Reciprocal association between pain and quality of life after newly acquired spinal cord injury

PURPOSE

Pain is highly prevalent in spinal cord injury (SCI) and a key determinant of quality of life (QoL). This is the first study to examine reciprocal associations between pain and QoL in patients undergoing their first inpatient rehabilitation after SCI.

METHODS

Longitudinal data, with three measurement time points (1 month and 3 months after SCI onset, and at discharge from inpatient rehabilitation) from the Inception Cohort of the Swiss Spinal Cord Injury Cohort Study. Participants were 381 individuals aged ≥ 16 years with a newly diagnosed traumatic or non-traumatic SCI. 75.1% were male and the average age was 53.2 years. Random intercept cross-lagged panel models were conducted to examine the reciprocal association between pain intensity and QoL, as measured with the International SCI QoL Basic Data Set three individual items (satisfaction with life, physical health, and psychological health) and total score (mean of the three individual items).

RESULTS

Both item and total QoL scores increased over time. 1 month: 5.3 (SD = 2.7), 3 months: 5.9 (SD = 2.3), discharge: 6.6 (SD = 2.0). Participants reported relatively low levels of pain intensity that remained stable over the course of inpatient rehabilitation. 1 month: 2.7 (SD = 2.3), 3 months: 2.6 (SD = 2.4), discharge: 2.7 (SD = 2.5). There were no significant cross-lagged associations between QoL and pain intensity across time.

CONCLUSION

Results indicate that pain intensity does not predict changes in QoL during first rehabilitation, and vice versa. Associations between pain intensity and QoL reported by previous studies may be attributable to individual characteristics and timely events that simultaneously influence pain and QoL.

Mental health and burnout during medical school: Longitudinal evolution and covariates

BACKGROUND

Medical students' rate of depression, suicidal ideation, anxiety, and burnout have been shown to be higher than those of the same-age general population. However, longitudinal studies spanning the whole course of medical school are scarce and present contradictory findings. This study aims to analyze the longitudinal evolution of mental health and burnout from the first to the last year of medical school using a wide range of indicators. Moreover, biopsychosocial covariates that can influence this evolution are explored.

METHOD

In an open cohort study design, 3066 annual questionnaires were filled in by 1595 different students from the first to the sixth year of the Lausanne Medical School (Switzerland). Depression symptoms, suicidal ideation, anxiety symptoms, stress, and burnout were measured along with biopsychosocial covariates. The longitudinal evolution of mental health and burnout and the impact of covariates were modelled with linear mixed models.

RESULTS

Comparison to a same-aged general population sample shows that medical students reported significantly more depression symptoms and anxiety symptoms. Medical students' mental health improved during the course of the studies in terms of depression symptoms, suicidal ideation, and stress, although suicidal ideation increased again in the last year and anxiety symptoms remained stable. Conversely, the results regarding burnout globally showed a significant worsening from beginning to end of medical school. The covariates most strongly related to better mental health and less burnout were less emotion-focused coping, more social support, and more satisfaction with health.

CONCLUSION

Both improvement of mental health and worsening of burnout were observed during the course of medical school. This underlines that the beginning and the end of medical school bring specific challenges with the first years' stressors negatively impacting mental health and the last year's difficulties negatively impacting burnout.

Reciprocal association between social support and psychological distress in chronic physical health conditions: A random intercept cross-lagged panel model

The onset of a chronic physical health condition (CHC) can highly impact individuals' well-being and mental health. Social support has been shown to help people rebound after the onset of a CHC. Nonetheless, little is known about the longitudinal pattern of social support and its reciprocal association with mental health in CHC. This study aimed to illustrate the longitudinal pattern of perceived social support and to examine the reciprocal association between perceived social support and psychological distress across 6 years. Two random intercept cross-lagged panel models were conducted, one for emotional and one for practical support, using yearly assessments of 582 Swiss Household Panel's participants reporting a CHC. A reciprocal association was found, with psychological distress 1 year after the onset being linked to less emotional support in the following year and vice versa, more emotional support being linked to less psychological distress the following year. A unidirectional association was found for practical support, with more psychological distress 1 year before the CHC onset being linked to more practical support at the onset year. This study underlines the importance of involving the social environment of individuals living with a CHC, especially around the first year after the onset.

Exposure of medical students to sexism and sexual harassment and their association with mental health: a cross-sectional study at a Swiss medical school

OBJECTIVES

To assess the self-reported prevalence of sexism and sexual harassment at a Swiss medical school, and to investigate their association with mental health. Research hypotheses were an association between sexism/sexual harassment and poor mental health and a higher prevalence of sexism/sexual harassment in clinical rotations.

