Reasons for disengagement from antiretroviral care in the era of "Treat All" in low- or middle-income countries: a systematic review

INTRODUCTION

Disengagement from antiretroviral therapy (ART) care is an important reason why people living with HIV do not achieve viral load suppression become unwell.

METHODS

We searched two databases and conference abstracts from January 2015 to December 2022 for studies which reported reasons for disengagement from ART care. We included quantitative (mainly surveys) and qualitative (in-depth interviews or focus groups) studies conducted after "treat all" or "Option B+" policy adoption. We used an inductive approach to categorize reasons: we report how often reasons were reported in studies and developed a conceptual framework for reasons.

RESULTS

We identified 21 studies which reported reasons for disengaging from ART care in the "Treat All" era, mostly in African countries: six studies in the general population of persons living with HIV, nine in pregnant or postpartum women and six in selected populations (one each in people who use drugs, isolated indigenous communities, men, women, adolescents and men who have sex with men). Reasons reported were: side effects or other antiretroviral tablet issues (15 studies); lack of perceived benefit of ART (13 studies); psychological, mental health or drug use (13 studies); concerns about stigma or confidentiality (14 studies); lack of social or family support (12 studies); socio-economic reasons (16 studies); health facility-related reasons (11 studies); and acute proximal events such as unexpected mobility (12 studies). The most common reasons for disengagement were unexpected events, socio-economic reasons, ART side effects or lack of perceived benefit of ART. Conceptually, studies described underlying vulnerability factors (individual, interpersonal, structural and healthcare) but that often unexpected proximal events (e.g. unanticipated mobility) acted as the trigger for disengagement to occur.

DISCUSSION

People disengage from ART care for individual, interpersonal, structural and healthcare reasons, and these reasons overlap and interact with each other. While HIV programmes cannot predict and address all events that may lead to disengagement, an approach that recognizes that such shocks will happen could help.

CONCLUSIONS

Health services should focus on ways to encourage clients to engage with care by making ART services welcoming, person-centred and more flexible alongside offering adherence interventions, such as counselling and peer support.

Neural signatures of shared subjective affective engagement and disengagement during movie viewing

When watching a negative emotional movie, we differ from person to person in the ease with which we engage and the difficulty with which we disengage throughout a temporally evolving narrative. We investigated neural responses of emotional processing, by considering inter-individual synchronization in subjective emotional engagement and disengagement. The neural underpinnings of these shared responses are ideally studied in naturalistic scenarios like movie viewing, wherein individuals emotionally engage and disengage at their own time and pace throughout the course of a narrative. Despite the rich data that naturalistic designs can bring to the study, there is a challenge in determining time-resolved behavioral markers of subjective engagement and disengagement and their underlying neural responses. We used a within-subject cross-over design instructing 22 subjects to watch clips of either neutral or sad content while undergoing functional magnetic resonance imaging (fMRI). Participants watched the same movies a second time while continuously annotating the perceived emotional intensity, thus enabling the mapping of brain activity and emotional experience. Our analyses revealed that between-participant similarity in waxing (engagement) and waning (disengagement) of emotional intensity was directly related to the between-participant similarity in spatiotemporal patterns of brain activation during the movie(s). Similar patterns of engagement reflected common activation in the bilateral ventromedial prefrontal cortex, regions often involved in self-referenced evaluation and generation of negative emotions. Similar patterns of disengagement reflected common activation in central executive and default mode network regions often involved in top-down emotion regulation. Together this work helps to better understand cognitive and neural mechanisms underpinning engagement and disengagement from emotionally evocative narratives.

Desistance, Disengagement, and Deradicalization: A Cross-Field Comparison

This article provides a critical comparison of the present knowledge base on desistance from crime and current writings on disengagement and deradicalization from violent extremism. Underlying the comparison is the fundamental premise that while violent extremism is a particular and perhaps egregious form of crime, it is a form of crime nonetheless, meaning that violent extremist offenders are not beyond the remits of the desistance framework. As of yet, however, there have been few attempts to connect these two research domains in a systematic way. Against this background, the present article intends to trace the outlines of both bodies of knowledge so as to determine the degree of overlap between these two kindred literatures. The results of this integrative literature indicate that studies on criminal desistance and violent extremist disengagement echo the same basic mechanisms of change, but also that differences in context affect how these mechanisms take shape. In highlighting the implications for theory, the findings of this review illustrate, above all, how a closer association between these two fields of study enriches our understanding of both.

The prevalence of occupational burnout and its individual and situational predictors among addiction therapists

This study assesses the prevalence and individual and organizational predictors of occupational burnout among addiction therapists. A total of 452 addiction therapists from a representative sample of 184 Polish alcohol treatment facilities (outpatient and inpatient) participated in the study (facility response rate = 42%). The Oldenburg Burnout Inventory was used to measure occupational burnout, and 15 subscales of the Copenhagen Psychosocial Questionnaire II were administered to assess psychosocial work conditions. In addition, the Coronavirus Anxiety Scale, the Hospital Anxiety and Depression Scale and the abbreviated six-item De Jong Gierveld Loneliness Scale measured other important dimensions of addiction therapists' psychosocial functioning. Logistic regression was used for the analysis of the data. Occupational burnout was noticeably prevalent in the study group: 62% of respondents experienced exhaustion and 50% experienced disengagement from work, both to at least a moderate degree. Situational (organizational) variables were the most important predictors, explaining much more of the variance in both dimensions of burnout than the individual factors, of which only depression was significantly related to higher levels of exhaustion. Coronavirus anxiety played a marginal role in explaining the severity of burnout. The current study is one of the first attempts to assess the level of occupational burnout among addiction therapists and to comprehensively investigate the factors contributing to it. The findings provide useful information for the development of interventions aimed at preventing or reducing burnout in this professional group.

Delayed ocular disengagement from arousing scenes

Visual exploration of the world is supported by eye movements which can be speeded up or delayed depending on bottom-up stimulation, top-down goals, and prior associations. Previous studies observed faster initiation of saccades toward emotional than neutral natural scenes; however, less is known concerning saccades which originate from emotional, compared with neutral, scenes. Here, we addressed this issue by examining a task in which participants continuously moved their gaze from and toward pictures (natural scenes), which could be emotional or neutral, and changed position in every trial. Saccades were initiated later when the starting picture was emotional compared to neutral, and this slowing was associated with the arousal value of the picture, suggesting that ocular disengagement does not vary with stimulus valence but is affected by engaging picture contents such as erotica and threat/injuries.

Predicting Churn in Online Games by Quantifying Diversity of Engagement

Understanding engagement patterns of users in online platforms, may it be games, online social networks, or academic websites, is a widely studied topic with many real-world applications and economic consequences. A holy grail in this area of research is to develop an automatic prediction algorithm for when a user is going to leave the platform and devise proper intervention. In this work, we study online recreational games and propose to model the engagement patterns of players through an unsupervised learning framework. We think of engagement as a continuous temporal process, measured along specific axes derived from gaming users' data using principal component analysis. We track the overall trend of the projection of the data along the significant principal components. We find that the geometric variability of the trajectory is a good predictor of the users' engagement level. Users characterized by a time series with large variability are users with higher engagement; namely, they will continue playing the game for prolonged periods of time. We evaluated our methodology on two data sets of very different game types and compared the performance of our method with state-of-the-art black-box machine learning algorithms. Our results were fairly competitive with these methods, and we conclude that churn can be predicted using an explainable, intuitive, and white-box decision-rule algorithm.

Why Is It so Difficult to Investigate Violent Radicalization?

Imagine that you are a researcher interested in disentangling the underlying mechanisms that motivate certain individuals to self-sacrifice for a group or an ideology. Now, visualize that you are one of a few privileged that have the possibility of interviewing people who have been involved in some of the most dramatic terrorist attacks in history. What should you do? Most investigations focused on terrorism do not include empirical data and just a handful of fortunate have made face-to-face interviews with these individuals. Therefore, we might conclude that most experts in the field have not directly met the challenge of experiencing studying violent radicalization in person. As members of a research team who have talked with individuals under risk of radicalization, current, and former terrorists, our main goal with this manuscript is to synopsize a series of ten potential barriers that those interested in the subject might find when making fieldwork, and alternatives to solve them. If all the efforts made by investigators could save the life of a potential victim, prevent an individual from becoming radicalized, or make him/her decide to abandon the violence associated with terrorism, all our work will have been worthwhile.

