Practitioner perspectives on the use of acceptance and commitment therapy for bereavement support: a qualitative study

BACKGROUND

There is currently a high demand for bereavement support coupled with inconclusive findings as to the efficacy of existing approaches. Acceptance and Commitment Therapy (ACT) aims to improve human functioning and has shown efficacy across a wide range of conditions. ACT may be a promising means of supporting bereaved people, yet evidence on the use of ACT for bereavement support is lacking. The aim of this study is to explore how ACT is currently used for bereavement support and practitioner perspectives of how it helps following bereavement.

METHODS

Semi-structured interviews were conducted online via MS Teams with practitioners experienced in using ACT for bereavement support. Data were analysed thematically guided by a framework approach.

RESULTS

Nine participants were recruited. Three themes were identified: (i) creating psychological space around grief; (ii) using psychological space for value-directed action in the midst of grieving, and (iii) adapting ACT for bereavement support. Practitioners indicated that ACT improves clients' relationship with distressing internal experiences. Metaphors and mindfulness techniques were used to encourage acceptance of grief responses, taking perspective on distressing thoughts and images, and contact with the present moment. Better relationships with distressing experiences were regarded as less psychologically taxing, improving coping and well-being, while providing the psychological space to engage in value-directed action. Values exploration, sometimes using metaphors and exercises, was seen as supporting the bereaved person to rediscover a sense of purpose and engage in meaningful activities alongside their grief. Practitioners used ACT flexibly, integrating other interventions, and adapted ACT to the perceived sensitivities of bereaved people, and age-related and developmental factors.

CONCLUSION

ACT is used to support people who have been bereaved to live effectively with the difficult thoughts and feelings associated with grieving and to enable them to gradually identify, reconnect with, and act in line with their values after loss.

Functional status, social support, and anxiety among postnatal women of Eastern India

Introduction

Though becoming a mother is a joyous experience, the postpartum time can be difficult and stressful for women as they deal with significant physical alterations and adjustments to their daily routines. However, very few studies have focused on the functional well-being of the woman after childbirth. This study aims to find the level of functional status, social support, and anxiety among women attending immunization clinics.

Methods

A descriptive cross-sectional research design was adopted to recruit 220 women in this study from two immunization clinic centers in Bhubaneswar, Odisha. Data were collected using a self-reported sociodemographic profile, functional level scale after childbirth, modified multidimensional scale of perceived social support, and postnatal anxiety scale. Descriptive and inferential statistical tests were used for data analysis, including mean, percentage, and Fisher exact.

Results

59.5 % of women returned to a moderate level of functional status after six weeks postpartum. The majority of women, 98.6 % and 83.6 %, reported high levels of return to personal care and baby care, respectively, whereas 34.7 % had moderate levels of return to home activities and 90 % had low levels of return to community and social tasks. Also, 70 % of women had high perceived social support, and 87.7 % had no anxiety. In this study, normal delivery women had better functional status than their cesarean delivery counterparts. Moreover, functional status was significantly associated with anxiety at six postpartum weeks.

Conclusion

After six weeks of childbirth, most women only partially resumed their pre-pregnancy functional state. So, much more time, rest, and support from family members were needed to recover to a fully functional level. Nurses, midwives, and the family members of women should be aware of the critical role that social support plays in enhancing a woman's functional and psychological status during the postpartum period.

Depression, postburn disability & quality of life: The moderating roles of burn specific coping strategies

Depression has been associated with poorer postburn functional outcomes. However, whether or not certain burn specific coping strategies moderate the relationships remains unknown. Burn survivors from 2015 Formosa Fun Coast Water Park explosion were recruited in a 3-year follow-up study. Using Wave 1 data collected 1 year after discharge, we conducted multivariate regression analysis to assess the associations between depression and postburn disability and quality of life. We also performed moderation analysis to determine moderating effects of burn specific coping strategies on the associations. Our results found depression was significantly associated with worsening postburn disability and poorer quality of life. When demographic and burn related variables were accounted for, we found avoidance coping moderated the depression-disability relationship. Depression was significantly and positively correlated with disability at low and medium levels of avoidance but not high. Optimism/problem solving moderated the depression-quality of life relationship. Depression was significantly and negatively correlated with quality of life at low and medium levels of optimism/problem solving but not high. Our study provided evidence supporting early identification and intervention of depression in burn survivors to optimize functional outcomes. Such knowledge may provide insights into potential targets in rehabilitation in depressed burn survivors.

[Professional and psychological impact of second victims among hospital healthcare professionals]

OBJECTIVE

To analyze the occupational and psychological consequences suffered by healthcare workers who are considered second victims (SV).

MATERIAL AND METHODS

Observational, descriptive and cross-sectional study among the healthcare workers of a university hospital. The answers collected in a specifically designed questionnaire about psychological consequences at work and the result of a post-traumatic stress scale, "Impact of Event Scale-Revised (IES-R, spanish version)" were evaluated. The variables between the groups were compared using the Chi square test (or Fisher's exact test) when both were qualitative and with the Student's T (or the Mann-Whitney U test for independent data), when one of them was quantitative. The level of statistical significance was P<.05.

RESULTS

75.5% (148/207) of the participants in the study suffered some adverse event (AE) and, of these, 88.5% (131/148) were considered SV. Physicians had a 2.2 times higher risk of feeling SV than nurses (95% CI: 1.88-2.52). The impact on the patient related to the AE explained why the professionals involved in it felt SV (P=.037). 80.6% (N=104) of the SVs presented post-traumatic stress. Women were 2.4 times more likely to suffer from it (OR: 2.4; 95% CI: 1.5-4.0). Intrusive thoughts in the SV were almost three times more frequent when the damage suffered by the patient was permanent or death (OR: 2.5; 95% CI: 0.2-3.6).

CONCLUSIONS

Many healthcare workers, especially physicians, considered themselves to be SV, and many of them suffered from post-traumatic stress. The impact on the patient related to the AE was a risk factor for being SV and for suffering psychological consequences.

Prevalence and Correlates of Physical Inactivity Among Individuals with HIV During the First COVID-19 Wave: A Cross-sectional Survey

Physical activity is associated with improved health outcomes among people with HIV (PWH). In the recent pandemic context, policies designed to mitigate COVID-19 transmission may result in an increase in sedentary lifestyle and decreased physical activity. In this study, we aimed to characterize self-reported physical activity and factors associated with physical inactivity during the first wave of the COVID-19 pandemic among a sample of PWH engaged in care. We also described whether psychological coping strategies measured by the Brief COPE differed based on physical activity levels. Among 260 surveyed PWH in two HIV clinics in the US Northeast, 28.5% (n = 74) met the criteria for being physically active according to the Centers for Disease Control and Prevention (CDC)'s physical activity guidelines. Receiving care in New Haven, CT, presence of a detectable HIV viral load, every day tobacco use, and unhealthy alcohol use were associated with physical inactivity. Problem-focused coping, emotion-focused coping, and avoidance-focused coping strategies were found to be protective against physical inactivity. In adjusted analysis, only problem-focused coping continued to be significantly associated with lower odds of reporting physical inactivity. Efforts are urgently needed to promote physical activity among PWH, including among those without problem-focused coping strategies.

Psychological distress, non-medical use of prescription medications, and perceived unmet mental health care needs: a cross-sectional study of Ontario students

PURPOSE

The non-medical use of prescription medications among adolescents has become a concerning public health issue. This study assessed the prevalence of the non-medical use of prescription medications in Ontario high school students, and explored the moderating effect of this use on the relationship between psychological distress and unmet mental health needs.

METHODS

Cross-sectional data for 4896 students, age 14-18, were drawn from the 2019 Ontario Student Drug Use and Health Survey. Psychological distress was measured using the Kessler-6 Distress Scale, unmet mental health needs were defined by self-report (yes/no), and non-prescription medication use was defined by self-reported frequency of use. Using logistic regression, we explored the effect of the non-medical use of prescription medications on the relationship between psychological distress and unmet mental health needs.

RESULTS

High proportions of Ontario students reported serious psychological distress (22%), some degree of unmet mental health need (38%), and/or non-medical use of prescription medications (13%). While there were strong associations between psychological distress and unmet mental health need, this association was weaker among those reporting non-medical use of prescription medications (OR = 3.3, 95% CI 1.9-5.7) compared to non-users (OR = 5.6, 95% CI 4.5-7.1).

