Biopsychosocial Perspective Research Articles

Anxiety, Disability, and Pain Predict Outcomes of Complex Regional Pain Syndrome: An 8-year Follow-up of a Prospective Cohort

Factors contributing to the varied outcomes of complex regional pain syndrome (CRPS) are not well known. This study aimed to determine whether baseline psychological factors, pain, and disability influence long-term CRPS outcomes. We conducted an 8-year follow-up from a previous prospective study of CRPS outcomes. Sixty-six people diagnosed with acute CRPS were previously assessed at baseline, 6 months, and 12 months and in the current study, 45 were followed up after 8 years. At each timepoint, we measured signs and symptoms of CRPS, pain, disability, and psychological factors. Mixed-model repeated measures were used to identify baseline predictors of CRPS severity, pain, and disability at 8 years. Predictors of greater CRPS severity at 8 years were female sex, greater baseline disability, and greater baseline pain. Predictors of greater pain at 8 years were greater baseline anxiety and disability. The only predictor of greater disability at 8 years was greater baseline pain. Findings suggest CRPS is best understood from a biopsychosocial perspective, and baseline anxiety, pain, and disability may influence the trajectory of CRPS outcomes as far as 8 years later. These variables could be used to identify those at risk of poor outcomes or form targets for early interventions. PerspectiveThis paper presents the findings of the first study to prospectively investigate predictors of CRPS outcomes over 8 years. Baseline anxiety, pain, and disability predicted greater CRPS severity, pain, and disability over 8 years. These factors could identify those at risk of poor outcomes or form targets for early interventions.

‘More harm than good’ – A qualitative study exploring the attitudes and beliefs of a group of Italian osteopaths about spinal imaging in the management of patients with chronic low back pain

ObjectivesChronic low back pain (CLBP) is one of the leading causes of disability worldwide and its related healthcare costs are constantly increasing. Imaging studies have limited clinical utility in managing this condition and their overuse can lead to negative effects on patients. Clinicians' and patients' misconceptions seem to be one of the main drivers of such unnecessary use. However, there is a lack of research investigating osteopaths' views on imaging. This study explored Italian osteopaths’ attitudes and beliefs towards imaging and its utilisation in the clinical evaluation and management of CLBP patients. MethodsA qualitative study, using elements of constructivist grounded theory, was conducted by means of semi-structured interviews. A purposive sampling approach was used to recruit 14 osteopaths practising in Italy with clinical and educational experiences. Data were collected until real saturation, transcribed verbatim and coded by using qualitative thematic analysis identifying categories, concepts and themes. ResultsTwo main themes were identified with seven subcategories. The overarching themes were 1) Clinical relevance and utility; 2) Interacting with the patient through a biopsychosocial perspective. ConclusionThe findings highlight that imaging plays a marginal role in the interviewed osteopaths' clinical practice, except for ruling out red flags or contraindications for treatment. Participants have shown awareness about the potential negative effects of imaging in CLBP patients. They underlined the need to reassure and educate patients to minimise the psycho-behavioural impact of diagnostic investigations on patients’ condition and also to provide a clinical value of their use, especially in relation to the complex and multidimensional nature of CLBP.

Severe malaria-related disability in Ethiopian children from the perspectives of caregivers: an interpretive description study

Purpose This study explored severe malaria-related disability in children from the perspectives of their caregivers. Materials and methods The interpretive description qualitative approach was employed. The participants were selected using the purposive sampling technique considering the child’s history of severe malaria, age (0–10 years), and location (urban/rural). Data were collected through face-to-face interviews with sixteen caregivers. Reflexive thematic data analysis was utilized. Through prolonged engagement, reflective journaling, an audit trail, and co-authors’ review, trustworthiness was enhanced. Results The study generated five themes from the interviews: mitigators of disability, contributors of disability, impact on body function, impact on activities and participation, and uncertainties about future well-being. The findings revealed previously unstudied social components of disability and environmental factors. Furthermore, the research uncovered health-related quality of life aspects that are out of the scope of the current comprehensive disability framework. Conclusions The study contributes to a deeper understanding of severe malaria-related disability in children from the biopsychosocial perspective. The findings could help policymakers, researchers, and clinicians who want to design rehabilitation interventions for the affected children or examine the components of disability on a large scale using quantitative methods. IMPLICATIONS FOR REHABILITATION Various contextual factors interacted with severe malaria and influenced functioning either as facilitators or barriers, implying disability related to malaria can be prevented or created. The long-term impacts of severe malaria are not limited to functioning and disability but also affect the health-related quality of life of children who survive severe malaria. Rehabilitation professionals should consider applying comprehensive functioning and disability frameworks such as the ICF when designing (or applying) screening tools, planning interventions, and evaluating the outcomes of intervention for children with severe malaria-related disability. Rehabilitation interventions for children with severe malaria-related disability should consider patient– or caregiver–reported outcomes (components of disability).

