was conducted on participants aged 18 to 60 years who visited the PCU of Songklanagarind Hospital from May 1, 2022, to June 31, 2022. Participants completed a self-administered questionnaire on baseline characteristics and the Primary Care Assessment, Personal Resource Questionnaire, satisfaction with life scale, Thai RQ, PHQ-9, and GAD-7, and the results were analyzed by descriptive, logistic regression, and Spearman's rank correlation.

RESULTS

Among the 216 participants, 72.2% were female, and the median age was 39 (24,51) years old. Most of them had normal RQ levels (61.1%). Of these, 4.2% and 12.1% exhibited moderate to high levels of depression and anxiety, respectively. This study found that sex (OOR 1.93; 95% CI 1.01-3.74), age (OOR 1.03; 95% CI 1.01-1.06), moderate and high social support levels (OOR 9.51; 95% CI 3.36-28.85), and a high life satisfaction level (OOR 4.67; 95%CI 1.75-13.25) were associated with RQ. Moreover, the results showed that ≥ 3 times visiting PCU (β 1.73; 95% CI 0.39-3.08), BMI (β 0.13; 95% CI 0.04-0.23) and experiencing stressful events (β 2.34; 95% CI 1.32-3.36) were positively associated with depression. Finally, experiencing stressful events (OR 4.1; 95% CI 1.09-15.47) significantly affected anxiety, however, moderate and high life satisfaction levels acted as a protective factor against anxiety (OR 0.19; 95% CI 0.07-0.54 and OR 0.03; 95% CI 0.01-0.16, respectively).

CONCLUSION

Although there were a few patients with moderate to severe levels of depression and anxiety, most of them had normal RQ levels. However, there were some patients with low RQ levels which correlated to a high risk of psychiatric diseases such as depression and anxiety. Healthcare providers should focus on interventions that enhance resilience in both proactive and defensive strategies to reduce negative mental problems during these formidable times.

Education, trust, and likelihood to vaccinate against COVID-19 among patients with diabetes in the American South

OBJECTIVE

The purpose of this study was to explain the relationship among education, likelihood to vaccinate for COVID-19, and trust in healthcare providers among patients living with diabetes in the American South.

METHODS

Explanatory iterative sequential mixed methods design combined retrospective chart review, self-report surveys, and qualitative interviews.

RESULTS

Analysis of covariance revealed that severity of diabetes was not linked to vaccine acceptance. Overall, patients reported higher likelihood to vaccinate if their healthcare providers strongly recommend the vaccine. People with "some college" education reported lowest likelihood to vaccinate, before and after their healthcare providers' strong recommendation. Integrated analysis revealed the complexity of patient-provider trust and vaccination decisions.

CONCLUSIONS

In the context of COVID vaccination, particularly as conspiracy theories entered the mainstream, measures of trust in the system may be a clearer indicator of vaccine decision making than trust in personal physician.

PRACTICE IMPLICATIONS

The nonlinear relationship between education and likelihood to vaccinate challenges providers to talk to patients about knowledge and understanding beyond a superficial, quantitative screening question about education. Health systems and public health officials need to find strategies to build trusting relationships for patients across systems, such as community health workers.

Factors influencing the preoperative anxiety in lung cancer patients undergoing video-assisted thoracoscopic surgery: The role of information needs, illness perception and patient trust

OBJECTIVES

This study aimed to investigate preoperative anxiety in patients with lung cancer scheduled for video-assisted thoracoscopic surgery (VATS) and explore the influence of demographic factors, information needs, illness perception, and patient trust in preoperative anxiety.

METHODS

This cross-sectional study was conducted at a tertiary referral center in China from August 14 to December 1, 2022. Patients with lung cancer (N = 308) scheduled for VATS were evaluated using the Amsterdam Anxiety and Information Scale (APAIS), Brief Illness Perception Questionnaire (BIPQ), and Wake Forest Physician Trust Scale (WFPTS). Multivariate linear regression was employed to determine the independent predictors of preoperative anxiety.

RESULTS

The average total APAIS anxiety score was (10.6 ± 4.2). Of the sample, 48.4% reported high preoperative anxiety (APAIS-A: ≥10). Multivariate linear regression analysis showed that preoperative anxiety was higher in women (B = 0.860); and that preoperative length of stay ≥24 h (B = 0.016), more information needs (B = 0.988), more severe illness perceptions (B = 0.101) and more patient trust (B = -0.078) may lead to higher preoperative anxiety levels.