Women's Disengagement Behaviors During Couple Conflict: Investigating Risk Indicators of Intimate Partner Violence

Intimate partner violence (IPV) is a major public health concern, leading to prevention efforts focused on identifying risk indicators of escalating conflict between partners. Certain behaviors during conflict discussions have been uniquely linked to IPV, and there is evidence that disengagement behaviors-an emerging construct-are associated with IPV as well. However, research on disengagement and IPV has largely been limited to self-report, and available observational research is largely cross-sectional. Addressing these limitations, this study prospectively examined the association between observed disengagement behaviors during couple's conflict discussions and IPV 1 year later, using a sample of 83 heterosexual married or cohabitating partners. Behavioral coding was used to assess each partner's observed disengagement behaviors and each partner's psychological and physical IPV was assessed via questionnaire 1 year later. Linear regressions were used to investigate links between indicators of engagement (i.e., listening, questions, eye contact) and psychological and physical IPV perpetration and victimization. Less question asking and higher eye contact by women were associated with greater psychological and physical IPV perpetrated by both women and men 1 year later. Lower listening behaviors by women were associated with greater psychological (but not physical) IPV perpetrated by men 1 year later. In contrast, no disengagement behaviors displayed by men were significantly related to IPV. Applying a latent change score framework using baseline IPV data, findings indicated replicability of results, though with less consistency, suggesting that women's disengagement behaviors may reflect a larger pattern of abuse that predates and follows disengaged couple interactions. Findings suggest that a unique blend of verbal and nonverbal indicators of women's disengagement during couple conflict provides a meaningful signal of the emotional climate of the relationship.

Understanding Men's Engagement and Disengagement When Seeking Support for Mental Health

Men are less likely to utilize health care services compared with women. When it comes to mental health, men have been reported to hold more reluctant attitudes toward engaging with mental health services. Current studies have predominantly been quantitative and focused on understanding effective strategies to promote men's engagement and why men may avoid help-seeking or may not seek help early; few studies exist of men's disengagement from services. Much of this research has been undertaken from the services' perspective. The study reported here attempts to gain better insight into the reasons men give for their disengagement from mental health services and what men say will reengage them back into the system. This research was a secondary analysis of data collected by a national survey conducted by Lived Experience Australia (LEA). Responses of 73 male consumers were gathered and analyzed. Analysis of the responses was split into two themes with associated subthemes: (1) Why men disengage: (1.1) Autonomy; (1.2) Professionalism; (1.3) Authenticity; and (1.4) Systemic Barriers; and (2) What will help men reengage: (2.1) Clinician-driven reconciliation, (2.2) Community and Peer Workers; and (2.3) Ease of reentry. Findings highlight strategies to prevent disengagement such as creating open and honest therapeutic environments and improving men's mental health literacy while providing care. Evidence-based approaches to reengage male consumers are suggested along with an emphasis on men's strong preferences for community-based mental health services and peer workers.

The relationship between occupational burnout and work ability among firefighters: exploring the mediating effects of insomnia, depressive symptoms, loneliness and alcohol misuse

Purpose

Firefighting is a profession associated with a high risk of elevated levels of occupational stress and burnout. The aim of this cross-sectional study was to explore the mediating effects of insomnia, depressive symptoms, loneliness and alcohol misuse in the relationship between two dimensions of burnout (i.e., exhaustion and disengagement) and work ability among firefighters.

Methods

A total of 460 firefighters from various regions of Poland completed a set of self-report questionnaires to assess constructs of interest. A mediation model was constructed to verify hypothesized paths, adjusted for socio-demographic and work-related background characteristics. Model parameters were estimated using a bootstrapping procedure, with sampling set at N = 1000.

Results

The proposed model explained 44% of variance in work ability. Higher levels of both exhaustion and disengagement predicted worsened work ability. When mediators were controlled for, these effects remained statistically significant. Depressive symptoms and feelings of loneliness were found to be partial mediators of the association between exhaustion and work ability, and between disengagement and work ability. The mediating effects of insomnia and alcohol misuse were non-significant.

Conclusions

Interventions aimed at counteracting the decrement in work ability among firefighters should target not only occupational burnout, but also depressive symptoms and a sense of loneliness as factors mediating its detrimental effects.

Attentional Bias for Sleep-Related Words as a Function of Severity of Insomnia Symptoms

Attentional bias to sleep-related information is thought to be a core feature for developing and/or maintaining insomnia. This study used a hallmark measure of attentional bias, the dot-probe task, to determine whether this bias toward sleep-related stimuli was a function of the severity of insomnia symptoms. A sample of 231 volunteers (175 females; mean age of 26.91 ± 8.05 years) participated in this online study, filling out the Insomnia Severity Index (ISI) and performing a visual dot-probe task. After categorizing individuals based on the ISI score into normal, subclinical, and moderate/severe sleep groups, we only found a marginally significant interaction between sleep groups and the type of stimuli on RTs, suggesting that subclinical and moderate/severe sleep groups reported slower RTs for sleep-related words than for neutral words. When we calculated the attentional bias score (ABS), we found that ABS significantly differed from zero in the moderate/severe sleep group only, suggesting a disengagement for sleep-related information as a function of the severity of insomnia symptoms. This finding seems to suggest that insomnia is related to greater difficulties in shifting away from sleep-related stimuli.

The Experience of Burnout in the SRNA Population and Association With Situational and Demographic Factors

There is limited research regarding student registered nurse anesthetist (SRNA) burnout. To our knowledge there is no recently published work that has explored the associations between characteristics of SRNAs and burnout. Addressing this gap could establish the SRNA experience of burnout, identify demographic characteristics and situational factors that may correlate with burnout, and lay the foundation for future research. The purpose of this exploratory descriptive study was to assess the SRNA experience of burnout and any relationship between burnout to demographic or situational factors via the Oldenburg Burnout Inventory-S and demographic questions. The research questions were: 1) Do SRNAs experience different levels of burnout during the didactic curricula and/or clinical training element of nurse anesthesia school? 2) Is there an association between SRNA burnout and demographic or situational factors? Power analysis set the minimum n at 421. Five hundred thirty SRNAs responded to the randomized survey through the American Association of Nurse Anesthesiology. Data analysis was conducted using one-way ANOVA, Spearman's rho, 2-tailed t-test, and Chi square analysis. More hours in class per week correlated with lower exhaustion scores. Higher disengagement scores were reported by SRNAs further in their training, while more hours per week in clinical correlated with both higher disengagement scores and increased total burnout scores.

Tonic activity in lateral habenula neurons acts as a neutral valence brake on reward-seeking behavior

Survival requires both the ability to persistently pursue goals and the ability to determine when it is time to stop, an adaptive balance of perseverance and disengagement. Neural activity in the lateral habenula (LHb) has been linked to negative valence, but its role in regulating the balance between engaged reward seeking and disengaged behavioral states remains unclear. Here, we show that LHb neural activity is tonically elevated during minutes-long periods of disengagement from reward-seeking behavior, both when due to repeated reward omission (negative valence) and when sufficient reward has been consumed (positive valence). Furthermore, we show that LHb inhibition extends ongoing reward-seeking behavioral states but does not prompt task re-engagement. We find no evidence for similar tonic activity changes in ventral tegmental area dopamine neurons. Our findings support a framework in which tonic activity in LHb neurons suppresses engagement in reward-seeking behavior in response to both negatively and positively valenced factors.

