Improvement In Mental Health Scores Research Articles

The impact of cancer prevention education on the mental health of college students based on the difference-in-differences method.

Cancer, as the second leading cause of death worldwide, poses significant challenges to human health and socio-economic development. In recent years, the incidence of cancer has shown a trend toward younger populations, drawing attention to cancer prevention education among college students. However, research on the specific impact of cancer prevention education on the mental health of college students is limited. This study aims to explore the impact of cancer prevention education on the mental health of college students, revealing the mediating role of disease awareness and the moderating roles of psychological resilience and cultural differences. A difference-in-differences (DID) approach was used, involving 1,670 freshmen from a Chinese university, divided into an experimental group (n = 835) and a control group (n = 835). The experimental group received a semester-long cancer prevention education program. Data were collected monthly from November 2022 to June 2023 using the Depression Anxiety Stress Scales (DASS-21) and a custom Disease Awareness Scale. The study found a significant improvement in mental health scores among the experimental group, with an average increase of 14.738 points on the DASS-21 scale (p < 0.001), representing a 23% reduction in stress, anxiety, and depression levels compared to the control group. Disease awareness in the experimental group improved by 17%, as measured by the Disease Awareness Scale, with a mediation effect of 3.563 points (p < 0.001). Furthermore, psychological resilience and cultural differences moderated the impact of the education program, with those scoring higher in resilience showing an additional 8% improvement in mental health scores (moderation effect = 0.892, p < 0.001), and cultural differences accounting for a 5% variance (moderation effect = 0.756, p < 0.001) in the outcomes. This study demonstrates that systematic and scientific cancer prevention education has a significant positive impact on the mental health of college students. Universities should promote comprehensive and personalized health education strategies to improve disease awareness, foster psychological resilience, and emphasize cultural differences, thereby enhancing the overall physical and mental health of college students and promoting their holistic development. This finding provides important empirical support and theoretical basis for the design and implementation of health education in universities.

Unicompartmental knee arthroplasty improves mental health in patients with single compartment knee osteoarthritis.

The purpose of this study was to determine if preoperative mental health status improves following unicompartmental knee arthroplasty (UKA) in patients with single compartment knee osteoarthritis (OA). A total of 163 patients underwent UKA [115 (71%) medial, 48 (29%) lateral] (mean age = 65 ± 11) completed preoperative and minimum 2-year postoperative veterans RAND 12 item health survey (VR-12) mental component score (MCS). VR-12 MCS was the primary outcome measure. Secondary measures included VR-12 physical component summary score (PCS), knee osteoarthritis outcome score (KOOS) and KOOS patient acceptable symptom state at the final follow-up. The median VR-12 MCS improved from 50.5 [interquartile range (IQR): 43.7-56.8] to 55.0 [IQR: 52.3-57.0] (p < 0.001) at a mean follow-up of 9.5 ± 4 years (range 2-19 years) following UKA. Preoperative VR-12 MCS was significantly correlated with patients postoperative VR-12 PCS (ρ = 0.294, p < 0.01), KOOS pain (ρ = 0.201, p = 0.012), KOOS ADL (ρ = 0.243, p = 0.002) and KOOS quality of life (ρ = 0.233, p < 0.01). Sixty-three (39%) patients improved from low VR-12 MCS (<50) to normal VR-12 MCS (≥50). One hundred forty-two (87%) achieved a normal VR-12 MCS score (≥50) postoperatively. At a mean of 10-year follow-up, patients who underwent UKA for single compartment osteoarthritic knee pain demonstrated significant improvement in mental health scores. UKA resulted in normal mental health in a majority of patients (87%). The resultant improved mental health scores were associated with improved patient pain and activities of daily living. Level III retrospective cohort study.

An evaluation of value-based outcomes for women admitted to a dialectical behaviour therapy integrated practice unit: a follow-up study.

