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Ng L, Schache K, Young M, Sinclair J. Value of Schwartz Rounds in promoting the emotional well-being of healthcare workers: a qualitative study. BMJ Open 2023; 13:e064144. [PMID: 37019482 PMCID: PMC10083799 DOI: 10.1136/bmjopen-2022-064144] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023] Open
Abstract
OBJECTIVES Schwartz Rounds are forums that enable healthcare staff to reflect on emotional and social dimensions of their work. In this study, we aimed to explore the experiences of Schwartz Rounds on emotional aspects of care and practice within a clinical environment. DESIGN Using qualitative methods, we interviewed participants individually and in focus groups. Interviews were recorded, transcribed and analysed by thematic analysis. SETTING The study was based at a public health service Te Whatu Ora Counties Manukau in Auckland, New Zealand's largest, most ethnically diverse population. PARTICIPANTS Participants were panellists who took part in successive Schwartz Rounds over a 10-month period. There were 17 participants with a range of experience (1-30 years) and occupations including clinical, allied, technical and administrative staff from medical specialties of plastic surgery, pain services, emergency medicine, intensive care, organ donation services, COVID-19 response and palliative care services. RESULTS Three themes were identified: the need for emotional processing, valuing guided reflection and realising our humanity. The third theme 'realising our humanity' comprised altruism, connection and compassion. Schwartz Rounds provided staff with clear benefits: emotionally resonant experiences within an environment of psychological safety and connection to the wider organisation. The daunting nature of emotional disclosure was mitigated by a supportive audience. CONCLUSION There is an organisational imperative to ensure that staff have opportunities to process intense emotions associated with healthcare work. Schwartz Rounds are one means to attend to the emotional welfare of healthcare staff, enabling them to gain different perspectives in the care of their patients and colleagues within system constraints.
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Affiliation(s)
- Lillian Ng
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
- Mental Health and Addictions, Division of Psychiatry, Te Whatu Ora Health NZ Counties Manukau, Auckland, New Zealand
| | - Kiralee Schache
- Department of Psychological Medicine, Te Whatu Ora Health NZ Counties Manukau, Auckland, New Zealand
- Department of Critical Care, Te Whatu Ora Health NZ Counties Manukau, Auckland, New Zealand
| | - Marie Young
- Department of Psychological Medicine, Te Whatu Ora Health NZ Counties Manukau, Auckland, New Zealand
| | - Joanna Sinclair
- Department of Anaesthesia and Pain Medicine, Te Whatu Ora Counties Manukau, Auckland, New Zealand
- People and Culture Directorate, Te Whatu Ora Health NZ and Counties Manukau, Auckland, New Zealand
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Abstract
OBJECTIVES To evaluate the efficacy and acceptability of 'Whitu: seven ways in seven days', a well-being application (app) for young people. DESIGN Prospective randomised controlled trial of Whitu against waitlist control, with 45 participants in each arm. PARTICIPANTS 90 New Zealand young people aged 16-30 recruited via a social media advertising campaign. SETTING Participants' homes. INTERVENTIONS Developed during the COVID-19 pandemic, and refined from a prototype version that was evaluated during a smaller qualitative study, 'Whitu: seven ways in seven days' is a well-being app that, as its name suggests, contains seven modules to help young people (1) recognise and rate emotions, (2) learn relaxation and mindfulness, (3) practice self-compassion and (4) gratitude, (5) connect with others, (6) care for their physical health and (7) engage in goal-setting. It can be completed within a week or as desired. MAIN OUTCOME MEASURES Primary outcomes were changes in well-being on the WHO 5-item Well-Being Index and Short Warwick-Edinburgh Mental Well-Being Scale. Secondary outcomes were changes in depression on the Centre for Epidemiological Studies Depression Scale, anxiety on the Generalised Anxiety Disorder 7-item Scale, self-compassion on the Self Compassion Scale-Short Form, stress on the 10-item Perceived Stress Scale, sleep on the single-item Sleep Quality Scale and user engagement on the end-user version of the Mobile Application Rating Scale and via qualitative feedback during an online survey. Outcomes were evaluated at baseline, 4 weeks (primary study endpoint) and 3 months, and analysed using linear mixed models with group, time and a group-time interaction. RESULTS At 4 weeks, participants in the Whitu group experienced significantly higher emotional (Mean difference (md) 13.19 (3.96 to 22.42); p=0.005) and mental (md 2.44 (0.27 to 4.61); p=0.027) well-being, self-compassion (md 0.56 (0.28 to 0.83); p<0.001) and sleep (md 1.13 (0.24 to 2.02); p=0.018), and significantly lower stress (md -4.69 (-7.61 to -1.76); p=0.002) and depression (md -5.34 (-10.14 to -0.53); p=0.030), compared with the waitlist controls. Group differences remained statistically significant at 3 months for all outcomes. Symptoms of anxiety were also lower in the intervention group at 4 weeks (p=0.096), with statistically significant differences at 3 months (md -2.31 (-4.54 to -0.08); p=0.042). Usability of Whitu was high (subjective ratings of 4.45 (0.72) and 4.38 (0.79) out of 5 at 4 weeks and 3 months, respectively) and qualitative feedback indicated individual and cultural acceptability of the app. CONCLUSIONS Given the evolving psychological burden of the COVID-19 pandemic, Whitu could provide a clinically effective and scalable means of improving the well-being, mental health and resilience of young people. Replication of current findings with younger individuals and in other settings is planned. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry (ACTRN12620000516987).