CONCLUSION

Our findings suggest that Ontario students experiencing distress and using non-prescribed medications are less likely to identify a need for mental health support, highlighting the consequences of apparent self-medication through misuse of prescription medications. To assist in the redirection of adolescent perceptions of healthy coping strategies, population-based educational programming, with targeted promotion of both formal and informal mental health care resources, should be considered.

Explaining Variation in Individual Aging, Its Sources, and Consequences: A Comprehensive Conceptual Model of Human Aging

We define aging as a characteristic deterioration in one (or more) observable attributes of an organism that typically occurs during later life. With this narrow functional definition, we gain the freedom to separate aging from other processes of age-related change (e.g., maturation, growth, illness, terminal decline). We introduce a structural model that distinguishes between (1) the phenomenon of aging, (2) the subjective experience of aging, (3) sources of aging, and (4) consequences of aging. A core focus of the model is on the role of buffering mechanisms of biological repair and personal adaptation that regulate the relations between sources of aging, aging proper, and its consequences. The quality and level of functioning of these buffering mechanisms also varies across the life span, which directly affects the sources of aging, resulting in either resilience against or accelerated aging, and thus can be considered to be a major source of the variation in aging processes among different individuals. External factors comprising attributes of the physical environment and sociocultural characteristics are considered as contexts in which aging occurs. These contextual factors are assumed to feed into the various components of the model. Our model provides an interdisciplinary account of human aging, its sources and consequences, and also its subjective experience, by integrating biological, psychological, lifestyle, and sociocultural factors, and by specifying their interrelations and interactions. The model provides a comprehensive understanding of individual human aging, its underlying processes, and modulating factors. It allows for the derivation of empirically testable hypotheses, and it helps practitioners to identify elements that lend themselves to targeted intervention efforts aimed at increasing the resilience of individuals against aging and buffering its negative consequences.

The nature and nurture of resilience-reactions of trizygotic triplet minors to their father's death

BACKGROUND

Parental bereavement during childhood is associated with an elevated risk for the development of psychiatric problems. This paper seeks to provide insight into the adjustment process of trizygotic triplets dealing with their father's death, thus, trying to give an impression of the individual nature of grief and resilience.

METHODS

We examined 11-year-old trizygotic triplets (2 boys and 1 girl) concerning behavioral problems (CBCL/6-18R, YSR/11-18R), posttraumatic stress disorder (UCLA PTSD Index for DSM‑5, UPID), depression ("Depressionsinventar für Kinder und Jugendliche," DIKJ), and fear ("Phobiefragebogen für Kinder und Jugendliche," PHOKI) shortly after their father's death and 6 months later. The girl was developmentally delayed and had moderate intellectual disability, while her brothers' development was age-appropriate.

RESULTS

The triplets showed very different adjustment to the traumatic event. While the boys showed less psychopathological response to their loss shortly after their father's death and adjusted physiologically during the following 6 months, their sister scored high in almost all dimensions and still presented with notable psychopathological symptoms at the 6‑month follow-up.

CONCLUSION

Outcomes differ distinctly despite objectively equal risk and protective factors. While it is known that above average intellectual abilities represent a protective factor for posttraumatic stress, these results show that intellectual retardation might be a prominent yet understudied risk factor in dealing with postbereavement psychopathology in children.

Sociocultural factors associated with physical activity in Black prostate cancer survivors

PURPOSE

Prostate cancer disproportionately affects Black men. Physical activity protects long-term health and quality of life outcomes in prostate cancer survivors. This study aimed to identify sociocultural factors related to physical activity among Black prostate cancer survivors to inform culturally tailored intervention development.

METHODS

This secondary analysis included data from 257 men who identified as Black or African American and were diagnosed with prostate cancer between 2013 and 2018. Participants completed validated self-report measures of perceived history of racial discrimination, religiosity, fatalism, sociodemographic (e.g., age, ethnicity, income) and clinical characteristics (e.g., years since diagnosis, comorbidity burden), and leisure-time physical activity. Regression analyses were conducted to examine the associations between sociocultural factors and mild, moderate, and vigorous physical activity.

RESULTS

Participants were on average 68.7 years old (SD = 7.7), and most were non-Hispanic (97.3%), married (68.9%), reported an annual household income above $50,000 (57.1%), received at least some college education (74.1%), and were overweight or had obesity (78.5%). Participants reported on average 88.1 (SD = 208.6) min of weekly mild physical activity, and most did not meet guidelines for weekly moderate (80.5%) or vigorous (73.0%) physical activity. After adjusting for covariates, older age and greater religiosity were associated with mild physical activity (ps ≤ 0.05). Higher levels of fatalism were associated with lower odds of meeting guidelines for moderate physical activity (OR = 0.87, 95% CI = 0.77-0.99).

CONCLUSIONS

Sociocultural factors such as religiosity and fatalism may be associated with some forms of physical activity in Black prostate cancer survivors. These findings suggest that incorporating faith-based practices into health behavior interventions may be appropriate for this population.

Beyond illness perception: the effects of psychological flexibility when coping with a chronic medical condition

Several factors have been suggested to affect well-being among patients with a Chronic Medical Condition (CMC). Using self-report questionnaires, the effects of Illness Cognitions (IC) and Psychological Flexibility (PF) on well-being (Subjective Happiness) was explored in two groups of patients at a large medical center in Tel Aviv, Israel. This included 79 patients with psoriasis and 71 patients with End-Stage Renal Disease (ESRD), the former representing moderate, and the latter severe, chronic medical conditions. Significant correlations between IC and PF, and well-being, were observed. In regression analyses, helplessness (an IC factor) and perceiving oneself as flexible (a PF factor) significantly contributed to well-being. Perceiving oneself as open and innovative (another PF factor) was associated with higher levels of well-being only among those with ESRD. This suggests that well-being is associated with both a specific cognitive inference regarding one's medical condition (IC) and a general attitude about change (PF). Additionally, it appears that the association between PF and well-being changes across different CMCs, possibly depending on the CMC severity. Theoretical and clinical implications are discussed.

Problematic media use and psychological adaptation in children in the COVID-19 pandemic: A descriptive cross-sectional study

PURPOSE

This study was conducted to determine the problematic media use and psychological adaptation levels of children.

DESIGN AND METHODS

Parents of 685 children living in Turkey participated in the descriptive cross-sectional design study. Descriptive Characteristics Form, Problematic Media Use Measure and Hacettepe Psychological Adaptation Scale were used to collect research data.

RESULTS

Problematic media use of the children is moderate. The COVID-19 pandemic increased the time spent in front of the screen in the majority of children. Psychological adaptation problem was determined in approximately one-third of children. Male gender and screen time spent affect problematic media use and psychological adaptation levels of children.

CONCLUSIONS

The COVID-19 pandemic increased the problematic media use and psychological adaptation problems of children.

PRACTICE IMPLICATIONS

It is recommended that nurses guide parents to limit children's screen time and to plan interventions to solve their psychological adaptation problems.

Effects of marital self-disclosure on marital relationship and psychological outcome for cancer patients: a systematic review

PURPOSE

Literature on marital self-disclosure interventions for cancer patients lacks consistency in methodology and content. Moreover, the impact of such interventions on physical and psychological health, marital relationships, and self-disclosure ability is controversial. This review aims to systematically analyze the studies of marital self-disclosure intervention, synthesize the structure and topics of marital self-disclosure, and summarize and evaluate its effects on improving physical and psychological outcomes and marital relationships in cancer patients and their spouses.

METHOD

This systematic review used the preferred reporting items of Systematic Reviews and Meta-Analyses (PRISMA). We conducted a systematic review of randomized controlled and quasi-experimental studies published from the establishment of the database to October 2022. Marital self-disclosure interventions were conducted with both cancer patients and their spouses. Studies published in a language other than English or Chinese, and studies below a quality grade of C were excluded. Data were extracted through a standardized data collection form, and two reviewers independently extracted and evaluated the data. The quality of the included studies was assessed using the Cochrane Handbook of Systematic Reviews of Interventions, and a third reviewer adjudicated in case of disagreement. The data were synthesized by vote counting based on direction of effect according to the Synthesis Without Meta-analysis (SWiM) reporting guideline.

RESULTS

Thirteen studies were included in the review. Based on quality evaluation, three studies were categorized as grade A (good), and ten studies were grade B (moderate). Seven studies reported moderate rates of participant refusal and attrition. The structure and topics of marital self-disclosure varied across different studies. The five studies had various prespecified disclosure topics, such as fear of cancer recurrence, benefit finding, and emotional distress. The overall results suggest that marital self-disclosure interventions can improve physical and psychological health, enhance marital relationships, and increase self-disclosure ability.