Predictors of Disengagement and Symptom Improvement Among Adults With Depression Enrolled in Talkspace, a Technology-Mediated Psychotherapy Platform: Naturalistic Observational Study

BACKGROUND

Depression is a common psychiatric condition with an estimated lifetime prevalence for major depression of 16.6% in the US adult population and is effectively treated through psychotherapy. The widespread availability of the internet and personal devices such as smartphones are changing the landscape of delivery of psychotherapy; however, little is known about whether and for whom this type of therapy is beneficial, and whether having synchronous video-based sessions provides additional benefits to clients above and beyond messaging-based therapy.

OBJECTIVE

This study examined the outcomes associated with the use of a digital platform (Talkspace) for technology-mediated psychotherapy. We examined the duration of client engagement in therapy and client depression score trajectories over 16 weeks. We explored the association of client characteristics, therapist characteristics, and service plan type with time-to-disengagement and trajectories of change in depression scores.

METHODS

This naturalistic observational study assessed data collected routinely by the platform between January 2016 and January 2018 and examined psychotherapy outcomes among a large representative sample of adult clients with clinically significant depression. Treatment disengagement was defined as a lack of client-initiated communication for more than 4 weeks. Clients completed the Patient Health Questionnaire-8 item (PHQ-8) at intake and every 3 weeks via an in-app survey. Cox regression analysis was used to examine the time until and predictors of disengagement. Changes in depression scores and predictors of change over time were examined using mixed-effects regression.

RESULTS

The study included 5890 clients and 1271 therapists. Client scores on the PHQ-8 declined over time, with the average client improving from a score of 15 to below the clinical cutoff of 10 by week 6. At the same time point, 37% of clients had disengaged from the therapy. When combined into a final Cox regression model, those who were more likely to disengage were clients aged 18 to 25 years versus those aged ≥50 years (odds ratio [OR] 0.82, 95% CI 0.74-0.9; P<.001), had higher education (OR 1.14, 95% CI 1.06-1.22; P<.001), had been in therapy before (OR 1.09, 95% CI 1.02-1.17; P=.01), and were living with a partner but unmarried versus single (OR 1.14, 95% CI 1.02-1.27; P=.02). Having a therapist with >10 years of experience was related to lower odds of disengagement (OR 0.87, 95% CI 0.8-0.94; P=.01). When combined into a final regression model predicting improvement in depression scores over time, clients showing more improvement were those with an associate's degree or higher (linear estimate=-0.07, P=.002) and higher intake PHQ-8 scores (estimate=3.73, P<.001). There were no differences based on the plan type.

CONCLUSIONS

Our findings add to the growing literature showing the benefits of technology-mediated psychotherapy over a relatively brief period (16 weeks).

Political Disengagement Among Youth: A Comparison Between 2011 and 2020

This study answers one general question using a country case: what shapes the young generations’ political disengagement in Singapore? Taking the generational differences and institutional influence perspectives, this study highlights the time dimension to show the ebb and flow of political and (new) media landscape changes in a non-Western context, Singapore. By comparing focus group discussions conducted among 19–30 years old in 2011 vs. 2020, this paper finds that despite similarly claiming disinterest in politics, the 2011 youth were more attentive to political news than the 2020 youth. The changes in political institutions gave rise to this increased situational engagement. However, the gap between paying attention and taking action was still large in 2020, or even larger than in 2011, due to the increased complexity and competitiveness of politics that the 2011 youth observed via social media. The persistence of political disinterest suggests its dispositional connections to psychological barriers that are socially constructed over generations.

Job Satisfaction and Burnout in Croatian Physiotherapists

BACKGROUND

Physiotherapists are important healthcare professionals in modern and multidisciplinary health forces. However, they are exposed to a high risk of occupational burnout, which is associated with reduced job satisfaction. Job satisfaction is essential for medical professionals because it directly influences patient safety and the quality of medical care. Therefore, this study aimed to determine the association between sociodemographic variables of Croatian physiotherapists, job satisfaction, and occupational burnout.

METHODS

A cross-sectional study was performed among 404 physiotherapists using a sociodemographic questionnaire, the Job Descriptive Index (JDI), and Oldenburg Burnout Inventory (OLBI).

RESULTS

The study group of Croatian physiotherapists was marked by a high level of job satisfaction and occupational burnout. However, a higher level of occupational burnout is associated with lower job satisfaction. The main determinants of job satisfaction were younger age, female gender, less work experience, and married or partnership. At the same time, a higher level of occupational burnout was associated with working in government institutions and being single.

CONCLUSIONS

As a reaction to psychological stress at work with the main components of exhaustion and disengagement, occupational burnout is negatively associated with job satisfaction. Therefore, assessing the factors influencing job satisfaction and burnout in the workplace can help develop physiotherapists' mental health prevention strategies.

Burnout and intention to leave among care workers in residential care homes in Hong Kong: Technology acceptance as a moderator

Care workers in residential care settings for older adults often experience job burnout, resulting in a high turnover rate. Previous studies offered contradictory findings on technology use in the workplace and its relationship with burnout. This study aimed to explore the moderator role technology acceptance plays in the relationship between burnout and intention to leave among care workers in residential care settings in Hong Kong. The study was based on a multicenter, cross-sectional questionnaire survey. The acceptance of general, and three specific, technologies (i.e., tablets, social robots and video gaming) was measured based on the scale of the Technology Acceptance Model. Two dimensions of burnout (exhaustion and disengagement) were measured using the Oldenburg Burnout Inventory scale. Intention to leave was measured using a self-reported item. Data collection took place from July to December 2018. We analysed data from 370 care workers from seven non-private residential care homes for older people in Hong Kong. A hierarchical multiple regression approach was used for moderator analysis. The results revealed that two measures of burnout (exhaustion and disengagement) were significantly and positively associated with intention to leave. The four measures of technology acceptance were negatively associated with intention to leave. The interaction of video-gaming acceptance and exhaustion was predictive of intention to leave (standardized beta = -0.20, p = .011). Acceptance of video gaming changed the strength of the relationship between exhaustion and intention to leave among participants. No significant moderating effects were observed in the relationship between disengagement and intention to leave. We highlight the importance of integrating technology variables, especially subjective appraisal of technology, in the issues of burnout and intention to leave. These findings shed new light on policies and practices that consider implement technology in routine care in residential care settings without unanticipated negative impacts for care staff.

Australian Mental Health Consumers' Experiences of Service Engagement and Disengagement: A Descriptive Study

Mental health issues are a severe global concern with significant personal, social, and economic consequences and costs. This paper reports results of an online survey disseminated across the Australian community investigating why people with mental health issues choose particular mental health services over others, what causes them to disengage from services, and what factors and qualities of services are important to consumers to support their continued engagement or re-engagement with mental health services. The importance of GPs was evident, given their key role in providing mental healthcare, especially to those referred to as “the missing middle”—consumers with mental health issues who fall through the gaps in care in other parts of the healthcare system. The study found that many respondents chose to engage with mental healthcare providers primarily due to accessibility and affordability, but also because of the relational qualities that they displayed as part of delivering care. These qualities fostered consumers’ sense of trust, feeling listened to, and not being stigmatized as part of help seeking and having their mental health needs met. Implications for education and practice are offered.

Patient-reported Reasons for Stopping Care or Switching Clinics in Zambia: A Multisite, Regionally Representative Estimate Using a Multistage Sampling-based Approach in Zambia

BACKGROUND

Understanding patient-reported reasons for lapses of retention in human immunodeficiency virus (HIV) treatment can drive improvements in the care cascade. A systematic assessment of outcomes among a random sample of patients lost to follow-up (LTFU) from 32 clinics in Zambia to understand the reasons for silent transfers and disengagement from care was undertaken.

METHODS

We traced a simple random sample of LTFU patients (>90 days from last scheduled visit) as determined from clinic-based electronic medical records from a probability sample of facilities. Among patients found in person, we solicited reasons for either stopping or switching care and predictors for re-engagement. We coded reasons into structural, psychosocial, and clinic-based barriers.