An earlier evaluation (Fox et al., ) highlighted reductions in risk behaviours and restrictive practices for women admitted to low secure dialectical behaviour therapy (DBT) unit. Since then, a value-based healthcare model has been adopted. To explore changes in health, social and psychological functioning, risk, quality of life, and in incidents of violence and restrictive practices, over the initial 12-month period of admission to a specialist DBT service. Data were extracted from electronic clinical records for 41 women with emotionally unstable personality disorder admitted to a specialist integrated practice unit (IPU) providing a comprehensive DBT programme. Secondary analysis was conducted on an anonymous dataset of routinely collected outcome measures at baseline admission, and 6 and 12 months post-admission. ANOVAs and pairwise post hoc comparisons, and non-parametric equivalents, were conducted to examine changes in outcomes. Findings showed statistically significant improvements in mental health scores on the ReQOL (p<.01), global, wellbeing, problems, functioning and risk scores on the COREOM (all p<.01), and severe disturbance, emotional wellbeing, socioeconomic status, risk and need scores on the HoNOS-Secure (all p<.05). Significant reductions in risk behaviours (p<.01) and restrictive practices (p<.01) were also apparent. The most substantiative improvements were largely demonstrated over a 12-month admission period. Admission to the DBT IPU yielded significant improvements on outcomes pertaining to quality of life, psychological distress, and risk. Importantly, these are outcomes that aligned with patients' perceptions of recovery.

Long-Term Psychosocial Consequences of Whole-Body Magnetic Resonance Imaging and Reporting of Incidental Findings in a Population-Based Cohort Study.

Management of radiological incidental findings (IF) is of rising importance; however, psychosocial implications of IF reporting remain unclear. We compared long-term psychosocial effects between individuals who underwent whole-body magnetic resonance imaging (MRI) with and without reported IF, and individuals who did not undergo imaging. We used a longitudinal population-based cohort from Western Europe. Longitudinal analysis included three examinations (exam 1, 6 years prior to MRI; exam 2, MRI; exam 3, 4 years after MRI). Psychosocial outcomes included PHQ-9 (Patient Health Questionnaire), DEEX (Depression and Exhaustion Scale), PSS-10 (Perceived Stress Scale) and a Somatization Scale. Univariate analyses and adjusted linear mixed models were calculated. Among 855 included individuals, 25% (n = 212) underwent MRI and 6% (n = 50) had at least one reported IF. Compared to MRI participants, non-participants had a higher psychosocial burden indicated by PHQ-9 in exam 1 (3.3 ± 3.3 vs. 2.5 ± 2.3) and DEEX (8.6 ± 4.7 vs. 7.7 ± 4.4), Somatization Scale (5.9 ± 4.3 vs. 4.8 ± 3.8) and PSS-10 (14.7 ± 5.7 vs. 13.7 ± 5.3, all p < 0.05) in exam 3. MRI participation without IF reporting was significantly associated with lower values of DEEX, PHQ-9 and Somatization Scale. There were no significant differences at the three timepoints between MRI participants with and without IF. In conclusion, individuals who voluntarily participated in whole-body MRI had less psychosocial burden and imaging and IF reporting were not associated with adverse long-term psychosocial consequences. However, due to the study design we cannot conclude that the MRI exam itself represented a beneficial intervention causing improvement in mental health scores.

Workers compensation patients experiencing depression report meaningful improvement in mental health scores after anterior cervical discectomy and fusion

BackgroundMental health has been demonstrated to affect postoperative outcomes. No prior literature has reported the relationship between preoperative mental health on outcomes following anterior cervical discectomy and fusion (ACDF) in the Workers Compensation (WC) population. MethodsWC claimants who underwent primary ACDF were identified from a single-surgeon retrospective database. Patients were separated by SF-12 MCS score into Depressed (<45.6) or Not Depressed (ND) (≥45.6) cohorts. Patient-reported Outcome Measurement Information System Physical Function (PROMIS PF), SF-12 Physical Component Score (SF-12 PCS), SF-12 MCS, visual analog scale (VAS) neck/arm pain, and Neck Disability Index (NDI) were collected and compared within and between groups. Minimum clinically important difference (MCID) achievement rates were compared between groups. ResultsDepressed patients had greater length of stay (p = 0.007) and postoperative narcotic consumption (p = 0.026). Depressed patients improved at 12-week to 2-year PROMIS PF, 6-month SF-12 PCS, 6-week to 6-month SF-12 MCS, 6-week to 6-month and 2-year VAS neck, all VAS arm, and 6-month NDI (p ≤ 0.045, all). ND patients improved at 12-week to 1-year PROMIS PF, 6-month to 2-year SF-12 PCS, 12-week to 1-year VAS neck, 6-week to 1-year VAS arm, and 12-week to 1-year NDI (p ≤ 0.044, all). Between groups, ND patients reported superior PROMIS PF, SF-12 MCS, VAS neck, VAS arm, and NDI scores at two or more periods (p ≤ 0.045, all). MCID achievement rate regarding SF-12 MCS was greater in the Depressed cohort at all postoperative points up to 1 year (p ≤ 0.020, all). ConclusionDepressed patients tended to have a greater length of stay and postoperative narcotic consumption immediately after surgery. Not depressed patients reported more favorable physical and mental function, pain, and disability scores preoperatively and postoperatively. Depressed patients reported greater MCID achievement in mental function following surgery. Depressed patients with WC have a greater likelihood of reporting tangible improvement in mental health scores following ACDF.