CONCLUSION

The limited number of studies, small sample sizes, diverse intervention strategies, and methodological heterogeneity weakened the evidence base for the effectiveness of marital self-disclosure interventions. Therefore, further high-quality randomized controlled trials (RCTs) are recommended to confirm the effectiveness of such interventions. These studies should also evaluate the interventions' long-term impact, analyze optional topics and methods, identify key features, and explore the development of the best intervention program.

Stressors in hospitalized patients and their associations with mental health outcomes: testing perceived social support and spiritual well-being as moderators

BACKGROUND

Although hospitalization can be a burdensome experience for all patients, research into the sources of this distress and potential protective factors has so far been scattered, specifically among the broad hospitalized population across all disease types and inpatient units. The present study explores the frequency and nature of the foremost experienced hassles among a sample of Lebanese hospitalized patients, tracing their correlations with depression and anxiety while also investigating positive coping (i.e., perceived social support and spiritual well-being) as potential moderator of these relationships.

METHODS

A total of 452 Lebanese inpatients from all medical units filled a survey composed of a list of 38 stressors experienced during hospitalization and other measures assessing depression, anxiety, perceived social support, and spiritual well-being.

RESULTS

Pain was the most common stressor experienced by the patients (88.9%), followed by the feeling of being overwhelmed (80.3%). When conducting a factor analysis, 18 stressors loaded on 4 distinct factors, hence yielding 4 main stressor groups (i.e., Illness Apprehension, Hopelessness/Uselessness, Social Isolation, and Spiritual Concerns). The multivariable analysis showed that increased illness apprehension (Beta = 0.69) and hopelessness (Beta = 1.37), being married (Beta = 1.17) or divorced (Beta = 1.38) compared to single, being admitted in a two-bed room compared to one-bed (Beta = 1.59), higher financial burden (Beta = 0.24), and lower socio-economic status (Beta = 1.60) were significantly associated with higher anxiety. Additionally, increased hopelessness (Beta = 0.82) and being married (Beta = 0.79) compared to single were significantly associated with higher depression. However, among patients experiencing high levels of stressors, those with high spiritual well-being and perceived social support had lower depressive/anxiety symptoms.

CONCLUSION

Our study characterized the principal stressors encountered during hospitalization, underscoring their associations with Lebanese inpatients' mental health. On the other hand, as perceived social support and spiritual well-being acted as negative moderators of these associations, intervention programs aimed at enhancing such adaptive coping techniques are strongly called upon to palliate the psychological distress of patients in hospital settings.

Relationships Between Sense of Coherence, Self-perception of Voice and Work Environment Among Teachers

OBJECTIVE

to analyze the relationship between sense of coherence and sociodemographic data, remote physical work environment, and self-perception of symptoms, vocal handicap and vocal fatigue in teachers.

METHODS

Seventy eight teachers pertaining to the municipal education network of a Brazilian capital city participated in the study, during the period of social isolation by COVID-19. An online questionnaire was applied with sociodemographic and physical remote work environment questions, the Sense of Coherence Scale (SOC-13), the Brazilian Dysphonia Screening Tool (Br-DST), the Vocal Fatigue Index (VFI), and the Vocal Handicap Index (VHI-10). Descriptive analysis, bivariate and multivariate Logistic regression models were performed to check the proportion of teachers with high and low SOC among the different categories of independent variables. Student's t test and Mann Whitney test were used to compare SOC, IDV, and VFI scores between the groups, and Hedge's g test was used to access the effect size. The total scores of SOC, VHI and VFI were correlated using Pearson's Correlation Coefficient. All tests adopted a 5% significance level.

RESULTS

Male teachers and those over 45 years old were, respectively, 6.79 (95%CI = 1.16-39.58) and 5.27 (95%CI = 1.40-19.76) times more likely to present a high SOC. The variables associated with a lower chance of presenting high SOC were vocal restriction (OR = 0.21; 95%CI = 0.06-0.79) and voice-related physical discomfort (OR = 0.13; 95%CI = 0.02-0.78). Regarding the remote work environment, in bivariate analysis, teachers who were dissatisfied with air quality (OR = 0.08; 95%CI = 0.01-0.65), temperature (OR = 0.11; 95%CI = 0.01-0.92), and noise (OR = 0.25; 95%CI = 0.61-0.99) were less likely to have high SOC. Higher values of SOC are associated with lower self-perception of vocal fatigue and voice handicap (P < 0,001).

CONCLUSION

The way individuals face stressful situations interferes with the self-perception of their voice and their work environment. The relationship between the sense of coherence and voice perception is relevant to favor programs to promote vocal health and stress management in teachers.

[The intensive care diary-a communication tool]

Diaries in intensive care units (ICU) are mostly written by families and nurses for patients with impaired consciousness. In the diary, the development of the patients is described in plain language by daily reports. Patients can read the diary later and process their experiences and, if necessary, reframe them differently. ICU diaries reduce the risks of psychosocial sequelae of patients and families and are now used worldwide. Diaries have different purposes and also serve as a communication tool: words are written to a person who will hopefully read them later. This can help families to stay connected and cope better with the situation. However, writing a diary can also be perceived as a burden by some relatives and nurses due to lack of time or because it seems to be too close. ICU diaries can serve as a tool for patientand family-centered care.

The factors that influence the adaptation process 6 months after a stroke: A path analysis

OBJECTIVE

The purpose of this study was to identify the determinant factors that influence the adaptation process and quality of life after a stroke.

METHODS

This study is an observational study using a cross-sectional design. Respondents were patients who were 6 months post-discharge after non-hemorrhagic strokae and their family caregivers. Information about respondents was taken from medical record data at two regional general hospitals in West Kalimantan Province, Indonesia. A total of 80 patients were selected using a consecutive sampling method. Theoretical models of patient and caregiver factors that influence adaptation responses and post-stroke quality of life were tested using path analysis.

RESULT

Caregiver coping, self-efficacy, and illness acceptance had a direct effect on the post-stroke psychosocial adaptation response by 58.1%, with self-efficacy contributing the most (β = 0.668, P < .0001). Self-efficacy, illness acceptance, and healthy behavior had a direct effect on the physiological adaptation response by 24.3%, where self-efficacy also contributed the most (β = 0.272, P < .014). Psychosocial adaptation and physiological adaptation had a direct effect on the quality of life by 54.6%, where psychosocial adaptation showed the largest contribution (β = 0.63, P < .0001).

CONCLUSION

Self-efficacy contributes the most to both psychosocial and physiological adaptations 6 months after stroke. Psychosocial adaptation and self-efficacy have been proven to be the determinant factors that contribute the most to the quality of life of patients 6 months after stroke.

Clinical environmental stressors and coping behaviors among undergraduate nursing students in Saudi Arabia: A cross-sectional study

Objectives

This study aimed to explore the level of stress, stressors sources, and coping strategies used among female Saudi undergraduate nursing students during their clinical practice.

Methods

A cross-sectional design was used. Using a convenience sampling technique, female nursing students in Riyadh, Jeddah, and Alahsa who enrolled in clinical courses were recruited from a governmental university from January to May 2022. Data were collected using a self-report questionnaire including socio-demographic characteristics, the Perceived Stress Scale (PSS), and the Coping Behavior Inventory (CBI).

Results

The degree of stress perceived by the 332 participants ranged from 3 to 99 (54.77 ± 0.95). Stress from assignments and workload was the most common type of stressor perceived by nursing students, with a score of 2.61 ± 0.94, followed by stress from the environment, with a score of 1.18 ± 0.47. Meanwhile, the students used staying optimistic as the most adopted strategy, with a score of 2.38 ± 0.95, followed by the transference strategy, a score of 2.36 ± 0.71, and the problem-solving strategy scored 2.35 ± 1.01. The coping strategy of avoidance is positively correlated with all of the stressor types (P < 0.01), while the problem-solving strategy is negatively correlated with stress from peers and daily life (r = -0.126, P < 0.05). Transference is positively correlated with stress from assignments and workload (r = 0.121, P < 0.05), and stress from teachers and nursing staff (r = 0.156, P < 0.01). Lastly, staying optimistic is negatively correlated with stress from taking care of patients (r = -0.149, P < 0.01), and with stress from lack of professional knowledge and skills (r = -0.245, P < 0.01).

Conclusions

These research findings are significant for nursing educators to identify nursing students' main stressors and coping strategies used. Effective countermeasures should be taken to promote a healthy learning environment, decrease the level of stressors and improve students' coping strategies during clinical practice.