Physiotherapists’ perceptions on using a multidimensional clinical reasoning form during psychologically informed training for low back pain.

PurposeBuilding clinical reasoning skills is important to effectively implement psychologically informed practice. We developed a multidimensional clinical reasoning form (CRF) to be used by physiotherapists in a psychologically informed practice training programme for low back pain. In this paper we describe the development of the CRF, how the CRF was used in the training, and present an evaluation of physiotherapists’ perceptions of the CRF. MethodsQualitative semi-structured interviews were conducted with ten physiotherapists purposively sampled in primary care. Data were gathered through pre, and post training focus group interviews and a secondary analysis of individual physiotherapist interviews conducted after the training. Thematic analysis was used to analyse the data and capture the emergent themes. ResultsTwo main themes emerged before the training: (1) the CRF ‘needs formal training’ and (2) ‘lacked instruction’. Three main themes emerged after the training (1) it provided ‘a helpful framework for multidimensional clinical reasoning’ (2) the CRF, and accompanying operational definitions, helped physiotherapists ‘elicit information, with ‘question prompts’ helpful in facilitating patient disclosure (3) ‘Utility’ - although the CRF was not formally used by the physiotherapists it provided a conceptual reasoning framework to work from with more challenging patients. ConclusionThe CRF was not designed to be used in isolation by clinicians without training. However, when used as a training adjunct it appears to be valued by physiotherapists to help develop their critical thinking and better characterise patients’ presentations in order to personalise care from a bio-psychosocial perspective.

The longitudinal contributions of child language, negative emotionality, and maternal positive affect on toddler executive functioning development

Executive functions (EF) develop rapidly across early childhood and play a prominent role in promoting adaptive outcomes later in development. Although the existing literature suggests that the development of early EF is sensitive to the influence of intrinsic and extrinsic factors, limited research has examined the joint contributions of multiple child and contextual factors in infancy/toddlerhood. The purpose of our longitudinal study was therefore to identify early environmental, behavioral, biologically-based factors that influence children’s EF outcomes in late toddlerhood. Participants included 409 mother-child dyads (209 girls) and the data was collected across children’s first three postnatal years. Parent-report measures were used to assess infant negative affectivity (5-months; IBQ-R) and toddler language (age 2; MCDI), and both maternal positive affect (5-months) and toddler frustration (age 2) were coded during mother-child interaction tasks. A battery of behavioral tasks was used to measure child EF in late toddlerhood (age 3). After controlling for maternal education (a proxy for children’s socio-economic environment), path analysis indicated that both infant and maternal affect at 5-months directly predicted toddlers’ language skills and frustration expression at age 2. Toddler language (but not frustration) also predicted child performance on multiple EF tasks at age 3. Finally, 5-month infant and maternal affect indirectly predicted age 3 EF via age 2 language. Our results identify language as a mechanism through which children’s early caregiving environment influences their EF development. Taken together, these findings illustrate the importance of applying a biopsychosocial perspective to the examination of early childhood EF development.

Is it time to rethink disability assessment in low back pain? Reliability, internal consistency, and construct validity of the Brazilian WHODAS 2.0 for chronic low back pain.