Quality of life assessment after parathyroidectomy in symptomatic primary hyperparathyroidism using the SF-36 questionnaire.

Primary hyperparathyroidism (PHPT) is a systemic disease which, along with bone and stone disease, also causes several subjective symptoms which impairs the quality of life (QoL). However, NIH guidelines do not include non-specific physical and neuropsychological symptoms as an indication of parathyroidectomy. SF-36 is one of the most commonly used tools for assessing QoL; it measures both physical health (PH) and mental health (MH). This is a prospective observational study including 50 patients of symptomatic PHPT. Patients were categorized into normocalcemia (8.5-10.4 mg/dL), mild hypercalcemia (10.5-11.9 mg/dL), moderate hypercalcemia (12-13.9 mg/dL), and severe hypercalcemia (>14 mg/dL). QoL was assessed by using SF36 survey both pre-operative and three months after parathyroidectomy. There was an overall improvement in QoL of individual groups both in PH and MH components (p <0.001). The improvement was more substantial for bodily pain, role physical, vitality and mental health. Although QoL was affected in patients with mild hypercalcemia, it was more affected in patients with severe hypercalcemia. The improvement in MH scores was dependent on the level of pre-operative calcium; however, the improvement in PH scores was independent of pre-operative calcium (p= 0.698). This study showed improvement in all aspects of PH and MH of SF-36 after parathyroidectomy, even in normocalcemics. Despite the fact that current guidelines for the management of PHPT do not include QoL as an indication for parathyroidectomy, we propose that parathyroidectomy should be considered, if patient is fit for surgery.

Associations Between Smoking Status and Physical and Mental Health-Related Quality of Life Among Individuals With Mobility Impairments.

In the general population, quitting smoking is associated with improved health-related quality of life (QoL), but this association has not been examined in smokers with chronic mobility impairments (MIs). We examined associations between smoking status and health-related QoL over 6 months, and whether relationships are moderated by depression and MI severity. This is a secondary analysis of a smoking cessation induction trial among smokers with MIs (n = 241, 56% female, 36% Black) assessed at baseline, and 4 and 6 months after. Participants were grouped into "Smokers" (smoking at 4 and 6 months), "Abstainers" (quit at 4 and 6 months), "Relapsers" (relapsed at 6 months), and "Late-quitters" (quit at 6 months). Physical and mental health-related QoL was assessed with the Short-Form Health Survey. Depression was defined as scores ≥10 on the Patient Health Questionnaire, and MI severity by the use of skilled care for personal needs. Data were analyzed with linear mixed models. Aggregating across time, among nondepressed participants, compared with "Smokers," the "Abstainer," and "Late-quitter" groups improved their physical health scores. "Late-quitters" also improved compared with "Relapsers." Among the total sample, compared with "Smokers," "Abstainers" showed improvements in mental health scores overtime, whereas "Relapsers" improved their score at 4 months, and "Late-quitters" improved at 6 months. Quitting smoking is associated with improvements in physical health-related QoL regardless of the severity of MI but only among those without depression at baseline. For mental health-related QoL, associations with quitting smoking were independent of baseline depression and severity of MI.

Evaluation of NHS Practitioner Health: capturing mental health outcomes using five instruments.

