Health Symptoms Research Articles

The relationship between co-occurring traumatic experiences and co-occurring mental health domains for veterans resident in Northern Ireland

IntroductionVeterans residing in Northern Ireland (NI) likely experience higher levels of co-occurring lifetime trauma exposure and associated co-occurring mental health symptoms, due to the Troubles. As NI veterans have been subject to little exploration it is difficult to know how to support them. This exploratory study explored the co-occurrence of mental health symptoms as a function of co-occurring traumatic experiences.MethodsTwo latent class analyses (LCA) were conducted on NI veteran data (n = 609). One LCA factored endorsements of 16-lifetime traumatic events, with a separate LCA exploring the co-occurrence of symptoms across six mental health domains. Mental health symptom classes were considered as a function of trauma classes, military-specific variables, gender and age.ResultsThree trauma classes were identified: High Multi Trauma (10.84%); High Combat/Conflict (47.62%); Moderate Combat Conflict (41.54%), and three mental health symptom classes: High Co-occurring Mental Health (19.38%); High Depression Moderate Anxiety/Alcohol (24.63%); Moderate Alcohol/Normative (55.99%). Significant predictors of High Co-occurring Mental Health class membership were UDR service, ‘Worst’ military trauma and High Multi Trauma class membership. Both combat classes had a negative relationship with the High Co-occurring Mental Health. Predictors of the High Depression Moderate Anxiety/Alcohol class were High Multi Trauma class membership and UDR service, with Age and Moderate Combat Class membership having a negative relationship.DiscussionNI veterans could be labelled as ‘traumatised’ due to high levels of combat/conflict exposure, yet the two combat classes seemed unrelated to membership of poorer mental health classes. UDR membership indicated that living in one’s theatre of war could have mental health implications. It was concerning that 45% experienced some co-occurring mental health symptoms with 19% experiencing the poorest symptoms. Hazardous alcohol use appeared unrelated to poor mental health. Further research is needed, utilising robust methods. No clinical inferences are to be made from this exploratory study.

Psychosocial Impact of Covid-19 Pandemic on Women’s Mental Health

Women mental health and impact of psychosocial factors on it, is highlighted in various psychological & clinical studies, due to pandemic made it a matter of more focus. Studying the long-term impacts of the coronavirus on society, our mind, body and its analysis perhaps will take more time. Out of the total population, a number of people felt a disrupted sleep as a hallmark of the pandemic, and suffered from depression, insomnia, irritability, violence including domestic violence, distress, work pressure due to online culture of work, and other related negative mental health symptoms as idiosyncratic attributes especially in covid sufferers. Covid-19 pandemic has altered family dynamics. More screen time, unended & fluctuated routines, for working women dissolving boundaries in workplace and personal life altered & flicking habits, all impacted mental health adversely. The human brain is evolved to live in social groups & wired for social interactions, epidemiological studies conducted on covid survivors, convalescents & victims shows altered brain biochemistry due to various psychosocial factors including financial losses, social isolation, intimate partner’s negative mental state, discrimination, disrupted sleep & routines, etc. Pandemic might has altered the romantic and loving relationships, and adversity of such psychosocial factors impacted people. Psychological strengths and resilience mainly depend on social determinants like social support, social culture, respect, engagement at workplace, parenting style in childhood & emotional attachment, society & family bonds, self-regulation & behavior controlling, and collective efficacy, all these determinants are positively associated with self-esteem that have direct impact on enhancing psychological strengths. Population for the study as participants were females in early adulthood & studying, professional and housewives. For data analysis, the statistical tools, descriptive, co-relational and regression analysis is used. The study focuses on effect of adverse aspects of adversity like pandemics financial crises like job losses, allowances or salary deductions, led to economic abuses, and somewhere gender discrimination, sexual abuse, household workload, escalation in family members expectations and responsibilities, adverse impact of these psychosocial factors on women’s mental health and role of education, knowledge, skills, and aptitude i.e. abilities & cognitive competencies in coping and managing the adversities like pandemic.