RESULTS

Among 1751 LTFU patients traced and found alive, 31% of patients starting antiretroviral therapy (ART) between 1 July 2013 and 31 July 2015 silently transferred or were disengaged (40% male; median age, 35 years; median CD4 level, 239 cells/μL); median time on ART at LTFU was 480 days (interquartile range, 110-1295). Among the 544 patients not in care, median prevalences for patient-reported structural, psychosocial, and clinic-level barriers were 27.3%, 13.9%, and 13.4%, respectively, and were highly variable across facilities. Structural reasons, including, "relocated to a new place" were mostly cited among 289 patients who silently transferred (35.5%). We found that men were less likely to re-engage in care than women (odds ratio, .39; 95% confidence interval, .22-.67; P = .001).

CONCLUSIONS

Efforts to improve retention of patients on ART may need to be tailored at the facility level to address patient-reported barriers.

Attentional Disengagement and the Locus Coeruleus - Norepinephrine System in Children With Autism Spectrum Disorder

Background

Differences in non-social attentional functions have been identified as among the earliest features that distinguish infants later diagnosed with autism spectrum disorder (ASD), and may contribute to the emergence of core ASD symptoms. Specifically, slowed attentional disengagement and difficulty reorienting attention have been found across the lifespan in those at risk for, or diagnosed with, ASD. Additionally, the locus coeruleus-norepinephrine (LC-NE) system, which plays a critical role in arousal regulation and selective attention, has been shown to function atypically in ASD. While activity of the LC-NE system is associated with attentional disengagement and reorienting in typically developing (TD) individuals, it has not been determined whether atypical LC-NE activity relates to attentional disengagement impairments observed in ASD.

Objective

To examine the relationship between resting pupil diameter (an indirect measure of tonic LC-NE activation) and attentional disengagement in children with ASD.

Methods

Participants were 21 school-aged children with ASD and 20 age- and IQ-matched TD children. The study consisted of three separate experiments: a resting eye-tracking task and visual and auditory gap-overlap paradigms. For the resting eye-tracking task, pupil diameter was monitored while participants fixated a central crosshair. In the gap-overlap paradigms, participants were instructed to fixate on a central stimulus and then move their eyes to peripherally presented visual or auditory targets. Saccadic reaction times (SRT), percentage of no-shift trials, and disengagement efficiency were measured.

Results

Children with ASD had significantly larger resting pupil size compared to their TD peers. The groups did not differ for overall SRT, nor were there differences in SRT for overlap and gap conditions between groups. However, the ASD group did evidence impairments in disengagement (larger step/gap effects, higher percentage of no-shift trials, and reduced disengagement efficiency) compared to their TD peers. Correlational analyses showed that slower, less efficient disengagement was associated with increased pupil diameter.

Conclusion

Consistent with prior reports, children with ASD show significantly larger resting pupil diameter, indicative of atypically elevated tonic LC-NE activity. Associations between pupil size and measures of attentional disengagement suggest that atypically increased tonic activation of the LC-NE system may be associated with poorer attentional disengagement in children with ASD.

Psychometric Evaluation of the Oldenburg Burnout Inventory for Nursing Students

BACKGROUND

Higher education students, especially nursing students, have drawn more attention as a group that is vulnerable to the risk of developing burnout syndrome.

PURPOSE

To test the psychometric properties of the Oldenburg Burnout Inventory in Nursing (OLBI-N).

METHODS

The OLBI-N validity and reliability was tested in a sample of 476 nursing students. The validity was assessed with explorative and confirmative factor analyses. For hypothesis testing, we evaluated the correlation between burnout and academic self-efficacy.

RESULTS

Two factors (exhaustion and disengagement) were identified, and the confirmative factor analysis of the OLBI-N yielded a good fit. The OLBI-N was significantly correlated with academic self-efficacy (r = .29, -.37, p < .01).

CONCLUSIONS

The OLBI-N is a valid, reliable questionnaire for measuring burnout among nursing students.

High Exhaustion in Geriatric Healthcare Professionals During the COVID-19 Second Lockdown

BACKGROUND

In a previous study, we assessed burnout in geriatric healthcare workers during the first lockdown that lasted from March to May 2020 in France, in response to the COVID-19 crisis.

OBJECTIVE

We carried out a follow-up study to assess burnout in the same population during the second lockdown that was implemented at the end of October 2020.

METHODS

We used an online survey to assess burnout in terms of exhaustion and disengagement in a sample of 58 geriatric healthcare workers.

RESULTS

We found higher levels of exhaustion, disengagement, and burnout among geriatric healthcare workers during the second than during the first lockdown. We also found high levels of exhaustion but moderate disengagement and burnout during the second lockdown.

CONCLUSION

The increased exhaustion, disengagement, and burnout during the second lockdown can be attributed to the increased workload in geriatric facilities throughout this crisis and during the second lockdown due to shortage in staff and increased number of shifts and allocated duties. The high levels of exhaustion reported among geriatric healthcare workers during the second lockdown can reflect their physical fatigue, as well as their feelings of being emotionally overextended and exhausted by their workload.

Burnout in health care providers working in the intensive care units of a tertiary care hospital, South India-a questionnaire-based survey

Background

The intensive care unit (ICU) is a special section of the hospital where intense monitoring and patient care are required. Health care providers (HCPs) who work in the ICU are exposed to a stressful environment and, in the long run, this may lead to exhaustion and burnout. It is observed that the burnout in HCPs in the ICU may have an impact on patient care and the psychological wellbeing of the caregiver. Thus, we aimed to assess the burnout in HCPs working in the ICUs of a tertiary care hospital in South India.

Methods

A single-center, questionnaire-based survey was carried out by HCPs who work in the ICUs of a tertiary care hospital in South India. A Google form link was created after obtaining approval from the Institutional Ethics Committee. The link was then circulated to the HCPs who work in the ICU and the responses were collected. The Google form fetched data related to demographics, profession, area of work, duration of work per day, total days of work in the ICU during the work period, and details of night duty. The Oldenburg burnout inventory questionnaire was used to measure burnout in the HCPs.

Results

A total of 60 HCPs with a mean age of 23.37±2.93 years, consented and filled out the online questionnaire. Of the 60 HCPs, 41 (68.33%) were females and 19 (31.67%) were males. Most of the participants were working in adult medical ICUs. The overall burnout level in all the participants was 2.39± 0.31, with the exhaustion level being 2.45±0.43 and the disengagement level being 2.32± 0.31. Between 70% and 80% of HCPs experienced high levels of burnout while working in the ICUs. Work area, work duration, sleep duration, and clinical experience had an impact on burnout levels of the HCPs.

Conclusion

Most of the HCPs who work in the ICU experience high levels of burnout. Lack of clinical experience in the ICU and long work hours with lack of sleep can increase burnout in the HCPs.

Financial Insecurity During the COVID-19 Pandemic: Spillover Effects on Burnout-Disengagement Relationships and Performance of Employees Who Moonlight

The novel Coronavirus disease (COVID-19) has magnified the issue of financial insecurity. However, its effect on individual-organizational relations and, consequently, on organizational performance remains understudied. Thus, the purpose of this study was to explore the spillover effect of financial insecurity on the burnout-disengagement relationship during the pandemic. The authors investigate in particular whether the spillover effect influences the performance of moonlighting employees and also explore the mediating effect of disengagement on the relationship between financial insecurity and burnout interaction effect and the performance (i.e., mediated-moderation). This study collected responses from 162 public and private sector employees who are engaged in moonlighting activities in Malaysia. The results from the partial least square structural equation modeling (PLS-SEM) revealed greater levels of financial insecurity and burnout associated with greater levels of work disengagement. The analysis of the interaction-moderation effect showed that when financial insecurity rises, the burnout effect on work disengagement increases among moonlighters. Using the PROCESS macro model, the results displayed burnout as a predictor of extra-role performance via a moderated (financial insecurity) mediation (work disengagement) relationship. Going forward, this study not only opens new avenues for research into the financial consequences of COVID-19 but also calls on managers to take proactive steps to mitigate the negative effect of the pandemic on the performance of moonlighting employees to keep them in the profession.