The World Health Disability Assessment Schedule 2.0 (WHODAS 2.0) was developed to assess health and disability based on the biopsychosocial model. The WHODAS 2.0 has not been validated for Brazilians with chronic non-specific low back pain (LBP). We aimed to evaluate the reliability, internal consistency, and construct validity of the Brazilian version of the WHODAS 2.0 in patients with chronic LBP. Methodological study. The Brazilian version of the WHODAS 2.0 was applied to 100 volunteers with chronic nonspecific LBP. Test-retest reliability, internal consistency, and construct validity were assessed using the Spearman correlation test, Cronbach's alpha (α) coefficient, and Spearman's correlation test between WHODAS 2.0, the Oswestry Disability Index (ODI), Roland-Morris Disability Questionnaire (RMDQ), and Fear Avoidance Beliefs Questionnaire (FABQ), respectively. WHODAS 2.0 showed satisfactory test-retest reliability with a moderate correlation for total WHODAS 2.0 (r=0.75, p<0.05). Internal consistency was adequate for all domains and total score (α=0.82-0.96). Regarding construct validity, WHODAS 2.0, ODI (r=0.70, p<0.05), and WHODAS 2.0 and RMDQ (r=0.71, p<0.05) had significant correlations. Total WHODAS 2.0 and FABQ-Phys subscale scores correlated moderately (r=0.66, p<0.05). The Brazilian WHODAS 2.0 was proved to be a valid and reliable tool for patients with chronic LBP. The item referring to sexual intercourse had 27% and 30% of the missing values during the test and retest stage, respectively and had a high percentage of missing data for work-related questions (41% missing data) in the life activities domain; therefore, the data must be interpreted with caution. WHODAS 2.0can be used as a disability assessment strategy from a biopsychosocial perspective in this population.

(112) Treatment Options for Female Sexual Dysfunction in Patients with Epilepsy: A Systematic Review

Abstract Introduction Epilepsy is one of the most common neurologic conditions worldwide, affecting approximately 5 million people globally every year. Many with this diagnosis rely on lifelong medications for seizure prophylaxis, which involve complex mechanisms of action with various hormones. The myriad of therapeutic side effects and the debilitating nature of this disease process make sexual dysfunction a common occurrence, with low libido, arousal, and orgasm being the primary complaints for 30-67% of female patients with epilepsy. Prioritizing quality of life from a biopsychosocial perspective is imperative – the need for investigating diverse treatment options for sexual dysfunction in these female patients becomes increasingly evident. Objective This study aims to discuss the available treatment options for sexual dysfunction in females with diagnosed epilepsy. Methods A systematic review in the PubMed database that spanned between January 2015 and November 2022 was executed. Six authors independently and thoroughly screened titles, abstracts, and full-text articles. They assessed the relevant medical literature that acknowledged the presence of female sexual dysfunction and explicitly stated treatment options for patients who have epilepsy. MeSH advanced key terms used to refine the search include: [“epilepsy”], [“female sexual dysfunction”], AND [“treatment”]. Results The published articles (n = 26) that fit the inclusion criteria were reviewed. The pathophysiology behind sexual dysfunction in patients with epilepsy is multifactorial. Seizure activity preferentially occurring in the temporal and frontal lobes alters several fundamental functions of the brain and nervous system, including the HPA axis and the release of gonadal hormones. Furthermore, anti-epileptic drugs target complex substrates that influence the limbic system, hypothalamus, pituitary, endocrine glands, as well as steroid and protein synthesis and metabolism in the liver and adipose tissue. Specifically, drugs documented to correlate with sexual dysfunction negatively are valproate, topiramate, and gabapentin. Agents such as lamotrigine, oxcarbazepine, and levetiracetam are reported to result in fewer sexual side effects and may even have a protective role against sexual dysfunction. Non-pharmacological approaches such as treating underlying comorbidities, addressing psychosocial variables, and mindfulness-based cognitive therapy have also proven significantly beneficial in treating and preventing adverse sexual outcomes. Conclusions Sexual dysfunction, secondary to epilepsy-induced seizures or anti-epileptic drug management, is not adequately explored and treated. The body of literature supports treating sexual dysfunction in females with epilepsy from a multidimensional standpoint; however, there remains a lack of thorough discussion on treatment options tailored to female pelvic anatomy. Going forward, continued research on how the pathologic consequences of epilepsy affect sexual function, unrelated to the use of anti-epileptic drugs, could enhance the prevention and comprehensive management of female sexual dysfunction in this population. Additionally, evaluating the effectiveness of topical estrogens, 5-HT1a agonists/5HT2a antagonist like Flibanserin, and melanocortin receptor agonists like Bremelanotide in female patients with epilepsy and other neurologic disorders may aid in the understanding of this relationship and spark further discussion. Sexual dysfunction and related symptoms have a devastating impact, indicating the need for this research, standardized guidelines, and a wide array of biopsychosocial treatment options. Disclosure No

