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Cummings JR, Zhang X, Gandré C, Morsella A, Shields-Zeeman L, Winkelmann J, Allin S, Augusto GF, Cascini F, Cserháti Z, de Belvis AG, Eriksen A, Fronteira I, Jamieson M, Murauskienė L, Palmer WL, Ricciardi W, Samuel H, Scintee SG, Taube M, Vrangbæk K, van Ginneken E. Challenges facing mental health systems arising from the COVID-19 pandemic: Evidence from 14 European and North American countries. Health Policy 2023; 136:104878. [PMID: 37611521 DOI: 10.1016/j.healthpol.2023.104878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 06/28/2023] [Accepted: 07/04/2023] [Indexed: 08/25/2023]
Abstract
We assessed challenges that the COVID-19 pandemic presented for mental health systems and the responses to these challenges in 14 countries in Europe and North America. Experts from each country filled out a structured questionnaire with closed- and open-ended questions between January and June 2021. We conducted thematic analysis to investigate the qualitative responses to open-ended questions, and we summarized the responses to closed-ended survey items on changes in telemental health policies and regulations. Findings revealed that many countries grappled with the rising demand for mental health services against a backdrop of mental health provider shortages and challenges responding to workforce stress and burnout. All countries in our sample implemented new policies or initiatives to strengthen mental health service delivery - with more than two-thirds investing to bolster their specialized mental health care sector. There was a universal shift to telehealth to deliver a larger portion of mental health services in all 14 countries, which was facilitated by changes in national regulations and policies; 11 of the 14 participating countries relaxed regulations and 10 of 14 countries made changes to reimbursement policies to facilitate telemental health care. These findings provide a first step to assess the long-term challenges and re-organizational effect of the COVID-19 pandemic on mental health systems in Europe and North America.
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Affiliation(s)
- Janet R Cummings
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States.
| | - Xinyue Zhang
- Rollins School of Public Health, Emory University, Atlanta, Georgia, United States
| | - Coralie Gandré
- Institut de recherche et documentation en économie de la santé (IRDES), Paris, France; AP-HP, Hôpital Robert Debré, Paris, France
| | | | - Laura Shields-Zeeman
- Department of Public Mental Health, Trimbos Institute, Utrecht, the Netherlands; Interdisciplinary Social Science, Utrecht University, Utrecht, the Netherlands
| | | | - Sara Allin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Gonçalo Figueiredo Augusto
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Centre, CHRC, NOVA University Lisbon, Lisbon, Portugal
| | | | - Zoltán Cserháti
- Semmelweis University, Health Services Management Training Centre, Budapest, Hungary
| | - Antonio Giulio de Belvis
- Università Cattolica del Sacro Cuore, Rome, Italy; Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Astrid Eriksen
- Department of Health Care Management, Technische Universität Berlin, Berlin, Germany
| | - Inês Fronteira
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Centre, CHRC, NOVA University Lisbon, Lisbon, Portugal; Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Margaret Jamieson
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Liubovė Murauskienė
- Department of Public Health, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | | | - Hadar Samuel
- Myers-JDC-Brookdale Institute, Jerusalem, Israel
| | | | - Māris Taube
- Department of Psychiatry and Narcology, Rīga Stradiņš University, Riga, Latvia
| | - Karsten Vrangbæk
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ewout van Ginneken
- European Observatory on Health Systems and Policies, Technische Universität Berlin, Berlin, Germany