Automated Disengagement Tracking Within an Intelligent Tutoring System

This paper describes a new automated disengagement tracking system (DTS) that detects learners' maladaptive behaviors, e.g. mind-wandering and impetuous responding, in an intelligent tutoring system (ITS), called AutoTutor. AutoTutor is a conversation-based intelligent tutoring system designed to help adult literacy learners improve their reading comprehension skills. Learners interact with two computer agents in natural language in 30 lessons focusing on word knowledge, sentence processing, text comprehension, and digital literacy. Each lesson has one to three dozen questions to assess and enhance learning. DTS automatically retrieves and aggregates a learner's response accuracies and time on the first three to five questions in a lesson, as a baseline performance for the lesson when they are presumably engaged, and then detects disengagement by observing if the learner's following performance significantly deviates from the baseline. DTS is computed with an unsupervised learning method and thus does not rely on any self-reports of disengagement. We analyzed the response time and accuracy of 252 adult literacy learners who completed lessons in AutoTutor. Our results show that items that the detector identified as the learner being disengaged had a performance accuracy of 18.5%, in contrast to 71.8% for engaged items. Moreover, the three post-test reading comprehension scores from Woodcock Johnson III, RISE, and RAPID had a significant association with the accuracy of engaged items, but not disengaged items.

Disengagement Training for the Treatment of Pathological Worry: A Preliminary Test

Pathological worry is characterized by an inability to distract or disengage from worry, and this uncontrollability is the defining feature of generalized anxiety disorder (GAD). The present study assessed a novel computerized strategy that targets these attention difficulties. Worry Disengagement Training (WDT), which involves alternating between writing about one's worry and positive topics, was evaluated in a sample with elevated worry (N = 50), most of whom met for GAD diagnosis (66%). Compared to waitlist, WDT led to increased ability to disengage from in vivo worry on a breath focus task, resulting in fewer negative intrusions (β = -.29, p = .02; sr² = .08). Relative to waitlist, WDT also led to lower self-reported general worry (β = -.36, p = .001, sr² = .14) and depressive symptoms (β = -.25, p = .02, sr² = .07). These effects remained in the subset of participants meeting criteria for GAD. WDT did not impact anxious arousal, suggesting some specificity of effects. These findings provide preliminary support for WDT as an effective strategy to increase disengagement ability and reduce worry and depression. Limitations and future directions are discussed.

Profiles of HIV Care Disruptions Among Adult Patients Lost to Follow-up in Zambia: A Latent Class Analysis

BACKGROUND

Patients report varied barriers to HIV care across multiple domains, but specific barrier patterns may be driven by underlying, but unobserved, behavioral profiles.

METHODS

We traced a probability sample of patients lost to follow-up (>90 days late) as of July 31, 2015 from 64 clinics in Zambia. Among those found alive, we ascertained patient-reported reasons for care disruptions. We performed latent class analysis to identify patient subgroups with similar patterns of reasons reported and assessed the association between class membership and care status (ie, disengaged versus silently transferred to a new site).

RESULTS

Among 547 patients, we identified 5 profiles of care disruptions: (1) "Livelihood and Mobility" (30.6% of the population) reported work/school obligations and mobility/travel as reasons for care disruptions; (2) "Clinic Accessibility" (28.9%) reported challenges with attending clinic; (3) "Mobility and Family" (21.9%) reported family obligations, mobility/travel, and transport-related reasons; (4) "Doubting Need for HIV care" (10.2%) reported uncertainty around HIV status or need for clinical care, and (5) "Multidimensional Barriers to Care" (8.3%) reported numerous (mean 5.6) reasons across multiple domains. Patient profiles were significantly associated with care status. The "Doubting Need for HIV Care" class were mostly disengaged (97.9%), followed by the "Multidimensional Barriers to Care" (62.8%), "Clinic Accessibility" (62.4%), "Livelihood and Mobility" (43.6%), and "Mobility and Family" (23.5%) classes.

CONCLUSION

There are distinct HIV care disruption profiles that are strongly associated with patients' current engagement status. Interventions targeting these unique profiles may enable more effective and tailored strategies for improving HIV treatment outcomes.

Attentional bias and disengagement as a function of Body Mass Index in conditions that differ in anticipated reward

BACKGROUND AND AIMS

Previous studies suggest that attentional bias and disengagement may vary as a function of Body Mass Index (BMI), most notably in a palatable food related context. Though this could indeed represent a food context specific effect, it could also represent a general reward related context effect. In addition, though mindfulness and stress have both been reported to affect attention, it is not yet clear whether these moderate the relationship between BMI and attention as a function of reward context. In the current study we addressed these questions. It was hypothesized that BMI would be positively associated with bias in a food context and money context relative to a neutral context. The inverse was expected for disengagement. It was expected that mindfulness would decrease these relationships and for stress the inverse was expected.

METHODS

In the current online study, eighty-seven participants (24 males and 63 females; age: M = 30.1, SD = 8.3; BMI: M = 24.2, SD = 4.67), filled out questionnaires and completed a visuospatial cueing task measuring attention and disengagement of attention in a neutral, food-related, and money-related condition.

RESULTS

There was no association between BMI and attentional bias. Higher BMI was associated with faster responses to money pictures presented opposite to a cued location as compared to money pictures that did not follow a predictive cue. Our results do not support a clear moderating role of mindfulness and stress.

DISCUSSION AND CONCLUSION

Our results imply faster processing and associated quicker responding to unanticipated reward-related stimuli in individuals with overweight or obesity.

Constellations of family risk for long-term adolescent antisocial behavior

Adolescent antisocial behavior (ASB) can have long-term individual and societal consequences. Much of the research on the development of ASB considers risk and protective factors in isolation or as cumulative indices, likely overlooking the co-occurring and interacting nature of these factors. Guided by theories of ASB risk (i.e., coercive family process, disengagement), this study uses latent profile analysis to evaluate whether there are subgroups of families in the population that conform to specific constellations of risk factors prescribed by established theories of risk for ASB, and whether subgroup membership confers differential risk for different ASBs. We leveraged a large sample of adolescents in Fall, Grade 6 (N = 5,300; M_age = 11.8; 50.9% female) for subgroup analysis, and predicted aggression, antisocial peer behavior, and substance use in Spring, Grade 8. Four family profiles were identified: Coercive (15%), characterized by high family conflict, low positive family climate, low parental involvement, low effective discipline, low adolescent positive engagement, and low parental knowledge; Disengaged (41%), characterized by low positive family climate, low parental involvement, low adolescent positive engagement, and low parental knowledge; Permissive (11%), characterized by high parental involvement, low effective discipline, high adolescent positive engagement, high parental knowledge, and high family conflict; and High Functioning (34% prevalence). In turn, group membership predicted long-term outcomes. Adolescents in Coercive families were at highest risk for ASB during Grade 8, followed by those in Disengaged and Permissive profiles; all three of which were at greater risk than adolescents in High Functioning families for every outcome. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Integration of HIV services with primary care in Yangon, Myanmar: a retrospective cohort analysis

OBJECTIVES

Integration of HIV care with general healthcare may improve patient engagement. We assessed patient outcomes in four clinics offering HIV care integrated into primary care clinics in Yangon, Myanmar.

METHODS

We carried out a retrospective cohort analysis of 4551 patients who started antiretroviral therapy between 2009 and 2017. Mortality and disengagement from care were assessed using Cox regression.

RESULTS

People living with HIV presented late with low CD4 counts [median (25^th , 75^th percentile) = 178 (65, 308) from 4216 patients] and advanced HIV (69% with stage 3 or 4). Survival was 0.95 at 1 year and 0.90 at 5 years. Males were at a higher risk of mortality than females [unadjusted hazard ratio (uHR) = 1.6 (95% CI: 1.3-2.0). Patients linked to HIV care via antenatal care or partner/parent notification were at reduced risk of mortality [uHR = 0.4 (95% CI: 0.1-1.0) and uHR = 0.5 (95% CI: 0.3-0.7)] relative to patients who presented for HIV testing. The cumulative incidence of disengagement was 0.06 at 1 year and 0.15 at 5 years. Young adults had a higher risk of disengagement than did children and older patients. Women linked to HIV care via antenatal care services were at increased risk of disengagement relative to patients who came for HIV testing (uHR = 2.4; 95% CI: 1.7-3.4). Mortality and disengagement remained steady over calendar time as the programme scaled up.