THE ROLE OF EXPRESSIVE ART THERAPY AND NEUROFEEDBACK ASSESSMENTS IN IMPROVING CLINICAL HYPNOSIS ADHERENCE AMONG ANXIETY SUFFERERS

Despite worldwide concern on anxiety, preventive measures in public health industries remained scarce. Previous studies found that therapeutic adherence is vital for the treatment efficacy of anxiety sufferers; polyvagal theory may address adherence issues by considering biopsychosocial perspectives. As such, this research intends to generate polyvagal-focused therapeutic guidance in line with anxiety sufferers. This study examines the effectiveness of the Creative Brain Health Intervention (CBHI), which includes expressive art therapy and neurofeedback assessments, as well as clinical hypnosis for anxiety sufferers. The study utilizes a qualitative method with a grounded theory approach to explore helpful and unhelpful factors of CBHI. The study samples were found to have minimal scores at a mild level (on anxiety or stress subscales) of eight (for the anxiety subscale) and 15 (for the stress counterpart) under DASS-21 following a screening procedure. Particularly, the samples were analyzed after CBHI through in-depth interviews for data collection. A total of 45 participants were recruited to generate the outcomes of this study, and the results show that mental healthcare can be enhanced by addressing adherence, stigma, and support through a public system and education, backed by six domains for anxiety treatment and innovative therapeutic approaches. The study recommends early intervention and prevention phases in future research to address stigmas and prevent mental disorder. Resultantly, therapeutic adherence could be enhanced with a polyvagal-focused framework CBHI established for this study. Consequently, the study suggests insights for developing therapeutic guidance to enhance adherence and prevent full-fledged anxiety complexities.

Biomechanics, pathomechanics, diagnosis, treatment, and return to play criterias of lateral ankle sprains: an evidence-based clinical guideline

Lateral ankle sprain (LAS), which is common in recreational and professional athletes, recurs and becomes chronic if left untreated. Since the number of mechanoreceptors it contains is high, LAS should not be considered only as a musculoskeletal disorder. A detailed clinical evaluation is recommended. Clinically, the patient presents with limitation of dorsiflexion range of motion (ROM), muscle atrophy and unequal strength between the muscles, deterioration in walking, running and jumping, and proprioceptive losses. The patient should be approached from a biopsychosocial perspective both in the evaluation and treatment phases. The treatment of the patient is carried out in 3 phases and the transition between phases should be based on mentioned criterias. In the acute phase of rehabilitation, emphasis should be placed on eliminating pain and edema, and preventing loss of ROM and muscle strength. In the subacute and chronic stages, emphasis should be placed on increasing the proprioceptive sense and muscle strength, improving the biomechanics of daily life and sports-specific movements such as walking, running, jumping. If the patient is an athlete, return to sports should be planned after the criterias met.

Physical Activity, Public Policy, Health Promotion, Sociability and Leisure: A Study on Gymnastics Groups in a Brazilian City Hall.

The present study analyzed a gymnastics program offered by the Department of Sports and Leisure at a Brazilian city hall, representing an example of an effective and consolidated public policy. The objective of this study was to understand the reasons for enrollment/joining (adhesion) and permanence (adherence) among female students in gymnastics groups in order to understand why this public policy has been taking place uninterruptedly for over thirty years and to characterize the quality of life of female gymnastics students. This is a case study that used mixed methods. As a quantitative method, the Portuguese version of the World Health Organization Quality of Life-Abbreviated Version (WHOQOL-bref) questionnaire was used. As a qualitative method, the focus group technique was used. Thus, 239 women aged between thirty-five and seventy-four years old, who were students of the gymnastics program, participated in this research by answering the WHOQOL-bref questionnaire. Two classes were selected using the socioeconomic criterion of social classes in inverse situations to carry out one focus group session; then, twenty students belonging to the two classes were randomly selected. It was verified that the public policy studied has led to an improvement in the quality of life of the students, with the benefits extending beyond physical health, and that in both groups adhesion occurred mainly due to the indication of students who already practiced, or due to medical indications. It was also found that, in both groups, the main reason for long-term adherence was the understanding of the gymnastics class as a space for sociability and a moment of leisure. Physical activity is an important health promotion strategy. In addition to its biological benefits, which are necessary for the prevention of chronic non-communicable diseases, it also improves health and quality of life through social and psychological benefits, characterizing it as an effective health care strategy from a biopsychosocial perspective.