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Varga A, Bakacs M, Zentai A, Nagy B, Nagy-Lőrincz Z, Erdei G, Illés É, Varga-Nagy V, Sarkadi Nagy E, Cserháti Z, Kaposvári C. Assessment of the public catering act in primary schools in Hungary. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky212.681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Varga
- National Institute of Pharmacy and Nutrition, Budapest, Hungary
| | - M Bakacs
- National Institute of Pharmacy and Nutrition, Budapest, Hungary
| | - A Zentai
- National Institute of Pharmacy and Nutrition, Budapest, Hungary
| | - B Nagy
- University of Physical Education, Center of Sports Nutrition Science, Budapest, Hungary
| | - Z Nagy-Lőrincz
- National Institute of Pharmacy and Nutrition, Budapest, Hungary
| | - G Erdei
- National Institute of Pharmacy and Nutrition, Budapest, Hungary
| | - É Illés
- National Institute of Pharmacy and Nutrition, Budapest, Hungary
| | - V Varga-Nagy
- National Institute of Pharmacy and Nutrition, Budapest, Hungary
| | - E Sarkadi Nagy
- National Institute of Pharmacy and Nutrition, Budapest, Hungary
| | - Z Cserháti
- National Institute of Pharmacy and Nutrition, Budapest, Hungary
| | - Cs Kaposvári
- National Institute of Pharmacy and Nutrition, Budapest, Hungary
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Erdei G, Bakacs M, Illés É, Nagy B, Kaposvári C, Mák E, Nagy ES, Cserháti Z, Kovács VA. Substantial variation across geographic regions in the obesity prevalence among 6-8 years old Hungarian children (COSI Hungary 2016). BMC Public Health 2018; 18:611. [PMID: 29743055 PMCID: PMC5944005 DOI: 10.1186/s12889-018-5530-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 05/01/2018] [Indexed: 11/10/2022] Open
Abstract
Background There have been previous representative nutritional status surveys conducted in Hungary, but this is the first one that examines overweight and obesity prevalence according to the level of urbanization and in different geographic regions among 6–8-year-old children. We also assessed whether these variations were different by sex. Methods This survey was part of the fourth data collection round of World Health Organization (WHO) Childhood Obesity Surveillance Initiative which took place during the academic year 2016/2017. The representative sample was determined by two-stage cluster sampling. A total of 5332 children (48.4% boys; age 7.54 ± 0.64 years) were measured from all seven geographic regions including urban (at least 500 inhabitants per square kilometer; n = 1598), semi-urban (100 to 500 inhabitants per square kilometer; n = 1932) and rural (less than 100 inhabitants per square kilometer; n = 1802) areas. Results Using the WHO reference, prevalence of overweight and obesity within the whole sample were 14.2, and 12.7%, respectively. According to the International Obesity Task Force (IOTF) reference, rates were 12.6 and 8.6%. Northern Hungary and Southern Transdanubia were the regions with the highest obesity prevalence of 11.0 and 12.0%, while Central Hungary was the one with the lowest obesity rate (6.1%). The prevalence of overweight and obesity tended to be higher in rural areas (13.0 and 9.8%) than in urban areas (11.9 and 7.0%). Concerning differences in sex, girls had higher obesity risk in rural areas (OR = 2.0) but boys did not. Odds ratios were 2.0–3.4 in different regions for obesity compared to Central Hungary, but only among boys. Conclusions Overweight and obesity are emerging problems in Hungary. Remarkable differences were observed in the prevalence of obesity by geographic regions. These variations can only be partly explained by geographic characteristics. Trial registration Study protocol was approved by the Scientific and Research Ethics Committee of the Medical Research Council (61158–2/2016/EKU).
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Affiliation(s)
- Gergő Erdei
- School of PhD Studies, Doctoral School of Pathological Sciences, Health Science Research, Semmelweis University, 26 Üllői Street, Budapest, 1085, Hungary. .,Division of Nutrition, National Institute of Pharmacy and Nutrition, 3 Zrínyi Street, Budapest, 1051, Hungary. .,Department of Dietetics and Nutrition Sciences, Faculty of Health Sciences, Semmelweis University, 17 Vas Street, Budapest, 1088, Hungary.