Exploring factors influencing coping with uncertainties in medical practice: insights from residents' experience

PURPOSE

Despite attempts to teach medical students and trainees about uncertainty in medical practice and how to tolerate it, studies on how to promote tolerance to uncertainty remain scarce. this study aims to investigate factors that could foster residents' tolerance to uncertainty.

METHODS

The authors used data sources, including semi-structured individual in-depth interviews with 20 medical residents working in two tertiary university hospitals. Inductive analysis of interview records determined key themes, identified categories, and performed a theoretical-type analysis of the participants' coping behaviors according to the attributes of uncertainty tolerance.

RESULTS

Two characteristics of residents which could lead to constructive coping with uncertainty were discovered: (1) communicative/collaborative behavior with their colleagues, superiors, and patients and (2) self-reflective/self-directed attitude in their medical practice. Both were used to classify four types of uncertainty coping behaviors: adaptive, self-contained, submissive, and isolated.

CONCLUSION

Fostering communicative/collaborative behaviors and self-reflective/self-directed attitude throughout the training period may result in residents being more tolerant of uncertainties in medical practice.

The relationship between childhood maltreatment and mental health problems: coping strategies and social support act as mediators

BACKGROUND

Childhood maltreatment significantly increases the risk of developing mental health problems in adolescence and adulthood. The present study examines if coping strategies and social support mediate the relationship between childhood maltreatment and mental health problems.

METHODS

Data analyzed were from the 2012 Canadian Community Health Survey Mental Health (CCHS-MH, N = 25,113), a national population survey. A structured diagnostic interview, the World Health Organization version of Composite International Diagnostic Interview (WHO-CIDI), was used to assess mental health status. Multiple mediation analysis with structural equation modelling is used to test the mediating effects of coping skills and social support in the relationship between childhood maltreatment and mental health problems.

RESULTS

Our findings demonstrate that both coping strategies and social support mediated the link between childhood maltreatment and major depressive episode (mediation proportion: 18.3%), generalized anxiety disorder (mediation proportion: 19.8%), and suicide ideation (mediation proportion: 15.9%). By and large, the study results showed that coping skills and social support had both direct and indirect effects on the studied mental health problems with coping skills having a stronger impact.

CONCLUSIONS

Personal resources play an important resilience role in the associations between maltreatment and mental disorders with positive coping strategies, an internal resource, having a stronger protective presence. This research reinforces the need for strengthening positive coping strategies as well as social support as preventive strategies to improve mental health for individuals who have experienced childhood maltreatment.

Mental Health and Spinal Cord Injury: Clinical Considerations for Rehabilitation Providers

Purpose of Review

Assessing and addressing the mental and behavioral health concerns of individuals with SCI during rehabilitation is crucial, as untreated mental health distress can lead to reduced gains in rehabilitation and poor overall health. This review provides an overview of the latest research on prevalence rates of common mental and behavioral health concerns in the SCI population, highlighting disability-specific factors that may impact traditional assessment and treatment of mental health concerns.

Recent Findings

While those with SCI are at a heightened risk for experiencing mental health distress, overall, the majority of those with SCI adapt well, and live a full and meaningful life.

Summary

Rehabilitation psychologists are a vital aspect of rehabilitation teams, as they can address behavioral health and mental health concerns that may impede patients achieving their rehabilitation goals.

A scoping review of COVID-19-related stress coping resources among nurses

Objective

The entire mental health hazard among the nurses dealing with COVID-19 is just the tip of the iceberg. The goal of this study was to find acceptable and adaptive coping techniques for nurses in order to keep the healthcare system resilient during and after the COVID-19 pandemic.

Method

The scoping review search took place from January 2020 to May 2021 published articles, and the results were saved in Endnote software. For data synthesis and review, the Joanna Briggs Institute manual and PRISMA-ScR principles were followed. Following backward and forward screening to exclude redundant, irrelevant, and ineligible studies, 13 studies (3,613 nurses) were finally selected for this review.

Results

The majorities of participants in these studies were female and had children, and worked in departments of critical care, emergency, and fever clinics. Safety concerns for family or colleagues, as well as a lack of safe working environment, were the primary causes of the mental illness. Professional responsibility attitude, COVID-19 training, workplace safety, team spirit, and a few relaxation activities such as deep breathing, reading books, watching movies, and praying, on the other hand, were found to be beneficial for stress coping among nurses.

Conclusion

Mentally fit nurses are more capable and flexible in the face of any life-threatening outbreak, even if it is very contagious. Several coping strategies were found to be effective for nurses during the COVID-19 pandemic, whereas problem-specific intervention trials might yield even better results. We should not delay specific mental health interventions to keep them viable and more efficient during a pandemic battlefield, whereas Post-Traumatic Stress Disorder and suicide rates can destroy the entire health care system.

The modifiable biopsychosocial drivers of psychological distress for adolescents with asthma: Implications for Clinical Care

PURPOSE

Overwhelming distress exceeds the capacity of healthy coping strategies to feel better using healthy coping strategies alone, resulting in the use of unhealthy coping strategies. Unhealthy coping strategies may exacerbate asthma symptoms and asthma can contribute to overwhelming distress. This study aimed to review the modifiable drivers of overwhelming distress in adolescents with asthma.

METHODS

The biopsychosocial drivers of psychological distress for adolescents with asthma were explored within the domains of the modifiable biopsychosocial model of health and wellbeing.

RESULTS

Asthma in adolescents is associated with problems in the domains of environment, developmental outcomes, sense of belonging, health behaviours, coping, and treatment of illness.

CONCLUSIONS

The relationship between asthma and psychological distress highlights the need for holistic treatment of asthma. Further research is needed to establish causation between variables and to investigate whether interventions that address either asthma symptoms or biopsychosocial drivers of distress can improve both factors.

HIV, psychological resilience, and substance misuse during the COVID-19 pandemic: A multi-cohort study

OBJECTIVE

The COVID-19 pandemic has dramatically impacted mental health, increasing rates of substance misuse. Resilience is a positive adaptation to stress that may act as a buffer against adverse mental health outcomes. Based on prior knowledge, we hypothesized that PLWH would display higher resilience than HIV-uninfected peers, and that high resilience would be associated with lower risk of substance misuse.

METHODS

This analysis of the Collaborating Consortium of Cohorts Producing NIDA Opportunities (C3PNO) included data from six USA cohorts that administered a COVID-19-related survey with a 3-month follow-up during May 2020 and March 2021. All data was self-reported. The Brief Resilience Scale and General Anxiety Disorder-7 were utilized. Primary analyses consisted of multivariate generalized linear mixed models with random intercepts using binary logistic regression.

RESULTS

A total of 1430 participants completed both surveys, of whom 670 (46.9%) were PLWH. PLWH had lower odds of anxiety (OR=0.67, 95% CI: 0.51-0.89) and higher odds of high resilience (OR=1.21, 95% CI: 1.02-1.44) than HIV-uninfected participants, adjusted for covariates. The presence of anxiety was associated with higher risk of misuse of all substances. High resilience was associated with lower risk of anxiety and misuse of substances, adjusted for covariates.

CONCLUSIONS

Psychological resilience was associated with lower risk of anxiety and substance misuse, potentially serving as a buffer against poor mental and behavioral health during the COVID-19 pandemic. Further research is needed to identify pathways of resilience in the context of substance misuse and comprehensive resilience-focused interventions.

[The intensive care diary-a communication tool]

Tagebücher auf Intensivstationen werden meist von Familien und Pflegenden für Patient:innen mit Bewusstseinsstörungen geschrieben. In dem Tagebuch wird in laienverständlicher Sprache die Geschichte der Patient:innen anhand täglicher Berichte beschrieben. Patient:innen können später das Tagebuchbuch lesen und ihre Erfahrungen und Erlebnisse verarbeiten und ggf. anders bewerten. Intensivtagebücher senken die Risiken für psychosoziale Folgeschäden bei Patient:innen und Familien und sind mittlerweile weltweit verbreitet. Tagebücher haben unterschiedliche Zwecke und dienen auch der Kommunikation: Es werden Worte an eine Person geschrieben, die sie später hoffentlich lesen wird. Dies kann Familien darin unterstützen, verbunden zu bleiben und die Situation besser zu bewältigen. Gleichzeitig kann das Schreiben eines Tagebuchs auch von einigen Angehörigen und Pflegenden als Belastung empfunden werden, weil keine Zeit verfügbar ist oder es zu nahe scheint. Intensivtagebücher können als ein Mittel zur patienten- und familienzentrierten Versorgung genutzt werden.