Factors Related to Recurrent Falls Among Older Adults Attending Primary Health Care: A Biopsychosocial Perspective

ABSTRACT The objective of this study was to investigate factors related to recurrent falls among older adults attending primary health care, considering the biopsychosocial perspective. A representative sample of 201 older adults were interviewed in three Primary Health Care units randomly selected in a city in southeastern Brazil. Outcome included self-report of two or more falls in the past 12 months. Exposures included personal and environmental aspects, according to domains of International Classification of Functioning of the World Health Organization (ICF-WHO). Recurrent falls were reported by 24.4% of the participants. Associations with depressive symptoms (p = .003), having osteoporosis (p = .031), chronic musculoskeletal pain (p = .020), frailty (p = .013), sleep satisfaction (p < .001), and functional status (p < .001) were found. In logistic regression models, cognitive status, musculoskeletal pain, and functional status were predictors of recurrent falls; however, only sleep satisfaction remained significant in the final model. Strategies aimed at preventing recurrent falls in primary health care should consider assessments and interventions targeting sleep aspects among older adults.

Patients’ lived experience and reflections on long COVID: an interpretive phenomenological analysis within an integrated adult primary care psychology NHS service

BackgroundLong Covid is an unknown illness which has been shown to affect sufferers regardless of mild initial COVID-19 or age. There is still a lot unknown about long COVID illness. There has been a call to understand this illness not only from a professional standpoint but also through the lived experience of patients. Patient reported outcomes through lived experience research is one such angle. To date, no research has explored the overall lived experiences and long COVID illness trajectory perspectives of the patients. This study aimed to gather patient reported outcomes of their long COVID through lived experience research. It recruited adult participants aged 18-years and over who had been referred to a primary care integrated psychology service. The study employed qualitative research using semi-structured interviews and Interpretive Phenomenological Analysis methodology.ResultsA total of eighteen participants completed the study. From their lived experiences, the participants uncovered the varied symptoms of long COVID. They also uncovered their lived progression of living with an unknown chronic illness. Common themes included uncertainty, mental and social impacts, and the processes of self-advocacy, mastering their symptoms, subjective recovery and future coping.ConclusionThis study uncovered the lived experience of long COVID in participants. The results from this study uncovered the lived subjective biopsychosocial experiences of long COVID chronic illness. Traditionally, patients receive care and recommendations from healthcare professionals. However, as long COVID is a new illness, this care model was limited. The participants in the current study described being left with a sense of uncertainty and role confusion. However, participants were able to realize their locus of control over their long COVID illness progression. This illustrates that patients have the resources to uncover the unknowns of this new illness which could inform clinical practice and further research. This suggests that that long COVID needs to be approached from a biopsychosocial perspective which emphasises patient involvement.

Relationship between Burden, Quality of Life and Difficulties of Informal Primary Caregivers in the Context of the COVID-19 Pandemic: Analysis of the Contributions of Public Policies

The study aimed to characterize and understand the difficulties experienced by informal caregivers from a bio-psychosocial and environmental perspective, taking into account the socio-demographic and health characteristics of the informal caregiver and the person cared for, quality of life, perceived burden, social support, and the impact of the COVID-19 pandemic on the informal caregiver and the person cared for. The participants were 371 informal primary caregivers, 80.9% female, aged between 25 and 85 years, mean 53.17 (SD = 11.45) years. Only 16.4% of the informal caregivers benefited from monitoring and training for informal caregiver skills; 34.8% received information on the rights of the person being cared for; 7.8% received advice or guidance on the rights and duties of the informal caregiver; 11.9% of the caregivers benefited from psychological support; and 5.7% participated in self-help groups. A convenience sample was used, and data were collected via an online questionnaire. The main findings show that the major difficulties experienced by caregivers are related to social constraints, the demands of caring, and the reactions of the person cared for. The results reveal that the burden of the main informal caregivers is explained by the level of education, quality of life, level of dependence of the person cared for, level of difficulties, and social support. The COVID-19 pandemic impacted caregiving by increasing the perceived difficulty of accessing support services, such as consultations, services, and support; causing distress feelings in the caregiver, such as, anxiety and worry; increasing the needs and symptoms of the person cared for; and increasing the degree of isolation, for both, the informal caregiver and the person cared for.