Adverse Childhood Experiences in Adults with Chronic Traumatic Brain Injury: Support for a Life Course Approach to Brain Injury Rehabilitation

BackgroundAdverse childhood experiences (ACEs) confer greater risk for adult traumatic brain injury (TBI), but little is known about their effects on post-injury outcomes. ObjectiveTo determine the prevalence and correlates of conventionally defined ACEs (occurring within household/in private; e.g., physical abuse) and community-level ACEs (e.g., bullying) after TBI. MethodsParticipants were 85 Philadelphia-area TBI Model System participants with chronic (>1 year post-injury) TBI. We examined cross-sectional associations between total conventional and community ACEs reported (out of 21) before age 18, mental health symptoms, and health-related quality of life (HRQoL), as well as relationships between ACEs and neighborhood deprivation (census-derived neighborhood socioeconomic status). ResultsThe median number of total ACEs was 3 (range: 0-17). Emotional abuse, physical abuse, and alcohol abuse in the household were the most common conventional ACEs (each at 36.5%). Witnessing violence (45%) was the most common community ACE. Black individuals (n=32) reported more community ACEs (p<.001) than White individuals (n=45). Community ACEs were significantly associated with greater neighborhood deprivation, though this relationship was confounded by race. Total ACEs was significantly related to more severe mental health symptoms (p<.001) and poorer HRQoL (p=.005), even after covariate adjustment. A fully-adjusted path model supported mental health as a mediator between total ACEs and HRQoL. ConclusionsResults of this preliminary study reveal an appreciable prevalence and potential far-reaching consequences of conventional and community ACEs among those with chronic TBI. The results underscore the value of trauma-informed and life course approaches to research and clinical care in TBI.

Structural Equation Modeling of Childhood Trauma and Self-Stigma in Adult Inpatients with Borderline Personality Disorder.

Child abuse and trauma are significant risk factors in the etiology of borderline personality disorder (BPD). Apart from affecting the risk of developing BPD, adverse childhood experiences seem to increase its symptoms and related disability. Self-stigma presents another common issue with equally prominent consequences for mental health. Despite being theoretically linked, the connections among childhood trauma, self-stigma, and mental health have not been explored in patients with BPD. This study aimed to provide first insights into this understudied topic. This cross-sectional study included 283 inpatients diagnosed with BPD participating in a residential transdiagnostic psychotherapeutic program. The patients completed several measurements - the Internalized Stigma of Mental Illness Scale, the Childhood Trauma Questionnaire - Short Form, the Clinical Global Impression - Severity, the Beck Depression Inventory-II, the Beck Anxiety Inventory, the Dissociative Experiences Scale, the Sheehan Disability Scale, and a demographic questionnaire. The data was statistically analyzed using IBM SPSS and AMOS 26 programs, and bivariate correlation tests and structural equation modeling explored the hypotheses. Retrospectively reported childhood trauma positively correlated with current self-stigma. Both childhood trauma and self-stigma were also positively related to several indicators of general psychopathology and disability. The significance of these connections was subsequently confirmed by structural equation modeling, where self-stigma acted as a partial mediator of childhood trauma, general psychopathology, and disability. Self-stigma significantly mediates the relationship between childhood trauma and selected mental health symptoms among adult patients diagnosed with BPD. Longitudinal studies are necessary to explore the causality of the findings. Therapeutic and societal efforts to tackle childhood trauma or self-stigma might benefit from reflecting its broader psychosocial context.

Prevalence and Predictors of Depression Symptoms Among Afghan Hypertensive Patients: Secondary Analysis of a Multi-Center Cross-Sectional Study.