CONCLUSIONS

HIV care within a primary care model is effective to attain early linkage to care, with high survival. However, close attention should be given to disengagement from care, in particular for pregnant women.

The Disengagement of Visual Attention: An Eye-Tracking Study of Cognitive Impairment, Ethnicity and Age

Various studies have shown that Alzheimer’s disease (AD) is associated with an impairment of inhibitory control, although we do not have a comprehensive understanding of the associated cognitive processes. The ability to engage and disengage attention is a crucial cognitive operation of inhibitory control and can be readily investigated using the “gap effect” in a saccadic eye movement paradigm. In previous work, various demographic factors were confounded; therefore, here, we examine separately the effects of cognitive impairment in Alzheimer’s disease, ethnicity/culture and age. This study included young (N = 44) and old (N = 96) European participants, AD (N = 32), mildly cognitively impaired participants (MCI: N = 47) and South Asian older adults (N = 94). A clear reduction in the mean reaction times was detected in all the participant groups in the gap condition compared to the overlap condition, confirming the effect. Importantly, this effect was also preserved in participants with MCI and AD. A strong effect of age was also evident, revealing a slowing in the disengagement of attention during the natural process of ageing.

The developmental precursors of blunted cardiovascular responses to stress

Blunted cardiovascular responses to stress have been associated with both mental and physical health concerns. This multi-method, longitudinal study examined the role of chronic social-developmental stress from adolescence onward as a precursor to these blunted stress responses. Using a diverse community sample of 184 adolescents followed from age 13 to 29 along with friends and romantic partners, this study found that high levels of parental psychological control at age 13 directly predicted a blunted heart rate response and indirectly predicted blunted respiratory sinus arrhythmia (RSA) reactivity under stress. Heart rate effects were mediated via indicators of a developing passive response style, including observational measures of withdrawal during conflict with friends and romantic partners, social disengagement, and coping with stressors by using denial. RSA effects were mediated via withdrawal during conflict with romantic partners and coping by using denial. The current findings are interpreted as suggesting a mechanism by which a key social/developmental stressor in adolescence may alter relational and ultimately physiological patterns of stress responding into adulthood.

The Nature, Value, and Experience of Engagement in Pediatric Rehabilitation: Perspectives of Youth, Caregivers, and Service Providers

Purpose: To conduct a qualitative investigation of engagement in pediatric rehabilitation therapy.Methods: Interviews were conducted with 10 youth, 10 caregivers, and 10 service providers. Transcripts were analyzed thematically using an inductive approach.Results: Themes illustrated three perspectives: engagement as a connection with components of the therapy process, engagement as working together, and engagement as an affective and motivational process. Engagement created valued connections with therapy components and forward momentum for therapy.Conclusions: The themes supported a view of engagement as complex, transactional, and multidimensional. Participants focused on different, yet not discrepant, aspects of engagement. Youth focused on having fun and personal connection with service providers. Caregivers provided a more complex perspective encompassing both their own and their child's engagement, with an emphasis on relationship, understanding what is taking place, and feeling valued in the process. Service providers highlighted goal attainment and the value of engagement in bringing about outcomes.

Loss to follow-up from antiretroviral therapy clinics: A systematic review and meta-analysis of published studies in South Africa from 2011 to 2015

Background

South Africa has the largest antiretroviral therapy (ART) programme in the world. To optimise programme outcomes, it is critical that patients are retained in care and that retention is accurately measured.

Objectives

To identify all studies published in South Africa from 2011 to 2015 that used loss to follow-up (LTFU) as an indicator or outcome to describe the variation in definitions and to estimate the proportion of patients lost to care across studies.

Method

All studies published between 01 January 2011 and October 2015 that included loss to follow-up or default from ART care in a South African cohort were included by use of a broad search strategy across multiple databases. To be included, the cohort had to include any patient ART data, including follow-up time, from 01 January 2010. Two authors, working independently, extracted data and assessed risk of bias from all manuscripts. Meta-analysis was performed for studies stratified by the same loss to follow-up definition.

Results

Forty-eight adult, 15 paediatric and 4 pregnant cohorts were included. Median cohort size was 3737; follow-up time ranged from 9 weeks to 5 years. Meta-analysis did not reveal an important difference in LTFU estimates in adult cohorts at 1 year between loss to follow-up defined as 3 months (11.0%, n = 4; 95% CI 10.7% – 11.2%) compared with 6 months (12.0%, n = 4; 95% CI 11.8% – 12.2%). Only two cohorts reported reliable LTFU estimates at 5 years: this was 25.1% (95% CI 24.8% – 25.4%).

Conclusion

South Africa should standardise a LTFU definition. This would aid in monitoring and evaluation of ART programmes, with the broader goal of improving patient outcomes.

The complexities and synergies of engagement: an ethnographic study of engagement in outpatient pediatric rehabilitation sessions

PURPOSE

To investigate client (youth/caregiver) and service provider engagement in outpatient pediatric rehabilitation therapy sessions.

METHODS

In an ethnographic study, five research assistants attended 28 outpatient sessions, mostly delivered by occupational, physical, and speech-language therapists, and rated signs of client, provider, and relational engagement using the Pediatric Rehabilitation Intervention Measure of Engagement - Observation version. Post-session interviews were conducted individually with 13 youth, 15 caregivers, and 26 providers.

RESULTS

Overall, there was a moderate to great extent of engagement. Provider engagement was rated as higher than client engagement, particularly in sessions with activities focusing on body structure/function. The interviews indicated associations among engagement-related constructs: (a) expectations influenced engagement/disengagement and therapy progress, (b) engagement was associated with positive affect and relationships, and (c) engagement was strongly associated with relationships and collaboration.

CONCLUSIONS

Engagement is a central process within a complex system of psychosocial constructs operating in therapy. Engagement is emergent, synergistic, and change-inducing - it emanates from, involves, and influences multiple aspects of therapy. Notably, engagement ties two pivotal elements - positive expectations and positive affect - to positive relationships, collaboration, and therapy progress. Implications for practice include an understanding of how providers manage the therapeutic context and work to foster engagement.Implications for rehabilitationEngagement, and its various elements, plays a central role in shaping how clients, parents, and clinicians value therapeutic encounters.Optimal therapy is often thought to include engagement, relationships, and collaboration; the importance of therapy expectations, positive affect, and perceptions of progress are frequently overlooked.Engagement and motivation may be maximized when youth and caregivers are asked explicitly about how they view their engagement in therapy.In addition to clarifying and aligning expectations with youth and caregivers, service providers can enhance engagement and motivation by intentionally creating enjoyable and meaningful interactions, developing relationships, negotiating consensus on goals and plans, and demonstrating therapy progress.Service providers can harness engagement and the system of related constructs by listening and communicating effectively, by entering the world of the client and family, and by being aware of, anticipating, and responding to engagement and disengagement.

Measuring Burnout Among Psychiatric Residents Using the Oldenburg Burnout Inventory (OLBI) Instrument

Burnout is prevalent among mental health providers and is significantly associated with the employee, consumer, and organizational costs. Nowadays, burnout prevalence is increasing and can challenge the residents' professional development, place patients at risk, and have a significant influence on a variety of personal costs. Considering its importance, this research attempted to measure the burnout experienced by Romanian psychiatric residents while also correlating demographic characteristics and work situations. A cross-sectional study was conducted on 116 Romanian psychiatric residents. Our questionnaire contained socio-demographic information and burnout assessment, which was performed using the Oldenburg Burnout Inventory (OLBI). The burnout scores were classified as high burnout (22.4% of the respondents), moderate burnout (51,7% of the respondents), and low burnout (25.9% of the respondents). As such, all psychiatric residents who suffered from high levels of burnout were satisfied with their salary and their work but dissatisfied with the resources available for attending patients. From all physicians who might experience burnout, psychiatrists are most likely to search for help. The fact that the majority of psychiatric residents in our study were satisfied with their salary and their work, but dissatisfied with the available resources for attending patients might be a result of the Romanian policy of increasing incomes for medical personnel. In conclusion, adding stress management training to the medical education curriculum could help the residents to deal more effectively with the training strain, develop personal techniques for helping themselves to improve their professional path, and potentially prevent upcoming physician burnout.