DESIGN

Cross-sectional study as a part of ETMED-L project, an ongoing cohort study of interpersonal competences and mental health of medical students.

SETTING

Single-centre Swiss study using an online survey submitted to medical students.

PARTICIPANTS

From 2096 registered students, 1059 were respondents (50.52%). We excluded 26 participants (25 due to wrong answers to attention questions, and 1 who did not answer the sexism exposure question). The final sample (N=1033) included 720 women, 300 men and 13 non-binary people.

MEASURES

Prevalence of self-reported exposure to sexism/sexual harassment. Multivariate regression analyses of association between being targeted by sexism or sexual harassment and mental health (depression, suicidal ideation, anxiety, stress, burnout, substance use and recent mental health consultation). Regression models adjusted for gender, academic year, native language, parental education level, partnership and an extracurricular paid job.

RESULTS

Being targeted by sexism or sexual harassment was reported by 16% of participants with a majority of women (96%). The prevalence increased with clinical work. After adjusting for covariates, we found association between being targeted by sexism/harassment and risk of depression (OR 2.29, 95% CI 1.54 to 3.41, p<0.001), suicidal ideation (B coefficient (B) 0.37, p<0.001) and anxiety (B 3.69, p<0.001), as well as cynicism (B 1.46, p=0.001) and emotional exhaustion (B 0.94, p=0.044) components of burnout, substance use (B 6.51, p<0.001) and a recent mental health consultation (OR 1.78, 95% CI 1.10 to 2.66, p=0.005).

CONCLUSIONS

Sexism and sexual harassment, although less common than usually reported, are behaviours of concern in this medical school and are significantly associated with mental health.

The relationship between medical students' empathy, mental health, and burnout: A cross-sectional study

OBJECTIVE

To investigate how medical students' empathy is related to their mental health and burnout.

METHODS

This cross-sectional study included 886 medical students from curriculum years 1-6. The cognitive, affective, and behavioural dimensions of empathy were measured with self-report questionnaires and an emotion recognition test. Regressions were used to test the relationship between the empathy dimensions, depressive symptoms, anxiety, and burnout as well as the influence of curriculum year and gender.

RESULTS

Cognitive and behavioural empathy were significantly related to less mental health issues and burnout, whereas affective empathy was related to more mental health issues and burnout. Students in later curriculum years reported less mental health issues and burnout than students in earlier years, whereas no systematic difference could be observed for empathy. Female students reported more mental health issues and burnout as well as higher empathy, except for behavioural empathy for which male students scored higher.

CONCLUSIONS

The cognitive, affective, and behavioural dimensions of empathy were differently related to the mental health and burnout of medical students. Students presenting mental health issues or burnout might have more difficulty to adapt their behaviour in social situations and keep a certain distance when taking others' perspective.

Study protocol for the ETMED-L project: longitudinal study of mental health and interpersonal competence of medical students in a Swiss university using a comprehensive framework of empathy

INTRODUCTION

Physician interpersonal competence is crucial for patient care. How interpersonal competence develops during undergraduate medical education is thus a key issue. Literature on the topic consists predominantly of studies on empathy showing a trend of decline over the course of medical school. However, most existing studies have focused on narrow measures of empathy. The first aim of this project is to study medical students' interpersonal competence with a comprehensive framework of empathy that includes self-reported cognitive and affective empathy, performance-based assessments of emotion recognition accuracy, and a behavioural dimension of empathy. The second aim of the present project is to investigate the evolution of mental health during medical school and its putative link to the studied components of interpersonal competence. Indeed, studies documented a high prevalence of mental health issues among medical students that could potentially impact their interpersonal competence. Finally, this project will enable to test the impact of mental health and interpersonal competence on clinical skills as evaluated by experts and simulated patients.

METHODS AND ANALYSIS

This project consists of an observational longitudinal study with an open cohort design. Each year during the four consecutive years of the project, every medical student (curriculum years 1-6) of the University of Lausanne in Switzerland will be asked to complete an online questionnaire including several interpersonal competence and mental health measures. Clinical skills assessments from examinations and training courses with simulated patients will also be included. Linear mixed models will be used to explore the longitudinal evolutions of the studied components of interpersonal competence and mental health as well as their reciprocal relationship and their link to clinical skills.

ETHICS AND DISSEMINATION

The project has received ethical approval from the competent authorities. Findings will be disseminated through internal, regional, national and international conferences, news and peer-reviewed journals.