Although depression is a frequently occurring mental disorder in patients with hypertension, little is known about the symptoms of depression among Afghan hypertensive patients. This study aimed to analyze the prevalence and predictors of depression symptoms among Afghan hypertensive patients. This was a secondary analysis of a multi-center cross-sectional study conducted between August and December 2022 across three major provinces in Afghanistan. Socio-demographic and clinical characteristics of the eligible participants were used in the analysis. A score of ≥ 5 on the PHQ-9 (Patient Health Questionnaire) was considered the cut-off point for labeling hypertensive patients as screening positive for depressive symptoms. We performed binary logistic regression to determine the predictors of depression symptoms among hypertensive patients. Out of 853hypertensive patients, 51.8% (95% CI: 48.4-55.2%) had depressive symptoms. Binary logistic regression revealed that low monthly household income [AOR=1.42, 95% CI (1.01-1.97), low education level [2.41 (1.57-3.71)], physical inactivity [1.81 (1.22-2.71)], poor blood pressure control [2.41 (1.57-3.71)], and the presence of medical comorbidity [1.59 (1.15-2.19)] were the predictors of depression symptoms. This study showed a high prevalence of depressive symptoms among Afghan hypertensive patients. Moreover, we found that low monthly household income, physical inactivity, low education level, poor blood pressure control, and the presence of medical comorbidity were the predictors of depression symptoms. Our findings suggest that hypertensive patients should be screened for mental health symptoms, and those most at risk for depression should seek supportive counseling.

Association of youth climate change worry with present and past mental health symptoms: a longitudinal population-based study

Young people are worried about climate change but the association with current and past mental health symptoms is rarely examined in longitudinal population-based samples. Drawing on a population-based birth cohort from the Canadian province of Quebec (n = 1325), this study used a cross-over design to (1) test the association between climate change worry at age 23-years and concurrent mental health symptoms assessed on standardised instruments, and (2) test the association between adolescent (15 and 17 years) symptoms of anxiety, depression, inattention-hyperactivity, and aggression-opposition and climate worry at age 23-years. Participant sex, cognitive ability, socioeconomic status, and parental mental health were adjusted for. Descriptive statistics showed that most participants were worried about climate change: 190 (14.3%) were extremely worried, 383 (28.9%) were very worried, 553 (41.7%) were somewhat worried, and 199 (15.0%) were not at all worried. In analysis 1, worry about climate change was associated with significantly higher concurrent anxiety, depression, and self-harm symptoms, even after adjustment for adolescent symptoms. In analysis 2, anxious adolescents were significantly more likely to be extremely worried about climate change six years later (RRR = 1.51, 95%CI = 1.10–2.07), while aggressive-oppositional adolescents were significantly less likely to be somewhat worried (RRR = 0.79, 95%CI = 0.63–0.0.99), very worried (RRR = 0.61, 95%CI = 0.48–0.78), or extremely worried (RRR = 0.51, 95%CI = 0.37–0.72). Taken together, participants who were worried about climate change had more concurrent mental health symptoms but were also more likely to have prior symptoms. Adolescents with higher anxiety were more likely to worry about climate change in early adulthood, while those with higher aggression-opposition were less likely to worry. Future studies should track climate worry longitudinally alongside symptoms using prospective follow-up studies.

Psychosocial Assessment Tool 2.0 and Long-term Mental Health Outcomes in Childhood Cancer.

To identify childhood cancer patients and their families at the greatest risk for psychosocial difficulties, this study examined the predictive validity of the Psychosocial Assessment Tool 2.0 (PAT2.0) on caregiver and patient-reported mental health outcomes at 1-year follow-up. The PAT2.0 was administered to caregivers a median of 0.08 years after cancer diagnosis. A brief psychosocial screening battery (Family Symptom Inventory and PROMIS v1.0 Pediatric Profile-25) was administered to patient-caregiver dyads (n=53) ∼1-year later. Linear regressions support the longitudinal predictive validity of the PAT2.0 for caregiver-reported child and caregiver mental health symptoms and child-reported peer relationships difficulties.

Experiences of cultural stress among U.S. citizen migrants: A mixed method approach.