| | - Márta Bakacs
- Division of Nutrition, National Institute of Pharmacy and Nutrition, 3 Zrínyi Street, Budapest, 1051, Hungary
| | - Éva Illés
- Division of Nutrition, National Institute of Pharmacy and Nutrition, 3 Zrínyi Street, Budapest, 1051, Hungary
| | - Barbara Nagy
- Division of Nutrition, National Institute of Pharmacy and Nutrition, 3 Zrínyi Street, Budapest, 1051, Hungary
| | - Csilla Kaposvári
- Division of Nutrition, National Institute of Pharmacy and Nutrition, 3 Zrínyi Street, Budapest, 1051, Hungary
| | - Erzsébet Mák
- Department of Dietetics and Nutrition Sciences, Faculty of Health Sciences, Semmelweis University, 17 Vas Street, Budapest, 1088, Hungary
| | - Eszter Sarkadi Nagy
- Division of Nutrition, National Institute of Pharmacy and Nutrition, 3 Zrínyi Street, Budapest, 1051, Hungary
| | - Zoltán Cserháti
- Division of Nutrition, National Institute of Pharmacy and Nutrition, 3 Zrínyi Street, Budapest, 1051, Hungary
| | - Viktória Anna Kovács
- Division of Nutrition, National Institute of Pharmacy and Nutrition, 3 Zrínyi Street, Budapest, 1051, Hungary
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Kovács R, Girasek E, Kovács E, Aszalós Z, Eke E, Ragány K, Cserháti Z, Szócska M. Managing intra-EU mobility-do WHO principles of ethical recruitment have relevance? Hum Resour Health 2017; 15:78. [PMID: 29121943 PMCID: PMC5679157 DOI: 10.1186/s12960-017-0247-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 10/04/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND The WHO Global Code of Practice on the International Recruitment of Health Personnel provides for guidance in health workforce management and cooperation in the international context. This article aims to examine whether the principles of the voluntary WHO Global Code of Practice can be applied to trigger health policy decisions within the EU zone of free movement of persons. METHODS In the framework of the Joint Action on European Health Workforce Planning and Forecasting project (Grant Agreement: JA EUHWF 20122201 (see healthworkforce.eu)), focus group discussions were organised with over 30 experts representing ministries, universities and professional and international organisations. Ideas were collected about the applicability of the principles and with the aim to find EU law compatible, relevant solutions using a qualitative approach based on a standardised, semi-structured interview guide and pre-defined statements. RESULTS Based on implementation practices summarised, focus group experts concluded that positive effects of adhering to the Code can be identified and useful ideas-compatible with EU law-exist to manage intra-EU mobility. The most relevant areas for intervention include bilateral cooperations, better use of EU financial resources, improved retention and integration policies and better data flow and monitoring. Improving retention is of key importance; however, ethical considerations should also apply within the EU. Compensation of source countries can be a solution to further elaborate on when developing EU financial mechanisms. Intra-EU circular mobility might be feasible and made more transparent if directed by tailor-made, institutional-level bilateral cooperations adjusted to different groups and profiles of health professionals. Integration policies should be improved as discrimination still exists when offering jobs despite the legal environment facilitating the recognition of professional qualifications. A system of feedback on registration/licencing data should be promoted providing for more evidence on intra-EU mobility and support its management. CONCLUSIONS Workforce planning in EU Member States can be supported, and more equitable distribution of the workforce can be provided by building policy decisions on the principles of the WHO Code. Political commitment has to be strengthened in EU countries to adopt implementation solutions for intra-EU problems. Long-term benefits of respecting global principles of the Code should be better demonstrated in order to incentivise all parties to follow such long-term objectives.
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Affiliation(s)
- Réka Kovács
- Health Services Management Training Centre, Semmelweis University, Kútvölgyi út 2, Budapest, Hungary.