CONCLUSIONS

Preoperative anxiety is common in patients with lung cancer scheduled for VATS. Therefore, more attention should be paid to women and patients with a preoperative length of stay of ≥24 h. Meeting information needs, transforming positive disease perceptions, and strengthening the doctor-patient trusting relationship are key protective factors for preoperative anxiety.

Confidence in treatment is contributing to quality of life in autoimmune liver diseases. The results of ERN RARE-LIVER online survey

BACKGROUND AND AIMS

Autoimmune liver diseases (AILDs) are associated with impaired health-related quality of life (HrQoL). The aim of this project was to identify potentially modifiable factors related to HrQoL in a large transnational cohort of patients with AILDs.

METHODS

A cross-sectional online survey was conducted on patients with autoimmune hepatitis (AIH), primary biliary cholangitis (PBC) or primary sclerosing cholangitis from 15 European countries. HrQoL was measured with EQ-5D-5L and EQ visual analogue scale (EQ-VAS) and analysed in relation to demographic, psychosocial, disease- and treatment-related factors. A Patient Health Questionnaire-2 score >3 indicated relevant depression. Multivariable linear regression analyses were used to identify potentially modifiable factors associated with HrQoL and confidence in treatment whilst adjusting for known confounders.

RESULTS

A group of 1178 European patients (79% female, mean age 48 ± 14 years) participated in the study. HrQoL was impaired in all three diseases (mean EQ-5D-5L = 0.75, mean EQ VAS = 68.9), most markedly in PBC (mean EQ-5D-5L = 0.73, mean EQ-VAS = 66.2). Relevant depression, which was detected in 17% of patients, was prominently associated with impaired HrQoL. In the regression analysis, treatment confidence was identified as an important modifiable factor positively contributing to HrQoL. This influence was observable even after adjusting for other covariates including depression. Management in a transplant centre, treatment with azathioprine in AIH, and with ursodeoxycholic acid in PBC, was associated with increased treatment confidence. Finally, improved patient-physician relationships contributed to treatment confidence.

CONCLUSION

Treatment confidence is a relevant modifiable determinant of HrQoL and should be further investigated to improve the standards of care for patients with AILDs.

The role of mental disorders in precision medicine for diabetes: a narrative review

This narrative review aims to examine the value of addressing mental disorders as part of the care of people with type 1 and type 2 diabetes in terms of four components of precision medicine. First, we review the empirical literature on the role of common mental disorders in the development and outcomes of diabetes (precision prevention and prognostics). We then review interventions that can address mental disorders in individuals with diabetes or at risk of diabetes (precision treatment) and highlight recent studies that have used novel methods to individualise interventions, in person and through applications, based on mental disorders. Additionally, we discuss the use of detailed assessment of mental disorders using, for example, mobile health technologies (precision monitoring). Finally, we discuss future directions in research and practice and challenges to addressing mental disorders as a factor in precision medicine for diabetes. This review shows that several mental disorders are associated with a higher risk of type 2 diabetes and its complications, while there is suggestive evidence indicating that treating some mental disorders could contribute to the prevention of diabetes and improve diabetes outcomes. Using technologically enabled solutions to identify mental disorders could help individuals who stand to benefit from particular treatments. However, there are considerable gaps in knowledge and several challenges to be met before we can stratify treatment recommendations based on mental disorders. Overall, this review demonstrates that addressing mental disorders as a facet of precision medicine could have considerable value for routine diabetes care and has the potential to improve diabetes outcomes.

Exploring Factors and Associate Responses for Anxiety in the Coronavirus Disease 2019 Pandemic: A Web-Based Survey in Japan

Background and Objectives

Anxiety plays an important role in psychology. An exploration of anxiety and its associated reactions may provide insight into measures for addressing mental health problems caused by the coronavirus disease 2019 (COVID-19) pandemic. Data from this study provide potential correlational responses to anxiety.