On September 20, 2017, Hurricane Maria made landfall in Puerto Rico, devastating the archipelago and forcing thousands of Puerto Ricans to migrate to the U.S. mainland. Guided by a cultural stress theory framework, the present mixed method study examined how various cultural stressors impact participants' daily interactions and mental health outcomes. A total of 319 adult Hurricane Maria survivors residing on the U.S. mainland participated in the study. A mixed method sequential explanatory design was used. First, we used latent profile analysis (LPA) and multinomial logistic regression to identify the varied cultural stress experiences that participants had. Then we used data from semistructured interviews to better understand the experiences of participants classified into the different LPA profiles. Four profiles were identified: "moderate cultural stress" (35%), "overall low" (29%), "high cultural stress" (26%), and "low language stress" (10%). Multinomial regression indicated that members of the moderate cultural stress, high cultural stress, and low language stress profiles all reported significantly higher depressive and anxiety symptoms compared to members of the overall low profile. Qualitative data exemplified the daily experiences of participants placed into each profile, demonstrating that participants have rich and varied experiences that can contribute to their mental health symptoms. The present study documents the contributions of hurricane trauma and cultural stress vis-à-vis current mental health symptoms. Clinicians working with Hurricane Maria survivors should be cognizant of and inquire about migration-related cultural stressors including discrimination, feelings of being unwelcomed, and difficulty communicating in the destination community's dominant language. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Hidden scars: the persistent multifaceted health and psychosocial consequences for Syrian torture survivors.

Background: The impact on the physical and mental health of those who survived torture and their close circles in the Syrian regime's detention facilities remains under-studied.Objective: This qualitative study explored Syrian refugees' narrations of captivity and torture, and the consequences of such extreme traumatic events on their physical and psychosocial health.Method: Thirteen audio-recorded interviews were conducted in Arabic with Syrian refugees. Study participants were at least 19 years of age, resided in diverse urban areas of Jordan, had experienced captivity and torture in Syrian detention facilities, and voluntarily agreed to participate in the study. Participation was anonymous, only oral consent was required, and no incentives were provided to participants. Interviews were transcribed and translated into English by a team of researchers, followed by analysis of repetitive themes according to the narrative paradigm.Results: Analysis of interviews elicited three major themes: extreme traumatic experiences of torture, and its physical and psychosocial health consequences. The first major theme was divided into two sub-themes: torture experienced by the participants themselves, and torture experienced by participants' close circles. The second major theme, pertaining to physical health, was divided into two sub-themes: acute and chronic health sequelae. The third major theme, related to psychosocial health, was divided into four sub-themes: mental health symptomatology, impacts on professional life, impacts on interpersonal relationships, and social consequences.Conclusions: Torture experiences of Syrian refugees had adverse consequences for the physical and psychosocial health, functioning, and the overall well-being of survivors and their close circles. Interventions may seek to improve both the acute and chronic health consequences, as well as the mental health symptoms and associated impacts on livelihood, professional, and relationship dynamics. They should span clinical, legal, and advocacy spheres, given that a holistic approach may contribute immensely to survivors' healing process.

Assessment of Quality of Life in Advanced-Stage Lung Cancer Patients Using EORTC QLQ-C30 Questionnaire

Introduction: Quality of life (QoL) is a multidomain concept that assesses a person through health status, functional status, and symptoms. The patient's QoL is greatly reduced due to the course of disease, severity of symptoms, and side effects of chemotherapy treatment. This study aimed to assess the QoL in advanced lung cancer patients using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC QLQ-C30). Methods: This descriptive and observational study was conducted at the Pulmonary Polyclinic, Prof. Dr. Chairuddin Panusunan Lubis Universitas Sumatera Utara (USU) Hospital from February to July 2024, with a cross-sectional design using patient medical records and EORTC QLQ-C30 questionnaire. The EORTC QLQ-C30 questionnaire was analyzed with a score formula and categorized as good, moderate, and bad. The sample was 100 lung cancer patients using a purposive sampling technique according to the criteria. Results: The results showed that almost all QoL was in the moderate category (80%). The general health status was mostly in the moderate category (61.66%), the functional status was mostly in the good category (75.35%), and the symptoms were in the moderate category (35.65%). In the functional scale, the role domain had the lowest mean, 69.99 ± 29.43. In the symptoms scale, the pain domain had the highest mean, 52.66 ± 29.43. Conclusion: The overall QoL of lung cancer patients was in the moderate category, lower than the healthy population. It needs to be improved, especially in the role domain, by providing supportive-expressive group therapy.