Gut-Brain Axis Perspective on Negative Symptoms and Their Neighbors in Early Adolescence: Can We Move Care Upstream?

The current study investigated symptom network patterns in adolescents from a gut-brain-axis (GBA) biopsychosocial perspective. Our secondary analysis of data from the Adolescent Brain Cognitive Development Study assessed symptom relationships using network analysis to provide information about multivariate structural dependencies among 41 signs and symptoms. Cross-sectional EBICglasso symptom networks were evaluated to assess patterns associated with anhedonia and depressed mood. Significant differences were identified between symptom neighbors of anhedonia compared with depressed mood based on stratification by age. The GBA perspective revealed several symptom neighbors that could expand clinical assessment, diagnosing criteria, education, and interventions for adolescents at risk for, or with, anhedonia or depressed mood. Results speak to the unique impact of symptoms on health that are not interchangeable with other symptoms and do not have equal effects. Mental health nurses should consider a holistic and proactive precision health approach to improving health and well-being through evidence-based assessment of symptom associations. [Journal of Psychosocial Nursing and Mental Health Services, 61(7), 29-38.].

The influence of lichen sclerosus on women's sexual health from a biopsychosocial perspective: a mixed methods study.

Women with lichen sclerosus (LS) may suffer sexually because of dyspareunia, fissures, and introital narrowing. However, the literature remains limited on the biopsychosocial aspects of LS and its impact on sexual health. To examine the biopsychosocial aspects and impact of LS on the sexual health of Danish women with vulvar LS. The study was conducted with a mixed methods approach, including women with LS from a Danish patient association. The quantitative sample consisted of 172 women who completed a cross-sectional online survey that included 2 validated questionnaires: the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (FSDS). The qualitative sample consisted of 5 women with LS who volunteered for audiotaped, individual, semistructured interviews. This mixed methods study combined data from 2 quantitative questionnaires (FSFI and FSDS) with qualitative interviews to achieve a comprehensive insight into the biopsychosocial aspects of sexual health in women living with LS. The sexual function of women with LS was considerably affected, with FSFI scores below the cutoff value of 26.55, indicating a risk of sexual dysfunction. On average, 75% of the women were sexually distressed, with a total FSDS score of 25.47. Furthermore, 68% of the sexually active women were considerably affected in terms of sexual function and sexual distress, thus meeting international criteria for sexual dysfunction. However, a negative impact on sexual function was not always related to sexual distress and vice versa. The qualitative analysis identified 4 overarching themes: (1) decrease in or loss of sexual activity, (2) interference with relationship dynamics, (3) importance of sex and intimacy - loss and restoration, and (4) worries about sexual insufficiency. Insight into the influence of LS on sexual health is important for health care professionals, including doctors, nurses, sex therapists, and physiotherapists, to provide the best guidance, support, and management for women with LS. The strengths of the study are its use of a mixed methods design and the inclusion of sexual function and sexual distress. A limitation is related to the properties of the FSFI regarding women with no sexual activity. LS has a considerable influence on women's sexual health in terms of sexual function and sexual distress, as supported by quantitative and qualitative measures. Our understanding of the complex interactions among sexual activity, intimate relations, and causes of psychological distress has been enriched.

Assessing possible moderators on the association between frequency of contact with non-cohabitating adult children and depressive symptoms among community-dwelling older adults