Longitudinal changes in psychological adaptation outcomes during spinal cord injury inpatient rehabilitation

OBJECTIVES

To determine average changes and individuals' patterns of change in depressive symptoms, anxiety symptoms, general distress, and life satisfaction between admission to spinal cord injury inpatient rehabilitation and discharge; and to identify factors associated with change.

METHOD

Longitudinal data collection as part of a national cohort study (N = 281). Changes in the psychological adaptation outcomes were analyzed using latent change score models. Reliable change indexes were calculated for each outcome to identify individuals' patterns of change. Biopsychosocial factors were examined as covariates of change.

RESULTS

On average, depressive symptoms, anxiety symptoms, and general distress decreased between admission and discharge, while life satisfaction increased. According to the reliable change indexes, several adaptation patterns were identified. The proportion of individuals following each pattern varied depending on the analyzed outcome: resilience (absence of clinically relevant symptoms at admission and discharge) was the most common for symptoms of depression (61.57%) and anxiety (66.55%), whereas vulnerability (clinically relevant symptoms at both measurement times) was the most common for distress (57.32%). Improvement patterns (statistically significant decreases) were identified for 6.41%, 4.27%, and 7.83% of participants in depressive symptoms, anxiety symptoms and distress, respectively. For life satisfaction, improvement (statistically significant increases) was found for 8.54%. Male sex, tetraplegia, self-efficacy, optimism, and social support were associated with average changes in the psychological adaptation outcomes.

CONCLUSIONS

On average, participants showed improvement in all analyzed outcomes. Still, there is substantial variability in change. Self-efficacy, social support, and optimism are potential intervention targets during inpatient rehabilitation to promote a favorable psychological adaptation process. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Longitudinal measurement invariance of the international spinal cord injury quality of life basic data set (SCI-QoL-BDS) during spinal cord injury/disorder inpatient rehabilitation

Purpose

This study aimed at testing the internal consistency and longitudinal measurement invariance of a brief quality of life questionnaire—the spinal cord injury quality of life basic data set (SCI-QoL-BDS)—among individuals with spinal cord injury/disorder undergoing first inpatient rehabilitation.

Methods

Longitudinal data from the Swiss spinal cord injury inception cohort study were used. Participants (n = 218) completed the SCI-QoL-BDS at one and three months post injury and at discharge. The SCI-QoL-BDS consists of three items assessing satisfaction with life as a whole, physical health, and psychological health. Internal consistency was examined at each time point and longitudinal measurement invariance was tested using longitudinal confirmatory factor analysis.

Results

Internal consistency coefficients ranged between .82 and .90. The confirmatory factor analysis revealed invariance of the factor structure and of all factor loadings across time. Additionally, all item intercepts except the one of satisfaction with physical health were invariant across time, suggesting partial intercept invariance of the SCI-QoL-BDS. Indeed, a response shift was observed in satisfaction with physical health. This item was evaluated more negatively in the early phase of inpatient rehabilitation, indicating the change of the evolving physical situation after the onset of a spinal cord injury.

Conclusion

The SCI-QoL-BDS is a consistent and valid measure to assess quality of life among individuals undergoing first spinal cord injury/disorder inpatient rehabilitation. However, we recommend using latent variable frameworks instead of mean scores when examining longitudinal changes in the measure to account for potential response shift.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11136-021-03027-5.

Adaptation during spinal cord injury rehabilitation: The role of appraisal and coping

OBJECTIVE

To test the spinal cord injury adjustment model (SCIAM) by examining whether primary appraisals (threat or loss) and coping strategies (approach-oriented and denial) sequentially mediate the impact of functional independence, psychological resources, and social support on depressive and anxiety symptoms among individuals with spinal cord injury during inpatient rehabilitation.

METHOD

Path analyses of longitudinal data from a Swiss inception cohort study (N = 207). Models were implemented separately for depressive and anxiety symptoms.

RESULTS

The initial models based on the SCIAM yielded poor fit and were respecified. Different from the SCIAM's assumptions, psychological resources and threat appraisal showed direct effects on depressive symptoms (β = -.28, SE = .07, p < .001 and β = .33, SE = .07, p < .001, respectively), while social support and threat appraisal showed direct effects on anxiety symptoms (β = -.23, SE = .06, p < .001 and β = .42, SE = .06, p < .001, respectively). Primary appraisals and coping strategies partially mediated the effects of psychological resources on depressive symptoms and fully mediated their effect on anxiety symptoms. However, this did not only happen via the SCIAM's sequential double mediation, since indirect effects were also observed via threat appraisal only. The final models explained 40 and 30% of the variance of depressive and anxiety symptoms, respectively.