Exploring relationships between parental stress, coping, and psychological outcomes for parents of infants with CHD.

This study aimed to explore relationships between parental stress, coping, and outcomes for parents of infants with CHD, via observational approach reflecting domains of the Parental Stress and Resilience in CHD (PSRCHD) model. Fifty-five parents of 45 infants with CHD completed questionnaires with measures of parental stress, Problem-Focused Coping (PFC), Emotion-Focused Coping (EFC), Avoidant Coping (AC), mental health (symptoms of anxiety and symptoms of depression), post-traumatic growth (PTG) and quality of life (QoL). Demographic and infant clinical data were obtained. Parental stress showed significant small to medium positive correlations with MH and PTG, but no significant correlations with QoL. EFC and AC showed significant small to medium positive correlations with MH, and medium negative correlations with parental QoL. EFC and PFC had significant small to medium correlations with PTG. PFC and AC had significant small to medium correlations with infant QoL. Hierarchical multiple regression analyses indicated that parental symptoms of anxiety, PTG, parental QoL, infant QoL were significantly predicted by models comprising of parental stress, coping styles, and clinical controls (adjusted R2 = 13.0-47.9%, p range < 0.001-.048), with results for parental symptoms of depression falling marginally above significance (adjusted R2 = 12.3%, p = .056). Parental stress, coping styles, and length of hospital stay are related to psychological outcomes in parents of infants with CHD. Future research may use the PSRCHD framework to assess mechanisms underlying CHD parents' stress and coping experiences and investigate longitudinal relationships between parental factors and parent and child outcomes.

A study into the mental health of PhD students in Australia: investigating the determinants of depression, anxiety, and suicidality.

PhD students are particularly vulnerable to experiencing poor mental health. Mental health concerns that arise during their studies can not only affect their study progress but also have long-lasting impacts on their mental health after their studies. Extensive research has been conducted on the mental health of university students, but few studies have focused on PhD students and even fewer on PhD students in Australia. The present study investigated demographic, occupational, psychological, social, and relational determinants of mental health symptoms (depression, anxiety, and suicidality) in PhD students in Australia. PhD students enrolled in Australian universities were invited to complete an online survey. Results from regression analyses identified key determinants of mental health symptoms in our sample of PhD students (N = 302). In particular, higher levels of imposter thoughts, perfectionism discrepancy, and loneliness were strong predictors of depression, anxiety, and suicidality. These findings contribute to our understanding of the mental health of PhD students in Australia. Importantly, these findings inform areas of focus where potential strategies can be implemented to better protect the mental health of this population. For example, strategies that mitigate loneliness or foster effective, collaborative student-supervisor relationships.

Impact of Artificial Intelligence Chatbots on Student Well-being and Mental Health: A Systematic Review

Students in schools and colleges face some challenges, including rigorous academic schedules, academic work load, standardized tests, and assignments deadline, which can contribute to significant stress and mental health risks. Thus, numerous studies have been conducted to control stress between students, such as self-guided stress management programs. This paper reviews several studies published between 2019 and 2023 exploring the impacts of deploying state-of-the-art artificial intelligence chatbots which are used to boost and manage psychological disorders and mental health symptoms such as anxiety, depression, fear, and worry between prospective and current undergraduate students. This study outlines the key phases of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). It begins with screening (115) articles and subsequently includes (13) articles for intensive review, which all focus on psychological disorders and mental health conditions that can be influenced by the conversational agents and chatbots. However, the results revealed that anxiety and depression are the main psychological disorders that can be influenced by conversational agents and chatbots. Moreover, this review revealed multiple cases of universities and schools, emphasizing the implementation of chatbots for both learning and advising functions. The Systematic Literature Review (SLR) in this study is constrained to the specific databases, and the search keywords were limited to the article title fields only; which excluded the abstracts. This could have caused some missing relevant studies. In future work, other essential databases will be included, such as Scopus and WoS. In addition, we will include more information about the technique and the complexities of using the chatbot as it may have a significant impact on student behaviors and emotions.