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Affiliation(s)
- Hiran Thabrew
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Anna Lynette Boggiss
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - David Lim
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Kiralee Schache
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Eva Morunga
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Nic Cao
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Alana Cavadino
- Department of Epidemiology and Biostatistics, The University of Auckland, Auckland, New Zealand
| | - Anna Sofia Serlachius
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
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Loseby P, Schache K, Cavadino A, Young S, Hofman PL, Serlachius A. The role of protective psychological factors, self-care behaviors, and HbA1c in young adults with type 1 diabetes. Pediatr Diabetes 2022; 23:380-389. [PMID: 34967089 DOI: 10.1111/pedi.13306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 12/21/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To investigate whether protective psychological factors in young adults with type 1 diabetes are associated with more optimal self-care behaviors and HbA1c, and to explore possible mediators between protective psychological factors and HbA1c. RESEARCH DESIGN AND METHODS This cross-sectional study examined the associations between protective psychological factors (optimism, positive efficacy expectancies, and self-compassion), maladaptive psychological factors (depression, anxiety, and stress), self-care behaviors, and HbA1c in 113 young adults (17-25 years) with type 1 diabetes in Auckland, New Zealand. Pearson's correlations, multiple linear regressions, and multiple mediation analyses were used to examine associations and mediators. RESULTS Higher positive efficacy expectancies (beliefs about coping with difficulties) were associated with more optimal HbA1c (β = -0.26, 95% CI: -1.99 to -0.45) and more optimal self-care behaviors (β = 0.33, 95% CI: 0.28 to 0.92) in the adjusted models. Higher levels of self-compassion were associated with more optimal self-care behaviors (β = 0.27, 95% CI: 0.09 to 0.43). Depression was associated with less optimal self-care behaviors (β = -0.35, 95% CI: -1.33 to -0.43) and stress was associated with less optimal HbA1c (β = 0.26, 95% CI: 0.27 to 1.21). Mediation results suggested that self-care behaviors mediated the relationship between all three of the protective psychological factors and more optimal HbA1c, and that lower stress also mediated the relationship between higher self-compassion and more optimal HbA1c. CONCLUSIONS This study adds to the emerging literature that protective psychological factors may play an adaptive role in improving health outcomes in young adults with type 1 diabetes. Interventions targeting protective psychological factors present a promising approach to optimizing wellbeing and self-care in youth with type 1 diabetes.
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Affiliation(s)
- Philippa Loseby
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | - Kiralee Schache
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand.,Psychological Medicine, Counties Manukau Health, Auckland, New Zealand
| | - Alana Cavadino
- Epidemiology and Biostatistics, School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Simon Young
- North Shore Hospital, Waitemata District Health Board, Auckland, New Zealand
| | - Paul L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Anna Serlachius
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
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Serlachius A, Boggiss A, Lim D, Schache K, Wallace-Boyd K, Brenton-Peters J, Buttenshaw E, Chadd S, Cavadino A, Cao N, Morunga E, Thabrew H. Pilot study of a well-being app to support New Zealand young people during the COVID-19 pandemic. Internet Interv 2021; 26:100464. [PMID: 34631433 PMCID: PMC8486611 DOI: 10.1016/j.invent.2021.100464] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/26/2021] [Accepted: 09/28/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Well-being apps represent a promising and scalable approach for improving mental health outcomes in youth, especially during a global pandemic when access to face-to-face interventions may be limited. Whitu (meaning 7 in the New Zealand Māori language Te Reo) is a newly developed well-being app with 7 modules that support young people to learn and practice evidence-based coping skills, including relaxation, mindfulness, self-compassion, and goal-setting. OBJECTIVE During this pilot, we explored the acceptability, usability, and preliminary efficacy of Whitu before refining the app for a randomized controlled trial (RCT). METHODS We recruited 20 New Zealand young people aged 16-25 years via social media to trial the first prototype of the Whitu app over 6 weeks. Within-group differences from baseline to 2- and 6-weeks post intervention in self-reported well-being, depression, anxiety, stress, self-compassion, optimism and sleep quality were evaluated using repeated-measures ANOVA. A further 21 participants aged 16-30 years were recruited to participate in 4 focus groups to give feedback on the app's usability and cultural acceptability. Feedback was analysed using directed content analysis. RESULTS Statistically significant improvements in anxiety (p = 0.024) and stress (p = 0.017) were observed from baseline to 2-weeks post intervention. Improvements in well-being (p = 0.021), depression (p = 0.031), anxiety (p = 0.005), and stress (p = 0.004) were also observed from baseline to 6-weeks. No statistically significant changes were seen in self-compassion, optimism, or sleep quality. Effect sizes (partial η2s) ranged from 0.25 (depression) to 0.42 (stress). Qualitative feedback comprised of five key themes, namely: factors affecting engagement, issues with functionality, preferences regarding aesthetics, effectiveness and adverse effects, and cultural acceptability. CONCLUSIONS Our preliminary results suggest that Whitu may be an effective app for improving multiple dimensions of young people's well-being. Modifications to the look and feel, cultural content, and onboarding have been undertaken based on the qualitative feedback, and an RCT is currently underway.