Experiences and needs of patients undergoing clinical isolation. Phenomenological-hermeneutic study

OBJECTIVE

To know the experience lived by people subjected to hospital isolation, as well as to recognize the most significant needs expressed during this process.

METHOD

Qualitative study from a phenomenological-hermeneutical approach. The study participants were patients subjected to hospital isolation during their admission to the trauma ward of the Vall d'Hebron University Hospital. Six in-depth interviews were conducted and recorded by audio. The data was analyzed using a thematic content analysis.

RESULTS

The feedback from the participants in this study was essential to understand the experience lived by people subjected to hospital isolation. These perceptions were listed in the format of 5 categories related to the following experiences: loneliness, perception of "feeling like the last one", lack of communication, resilience and lack of attention and 3 categories related to their needs.

CONCLUSIONS

The findings suggest that isolation requires compliance with a series of rules and restrictions in the hospital setting that, despite its therapeutic purposes, can promote negative feelings. Based on the results of our research, we conclude that an effort should be made to improve actions aimed at minimizing these feelings in situations of isolation.

[Influence of the caregiver on the cognitive and functional decline of people with dementia: A systematic review]

Dementia is a neurodegenerative disease that requires the accompaniment of a caregiver who is in charge of assisting and supervising basic and psychosocial needs. The objective of this article was to determine the influence of the caregiver on the cognitive and functional decline of patients with dementia. The method was a systematic review by searching the Scopus, Pubmed and Science Direct databases between the years 2010-2020. In conclusion, the informal caregiver condition was the most reported by the investigations, generally assumed by wives and children; Caregiver characteristics such as personality, subjective interpretations of the functional status of adults with dementia, and caregivers' coping strategies were associated with a decrease in the rate of cognitive and functional impairment of people with dementia.

Composite psychosocial risk based on the fear avoidance model in patients undergoing anterior cruciate ligament reconstruction: Cluster-based analysis

OBJECTIVES

To examine associations between preoperative fear-avoidance model (FAM) risk subgroup status and patient expectation of surgical success with postoperative outcomes at 6 and 12 months after anterior cruciate ligament reconstruction (ACLR).

DESIGN

Cohort study.

SETTING

Academic medical center.

PARTICIPANTS

54 patients (25 females) undergoing unilateral ACLR.

MAIN OUTCOME MEASURES

Cluster analysis distinguished FAM risk subgroups based on preoperative fear of movement/reinjury, self-efficacy, and pain catastrophizing. Preoperative expectation for surgical success was assessed with a numeric rating scale. Six and 12-month outcomes included Subjective Patient Outcomes for Return to Sport, Knee Injury and Osteoarthritis Outcome Score (KOOS) sports/recreation and quality of life, and International Knee Documentation Committee (IKDC) Subjective Knee Form.

RESULTS

Thirteen (24%) patients were "moderate-to-high FAM risk." Moderate-to-high FAM risk patients had lower odds of return to sport at 12 months (OR = 0.3, p = .05) and lower KOOS sports/recreation at 6 months (st. beta = -0.27, p = .05), KOOS quality of life at 12 months (st. beta = -0.42, p = .007), and IKDC at 6 (st. beta = -0.29, p = .04) and 12 months (st. beta = -0.47, p = .001). Higher expectation was associated with lower 6-month IKDC (st. beta = -0.36, p = .008) and 12-month KOOS quality of life (st. beta = -0.29, p = .05).

CONCLUSIONS

Preoperative FAM risk influences patient-reported outcomes and return to sport at 6 and 12 months.

Informal caregivers' quality of life and management strategies following the transformation of their cancer caregiving role: A qualitative systematic review

Objectives

Globally, informal caregivers caring for cancer patients meet challenges within their caregiving role, which significantly influence their quality of life. This qualitative systematic review aimed to analyze how cancer caregiving influence the quality of life of informal caregivers and the management strategies of informal caregivers for their role as cancer caregivers.

Methods

Following the enhancing transparency in reporting the synthesis of qualitative research (ENTREQ) statement, Wanfang database, the China National Knowledge Infrastructure (CNKI), CINAHL, MEDLINE, PubMed, Cochrane Library, PsycARTICLES and PsycINFO, and grey literature in English and Chinese from 1 May 2009 to 31 December 2019 were searched. Quality of included studies was assessed by the Critical Appraisal Skills Programme (2018) Qualitative Checklist and thematic synthesis was conducted.

Results

Of the 8,945 studies identified, 6 studies met the inclusion criteria. One analytical theme relating to the QoL of informal caregivers following cancer caregiving was identified: "challenges of caregiving". In terms of the management strategies to the role of cancer caregivers, two analytical themes were identified: "self-adjustment" and "seeking for formal and informal support".

Conclusions

Cancer caregiving influences informal caregivers' QoL significantly and informal caregivers develop diverse coping strategies to deal with the difficulties occurred while balancing the relationship between their own lives and caregiving. However, professional and policy support remain inadequate for informal caregivers that require the need for improvement in terms of health care professionals and policymakers.

Analysis of adversity quotient of nursing students in Macao: A cross-section and correlation study

Objectives

To investigate the adversity quotient (AQ) of Macao undergraduate nursing students and analyse its influencing factors.

Methods

A cross-section design was used, and a convenience sample of nursing students (n = 158 valid) was selected from a tertiary institute in Macao. In addition to demographic questions, the Chinese versions of the Adversity Quotient Scale, the Emotional Intelligence (EI) Scale, the Simplified Coping Style Questionnaire and the Parenting Styles Scale were used to assess the students’ characteristics.

Results

The average AQ score of the students was 116.72 ± 11.39. AQ scores were negatively correlated with coping-negative, and maternal style (excessive interference, excessive protection) (r = −0.332, P < 0.001; r = −0.167, P = 0.036). Coping-negative entered the regression equation (F = 19.154, P < 0.001). The female nursing students had higher scores in ownership dimension of AQ than their male counterparts (31.98 ± 3.26 vs. 29.21 ± 3.08, t = −4.442, P < 0.001).

Conclusions

The average AQ scores of Macao undergraduate nursing students were moderate. The female nursing students are more likely to attribute the cause of adversity to themselves, and specific psychosocial and cultural issues may be at play. There is a necessity for Macao nursing students to improve their ability to overcome setbacks. Special attention should be paid to the cultivation of students’ positive coping styles.

Psychological adaptive difficulties and their management during COVID-19 pandemic in people with diabetes mellitus

BACKGROUND AND AIMS

People with diabetes have multiple psychosocial issues related to diabetes and its complications and this may be exacerbated during the COVID-19 pandemic.

METHODS

We reviewed the psychological adaptative difficulties in people with diabetes especially during natural disasters including the prevailing COVID-19 pandemic.

RESULTS

There are significant concerns regarding worsening of glycemic control, unavailability of appropriate medicines, inaccessibility to health care or acquiring SARS- CoV-2 infection and subsequent poorer outcomes during the COVID-19 pandemic. Although there are some guidance documents for managing diabetes and associated complications during COVID-19 pandemic but very few address the psychological issues in people with diabetes. We discuss the psychological adaptive difficulties and an approach to address the psychosocial concerns in people with diabetes during the COVID-19 pandemic.

CONCLUSIONS

People with diabetes have significant diabetes distress and psychological adaptive difficulties that is aggravated by the COVID-19 pandemic. An integrated multidisciplinary approach is needed to manage the prevailing psychological issues amongst people with diabetes during the COVID-19 pandemic.

Sense of Coherence and Coping Strategies in Patients With Dysphonia

AIM

To analyze sense of coherence (SOC) of dysphonic individuals considering the type and degree of dysphonia, coping strategies, and sociodemographic variables.

METHODS

This cross-sectional study was performed with 50 dysphonic individuals under follow-up at a Brazilian Speech-Language Pathology Clinic. They answered a questionnaire with sociodemographic information, the PEED-10 (Brazilian Voice Disability Coping Questionnaire) and the Brazilian version of Sense of Coherence scale. The SOC was categorized as high or low using Cluster analysis. After descriptive analysis, data were analyzed through both the bivariate and multivariate logistic regression model method and the Spearman's correlation test (P< 0.05).