CONCLUSIONS

The findings only partially supported the SCIAM's sequential double mediation mechanism. Psychological resources, social support, and primary appraisals can have direct effects on psychological adaptation outcomes and may be suitable intervention targets during inpatient rehabilitation. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

The longitudinal impact of a chronic physical health condition on subjective well-being

OBJECTIVE

Chronic health conditions (CHC) can have severe impacts on an individual's life, affecting well-being and mental health. Nonetheless, individuals can show different response patterns of psychological adaptation following a CHC onset. This study aimed to identify profiles of subjective well-being (SWB) at 1 year before (T - 1), 1 year after (T + 1), and 4 years after (T + 4) the onset of a physical CHC using seven indicators (health satisfaction, life satisfaction, energy, joy, worry, sadness, anger), examine transitions between the identified profiles, and determine predicting factors of these transitions.

METHOD

Latent profile analysis and latent transition analysis was conducted using a sample of 357 participants reporting a physical CHC drawn from the Swiss Household Panel dataset.

RESULTS

Three profiles were identified at T - 1: low, high, and very high SWB. At T + 1 and T + 4, a fourth vulnerable profile emerged. Transition analysis showed that, overall, the most probable transition was to stay in similar profiles across time. However, recovery toward higher SWB profiles and delayed reaction toward lower SWB profiles appeared between 1 and 4 years following the CHC onset. Factors predicting recovery patterns from low to high SWB are better health status, fewer negative life events, and financial scarcity, whereas lower emotional stability was related to a delayed reaction from high to low SWB.

CONCLUSION

This study underlines the importance of personal factors in the adaptation following CHC onset. Routine assessment of personality traits would enable identifying individuals at greater risk of lower SWB following the onset of a CHC. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Non-verbal Adaptation to the Interlocutors' Inner Characteristics: Relevance, Challenges, and Future Directions

Human diversity cannot be denied. In our everyday social interactions, we constantly experience the fact that each individual is a unique combination of characteristics with specific cultural norms, roles, personality, and mood. Efficient social interaction thus requires an adaptation of communication behaviors to each specific interlocutor that one encounters. This is especially true for non-verbal communication that is more unconscious and automatic than verbal communication. Consequently, non-verbal communication needs to be understood as a dynamic and adaptive process in the theoretical modeling and study of social interactions. This perspective paper presents relevance, challenges, and future directions for the study of non-verbal adaptation in social interactions. It proposes that non-verbal adaptability is more pertinently studied as adaptation to interlocutor's inner characteristics (i.e., expectations or preferences) than to interlocutor's behaviors per se, because behaviors are communication messages that individuals interpret in order to understand their interlocutors. The affiliation and control dimensions of the Interpersonal Circumplex Model are proposed as a framework to measure both the interlocutors' inner characteristics (self-reported) and the individuals' non-verbal responses (external coders). These measures can then be compared across different interactions to assess an actual change in behavior tailored to different interlocutors. These recommendations are proposed in the hope of generating more research on the topic of non-verbal adaptability. Indeed, after having gathered the evidence on average effects of non-verbal behaviors, the field can go further than a “one size fits all” approach, by investigating the predictors, moderators, and outcomes of non-verbal adaptation to the interlocutors' inner characteristics.

Body experience during post-acute rehabilitation in individuals after a traumatic spinal cord injury: a qualitative interview-based pilot study

STUDY DESIGN

Qualitative interview-based pilot study.

OBJECTIVES

A traumatic spinal cord injury (TSCI) profoundly disrupts the way individuals experience their body. Awareness of one's body is an important element in the psychological adjustment process after TSCI. This pilot study aimed to explore the body experience of individuals during post-acute rehabilitation following TSCI.

SETTING

Specialized acute care and rehabilitation center in Switzerland.

METHODS

Eight semi-structured face-to-face interviews were conducted with patients in the post-acute phase of their TSCI. Body experience was explored in relation to perceptive, cognitive, emotional, and behavioral aspects. The interviews were transcribed verbatim, and a structured content analysis was performed according to the Mayring method.

RESULTS

The individuals verbalized body experience in all explored aspects. The two participants with tetraplegia described high body-related awareness, including dependence on other persons or aids, whereas individuals with paraplegia focused on their ability to regain activity and perceived autonomy, which was sustained by increasing injury- and self-related comprehension. They expressed uncertainty in their understanding of their paralyzed body while also verbalizing to see a continuity in their identity pre and post TSCI. Their emotions varied from anxiety and anger to hope and optimism. The interviewees confirmed that the growing ability to describe perceptions related to their body increased their active participation in the rehabilitation process and stimulated hope for the future.