NHS Practitioner Health is the England wide programme providing mental health and addiction healthcare to doctors and dentists. Outcomes are assessed using five measures. To contribute to a service evaluation of NHS Practitioner Health. To determine responsiveness to change and compare outcome measures. Measures were completed at baseline and 6 months: Generalized Anxiety Disorder Assessment (GAD-7), Perceived Stress Scale (PSS), Patient Health Questionaire-9 (PHQ-9), Warwick-Edinburgh Mental Wellbeing scale (WEMWBS), Psychological Outcome Profiles (PSYCHLOPS). Responsiveness to change was determined using effect size with improvement threshold ≥0.80. Instruments were compared using Bland-Altman plots. Our sample, n = 402; with 14 (3.5%) excluded for missing data; final sample, n = 388. All measures showed strong mean effect sizes: PSYCHLOPS 1.86 (95%CI 1.73-1.99), 75.8% ≥0.80; PSS 1.48 (1.34-1.62), 64.4% ≥0.80; WEMWBS 1.24 (1.13-1.35), 58.2% ≥0.80; GAD-7 1.07 (0.96-1.18), 52.8% ≥0.80; PHQ-9 0.86 (0.76-0.96), 52.8% ≥0.80. Findings were largely unchanged after stratification by diagnosis, presenting problem or therapy type. Fifty (12.9%) participants did not reach the threshold for improvement on any instrument. Bland-Altman plots indicated generally strong agreement between measures; combining PSYCHLOPS with WEMWBS maximised capture of improvement with only 3.6% of patients lying outside limits of agreement; GAD-7 was most likely to duplicate recovery scores of other measures. Patients attending the NHS Practitioner Health service demonstrated high levels of improvement in mental health scores. The patient-generated instrument produced higher change scores than standardised instruments. Combining PSYCHLOPS and WEMWBS captured 96% of patients with above threshold improvement; GAD-7 added little to overall recovery measurement.

Desiccated Thyroid Extract Versus Synthetic LT4/T3 Combination Versus LT4 Monotherapy in the Treatment of Primary Hypothyroidism With Special Attention to the Thr92AlaD2 Polymorphism. With Special Attention to the Gene Polymorphism

Introduction: Before the availability of levothyroxine (LT4), patients were treated with desiccated thyroid extract (DTE). When switching from DTE to LT4, despite adequate dosing based on serum TSH levels, some patients still feel unwell with fatigue, mental fogginess, weight gain etc. A recent randomized, crossed over study between DTE vs. LT4 conducted in our department showed that once-daily DTE caused modest weight loss and possible improvement in mental health scores without appreciable adverse effects; also, nearly half of the study patients preferred DTE over LT4. A few studies have shown that LT4/T3 combination had beneficial effects in improving quality of life relative to LT4 alone. Furthermore, it has been reported that patients with CC genotype in the deiodinase type 2 polymorphism responded more favorably with LT4/T3 combination than T4 monotherapy. Hypothesis: This study investigated the efficacy and effectiveness of DTE vs. LT4/T3 combination vs. LT4 monotherapy in hypothyroid patients based on genotypic differences of deiodinase type 2. Methodology: This was a prospective, randomized, double-blind, crossover study. 75 subjects completed the study. There were 3 arms: DTE, LT4+T3 combination, and LT4 alone. Each subject was randomly allocated to one of these 3 arms for 12 weeks randomly. The study was powered to detect the primary outcome. The primary endpoint was post-treatment score on the 36-point thyroid symptom questionnaire. Secondary endpoints were weight, general health questionnaire, the Beck depression inventory, Wechsler Memory testing, lipid panels and thyroid function tests. Analysis was performed with a linear mixed model using subject as a random factor and group as a fixed effect. Results: There was no significant difference between the 3 arms on the thyroid symptom questionnaire (p=.32), and the secondary outcomes showed no between group differences. Auditory memory index (p=.008), and visual working memory index (p=.02) were higher in the Hashimoto’s than non-Hashimoto’s group. There was no significant primary or secondary outcome difference among various genotypes of deiodinase 2. There was no relationship between Hashimoto’s vs. non-Hashimoto’s based on genotypes or likelihood of carrying Thr92AlaD2 polymorphism. Though there was no statistically significant preference for any treatment, numerically more patients with Hashimoto’s preferred DTE and LT4/T3 combination than LT4-monotherapy. Conclusions: There was no significant difference between hypothyroid patients taking DTE vs. LT4/T3 combination vs. LT4 monotherapy. Numerically, Hashimoto’s patients tended to prefer DTE and LT4/T3 combination. Also, there was no observed relationship between Hashimoto’s and polymorphism. Further studies with more patients may be needed.