RESULTS

Most individuals presented a high SOC (60%). Individuals with mild dysphonia were 7.00 times more likely to present high SOC (95% CI = 1.24-39.38).  Individuals between 45 and 70 years old were 5.03 times more likely to present high SOC (95% CI = 1.25-20.28). In addition, the higher SOC, as well as the scores of manageability domain, the lower the use of strategies focused on emotion.

CONCLUSION

Patients with mild dysphonia are more likely to have a high SOC. The same goes for individuals over the fourth decade of life. Also, the greater the SOC, the fewer emotional strategies are used to cope with dysphonia.

Shock to the Heart: Psychosocial Implications and Applications of Sudden Cardiac Death in the Young

PURPOSE OF REVIEW

Although rare, sudden cardiac death (SCD) in the young is a tragic event, having a dramatic impact upon all involved. The psychosocial burden associated with SCD can leave friends, families, and entire communities bereft. With only limited evidence to describe the volatile emotional reactions associated with a young SCD, there is an urgent need for care providers to better understand the psychological complexities and impacts faced by both at-risk individuals and those directly affected by these tragic events.

RECENT FINDINGS

Current knowledge of the psychosocial implications associated with SCD in the young has recently generated interest in the cardiovascular community, with the goal of addressing prevention strategies (screening), family bereavement, and the psychological impact of at-risk or surviving individuals. With the emergence of novel strategies aimed at reducing the public health impact of SCD in the young, further discussion regarding the psychosocial impact of SCD, encompassing prevention, survivorship, and the downstream communal effects of a young death is required. Support systems and intervention could assist in the management of the associated psychosocial burden, yet there is a lack of clinical guidelines to direct this form of care. There is an important need for multidisciplinary collaboration across subspecialties to provide support to grieving individuals and manage patient well-being throughout the screening process for SCD. This collaborative approach requires the integration of cardiovascular and psychological expertise where relevant.

Psychologically informed physical therapy for musculoskeletal pain: current approaches, implications, and future directions from recent randomized trials

Supplemental Digital Content is Available in the Text.

Randomized trials have examined the efficacy of psychologically informed physical therapy methods including graded activity or graded exposure, cognitive-behavioral-based physical therapy, acceptance and commitment-based physical therapy, and internet-based psychological programs compared to traditional physical therapy approaches for musculoskeletal pain. Summary findings suggest that psychologically informed physical therapy is a promising care model; however, more convincing evidence is needed to support widespread adoption, especially in light of clinician training demands.

Psychologically informed physical therapy (PIPT) blends psychological strategies within a physical therapist's treatment approach for the prevention and management of chronic musculoskeletal pain. Several randomized trials have been conducted examining the efficacy of PIPT compared to standard physical therapy on important patient-reported outcomes of disability, physical function, and pain. In this review, we examine recent trials published since 2012 to describe current PIPT methods, discuss implications from findings, and offer future directions. Twenty-two studies, representing 18 trials, were identified. The studied PIPT interventions included (1) graded activity or graded exposure (n = 6), (2) cognitive-behavioral-based physical therapy (n = 9), (3) acceptance and commitment-based physical therapy (n = 1), and (4) internet-based psychological programs with physical therapy (n = 2). Consistent with prior reviews, graded activity is not superior to other forms of physical activity or exercise. In a few recent studies, cognitive-behavioral-based physical therapy had short-term efficacy when compared to a program of standardized exercise. There is a need to further examine approaches integrating alternative strategies including acceptance-based therapies (ie, acceptance and commitment therapy or mindfulness) or internet-based cognitive-behavioral programs within physical therapy. Although PIPT remains a promising care model, more convincing evidence is needed to support widespread adoption, especially in light of training demands and implementation challenges.

Anxiety Severity Levels and Coping Strategies during the COVID-19 Pandemic among People Aged 15 Years and Above in Gonabad, Iran

BACKGROUND

The coronavirus disease 2019 (COVID-19) outbreak is a global health problem. It is necessary to provide evidence on its unprecedented psychological effects to develop effective psychological interventions. The current study aims to determine the anxiety severity level, coping strategies, and influencing factors in response to the COVID-19 pandemic among people aged 15 years and above in Gonabad, Iran.

METHODS

We conducted a cross-sectional survey via online questionnaires between February and March 2020. We evaluated the anxiety severity levels and coping strategies using the Corona Disease Anxiety Scale (CDAS) and Coping Inventory for Stressful Situations-Short Form (CISS-SF), respectively. Multinomial and ordinal logistic regression models were used to identify the predictors of coping strategies and anxiety.

RESULTS

Totally, 500 people completed the questionnaires (response rate: 73%). Of them, 53.4% (95% confidence interval [CI]: 48.9%- 57.8%) suffered moderate to severe levels of anxiety. More than half of the respondents (52.0%; 95% CI: 47.5%-56.4%) utilized emotional-based or avoidant coping strategies. People with no academic education (odds ratio [OR]: 2.16; 95% CI: 1.41- 3.31) and without physical exercise (OR: 2.04; 95% CI: 1.22-3.33) preferred emotional-based coping instead of problem-based coping strategy. Female gender (OR: 1.60, 95%, CI: 1.13-2.28), underlying medical conditions (OR: 2.52, 95% CI: 1.65-3.87), and emotional-based coping (OR: 4.06, 95% CI: 2.76-5.99) were associated with higher severity levels of anxiety.

CONCLUSION

The severity of anxiety during the COVID-19 pandemic was significant among participants. Further attention is needed to enhance the mental health of the vulnerable population during the COVID-19 pandemic. Our findings also identified some factors related to the severity level of anxiety related to COVID-19 that could help formulate better psychological interventions.

Dialogues in Infertility: Exploring the Potential for Psychological Adaptation

The objective of this paper is to detail the process of psychological adaptation for a woman navigating the world after a diagnosis of age-related infertility. Infertility is a medical condition, but it occurs within a social and cultural context, thereby creating social and psychological dimensions. Discrepancies between a woman's fertility ideals and her reality may be related to both personal preferences and contributing social factors. The discussion will be based on longitudinally collected interview data. Drawing on the Dialogical Self Theory, the paper will focus on intra-psychological dynamics (dialogues) and will analyze the adaptation process in terms of I-positions. Based on idiographic analyses the conclusion is that adaptation takes place by taking subjective personal control over the uncertainty of infertility. By integrating new I-position into intra-personal phenomena, the core "I" will be united with new qualities and is seen as an authentic elaboration resulting from the formation of personal, subjective meaning in a uniquely personal developmental trajectory.

Appraisals and coping mediate the relationship between resilience and distress among significant others of persons with spinal cord injury or acquired brain injury: a cross-sectional study

Background

Many significant others of persons with serious conditions like spinal cord injury (SCI) and acquired brain injury (ABI) report high levels of psychological distress. In line with the stress-coping model, the aim of the present study was to investigate the relationship between personal resource resilience and psychological distress, and whether appraisals of threat and loss, and passive coping mediate this relationship.

Methods

Significant others (n = 228) of persons with SCI or ABI completed questionnaires shortly after admission to first inpatient rehabilitation after onset of the condition. The questionnaire included measures to assess psychological distress (Hospital Anxiety and Depression Scale), resilience (Connor-Davidson Resilience Scale-10), appraisals (Appraisals of Life Events scale, threat and loss) and passive coping (Utrecht Coping List). The PROCESS tool was used to test the presence of mediation. Confounding and differences between SCI and ABI were investigated.

Results

High levels of psychological distress among significant others were found (34–41%). Fifty-five percent of the variance in psychological distress was explained by the relationship between resilience and psychological distress. This relationship was mediated by appraisals of threat and loss, and passive coping. The relationship between resilience and psychological distress was similar in the SCI and ABI groups.

Conclusions

The results of our study indicate that appraisals of threat and loss and passive coping are mediating factors in the relationship between resilience and psychological distress. It seems useful to investigate if interventions focussing on psychological factors like resilience, appraisal and coping are effective to prevent or reduce psychological distress among significant others of persons with SCI or ABI.

Trial registration

Dutch trial register NTR5742. Registered January 9, 2016.