CONCLUSIONS

Exploration of individual body experience after a recent TSCI can strengthen patients' body awareness, communication and engagement in rehabilitation and help the interprofessional rehabilitation team individualize the rehabilitation process.

Mental health, quality of life, self-efficacy, and social support of individuals living with spinal cord injury in Switzerland compared to that of the general population

STUDY DESIGN

Comparative study of survey self-report data.

OBJECTIVES

To compare individuals living with spinal cord injury (SCI) in Switzerland to the general population in terms of mental health, quality of life, self-efficacy, and social support.

SETTING

Community, Switzerland.

METHODS

Data from the 2017 community survey of the Swiss Spinal Cord Injury Cohort Study were compared to data from two matched (1:3 nearest neighbor propensity score) general population surveys collected in the same year. Measures of mental health (mental health index, psychological distress item, vitality scale, and energy item), quality of life (WHOQOL-BREF item), self-efficacy (General Self-Efficacy Scale item), and social support (items of relationship satisfaction, living alone, and marital status) were compared across datasets using regression adjusted for non-response correction weights. The analyses were then replicated in subgroups defined by sociodemographic, lesion-related, and secondary health issues factors.

RESULTS

Individuals with SCI had significantly higher psychological distress and poorer mental health, vitality, energy, and quality of life than the general population, with medium to large effect sizes (Cohen's d: 0.35-1.08). They also had lower self-efficacy and relationship satisfaction, lived more frequently alone, and were more frequently single. Individuals with less severe secondary health issues reported mental health and quality of life more similar to the general population than those reporting more severe issues.

CONCLUSIONS

This study highlights a significant long-term impact of SCI on well-being and psychosocial resources, underlining the need for ongoing biopsychosocial care beyond inpatient rehabilitation.

Virtual patient simulation in breaking bad news training for medical students

OBJECTIVE

The present study explores students' perspective on the added value of a virtual patient (VP) simulation as part of a breaking bad news training in undergraduate medical education.

METHODS

The VP simulation allows trying out and practicing different ways of disclosing a cancer diagnosis to a VP (avatar) and to react to emotionally-laden patient statements with the opportunity of self-observation through video recording. After testing the simulation, 23 students shared their experience in focus groups analyzed using thematic analysis.

RESULTS

Self-observation is the most valued feature of the simulation, because it enables users to reflect on their behaviors and adjust them. The competences developed are otherwise technical (e.g., organization of information) and concern less interactional competences. Areas for improvement of the simulation are the interactivity, quality, and diversity of the VPs.

CONCLUSION

The findings show that VP simulations help develop technical communication competences and are best suited as add-ons to other forms of training, in which relational aspects can be targeted. Self-observation is especially valued because it allows for a critical view regarding one's own communication behaviors in a stress-free environment.

PRACTICE IMPLICATIONS

The proposed simulation is beneficial as an add-on to lectures, supervision, and simulated patient interviews.

Psychological distress trajectories in chronic physical health conditions

OBJECTIVE

The onset of a chronic health condition (CHC) can have a severe impact on an individual's life, affecting mental and physical health. This study's goal was to investigate psychological distress trajectories starting from 1 year before to 4 years after the onset of a physical CHC. The specific aims were to identify the number and shape of longitudinal psychological distress trajectories and to test health-related, psychological, social, and demographic factors predicting these trajectories.

METHOD

Two samples were drawn from the Swiss Household Panel data set: a CHC sample (n = 361) and a 1-to-1 matched comparison sample of healthy individuals. Latent growth mixture modeling was used to identify psychological distress trajectories over 6 years. Factors predicting trajectories were then tested using multinomial logistic regression.

RESULTS

Four psychological distress trajectories were identified in the CHC sample: resilience (53.9%), chronic (22.2%), delayed (15.0%), and recovery (8.9%). In the comparison sample, two trajectories were identified: low psychological distress (90%) and elevated psychological distress (10%). Protective factors associated with resilient trajectory membership in the CHC sample were higher emotional stability, higher relationship satisfaction, and male gender.

CONCLUSION

Individuals living with a CHC had an increased risk of vulnerability compared with a sample of healthy individuals. This advocates awareness of mental health issues following the onset of a CHC. In this regard, biopsychosocial factors (gender, emotional stability, and relationship satisfaction) offer prevention and intervention opportunities for more vulnerable individuals. (PsycINFO Database Record (c) 2020 APA, all rights reserved).