Communication, Shared Decision-making and Goals of Care in the ICU through Electronic Health Records: A Scoping Review.

The care of critically ill patients involves communication and shared decision-making with families and determination of goals of care. Analyzing these aspects through electronic health records (EHRs) can support research in ICUs, associating them with outcomes. This review aims to explore studies that examine these topics. A scoping review was conducted through a systematic literature search of articles in PubMed, Web of Science, and Embase databases using MESH terms up to 2024, conducted in ICU settings, focusing on communication with families, shared decision-making, goals, and end-of-life care. A total of 10 articles were included, divided into themes: Records and family, and records in quality improvement projects. Variables based on records with common characteristics were identified. Outcome analysis was performed through questionnaires to family members, healthcare professionals or by analyzing care processes. The studies revealed associations between family members' perceptions and mental health symptoms and documented elements such as communication, therapeutic limitations, social and spiritual support. Studies evaluating quality communication improvement projects did not show significant impact on documented care, except for those that assessed improvements based on palliative care. The analysis of documented care for critically ill patients can be conducted from various perspectives. Processes amenable to improvement, such as communication with family members, definition of goals of care, limitations, shared decision-making, evaluated through EHRs, are associated with mental health symptoms and perceptions of families of critically ill patients. Documentation-based studies can contribute to improvements in patient- and family-centered care in the ICU. de Aquino VW, da Silveira GF, Boniatti MM, Terres MS. Communication, Shared Decision-making and Goals of Care in the ICU through Electronic Health Records: A Scoping Review. Indian J Crit Care Med 2024;28(10):977-987.

Suicidal behaviors among refugee women in Jordan: post-traumatic stress disorder, social support and post-displacement stressors

BackgroundThis paper examines the frequency of suicidal behaviors (suicidal ideation or attempt) among a sample of Syrian refugee women living in non-camp settings in Jordan. We asked several questions surrounding suicide and examined the associations between post-traumatic stress disorder (PTSD), social connectedness, post-displacement stressors and suicidal behaviors.MethodsParticipants (n = 507) were recruited using a clinic-based systematic sampling from four health clinics throughout Jordan in 2018. We used a multivariable logistic regression to examine the hypothesis of whether positive screening for PTSD (PCL-5), social isolation (have no friends or family members available to help), and greater number of post-displacement stressors (PMLD Checklist) is associated with suicidal behaviors.ResultsApproximately one-tenth (9.86%) of participants surveyed reported suicidal behaviors (suicidal ideation or attempt) in the past six months. Our hypothesis was partially supported. In the adjusted multivariable analyses, screening positive for PTSD [OR:4.02 (95% CI:1.33, 12.15)] increased odds of suicidal behaviors, while having one friend or family member available to help when in need [OR:0.31 (95% CI:0.13, 0.78)] decreased odds of suicidal behaviors. We did not find any associations between the number of post-displacement stressors and suicidal behaviors in the multivariable model.ConclusionAgencies and practitioners addressing suicidal behaviors among Syrian refugee women should provide interventions that aim to reduce PTSD symptoms and social isolation. Potential intervention includes screening for mental health symptoms and suicidal behaviors during routine visits with service providers, as well as providing proper mental health and psychosocial support services according to the mapping of available services.

A Study of the Psychometric Properties of the Pediatric Symptom Checklist-17 for Children With Developmental Delays and Disorders.