The data on psychological adaptation during polar winter-overs in Sub-Antarctic and Antarctic stations

The data presented in this article relate to the research article entitled "assessing psychological adaptation during polar winter-overs: The isolated and confined environments questionnaire (ICE-Q)" [1]. These data were acquired in order to develop a standardized instrument - the ICE-Q - designed to assess psychological adaptation within isolated, confined, and extreme environments. A total of 140 winterers from several sub-Antarctic (Amsterdam, Crozet, Kerguelen) and Antarctic (Concordia, Terre Adélie) stations voluntarily participated. Data were collected by multiple self-report questionnaires including a wide variety of well-known and validated questionnaires to record the winterers' responses to polar stations. Data were gathered across two or three winter seasons within each of the 5 polar stations to ensure sufficiently large sample. From four to seven measurement time along a one-year period were proposed to the participants, resulting in 479 momentary assessments. Results of exploratory factor analyses, confirmatory factor analyses, exploratory structural equation modelling, reliability analyses, and test-retest provided strong evidence for the construct validity of the ICE-Q (19-item 4-factor questionnaire). The four factors were social, emotional, occupational and physical. Future studies would examine the dynamic of psychological adaptation in isolated, confined and/or extreme environments during polar missions.

Coping style at diagnosis and its association with subsequent health-related quality of life in women with breast cancer: A 3-year follow-up study

PURPOSE

The aim of this study was to describe distinct coping styles of women newly diagnosed with breast cancer and to determine whether there is an association between those styles and the women's long-term health-related quality of life (HRQOL).

METHODS

Using a prospective longitudinal study design, we enrolled 101 women recently diagnosed with breast cancer in South Korea and asked them to complete a questionnaire that included the Mini-Mental Adjustment to Cancer (Mini-MAC) scale and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC QLQ-C30).

RESULTS

From the baseline data, we identified two coping style clusters. The first ("FS cluster") had higher scores on the fighting spirit subscale and lower scores on the helpless-hopeless and anxious preoccupation subscales (n = 52, 51.5%), while the second ("HHAP cluster") scored higher on the helpless-hopeless and anxious preoccupation subscales and lower on the fighting spirit subscale (n = 49, 48.5%). In the longitudinal analysis, the FS cluster had a better HRQOL then the HHAP cluster for 2 years after diagnosis, but the HRQOLs did not differ significantly 3 years after diagnosis.

CONCLUSIONS

Maladaptive coping at diagnosis may predict poor HRQOL in women with breast cancer. Regular screening of coping style and interventions to improve poor coping style should be considered for at least 2 years post initial diagnosis.

Cognitive-behavioral-based physical therapy to enhance return to sport after anterior cruciate ligament reconstruction: An open pilot study

OBJECTIVES

To describe feasibility, adherence, acceptability, and outcomes of a cognitive-behavioral-based physical therapy (CBPT-ACLR) intervention for improving postoperative recovery after anterior cruciate ligament reconstruction (ACLR).

DESIGN

Pilot study.

SETTING

Academic medical center.

PARTICIPANTS

Eight patients (mean age [SD] = 20.1 [2.6] years, 6 females) participated in a 7-session telephone-based CBPT-ACLR intervention beginning preoperatively and lasting 8 weeks after surgery.

MAIN OUTCOME MEASURES

At 6 months, patients completed Knee Injury and Osteoarthritis Outcome Score (KOOS) sports/recreation and quality of life (QOL) subscales, International Knee Documentation Committee (IKDC), Tampa Scale of Kinesiophobia (TSK), Pain Catastrophizing Scale (PCS), and Knee Self-Efficacy Scale (K-SES), return to sport (Subjective Patient Outcome for Return to Sports), and satisfaction. Minimal clinically important difference (MCID) was used for meaningful change.

RESULTS

Seven (88%) patients completed all sessions. Seven (88%) patients exceeded MCID on the TSK, 6 (75%) on the PCS, 5 (63%) on the KOOS sports/recreation subscale, 4 (50%) on the IKDC, and 3 (38%) on the KOOS QOL subscale. Three (38%) patients returned to their same sport at the same level of effort and performance. All patients were satisfied with their recovery.

CONCLUSIONS

A CBPT-ACLR program is feasible and acceptable for addressing psychological risk factors after ACLR.

The Experience of Dutch Women Using a Coping Intervention for Oocyte Retrieval: A Qualitative Study

BACKGROUND

Many women experience oocyte retrieval during an IVF treatment as a stressful and emotionally difficult situation. Women fear the pain as associated with oocyte retrieval. Based on the existing literature, a coping intervention for oocyte retrieval (CIFOR) was developed to deal with the stress and pain during oocyte retrieval. The objective of this study was to explore the experiences of women using coping intervention for oocyte retrieval (CIFOR) while undergoing oocyte retrieval.

METHODS

For this generic qualitative study, a purposeful sample of fifteen women was gathered from a university clinic in the Netherlands and each participant was interviewed. Background information about the IVF treatment was collected from medical files. Semi-structured interviews were performed approximately 15 min after the OR procedure. Data were analyzed using the Qualitative Analysis Guide of Leuven and processed using MAXQDA.

RESULTS

Twenty-five women were approached for this study between January and May 2018. This study identified five themes that were important in the experiences of women using CIFOR: highly valuing the CIFOR, feasible in daily practice, need for information, sense of control and partner's involvement.

CONCLUSION

Women highly valued the tool. They found CIFOR feasible in daily practice and it fulfilled their needs for information. In addition, women had a sense of control using the intervention. Future research will involve performing a pilot study according to the Medical Research Council framework with outcomes based on the patient's sense of control, ability to cope, coping strategies, anxiety and pain.

Suicide Attempt Following Pacemaker Implantation in an Eighty-Three-Year-Old Male: A Case Report

As the global population ages, cardiac pacing procedures are rising exponentially to keep pace with the increasing incidence of bradyarrhythmias. The efficacy of pacemakers is well established, but recipients may have poor psychosocial adaptation leading to development or exacerbation of mental disorders, that may manifest with anxiety, depressive symptoms or rarely suicidal tendencies. An 83-year-old male of African descent was referred to us for evaluation and expert management. He came with chief complaints of general body malaise, light-headedness, chest pain and fainting spells for about 6 months. He was diagnosed with hypertension 4 years prior, and there was no history of mental illness in the patient or his family. Echocardiography (ECHO) revealed features of hypertensive heart disease while electrocardiogram (ECG) showed features of third-degree heart block. He underwent successful pacing with a resultant ventricular paced rhythm. The patient was stable and symptom free post pacing, but on the fourth day he jumped off the window of the ward in the hospital’s second floor. Post suicide attempt examination revealed epistaxis, right periorbital hematoma with a temporal lacerated wound and deformed ankles bilaterally. ECG showed a ventricular paced rhythm and the chest radiograph showed an intact pacemaker. Ophthalmological review was evident for right sided blepharospasm with massive chemosis and bilateral constricted reactive pupils. Radiological investigations showed right orbital fracture, stable C5 and C6 fractures, and bilateral bimalleolar fractures with ankle dislocation. Neurosurgical review was unremarkable and psychiatric review could not be performed. The patient died 18 h after the suicide attempt incidence. Emotional disturbances post pacing impairs the quality of life and in the worst case scenario could lead to unanticipated cessation of life. In view of this, thorough evaluation and monitoring of the patient’s psychological well-being both pre and post pacing is paramount.

Coping styles in patients with hypospadias

OBJECTIVE

The objective of this study is to investigate the coping styles used by patients with hypospadias. Long-term hypospadias studies generally show satisfying outcomes, but some report a lower quality of life (QoL) or poorer psychosocial adjustment, particularly in patients with proximal hypospadias. A lower QoL or psychosocial adjustment was found to be associated with passive coping styles in other pediatric patient populations. Hypothetically, patients with hypospadias also develop different coping styles due to medical experiences in childhood, leading to the lower QoL outcomes on the long term. However, coping styles of patients with hypospadias have never been analyzed.

PATIENTS AND METHODS

Adult men with hypospadias repair in childhood were recruited (n = 55; aged 19.9 [IQR 19.2-22.1]). Coping styles were determined with the Utrecht Coping List (UCL) and results compared with a reference group of male students (n = 55, age 20-30 years, no medical history). Sub analysis of coping styles of the hypospadias groups was done based on three items: severity of hypospadias, time of last hypospadias surgery and occurrence of postoperative complications.

RESULTS

Compared to the reference groups, patients with hypospadias had higher scores on Avoidance (P < 0.05), particularly patients who had ≥1 postoperative complication or proximal hypospadias. Patients with proximal hypospadias also had lower scores on Seeking Social Support compared to the reference group (P < 0.05). Within the hypospadias group, coping style scores did not differ based on severity of hypospadias, timing of surgery or postoperative complications.

CONCLUSION

Patients with hypospadias, particularly those with proximal hypospadias or a postoperative complication, more often use an avoiding coping style compared to a reference population. Attention to coping styles during the follow-up of patients with hypospadias might help to improve the QoL in these patients.