The relations between Principal support and work engagement and burnout: Testing the role of teachers' emotions and educational level

BACKGROUND

One of the resources that may prevent burnout and foster the work engagement of teachers is Principal support. In this study we aimed to further explore the links between Principal support and work engagement and burnout, by testing the role of the teachers' emotions and the educational levels of primary schools.

OBJECTIVES

Testing 1) the mediating role of teachers' emotions in explaining the relationship between perceived Principal support and work engagement and burnout, 2) differences in tested constructs, and the structural equivalence of the proposed relationship among constructs, between teachers from two educational levels of primary schools.

METHODS

The study included subsamples of 868 class teachers (lower grades) and 1057 subject teachers (upper grades) employed at 104 primary schools in Croatia. Teachers filled out self-report scales measuring burnout, work engagement, perceived Principal support and the positive and negative emotions experienced in relation to students.

RESULTS

Emotions partially mediate the relationship between perceived Principal support and work engagement and burnout among teachers. Although class teachers experience higher levels of positive emotions and work engagement compared to subject teachers, the results confirmed the structural equivalence of the hypothesized model across two education levels of primary school.

CONSLUSION

The Principal support predicts work engagement and burnout in teachers both directly and indirectly via emotions.

Pinpointing mechanisms of a mechanistic treatment: Dissociable roles for overt and covert attentional processes in acute and long-term outcomes following Attention Bias Modification

Biased patterns of attention towards threat are implicated as key mechanisms in anxiety which can be modified through automated intervention (Attention Bias Modification; ABM). Intervention refinement and personalized dissemination efforts are substantially hindered by gaps in understanding the precise attentional components that underlie ABM's effects on symptoms-particularly with respect to longer-term outcomes. Seventy adults with transdiagnostic anxiety were randomized to receive 8 sessions of active ABM (n=49) or sham training (n=21). Reaction time and eyetracking data, collected at baseline, post-training, and 1-month follow-up, dissociated multiple core attentional processes, spanning overt and covert processes of engagement and disengagement. Self-reported symptoms were collected out to 1-year follow-up. Covert disengagement bias was specifically reduced by ABM, unlike all other indices. Overt disengagement bias at baseline predicted acute post-ABM outcomes, while covert engagement bias was non-specifically predictive of symptom trajectories out to 1-year follow-up. Results suggest unique and dissociable roles for each discrete mechanism.

Is Exhaustion More Sensitive Than Disengagement to Burnout in Academic Anesthesia? A Study Using the Oldenburg Burnout Inventory

Reportedly, clinicians of all kinds are experiencing alarming rates of burnout, and its prevalence among anesthesia providers is high. We examined burnout in a large academic anesthesia department with a commonly used questionnaire, the Oldenburg Burnout Inventory, which provides scores on two scales, "exhaustion" and "disengagement." We examined differences in scores between exhaustion and disengagement and their prevalences. All N = 415 staff members of the department were requested to complete the Oldenburg Burnout Inventory and N = 130 (31%) did so. The mean ± standard deviation was 2.52 ± 0.51 (range, 1.13 to 3.75) for exhaustion and 2.27 ± 0.52 (range, 1.13 to 3.63) for disengagement. The mean for exhaustion exceeded that for disengagement by 0.25 ± 0.42 (range, -1.25 to 1.25), t(129)=6.68, p < 0.0001 by paired t test. Mean ratings exceeded the midpoint (2.5) between the "burned out" and "not burned out" ends of the rating scale for 49% of respondents for exhaustion, but only 30% for disengagement. More respondents (N = 87, 67%) had a higher mean for exhaustion than disengagement than the opposite pattern (N = 28, 22%), M = 29.5, p < 0.0001 by sign test. Thus, burnout symptoms were common but reflected more in exhaustion than disengagement. Literature review suggested that the difference between the exhaustion and disengagement means that we found was larger than typical, but not unusual, for health-care-related groups, and typical for other groups. Future studies should clarify circumstances under which exhaustion exceeds disengagement and vice versa, both in anesthesia and other fields.

Rates and predictors of disengagement of patients with first-episode psychosis from the early intervention service for sychosis service (EASY) covering 15 to 64 years of age in Hong Kong

AIM

This study aims at assessing the rate and predictors of disengagement of patients with first-episode psychosis (FEP) from the early intervention (EI) service in Hong Kong (EASY) that covers age 15 to 64.

METHODS

All FEP patients aged 15 to 64 years who were newly registered with the EASY programme of Kowloon West Psychiatric Unit from January to December 2012 were included. Data on socio-demographic, clinical characteristics and disengagement over 3 years of the EI service were obtained retrospectively through systematic clinical record review. Predictors of 3 different types of disengagement and their rate of occurrence were identified: complete disengagement (type I), disengaged and re-engaged through hospitalization (type II) and re-engaged as outpatient (type III).

RESULTS

Among the 277 patients included for analysis, 36 patients (13%) had type I disengagement, 17.2% (N = 21) were of age 15 to 25 and 9.7% (N = 15) were of age 25 to 64. Type II and type III disengagements were 4.3% and 13.4%, respectively. Early-stage poor drug compliance significantly predicted type I and type II disengagements. History of substance use, suicidal attempts and poor drug compliance predicted type III disengagement. Younger patients had significant earlier disengagement (χ²  = 5.01, df = 1, P = .025).

CONCLUSION

Results of the current study highlighted the different patterns of disengagement for different age groups and the importance of identifying the high-risk group at early stage of the illness. With the expansion of EI service for wider age group, studies of the differential needs of patient with different ages would be important to guide the future service development.

The Multisensory Attention Assessment Protocol (MAAP): Characterizing individual differences in multisensory attention skills in infants and children and relations with language and cognition

Multisensory attention skills provide a crucial foundation for early cognitive, social, and language development, yet there are no fine-grained, individual difference measures of these skills appropriate for preverbal children. The Multisensory Attention Assessment Protocol (MAAP) fills this need. In a single video-based protocol requiring no language skills, the MAAP assesses individual differences in three fundamental building blocks of attention to multisensory events-the duration of attention maintenance, the accuracy of intersensory (audiovisual) matching, and the speed of shifting-for both social and nonsocial events, in the context of high and low competing visual stimulation. In Experiment 1, 2- to 5-year-old children (N = 36) received the MAAP and assessments of language and cognitive functioning. In Experiment 2 the procedure was streamlined and presented to 12-month-olds (N = 48). Both infants and children showed high levels of attention maintenance to social and nonsocial events, impaired attention maintenance and speed of shifting when competing stimulation was high, and significant intersensory matching. Children showed longer maintenance, faster shifting, and less impairment from competing stimulation than infants. In 2- to 5-year-old children, duration and accuracy were intercorrelated, showed increases with age, and predicted cognitive and language functioning. The MAAP opens the door to assessing developmental pathways between early attention patterns to audiovisual events and language, cognitive, and social development. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Unpacking the Associations Among Maltreatment, Disengagement Coping, and Behavioral Functioning in High-Risk Youth

Given the association between child maltreatment and a host of negative behavioral consequences, there remains a need to continue to identify mechanisms underlying this association as a means of improving intervention efforts. The present study examined one potential mechanism, namely, disengagement coping. We asked 6- to 17-year-old maltreated ( n = 249) and comparison ( n = 133) youth questions about emotional experiences that induced sadness and anger, strategies they used to cope with those emotions, and behavioral functioning (i.e., behavioral problems and aggression). Maltreated adolescents reported higher levels of behavioral problems and aggression relative to comparison adolescents, and adolescents who disengaged from emotional situations reported more behavioral problems relative to those who did not disengage. Tests of mediation suggested that, for adolescent-age youth, part of the association between maltreatment status and behavioral problems was explained by disengagement. In children, maltreatment was not associated with disengagement or behavioral problems. Results have implications for understanding age-related differences in the emotional and behavioral consequences of maltreatment.