| | - Edmond Girasek
- Health Services Management Training Centre, Semmelweis University, Kútvölgyi út 2, Budapest, Hungary
| | - Eszter Kovács
- Health Services Management Training Centre, Semmelweis University, Kútvölgyi út 2, Budapest, Hungary
| | - Zoltán Aszalós
- Health Services Management Training Centre, Semmelweis University, Kútvölgyi út 2, Budapest, Hungary
| | - Edit Eke
- Health Services Management Training Centre, Semmelweis University, Kútvölgyi út 2, Budapest, Hungary
| | - Károly Ragány
- Health Services Management Training Centre, Semmelweis University, Kútvölgyi út 2, Budapest, Hungary
| | - Zoltán Cserháti
- Health Services Management Training Centre, Semmelweis University, Kútvölgyi út 2, Budapest, Hungary
| | - Miklós Szócska
- Health Services Management Training Centre, Semmelweis University, Kútvölgyi út 2, Budapest, Hungary
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Girasek E, Kovács E, Aszalós Z, Eke E, Ragány K, Kovács R, Cserháti Z, Szócska M. Headcount and FTE data in the European health workforce monitoring and planning process. Hum Resour Health 2016; 14:42. [PMID: 27423330 PMCID: PMC4947240 DOI: 10.1186/s12960-016-0139-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 07/01/2016] [Indexed: 06/01/2023]
Abstract
BACKGROUND Health workforce (HWF) planning and monitoring processes face challenges regarding data and appropriate indicators. One such area fraught with difficulties is labour activity and, more specifically, defining headcount and full-time equivalent (FTE). This study aims to review national practices in FTE calculation formulas for selected EU Member States (MS). METHODS The research was conducted as a part of the Joint Action on European Health Workforce Planning and Forecasting. Definitions, categories and terms concerning the five sectoral professions were examined in 14 MS by conducting a survey. To gain a deeper understanding of the international data-reporting processes (Joint Questionnaire on Non-Monetary Health Care Statistics-JQ), six international expert interviews were conducted by using a semi-structured interview guide. RESULTS Of the 14 investigated countries, four MS indicated that they report FTE to the JQ and that they also calculate FTE data for national planning purposes. The other countries do not use FTE data for national purposes, but most of them do use special calculations and/or estimation methods for converting headcount to FTE. The findings revealed significant differences between national calculation methods when reporting FTE data to the JQ. This diversity in terms of calculations and estimations can lead to biases with respect to international comparisons. This finding was reinforced by the expert interviews, since the experts agreed that the activities of healthcare professionals are a fundamental factor in HWF monitoring and planning. Experts underscored that activity should also be measured by FTE, and not only by headcount. CONCLUSIONS FTE and headcount are significant factors in HWF planning and monitoring; therefore, national data collections should place emphasis on collecting data and calculating the appropriate indicators. National FTE could serve as a call to action for HWF planners due to the lack of matching international FTE data. At the international level, it is beneficial to monitor the trends and numbers regarding human resources and working time. For the moment, the exchange of information and mutual assistance for developing the capacity to apply common methodology could be a first step towards the standardisation of data collections.
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Affiliation(s)
- Edmond Girasek
- Health Services Management Training Centre, Semmelweis University, Kútvölgyi út 2, Budapest, Hungary
| | - Eszter Kovács
- Health Services Management Training Centre, Semmelweis University, Kútvölgyi út 2, Budapest, Hungary
| | - Zoltán Aszalós
- Health Services Management Training Centre, Semmelweis University, Kútvölgyi út 2, Budapest, Hungary
| | - Edit Eke
- Health Services Management Training Centre, Semmelweis University, Kútvölgyi út 2, Budapest, Hungary
| | - Károly Ragány
- Health Services Management Training Centre, Semmelweis University, Kútvölgyi út 2, Budapest, Hungary
| | - Réka Kovács
- Health Services Management Training Centre, Semmelweis University, Kútvölgyi út 2, Budapest, Hungary
| | - Zoltán Cserháti
- Health Services Management Training Centre, Semmelweis University, Kútvölgyi út 2, Budapest, Hungary
| | - Miklós Szócska
- Health Services Management Training Centre, Semmelweis University, Kútvölgyi út 2, Budapest, Hungary
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Ádám S, Nistor A, Nistor K, Cserháti Z, Mészáros V. [Facilitating the diagnosis of depression and burnout by identifying demographic and work-related risk and protective factors among nurses]. Orv Hetil 2015; 156:1288-97. [PMID: 26234310 DOI: 10.1556/650.2015.30220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Depression and burnout are frequent comorbidities among nurses. Despite similar symptoms, their management differ. Therefore, their timely diagnosis is essential. AIM To identify demographic and work-related risk and protective factors of burnout and depression, and facilitate their diagnosis. METHOD A cross-sectional study among 1,713 nurses was carried out. Depression and burnout were assessed by the shortened Beck Depression Questionnaire and Maclach Burnout Inventory, respectively. Risk and protective factors were explored using t-tests and analysis of variance. RESULTS The prevalence of depression and moderate-to-high burnout was 35.1% and 34-74%, respectively. Having a partner/child and longer employment in the outpatient setting protected from burnout. Lack of a partner and male sex emerged as risk factors of depression and depersonalisation, respectively. CONCLUSIONS High prevalence of depression and burnout among nurses poses a significant public health issue. Familiarity with the disease-specific risk and protective factors identified in this research may facilitate timely diagnosis and effective disease management.