P55. Obese patients achieve similar mental health benefit as nonobese patients after adult spinal deformity surgery

BACKGROUND CONTEXT Previous research on the impact of obesity on outcomes after adult spinal deformity surgery has reported radiographic and clinical outcomes, but no analysis has compared the mental health status and outcomes in these patients. PURPOSE This study examines the pre- and postoperative SF 36 mental health status in obese and non-obese patients undergoing correction of adult degenerative scoliosis. STUDY DESIGN/SETTING Multicenter prospective analysis of adult spinal deformity database. PATIENT SAMPLE A prospective, multicenter database of ASD patients was reviewed. Patients who had at least 2 years follow-up were analyzed. OUTCOME MEASURES Demographic and pre- and post-operative SF-36 mental health scores were assessed. A BMI threshold of 35 was selected to more accurately reflect real-world perception of obesity. METHODS A prospective database was analyzed using paired t-test and Mann-Whitney U analysis for continuous variables and Chi-Square analysis for categorical variables. RESULTS A total of 120 patients were included; 60 had a BMI 35. Patients were propensity matched on pre-operative SVA, PI-LL, and Cobb angle. There were no differences between groups in age, number of levels instrumented, pre-operative back pain, ODI, SRS-22, Sacral slope, Cobb angle or PI-LL. When comparing patients with a BMI threshold of 35, there was no difference in pre-operative mental health (42 vs 44.2; p CONCLUSIONS In this prospective evaluation of a large database of patients undergoing correction of ASD, patients with BMI >35 were not significantly different from non-obese patients pre-operatively or post-operatively. Furthermore, they experience similar improvement in mental health scores post-operatively compared to non-obese patients. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Effect of Monthly High-Dose Vitamin D on Mental Health in Older Adults: Secondary Analysis of a RCT.

To test the effect of monthly high-dose vitamin D supplementation on mental health in pre-frail older adults. Ancillary study of a 1-year double-blind randomized clinical trial conducted in Zurich, Switzerland. A total of 200 community-dwelling adults 70 years and older with a prior fall event in the last year. Participants were randomized to receive 24 000 IU vitamin D3 (considered standard of care), 60 000 IU vitamin D3 , or 24 000 IU vitamin D3 plus 300 μg calcifediol per month. The primary end point was the Mental Component Summary (MCS) of the SF-36. Secondary end points were the SF-36 Mental Health (MH) subscale and the Geriatric Depression Scale (GDS-15). Participants' mean age was 78 years (67% women), and 58% were vitamin D deficient (<20 ng/mL). Over time, primary and secondary end points did not differ significantly among the three treatment groups or in subgroups by vitamin D status at baseline. Given the lack of a true placebo group, we explored in a predefined observational analysis the change in mental health scales by achieved 25(OH)D levels at 12 months. After adjusting for confounders, participants achieving the highest 25(OH)D quartile (Q) at 12 months (44.7-98.9 ng/mL) had the greatest improvements in MCS (Q4 = 0.79 vs Q1 = -2.9; p = .03) and MH scales (Q4 = 2.54 vs Q1 = -3.07; p = .03); these associations were strongest among participants who were vitamin D deficient at baseline. No association was found for GDS (p = .89). For mental health, our study suggests no benefit of higher monthly doses of vitamin D3 compared with the standard monthly dose of 24 000 IU. However, irrespective of vitamin D treatment dose, achieving higher 25(OH)D levels at 12-month follow-up was associated with a small, clinically uncertain but statistically significant improvement in mental health scores.

Feasibility of a UK community-based, eTherapy mental health service in Greater Manchester: repeated-measures and between-groups study of ‘Living Life to the Full Interactive’, ‘Sleepio’ and ‘Breaking Free Online’ at ‘Self Help Services’

ObjectivesThere is increasing evidence to support the effectiveness of eTherapies for mental health, although limited data have been reported from community-based services. Therefore, this service evaluation reports on feasibility and...

Remote Ambulatory Management of Veterans with Obstructive Sleep Apnea.