Disengagement from street gangs: a systematic review of the literature

Many studies identify the risk factors for joining street gangs, but few explore disengagement. This article provides a systematic review of the factors which contribute to disengagement from gangs. Understanding this area is of paramount importance to developing policy and guiding practitioners working with this population, given the impact this lifestyle has on gang members and society as a whole. Seven academic databases, reference lists of relevant publications, an online search engine and a government database were used to identify relevant studies. Inclusion and exclusion criteria and quality assessment methods were employed. Data were then extracted and synthesised. Of 2515 citations, seven were found to have methodological rigour. The findings suggest there is not one definitive reason for gang exit but rather that multiple factors contribute. Variability was found in the quality scores. The limitations of this review are discussed, along with clinical implications and suggestions for future research.

Moral (dis)engagement with anthropogenic climate change in online comments on newspaper articles

Anthropogenic climate change (ACC) is widely acknowledged to be morally significant, but little is known about everyday moralising around ACC. We addressed this gap via quantified thematic analysis of 300 online comments to British newspaper articles on ACC, drawing on Bandura's moral disengagement theory. Moral disengagement through denial of ACC was widespread. Other disengagement strategies, such as palliative comparison and diminishing agency, occurred less often. There was also some moral engagement, most often through assertions of the existence of ACC and/or its harmful effects. Moral disengagement was significantly more common in comments on right wing than left wing newspapers, whereas the opposite was true of moral engagement. Although Bandura's framework provided a useful starting point to make sense of ACC moralising, it did not capture moral concerns that extended beyond its "harm/care" remit. In particular, many "denial" comments included a "dishonesty" discourse, whereby ACC proponents were accused of deception for ulterior motives. To classify this discourse as moral disengagement obscures its engagement with a different set of moral issues around trust and honesty. We suggest that Bandura's theory represents one possible "moral landscape" around ACC and could be extended to encompass a broader range of moral concerns.

Perspectives of cannabis use in the life experience of men with schizophrenia

Substance use amongst people with schizophrenia is well-established: up to 50% report using illicit substances. The occurrence of both conditions can also induce people to disengage from mental health services. The research question sought to understand, from the perspective of both service users and clinicians, cannabis use within the experience of people with schizophrenia. The transcripts of the seven participants and the two focus groups were analysed using interpretative phenomenological analysis. Service Users and Clinicians were recruited from Assertive outreach community-based teams. seven male service users who described their ethnic identity as 'black', diagnosed with schizophrenia and a history of treatment disengagement and 12 clinicians who worked with this client group. The two component study involved semi-structured interviews with the Service Users and two focus groups with the Clinicians. Service Users perceived cannabis use as a means by which they could 'reestablish their identity' that had been damaged and the social consequences of diagnosis. Clinicians similarly perceived drugs, cannabis in particular, as a significant part of the service users' life. This study provides greater depth to understanding cannabis use within the experience of people with a diagnosis of schizophrenia.

Experiences of mental health services for 'black' men with schizophrenia and a history of disengagement: A qualitative study

Whilst mental disorders can be disabling they are also treatable, yet engagement with services is often poor and disengagement from treatment is a major concern for mental health nurses. Participants were service users typically perceived as the most disengaged from mental health services, yet they were willing to engage in the research interviews. The seven participants were all male with a diagnosis of schizophrenia, a history of disengagement from mental health services and described their ethnicity as 'black'. Participants were under the care of Assertive Outreach Teams and were recruited after the researcher was introduced to them by clinicians who were working with them. After ethical approval, in-depth, semi-structured interviews were used to elicit the experiences of participants. Through interpretative phenomenological analysis, themes were developed. Interpretative Phenomenological analysis generated four themes: (i) "People just keep hounding me", (ii) Antipathy to Medication, (iii) Choice and the value of services, (iv) Stigmatisation and identity. By rigorously examining how service users with schizophrenia make sense of their experience of their relationship with mental health services, there is potential to give voice to the experiences of the recipients of mental health services. This study uncovered the complex nature of disengagement and in view of this there may never be a straightforward mechanism developed to engage all people with schizophrenia with mental health services. When the participants' experiences are considered in a broader social context it may be possible to reflect on how services can be adapted to facilitate better engagement.

Predictors of emotional exhaustion, disengagement and burnout among improving access to psychological therapies (IAPT) practitioners

BACKGROUND

Among mental health staff, burnout has been associated with undesirable outcomes, such as physical and mental ill-health, high levels of staff turnover and poorer patient care.

AIMS

To estimate the prevalence and predictors of burnout amongst Improving Access to Psychological Therapist (IAPT) practitioners.

METHODS

IAPT practitioners (N = 201) completed an on-line survey measuring time spent per week on different types of work related activity. These were investigated as predictors of burnout (measured using the Oldenburg Burnout Inventory).

RESULTS

The prevalence of burnout was 68.6% (95% confidence interval (CI) 58.8-77.3%) among psychological wellbeing practitioners (PWP) and 50.0% (95% CI 39.6-60.4%) among high intensity (HI) therapists. Among PWPs hours of overtime-predicted higher odds of burnout and hours of clinical supervision predicted lower odds of burnout. The odds of burnout increased with telephone hours of patient contact among PWPs who had worked in the service for two or more years. None of the job characteristics significantly predicted burnout among HI therapists.

CONCLUSIONS

Our results suggest a high prevalence of burnout among IAPT practitioners. Strategies to reduce burnout among PWPs involving reductions in workload, particularly telephone contact and increases in clinical supervision need to be evaluated.

Reappraisal Modulates Attentional Bias to Angry Faces

Heightened attentional bias to emotional information is one of the main characteristics of disorders related to emotion dysregulation such as anxiety, depression, and substance abuse. Although reappraisal, an emotion regulation strategy, is known to effectively modulate subjective experience of emotions, it remains unknown whether reappraisal can alter attentional biases to emotional information. In the current research, we investigated the influence of instruction-induced state reappraisal (Study 1) and trait reappraisal (Study 2) on attentional biases to happy and angry faces. In Study 1, healthy young women were recruited and randomly assigned to one of the three groups: up-, down-, and no-regulation. Participants were instructed to reappraise their emotions to increase and decrease emotional experience while viewing an emotionally negative film clip. Attentional bias was assessed with a dot-probe task with pictures of angry and happy facial expressions. In Study 2, a separate group of healthy young men and women participated. Participants’ trait reappraisal and suppression as well as state and trait anxiety were assessed. A dot-probe task was completed by all participants. Statistical tests in Study 1 revealed that participants who reappraised to decrease negative emotions while viewing an emotionally negative film clip had reduced attentional bias to subsequently presented angry faces compared to participants who reappraised to increase negative emotions. Multiple regression analyses in Study 2 revealed that trait reappraisal predicted slower orienting toward angry faces, whereas state anxiety predicted slower disengagement from angry faces. Interestingly, trait suppression predicted slower disengagement from happy faces. Taken together, these results suggest that both instruction-induced state reappraisal and trait reappraisal are linked to reduced attentional bias to negative information and contribute to better understanding of how everyday emotion regulation styles contribute to attentional processing of emotional information.

Mindful Sustainable Aging: Advancing a Comprehensive Approach to the Challenges and Opportunities of Old Age

The primary aim of this article is to present a new concept called mindful sustainable aging (MSA), which is informed by mindfulness practices that support the physical, the mental, and especially, the social and the existential dimensions of old life. The concept of MSA is discussed and compared with four influential psychosocial theories in the field of gerontology, i.e., activity theory, disengagement theory, successful aging theory and gerotranscendence theory. The article ends with reviewing research on how mindfulness practice can help to manage, diminish and/or improve a number of serious physical conditions that are common among older people. The potential of mindfulness when it comes to facilitating for older adults in their quest for spiritual and existential meaning is discussed extensively throughout the article.