IntroductionWith the increase of older adult population, late life depression is emerging as a major problem in many countries as it significantly deteriorates function and quality of life in older adults. Late life depression is a multidimensional disease that requires intervention in biopsychosocial perspective. Recent reduction in family size and rapid simplification of generations are making this decrease more dramatic. Thus, single older households are becoming general type of household in late life, emphasizing the importance of social engagement in late life depressionObjectivesthe purpose of this study is to assess the correlation between the frequency of face-to-face and non-face-to-face contact with non-cohabitating adult children and late life depression after the COVID-19 pandemic. Additionally, we hypothesized 10 possible moderators and evaluated the moderation effect of each moderator on the correlation. By identifying groups of older adults that are more affected by contact with their children, the understanding of the relationship between late life depression and family contact in older adults might provide insights to set intervention targets in the community.MethodsOlder adults who completed the Living Profiles of Older People Survey in Korea were included. In total, 7,573 participants were analyzed by measuring their contact frequency and depression symptoms. Regression analysis was done adjusting covariates. Process macro was used to verify the moderating effects of variables.ResultsMultivariable logistic regression analysis showed that both infrequent face-to-face (OR=1.87, 95% CI=1.56-2.23) and non-face-to-face contact (OR=1.22, 95% CI=1.03-1.44) with non-cohabitating adult children group was associated with higher risk of late life depression compared to a frequent contact group. Further linear regression analysis, which viewed depressive symptoms as SGDS-K score, indicated consistent results in face-to-face and non-face-to-face contact (estimate=0.468, standard error [SE]=0.091, p&lt;0.001 and estimate=0.262, standard error [SE]=0.079, p&lt;0.001, respectively). Finally, using moderation analysis, association with late life depression and frequency of face-to-face contact was moderated by age, quartiles of household income, number of chronic diseases, frequency of physical activity, existence of spouse, and nutritional status (NSI) whether effect of frequency of non-face-to-face contact on late life depression was increased by participation in social activity, frequent physical activity, and good cognitive function (MMSE-DS score)(p for interaction&lt;0.05).ConclusionsFrequent contact of non-cohabitating children lowers the risk of later life depression. Several variables were found significant in moderating contact frequency-depression symptoms.Disclosure of InterestNone Declared

Psychopathology without Borders: Transcultural psychiatry and implications in clinical presentation and practice

IntroductionExisting as an emerging topic in the field and undergoing constant evolution, Transcultural Psychiatry addresses how social and cultural factors influence mental illness. During the second half of the twentieth century, phenomena such as globalization, massive migrations and immigration, occurring in ever increasing frequency, continue to bring this topic to the forefront of discussion as challenges in the treatment of patients from varying cultural backgrounds emerge. Viewed from the biopsychosocial perspective, culture delineates a framework for the evaluation of various expressions of emotion and behaviour as well as defining the limits of what counts as disorder. As border restrictions are lifted, cases which present with these particularities are bound to increase, necessitating an increased attention to the influence that cultural and social factors play in the psychopathological clinical pictures which may present to the practitioner.ObjectivesThe authors aim to briefly explore the concept of transcultural psychiatry and its importance in clinical presentation and practice with recourse to various clinical cases of international patients hospitalized in a Portuguese Psychiatry ward during a two-year period.MethodsA brief non-systematized literature review was performed based on works most pertinent to the topic discussed. As compliment to the topic, a discussion of various clinical cases of hospitalized international patients is presented.Results Culture has been demonstrated to contribute to psychopathological presentations in a variety of forms, solidifying the old adage that ‘no man is an island’ and giving reason to the biopsychosocial approach applied in clinical practice. The impact of sociocultural factors is such that the DSM-5-TR includes in its classification culture-specific syndromes. The cases discussed demonstrate the various nuances necessary not only in exploring psychopathology, but also in implementing appropriate standards of care.ConclusionsTranscultural psychiatry rises as a relatively recent topic as well as raising important philosophical, theoretical and technical challenges for mental health practitioners. Although existing as a subspecialty, each mental health practitioner should strive to be transcultural, taking into consideration the influence that these factors exert on mental illness. The patient should be evaluated with consideration to their cultural background, as well as not neglecting how the culture of the practitioner may influence the interpretation of psychopathological presentation.Disclosure of InterestNone Declared