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Affiliation(s)
- Anna Serlachius
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand,Corresponding author.
| | - Anna Boggiss
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand
| | - David Lim
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand
| | - Kiralee Schache
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand,Psychological Medicine, Counties Manukau Health, Auckland, New Zealand
| | - Kate Wallace-Boyd
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand
| | - Jennifer Brenton-Peters
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand
| | - Elise Buttenshaw
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand
| | - Stephanie Chadd
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand
| | - Alana Cavadino
- Epidemiology and Biostatistics, School of Population Health, The University of Auckland, New Zealand
| | | | - Eva Morunga
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand,Auckland District Health Board, Auckland, New Zealand
| | - Hiran Thabrew
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, The University of Auckland, New Zealand,Auckland District Health Board, Auckland, New Zealand
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Serlachius A, Schache K, Boggiss A, Lim D, Wallace-Boyd K, Brenton-Peters J, Buttenshaw E, Chadd S, Cavadino A, Cao N, Morunga E, Thabrew H. Coping Skills Mobile App to Support the Emotional Well-Being of Young People During the COVID-19 Pandemic: Protocol for a Mixed Methods Study. JMIR Res Protoc 2020; 9:e23716. [PMID: 32991303 PMCID: PMC7546866 DOI: 10.2196/23716] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/15/2020] [Accepted: 09/15/2020] [Indexed: 01/07/2023] Open
Abstract
Background The COVID-19 pandemic is likely to increase anxiety and distress in young people worldwide. It is important to prioritize mental health during crisis events to mitigate the negative and often long-term effects of the crises on young people, families, and society. Mental health and well-being apps represent a scalable approach for improving psychological outcomes in young people and have potential to improve the equity of service access. Objective The Whitu: 7 Ways in 7 Days well-being app was recently developed by our group to address the urgent need for innovative approaches to reach young New Zealanders who are struggling to cope with the COVID-19 pandemic. The aim of this study is twofold: to evaluate the acceptability of the prototype app and to examine the effectiveness of the refined app at improving mental and emotional well-being and reducing depression, anxiety, and stress in young people in New Zealand. Methods A two-phase mixed methods study will be undertaken to achieve these aims. During the first phase, 20 young people aged 16-30 years (including those of Māori and Pacific ethnicity) will participate in a qualitative study to help refine the prototype app. During the second phase, 90 young people aged 16-30 years will participate in a randomized waitlist-controlled trial (RCT) to evaluate the efficacy of the refined Whitu app at 4 weeks and 3 months after baseline. Outcomes will be evaluated using validated web-based questionnaires at baseline, 4 weeks, and 3 months. Results The study received ethics approval in May 2020, and recruitment for the focus groups commenced in June 2020. Recruitment for the RCT is expected to commence in October 2020. Participants for both study phases will be recruited via social media and web-based communities. Data collection for the RCT is expected to be completed by January 2021, and analyses are expected to be completed by March 2021. Linear mixed modelling will be used to determine between-group differences in psychological outcomes. Conclusions There is an urgent need to develop culturally appropriate, scalable mental health interventions to address the psychological consequences of the COVID-19 pandemic. In this study, we will develop and test an evidence-based well-being app that, if effective, can be made available to all young people in New Zealand and internationally. Trial Registration Australian New Zealand Clinical Trials Registry (ACTRN12620000516987); https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=379597. International Registered Report Identifier (IRRID) PRR1-10.2196/23716
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Affiliation(s)
- Anna Serlachius
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Kiralee Schache
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand.,Psychological Medicine, Counties Manukau Health, Auckland, New Zealand
| | - Anna Boggiss
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - David Lim
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Kate Wallace-Boyd
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | | | - Elise Buttenshaw
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Stephanie Chadd
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - Alana Cavadino
- Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand
| | | | - Eva Morunga
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand.,Auckland District Health Board, Auckland, New Zealand
| | - Hiran Thabrew