Primary care physicians (PCPs) frequently serve pediatric patients with developmental delays and disorders (DD/D). Although the most widely used primary care behavioral health screener, the Pediatric Symptom Checklist-17 (PSC-17), is validated for use with children without DD/D, it is unclear whether this measure accurately identifies behavioral health symptoms in youth with DD/D. Thus, the purpose of this study was to assess the psychometric properties of the PSC-17 for children with DD/D. Medical record data from 3596 pediatric patients at a primary care clinic were analyzed. Descriptive analyses, measurement invariance testing, and internal consistency evaluations were conducted to assess the psychometric properties of the PSC-17. The results of these analyses support the use of the PSC-17 for behavioral health screening for children with DD/D. Behavioral health screening in this population is critical, because the timely identification of behavioral health concerns can facilitate early intervention, which may enhance long-term functioning.

The relationship of childhood maltreatment, adult sexual victimization, depressed mood and symptoms of trauma with fear of childbirth

Background: Fear of childbirth (FoB) is experienced to some degree by most pregnant people and can be intense enough to merit treatment. Despite significant research on the topic of FoB, studies investigating various forms of maltreatment and mental health symptoms in relation to FoB are very limited. In particular, studies including multiple forms of maltreatment along with mental health symptoms as predictors of FoB are extremely limited. We sought to fill this gap and clarify the relative contributions of these variables to the prediction of FoB. Methods: This was a secondary analysis of data from pregnant people in Canada. Participants (N = 881) provided demographic and reproductive history information, completed self-report measures of FoB, childhood maltreatment (multiple forms), adult sexual victimization, depressed mood and symptoms of posttraumatic stress disorder (PTSD). They were also administered a diagnostic interview to assess for specific phobia, FoB. Analyses included descriptive information, Wilcoxon rank sum tests, linear and logistic regression, and path analysis. Results: Most forms of maltreatment showed some association with increased FoB. However, when assessed together, only emotional maltreatment remained a significant predictor of FoB. Both depressed mood and symptoms of PTSD contributed more to FoB than maltreatment, and mediated the relationship of emotional maltreatment with FoB. The only direct effects of childhood emotional maltreatment on FoB were for fears of medical interventions and feelings of embarrassment during labour and delivery. Limitations: Study findings fill significant gaps in our understanding of the relationship between maltreatment, mental health symptoms and FoB. However, the study sample was limited to Canadian participants, most of whom were socio-economically advantaged, cis-gender women of European descent, thus limiting the generalizability of the findings. Further, as childhood maltreatment and sexual assault experiences in adulthood were reported retrospectively, study findings are also vulnerable to recall bias. Conclusions: Findings contribute to our understanding of the relationship between childhood maltreatment, adult sexual victimization, mental health and FoB. These findings can facilitate future research and improved care via a focus on depressed mood, symptoms of PTSD, emotional maltreatment and specific fears of medical interventions and social discomfort as significant contributors to one's experience of FoB.

A character-strengths based coaching intervention to improve wellbeing of rural community health workers in Madhya Pradesh, India: Protocol for a single-blind randomized controlled trial

BackgroundThere is scarce knowledge on the use of structured positive psychology interventions for reducing work-stress and improving wellbeing of rural community health workers in India, particularly the Accredited Social Health Activists (ASHAs) who are village-level (resident women, incentivised) lay health workers. This trial will test the effectiveness of a ‘character-strengths’ based coaching intervention compared to routine supervision on wellbeing (‘authentic happiness’) of ASHAs. MethodsThis protocol is for a single-blind, parallel group randomized controlled trial comparing the effectiveness of a five-day residential workshop focusing on the use of character-strengths and subsequent 8- to 10-week remote telephonic coaching (weekly) to individually support ASHAs to improve their wellbeing, against routine health system support. The arms are intervention added to routine ASHA supervision (weekly, by the ASHA supervisor), and routine supervision alone (control arm). The target sample comprises 330 rural ASHAs in Madhya Pradesh, India. The primary outcome of mean Authentic Happiness Inventory (AHI) scores will be compared between arms at 3-month follow-up. Secondary outcomes will include an assessment of ASHA's self-reported affect, self-efficacy, flourishing, burnout, motivation, physical health symptoms, quality of life, and routine work performance indicators, and the consequent patient-level outcomes [e.g., service satisfaction and depression remission rates after receiving brief psychological treatment by trained ASHAs]. We will also evaluate the costs of developing and delivering the intervention. DiscussionThis trial will determine whether a character-strengths based coaching intervention is an effective and scalable approach for reducing work-stress and improving wellbeing of rural ASHAs in low-resource settings.