The Breast Feeding Adaptation Scale-Short Form: Development and Testing of Its Psychometric Properties and Measurement Invariance

PURPOSE

This study sought to develop the Breastfeeding Adaptation Scale-Short Form(BFAS-SF) for use at 4 weeks postpartum, to test its validity and reliability, and to examine its measurement invariance. The latent mean score of the BFAS-SF across multiple groups was also compared.

METHODS

This methodological research study was conducted to develop a short form of the BFAS and to test its psychometric properties and measurement invariance. Data were collected twice for measurement invariance testing. The sample included 431 and 272 breastfeeding mothers at 2 weeks and 4 weeks postpartum, respectively.

RESULTS

Confirmatory factor analysis supported six dimensions of the BFAS-SF at 4 weeks postpartum. Multi-group confirmatory factor analysis revealed evidence for invariance of the BFAS-SF according to employment status, parity, delivery mode, and the postpartum period. There were statistically significant latent mean differences. Mothers who were unemployed and who had a vaginal delivery showed significantly higher scores for breastfeeding confidence, sufficient breast milk, and baby's satisfaction with breastfeeding.

CONCLUSION

The BFAS-SF is valid, reliable, and an appropriate instrument for assessing mothers' breastfeeding adaptation. It can be used to compare mean scores according to employment status and delivery mode.

Calibration and initial validation of a general self-efficacy item bank and short form for the NIH PROMIS®

AIMS

General self-efficacy is associated with adaptive coping and positive health outcomes. The Patient-Reported Outcomes Measurement Information System (PROMIS^®) has developed self-efficacy item banks for managing chronic conditions, but lacks a general self-efficacy measure. We sought to refine and validate an item-response theory (IRT)-based measure of general self-efficacy for PROMIS^®.

METHODS

Ten items were modified from the NIH Toolbox^® Self-Efficacy Item Bank by creating "confidence" response options, and administered to a general population sample (n = 1000) with the Toolbox^® Self-Efficacy Item Bank, Life Orientation Test-Revised (LOT-R), and Generalized Expectancy for Success Scale (GESS). We split the sample in half for exploratory factor analysis (EFA) followed by confirmatory factor analysis (CFA). IRT analyses included evaluation of differential item functioning (DIF).

RESULTS

Participants had a mean age of 47.8 years and 50.3% were male. EFA showed all items loaded onto one dominant factor and CFA yielded a good fitting model for a general self-efficacy bank with confidence response options (CFI = 0.987, TLI = 0.984, RMSEA = 0.090). Items showed no evidence of DIF by gender, age, education, or race. Internal consistency reliability was α = .94 and .88 for a new 10-item general self-efficacy bank and 4-item short form, respectively. The new bank was correlated with the LOT-R (r = .58), the GESS (r = .55), and the Toolbox^® Self-Efficacy Item Bank (r = .87).

CONCLUSIONS

The PROMIS^® General Self-Efficacy measure demonstrated sufficient unidimensionality and displayed good internal consistency reliability, model fit, and convergent validity. Further psychometric testing of the PROMIS^® General Self-Efficacy Item Bank and Short Form can evaluate its utility in people with chronic health conditions.

Effect of a Social Support Program for Mothers of Children with Precocious Puberty: A Preliminary Quasi-Experimental Study

PURPOSE

The purpose of this study was to evaluate the effects of a social support program on the stress, anxiety, guilt, and life satisfaction levels among Korean mothers of children with precocious puberty.

DESIGN AND METHODS

A non-equivalent control group and a non-synchronized design were used in this quasi-experiment study. Thirty-four mothers (divided into equal-sized experimental and control groups), 32-47 years of age, with children aged 6-11 years old, were recruited from a pediatric outpatient department at a national university hospital. The experimental group was involved in four sessions of a 4-week social support program. Descriptive statistics were used for demographic characteristics. Chi-square tests and t-tests were used to evaluate group differences.

RESULTS

The program significantly reduced mothers' stress and guilt and significantly increased their life satisfaction. No significant differences in changes in anxiety were reported between the groups.

CONCLUSIONS

This study confirms that the social support program was a useful nursing intervention for Korean mothers of children with precocious puberty, which can be extensively applied to help mothers in similar situations.

PRACTICE IMPLICATIONS

The preliminary study findings may inform healthcare professionals to develop effective interventions to promote psychosocial well-being of mothers of children with precocious puberty through strengthening their social support and to further improve the quality of life of children with precocious puberty and their families.

The impact of brief lifestyle self-management education for the control of seizures

AIM:

this study examined a brief lifestyle self-management intervention, based on self-determination theory, to manage seizure frequency, and its effects on health-related quality of life and resilience in people with epilepsy aged over 18 years.

BACKGROUND:

most people with epilepsy can identify factors that may trigger seizures and may try to avoid these; however, education from clinicians on this varies.

DESIGN:

a cohort study with control design.

METHOD:

sixty participants were purposively sampled and allocated to an intervention or a control group.

RESULTS:

moderate correlations were found, particularly between: resilience and satisfaction with life; medication adherence and psychological quality of life; and psychological quality of life and satisfaction with life. The mean seizure occurrences between the control and intervention groups were 12.71 (SD 24.55) and 6.76 (SD 13.40) respectively after the intervention. While the study was not powered to assess this, the intervention may be most effective regarding medication adherence and physical health quality of life.

CONCLUSION:

the relationship between self-efficacy and seizure management appeared to be strengthened by the programme. This study is the first known to measure resilience in relation to lifestyle self-management for seizure control in people with epilepsy. Relevance to practice: nurses are well placed to work with patients' strengths towards self-efficacy and potentially resilient coping.

Does social participation accelerate psychological adaptation to health shocks? Evidence from a national longitudinal survey in Japan

PURPOSE

It is well-known that people psychologically adapt to health shocks over time and social participation (SP) has a favourable impact on health. Combining these two understandings, the current study addresses how psychological adaptation to major health shocks was affected by SP experience one year prior to the initial diagnosis.

METHODS

Data were collected from a twelve-wave nationwide panel survey conducted from 2005 to 2016, starting with 34,240 individuals aged 50-59 years. Individuals who were initially diagnosed with cancer, stroke, heart disease or diabetes at any time between the second and twelfth waves and kept diagnosed as such were focused on. Random-effects models were estimated to examine how baseline SP prior to the diagnosis affected the pace of change in psychological distress, which was measured using Kessler 6 (K6) scores (range 0-24; M 3.3 SD 4.2), following immediate responses to the initial diagnosis.

RESULTS

Baseline SP enabled or accelerated psychological adaptation to major health shocks. It is noted that the pace of decline of the K6 score per year after the immediate responses was 0.20 for cancer and 0.09 for diabetes (both p < 0.001) among men with baseline SP, in contrast with non-significant and limited changes among those without it. While the results for women were more mixed than those for men, the former results confirmed favourable impacts of baseline SP on psychological adaptation to health shocks in general.

CONCLUSIONS

The results highlight a favourable impact of SP on psychological adaptation to health shocks.

Clinical and sociodemographic factors that may influence the resilience of women surviving breast cancer: cross-sectional study

PURPOSE

Breast cancer is one of the most common diseases, affecting many thousands of women. Although more than 80% of women survive the experience, very few studies have been conducted to examine the question of resilience among long-term survivors of breast cancer. The aim of this study is to describe the clinical and sociodemographic factors that correlate with greater resilience in women survivors of breast cancer, in the Costa del Sol Health Area (Spain).

METHODS

Accordingly, a descriptive cross-sectional study was conducted, with respect to 59 survivors of breast cancer, who each completed a questionnaire for analysis according to the Connor-Davidson Resilience Scale (CD-RISC).

RESULTS

The median resilience score was 77 (interquartile range 70-80). The group of patients who had survived for six or more years since the diagnosis had a higher score for total resilience (90: IR 76-92) than those diagnosed more recently (74: IR 65.7-83.7) (p = 0.012). Regarding the patients' education background, the group with no formal qualifications or only primary studies had a score of 72 (IR 64-84), versus 79 (IR 74-89.7) for the group with higher levels of education (p = 0.016). Of the clinical variables, only the administration of chemotherapy was significantly associated with the score obtained on the CD-RISC scale (p = 0.012).

CONCLUSIONS

The results obtained in this study lead us to conclude that sociodemographic and clinical factors have a positive impact on the level of resilience among women resident in the Costa del Sol Health Area and who are long-term survivors of breast cancer.