Despite significant medical sequelae of obstructive sleep apnea (OSA), the condition remains undiagnosed and untreated in many affected individuals. We explored the feasibility of a comprehensive, telemedicine-based OSA management pathway in a community-based Veteran cohort. This prospective, parallel-group randomized pilot study assessed feasibility of a telemedicine-based pathway for OSA evaluation and management in comparison to a more traditional, in-person care model. The study included 60 Veterans at the Philadelphia Veterans Affairs Medical Center and two affiliated community-based outpatient clinics. Telemedicine pathway feasibility, acceptability, and outcomes were assessed through a variety of quantitative (Functional Outcomes of Sleep Questionnaire, dropout rates, positive airway pressure [PAP] adherence rates, participant satisfaction ratings) and qualitative (verbal feedback) metrics. There was no significant difference in functional outcome changes, patient satisfaction, dropout rates, or objectively measured PAP adherence between groups after 3 months of treatment. Telemedicine participants showed greater improvement in mental health scores, and their feedback was overwhelmingly positive. Our pilot study suggests that telemedicine-based management of OSA patients is feasible in terms of patient functional outcomes and overall satisfaction with care. Future studies should include larger populations to further elucidate these findings while assessing provider- and patient-related cost effectiveness.

Is Stroke Early Supported Discharge still effective in practice? A prospective comparative study

Objective: Randomised controlled trials have shown the benefits of Early Supported Discharge (ESD) of stroke survivors. Our aim was to evaluate whether ESD is still beneficial when operating in the complex context of frontline healthcare provision. Design: We conducted a cohort study with quasi experimental design. A total of 293 stroke survivors (transfer independently or with assistance of one, identified rehabilitation goals) within two naturally formed groups were recruited from two acute stroke units: ‘ESD’ n=135 and ‘Non ESD’ n=158 and 84 caregivers. The ‘ESD’ group accessed either of two ESD services operating in Nottinghamshire, UK. The ‘Non ESD’ group experienced standard practices for discharge and onward referral. Outcome measures (primary: Barthel Index) were administered at baseline, 6 weeks, 6 months and 12 months. Results: The ESD group had a significantly shorter length of hospital stay (P=0.029) and reported significantly higher levels of satisfaction with services received (P<0.001). Following adjustment for age differences at baseline, participants in the ESD group (n=71) had significantly higher odds (compared to the Non ESD group, n=85) of being in the ⩾90 Barthel Index category at 6 weeks (OR = 1.557, 95% CI 2.579 to 8.733), 6 months (OR = 1.541, 95% CI 2.617 to 8.340) and 12 months (OR 0.837, 95% CI 1.306 to 4.087) respectively in relation to baseline. Carers of patients accessing ESD services showed significant improvement in mental health scores (P<0.01). Conclusion: The health benefits of ESD are still evident when evidence based models of these services are implemented in practice.

Influence of low back pain on total knee arthroplasty outcome

BackgroundPreoperative pain and functional status are strong determinants of postsurgical success in total knee arthroplasty. Patients suffering chronic pain from other coexistent musculoskeletal problems may respond differently postoperatively, with potentially poorer outcomes after surgery. The aim of the study was to determine the influence of low back pain on the outcome of total knee replacement surgery. MethodsAll patients completed Oxford Knee Scores (OKS), American Knee Society Scores (AKSS) and SF-12 (both physical and mental components). Patients were divided into those with (n=40) and without a documented history of low back pain (n=305). ResultsOKS, AKSS and SF-12 physical scores were significantly worse for patients with low back pain at 24months following surgery. The mental component of the SF-12 measure demonstrated a significant improvement in median mental health post-operatively for patients with no current history of low back pain. In contrast the group with low back pain showed no improvement in mental health scores post-operatively. ConclusionThis study demonstrates that symptomatic low back pain influences functional outcome after total knee arthroplasty surgery and that patients with low back pain show limited or no improvement in mental health post-operatively.Level of evidence II.

Does Starting With the Behavioural Component of Cognitive Behavioural Therapy (CBT) Increase Patients’ Retention in Therapy?

This study examined whether starting with the behavioural component of cognitive behavioural therapy (CBT) decreases the drop-out rate in outpatients with comorbid anxiety and depression. Retrospective data were collected on 60 patients with anxiety and depression. Mean values of different psychosocial assessment scales during screening, mid-session and discharge session were compared between the patients receiving and not receiving any type of behavioural interventions and among the patients receiving different types of behavioural interventions. A significant relationship was found (p &lt; .05) between behavioural interventions and retention in therapy. Patients who did not receive any sort of behavioural intervention showed a greater rate of drop-out than those who received behavioural interventions. In the group of patients receiving different types of behavioural interventions, there was significant improvement in mental health scores between the screening and discharge sessions in those who received exposure therapy. The study findings will be helpful to retain patients with comorbid anxiety and depression in an outpatient therapy setting. If patient retention is increased, CBT can be more effectively delivered and thereby achieve better health outcomes for patients, more effective use of therapy service resources, and decrease the socioeconomic burden of anxiety and depression on the community.