RELATIONSHIP BETWEEN POSITIVE AND NEGATIVE SYMPTOMS WITH DIMENSIONS OF QUALITY OF LIFE IN PATIENTS WITH SCHIZOPHRENIA

Introduction: Schizophrenia is an endogenous psychotic disorder, which is characterized by the presence of positive and negative symptoms that affect the normal functioning of patients and play important role in their quality of life. Purpose: The main purpose of this research was to introduce the relationship between positive and negative symptoms and quality of life in patients with schizophrenia. Methods: The research involved 40 randomly selected male and female respondents from 18 to 60 years of age who suffer from schizophrenia according to the diagnostic criteria of the International Classification of Diseases – ICD 10. The instruments used are: the Positive and Negative Syndrome Scale (PANSS), and the Scale for the quality of life (WHOQOL Questionnaire - BREF). The statistical analysis of the data was done with the SPSS software package (version 20). Results: The study showed that there is a statistically significant negative relationship between positive symptoms of schizophrenia and mental health (r= -.682, p&lt;.01), positive symptoms and social relationships (r=-.764, p&lt;.01), positive symptoms and living conditions (r=-.732, p&lt;.05). Regarding negative symptoms of schizophrenia and dimensions of quality of life, it was found that there is a statistically positive significant relationship between negative symptoms of schizophrenia and physical health (r=.833, p&lt;.01); negative symptoms of schizophrenia and mental health (r=-.752, p&lt;.05); negative symptoms of schizophrenia and social relationships (r=.831, p&lt;.01); and negative symptoms of schizophrenia and living conditions (r=.850, p&lt;.01). Conclusion: Quality of life is a broad concept that includes a person's subjective opinion regarding their physical and psychological health, social relationships and the environment. This study emphasizes that positive symptoms of schizophrenia negatively affects the dimensions of quality of life in all the above-mentioned areas.

Urban Care for Unpaid Caregivers: Community Voices in the Care Block Program, in Bogotá, Colombia.

The Care Block of Bogotá, Colombia, is an urban program that offers services for low-income unpaid caregivers. This study aimed to (i) characterize unpaid caregivers' subjective well-being, mental health symptoms, physical activity levels, and use of public spaces linked to the Care Block; (ii) identify caregivers' perceived built and social environment facilitators and barriers to accessing the Care Block facility; and (iii) document the community-led advocacy process to improve the Care Block program. The quantitative component included a subjective well-being and mental health symptoms survey, and the System for Observing Play and Recreation in Communities (SOPARC) instrument. The qualitative component included the Our Voice citizen science method augmented with portable virtual reality equipment to engage participants in advocacy for changes. Participants (median age of 53years) dedicated a median of 13.8h a day to unpaid caregiving, had an average subjective well-being score of 7.0, and 19.1% and 23.8% reported having depression and generalized anxiety symptoms respectively. Caregivers reported that the program fosters their perception of purpose, enjoyment, resilience, and cognitive and emotional awareness. SOPARC evaluation showed that most women engaged in moderate to vigorous physical activity. The caregivers highlighted education, physical activity services, and integration of facilities as facilitators to accessing the Care Block program. Poor quality and lack of sidewalks and roads, limited personal safety, and the risk of pedestrian-vehicle collisions were identified as barriers. Virtual Reality sparked compelling dialogue between participants and stakeholders, allowing stakeholders to reflect on an urban program facilitating unpaid care work.