COVID-19 PANDEMIC IN URUGUAY AND THE NEED FOR A PERSON AND SOCIAL CENTERED MEDICINE

Background: During the COVID-19 pandemic, the Uruguayan government decided to call for an attitude of responsible freedom of the population and created an Honorary Scientific Advisory Group (GACH). The intention was to report the scientific evidence available on the health situation with transparency and technical independence and to recommended interventions. This paper aims (1) to analyze the strategy to combat the COVID-19 pandemic used in Uruguay from the perspective and principles of person-centered medicine (PCM), (2) to report and examine from a broad perspective the policy regarding health authorities, scientific evidence and population, and (3) to discuss the importance of mental health and behavioral monitoring for identifying vulnerable groups that require special attention and care.&#x0D; Methods: Retrospective and narrative analysis of the creation of a socioeconomic and behavioral observatory [OSEC], critical evaluation of key data collection on population mental health, and assessment of the influence of OSEC in the context of the pandemic in Uruguay. T-test was used to assess mean differences of mental health trends in the general population using GHQ-12 panel data. The article presents the results obtained on the country’s mental health data through the analysis of a helpline consultations and a digital panel survey of a representative sample of the Uruguayan population. Screening instruments were used, which allowed for an identification of risk groups.&#x0D; Results: The evidence shows the impact of the pandemic on the emotional distress of the population, indicating that the population discomfort decreased significantly when the pandemic situation began to improve. In addition, differences according to socioeconomic status and age groups were observed, showing that the most disadvantaged had significantly higher levels of emotional distress than those of the middle and upper class, at all times of analysis.&#x0D; Conclusions: Apparently, it is possible to extend the principles of beneficence, autonomy, and justice applied at the individual level to the level of collective health policies. This is essential to achieve the active participation of the population in their self-care and to promote greater and more transparent communication with the health and scientific fields. It is also necessary to adopt a holistic, biopsychosocial perspective, which makes it possible to identify the vulnerable sectors of society and the areas in which special attention is required.

Facilitators and barriers to the implementation of pain neuroscience education in the current Lebanese physical therapist health care approach: a qualitative study

Purpose The purpose of this paper was first to gain an in-depth understanding of the barriers and facilitators to implementing the BPS model and pain neuroscience education in the current Lebanese physical therapy health care approach and explore its acceptability. Method A qualitative semi-structured interview using purposive sampling was conducted with eight Lebanese physical therapists practising in different governorates. The transcribed text from the interviews was analyzed using inductive thematic analysis. Results Two topics were generated and constructed by the researchers: (1) “barriers to the implementation of pain neuroscience education, with subthemes including (a) “current health care approach,” (b) “basic curriculum and continuing education,” (c) “patients’ barriers”; (2) “facilitators to the implementation of pain neuroscience education,” with subthemes containing (a) “interest in the BPS model, (b) “therapeutic alliance,” and (c) “motivation for future training on BPS approach.” Conclusion The analysis of the results showed that Lebanese physical therapists currently hold a strong biomedical view of chronic pain, assessment, and treatment. However, despite the presence of barriers and challenges, they are aware and open to consider the implementation and future training about the BPS model and pain neuroscience education in their approach. IMPLICATIONS FOR REHABILITATION The exploration of potential barriers and facilitators to the bio-psychosocial model and pain neuroscience education implementation may provide an opportunity for better development and design of a culturally sensitive pain neuroscience education material for Arab-speaking and Lebanese physical therapists. The exploration of barriers and facilitators to the implementation of pain neuroscience education will help to improve pain education and ensure better clinical pain management. The most important barriers were the dominant characteristic of the Lebanese physical therapist’s health approach, which is focused on a biomechanically oriented model, and their lack of knowledge to approach chronic pain from a biopsychosocial perspective.

Physiotherapists Using the Biopsychosocial Model for Chronic Pain: Barriers and Facilitators-A Scoping Review.

The use of the biopsychosocial model in primary care physiotherapy for chronic pain is far from the recommendations given in research and current guidelines. To understand why physiotherapists have difficulty implementing a biopsychosocial approach, more insight is needed on the barriers and facilitators. This scoping review aimed to investigate and map these barriers and facilitators that physiotherapists working in primary care reportedly face when treating patients with chronic musculoskeletal pain from a biopsychosocial perspective. Four electronic databases (PubMed, Embase, CINAHL and ERIC) and the grey literature were searched. Studies were included if they investigated the experiences of physiotherapists in the treatment of chronic pain from a biopsychosocial perspective in primary care. Extracted data were discussed and sub grouped in themes following a qualitative content analysis approach. To align with current use of theories on behavior change, the resulting themes were compared to the Theoretical Domains Framework. After screening, twenty-four studies were included. Eight groups of barriers and facilitators were identified, thematically clustered in six themes: knowledge, skills, and attitudes; environmental context and resources; role clarity; confidence; therapeutic alliance; and patient expectations. The results of this review can be used to inform the development of implementation programs.