Methods

A cross-sectional study using data collected via an online self-reported questionnaire was conducted in Japan during the COVID-19 pandemic. Using the State-Trait Anxiety Inventory (STAI-6), we assessed anxiety levels and explored the relationship between anxiety STAI-6 score, sources of COVID-19 information, the influences of COVID-19, social anxiety symptoms, discrimination, and evaluation of the government.

Results

A total of 4,127 participants were included in the analysis. The level of anxiety was not equally distributed across the general population with respect to age, gender, educational level, occupation, income, presence of underlying disease, and location (p < 0.05). The number of sources of information on COVID-19 had a positive correlation with the STAI-6 score (Spearman’s rho = 0.176, p < 0.001). The influence of the pandemic was correlated with moderate–severe anxiety. A high level of anxiety added to social anxiety (Spearman’s rho = 0.04, p < 0.05) and discriminatory behavior (Spearman’s rho = 0.11, p < 0.01). Being female (Estimate = 0.926) and from a non-emergency area (Estimate = −0.308) was related to higher STAI scores, and higher education (Estimate = −0.305), and income (Estimate = −0.168) decreased the STAI score. The respondents who had a lower evaluative score of the preventive activities undertaken by the national and local governments had higher STAI-6 scores.

Conclusion

Our findings provide statistical evidence for the associated reaction of anxiety and that anxiety reactions may vary in predictable ways. Further studies should focus on the strategic interventions that may decrease the associated responses to anxiety, to address mental health issues due to the pandemic.

Community-Based HIV and Viral Hepatitis Fellowship Evaluation: Results from a Qualitative Study

PURPOSE

The UMass Chan Medical School/New England AIDS Education and Training Center Community-Based HIV and Viral Hepatitis Fellowship was launched in 2014 to train physicians and nurse practitioners to become experts in outpatient management of HIV, hepatitis B and C, and latent tuberculosis. The purpose of this study was to identify areas of strength and improvement and understand fellows' perceptions of the program and its impact on their current positions and career trajectories.

METHODS

Qualitative study utilizing a semi-structured interview guide with (11) fellowship graduates (8 MDs; 3 NPs). 45 to 60 min interviews were conducted in April and May 2021, recorded and transcribed. Transcripts were analyzed for representative themes and general patterns in the data.

RESULTS

Results indicate high satisfaction with the fellowship, which left a positive and indelible impact on their careers and patient care. Fellows highlighted the program's commitment to health equity, its role in transforming them into leaders and advocates for HIV in primary care, and their ability to balance their work and training demands with their personal lives and needs. The fellowship motivated them to become more involved in public health initiatives, serve marginalized communities and reduce their health disparities. They expressed confidence in their ability to independently manage outpatient HIV, viral hepatitis B and C, and latent tuberculosis, and found areas of overlap with their work in primary care.

CONCLUSION

As the care of people with HIV becomes more commonplace in primary care clinics, it is imperative that primary care providers receive the necessary training and education to meet this need. Our study of 11 former fellows shows that the Community-Based HIV and Viral Hepatitis Fellowship offers such training, spreads it to other institutions, and can be a model for other programs nationwide.

The effects of family physician-contracted service on health-related quality of life and equity in health in China

Background

Family physician-contracted service (FPCs) has been recently implemented in Chinese primary care settings. This study was aimed at measuring the effects of FPCs on residents’ health-related quality of life (HRQoL) and equity in health among the Chinese population.

Methods

The study data was drawn from the 2018 household health survey (Shaanxi Province, China) using multistage, stratified cluster random sampling. We measured HRQoL using EQ-5D-3L based on the Chinese-specific time trade-off values set. Coarsened exact matching (CEM) technique was used to control for confounding factors between residents with and without a contracted family physician. The concentration index (C) was calculated to measure equity in health.

Results

Individuals with a contracted family physician had significantly higher HRQoL than those without, after data matching (0.9355 vs. 0.8995; P <  0.001). Additionally, the inequity in HRQoL among respondents with a contracted family physician was significantly lower than those without a contracted family physician (Cs of EQ-5D utility score: 0.0084 vs. 0.0263; p <  0.001).

Conclusions

This study highlights the positive effects of FPCs on HRQoL and socioeconomic-related equity in HRQoL. Future efforts should prioritize the economically and educationally disadvantaged groups, the expansion of service coverage, and the competency of family physician teams to further enhance health outcome and equity in health.