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Affiliation(s)
- Szilvia Ádám
- Magatartástudományi Intézet, Semmelweis Egyetem, Általános Orvostudományi Kar Budapest, Nagyvárad tér 4., 1089
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Nistor K, Ádám S, Cserháti Z, Szabó A, Zakor T, Stauder A. A Koppenhágai Kérdőív a Munkahelyi Pszichoszociális Tényezőkről II (COPSOQ II) magyar verziójának pszichometriai jellemzői. ACTA ACUST UNITED AC 2015. [DOI: 10.1556/0406.16.2015.2.3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Ádám S, Cserháti Z, Mészáros V. High Prevalence of Burnout and Depression may Increase the Incidence of Comorbidities Among Hungarian Nurses. Ideggyogy Sz 2015; 68:301-9. [DOI: 10.18071/isz.68.0301] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Mészáros V, Cserháti Z, Oláh A, Perczel Forintos D, Adám S. [Coping with work-related stress in health care professionals -- strategies for the prevention of burnout and depression]. Orv Hetil 2013; 154:449-54. [PMID: 23506801 DOI: 10.1556/oh.2013.29572] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The prevalence of depression and burnout among health care professionals is high in Hungary. However, there is limited empirical data on disease prevention among these populations. AIMS This study aims at evaluating the mediating role of coping mechanisms in preventing depression and burnout. METHODS Cross-sectional survey among 1333 health care professionals. Participants completed self-administered questionnaires about their perception of work stress, burnout and depressive symptoms, as well as their preferred coping strategies. Analyses were performed using structural equation modelling. RESULTS The prevalence of severe depression and lack of personal accomplishment was 5.6% and nearly 50%, respectively. Work stress predicted symptoms of burnout and depression both directly and indirectly through the mediation by coping strategies. Of the coping strategies, cognitive restructuring, which accentuates the realistic assessment of challenging situations, was found to reduce the probability of the development of burnout and depression symptoms. CONCLUSIONS This study provides further data for the development of cognitive interventional strategies and highlights the significance of these strategies in the prevention of depression and burnout among Hungarian health care professionals.
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Konkolÿ Thege B, Pilling J, Cserháti Z, Koppˆ MS. Mediators between bereavement and somatic symptoms. BMC Fam Pract 2012; 13:59. [PMID: 22709333 PMCID: PMC3426491 DOI: 10.1186/1471-2296-13-59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 06/18/2012] [Indexed: 11/10/2022]
Abstract
Background In our research we examined the frequency of somatic symptoms among bereaved (N = 185) and non-bereaved men and women in a national representative sample (N = 4041) and investigated the possible mediating factors between bereavement status and somatic symptoms. Methods Somatic symptoms were measured by the Patient Health Questionnaire (PHQ-15), anxiety with a four-point anxiety rating scale, and depression with a nine-item shortened version of the Beck Depression Inventory. Results Among the bereaved, somatic symptoms proved to be significantly more frequent in both genders when compared to the non-bereaved, as did anxiety and depression. On the multivariate level, the results show that both anxiety and depression proved to be a mediator between somatic symptoms and bereavement. The effect sizes indicated that for both genders, anxiety was a stronger predictor of somatic symptoms than depression. Conclusions The results of our research indicate that somatic symptoms accompanying bereavement are not direct consequences of this state but they can be traced back to the associated anxiety and depression. These results draw attention to the need to recognize anxiety and depression looming in the background of somatic complaints in bereavement and to the importance of the dissemination of related information.
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