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand.,Auckland District Health Board, Auckland, New Zealand
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Serlachius A, Schache K, Kieser A, Arroll B, Petrie K, Dalbeth N. Association Between User Engagement of a Mobile Health App for Gout and Improvements in Self-Care Behaviors: Randomized Controlled Trial. JMIR Mhealth Uhealth 2019; 7:e15021. [PMID: 31411147 PMCID: PMC6711037 DOI: 10.2196/15021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/04/2019] [Accepted: 07/04/2019] [Indexed: 12/22/2022] Open
Abstract
Background Mobile health (mHealth) apps represent a promising approach for improving health outcomes in patients with chronic illness, but surprisingly few mHealth interventions have investigated the association between user engagement and health outcomes. We aimed to examine the efficacy of a recommended, commercially available gout self-management app for improving self-care behaviors and to assess self-reported user engagement of the app in a sample of adults with gout. Objective Our objective was to examine differences in self-reported user engagement between a recommended gout app (treatment group) and a dietary app (active control group) over 2 weeks as well as to examine any differences in self-care behaviors and illness perceptions. Methods Seventy-two adults with gout were recruited from the community and three primary and secondary clinics. Participants were randomized to use either Gout Central (n=36), a self-management app, or the Dietary Approaches to Stop Hypertension Diet Plan (n=36), an app based on a diet developed for hypertension, for 2 weeks. The user version of the Mobile Application Rating Scale (uMARS, scale: 1 to 5) was used after the 2 weeks to assess self-reported user engagement, which included an open-ended question. Participants also completed a self-report questionnaire on self-care behaviors (scale: 1-5 for medication adherence and diet and 0-7 for exercise) and illness perceptions (scale: 0-10) at baseline and after the 2-week trial. Independent samples t tests and analysis of covariance were used to examine differences between groups at baseline and postintervention. Results Participants rated the gout app as more engaging (mean difference –0.58, 95% CI –0.96 to –0.21) and more informative (mean difference –0.34, 95% CI –0.67 to –0.01) than the dietary app at the 2-week follow-up. The gout app group also reported a higher awareness of the importance of gout (mean difference –0.64, 95% CI –1.27 to –0.003) and higher knowledge/understanding of gout (mean difference –0.70, 95% CI –1.30 to –0.09) than the diet app group at follow-up. There were no significant differences in self-care behaviors between the two groups postintervention. The gout app group also demonstrated stronger negative beliefs regarding the impact of gout (mean difference –2.43, 95% CI –3.68 to –1.18), stronger beliefs regarding the severity of symptoms (mean difference –1.97, 95% CI –3.12 to –0.82), and a stronger emotional response to gout (mean difference –2.38, 95% CI –3.85 to –0.90) at follow-up. Participant feedback highlighted the importance of tracking health-related information, customizing to the target group/individual, providing more interactive features, and simplifying information. Conclusions Participants found the commercially available gout app more engaging. However, these findings did not translate into differences in self-care behaviors. The gout app group also demonstrated stronger negative illness perceptions at the follow-up. Overall, these findings suggest that the development of gout apps would benefit from a user-centered approach with a focus on daily, long-term self-care behaviors as well as modifying illness beliefs. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12617001052325; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373217.
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Affiliation(s)
- Anna Serlachius
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Kiralee Schache
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Anel Kieser
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Bruce Arroll
- General Practice and Primary Healthcare, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Keith Petrie
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Nicola Dalbeth
- Bone and Joint Research Group, Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Schache K, Consedine N, Hofman P, Serlachius A. Gratitude - more than just a platitude? The science behind gratitude and health. Br J Health Psychol 2018; 24:1-9. [DOI: 10.1111/bjhp.12348] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 10/22/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Kiralee Schache
- Department of Psychological Medicine; Faculty of Medical and Health Sciences; University of Auckland; New Zealand
| | - Nathan Consedine
- Department of Psychological Medicine; Faculty of Medical and Health Sciences; University of Auckland; New Zealand
| | - Paul Hofman
- Liggins Institute; University of Auckland; New Zealand
| | - Anna Serlachius
- Department of Psychological Medicine; Faculty of Medical and Health Sciences; University of Auckland; New Zealand
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