An evaluation of an intervention sequence outline in positive behaviour support for people with autism and severe escape-motivated challenging behaviour

Background Positive behaviour support emphasises the impact of contextual variables to enhance participation, choice, and quality of life. This study evaluates a sequence for implementing changes to key contextual variables for 4 individuals. Interventions were maintained and data collection continued over a 3-year period.Method Functional assessments were conducted with 4 individuals with exceptionally severe challenging behaviours. Interventions were based on the multi-element model of behavioural support (LaVigna & Willis, 2005a). Dependent variables were behavioural ratings of (1) frequency, (2) episodic severity, (3) episodic management difficulty, and measures of (4) mental health status, and (5) quality of life. The intervention sequence was low arousal environment, rapport building, predictability, functionally equivalent skills teaching, and differential reinforcement strategies.Results Substantial reductions in target behaviours were observed, along with incremental improvement in mental health scores and quality-of-life scores.Conclusion The study demonstrates the efficacy of positive behaviour support for people with exceptionally severe behaviour in individually designed services.

Commentary on: Quality of Life Evaluation of Patients Undergoing Lumbar Discectomy Using Short Form 36.

Dear Editor, I have recently reviewed the interesting article by Farzanegan et al. (1), published in the 2011 issue of the Anesthesiology and Pain Medicine: “Quality of life (QOL) evaluation of patients undergoing lumbar discectomy using Short Form 36”. Lumbar discectomy improved both the physical and mental health subscales in patients’ QOL with chronic disc herniation. The mean improvement in physical health scores was significantly higher in the female patients, than in the male subjects. However, there are no statistically significant differences in the improvement in mental health scores between the two sexes, or their education levels and body mass index’ (BMI). Lumbar radiculopathy is a disease, and lumbar discectomy is the most common surgical procedure for patients who are experiencing back and leg pain as a result of herniated discs. It is well-known that surgical procedures such as; percutaneous endoscopic discectomy, lumbar microdiscectomy, or spinal fusion, improve the patients’ QOL after 6 months. Also QOL improves more quickly in surgically treated patients, then in those treated conservatively. The results of this article are consistent with previous studies. Depression plays a role in pain; it is a major contributor to how pain is processed and coped with, affecting QOL and disability after back surgery. Patients with more depressive symptoms preoperatively, were less likely to achieve clinically significant improvements in disability and QOL following lumbar discectomy (2). Hence, patients with depressive symptoms may benefit from preoperative psychological treatment, with the aim of improving their outcomes. Patients with psychological comorbidities often experience long-term disability from low-back pain. In the present study, the Short Form 36 (SF-36) questionnaire was used to assess QOL after lumbar surgery. The SF-36 consists of eight sections, which are; vitality, physical functioning, bodily pain, general health perceptions, physical role functioning, emotional role functioning, social functioning, and mental health. Despite the fact that the SF-36 has a number of advantages for the evaluation of QOL, there is still a need for greater precision in measuring QOL. In addition, this article lacks an interpretation of why educational levels and BMI do not affect the SF-36. In chronic low back pain patients, pain severity is more strongly related to being overweight and psychological factors than to pathophysiological changes (3). Although, this study has a few demerits, Farzanegan et al. have provided evidence that lumbar discectomy is a safe and effective technique to improve both the physical and mental health subscales of the QOL in patients with chronic disc herniation.

Quality-of-Life Evaluation of Patients Undergoing Lumbar Discectomy Using Short Form 36

Background: Back pain is one of the most common health problems for which physicians are consulted, and it can considerably decrease the quality of life of patients during a great part of their lives. Objectives: Our study was designed for assessing the improvement in the quality of life of patients undergoing lumbar discectomy for chronic low back pain. Patients and Methods: We included 148 patients with chronic low back pain in the analytic observational study. Using the 36-Item Short-Form Health Survey (SF-36), we evaluated the quality of life before and 6 and 12 months after lumbar discectomy. Results: Physical and mental health scores of patients significantly improved after 6 and 12 months of lumbar discectomy. The mean improvement in physical health scores was significantly higher in female patients than in male patients. However, the improvement in mental health scores was not significantly difference between the 2 sexes and the educational and body mass index (BMI) groups. Conclusions: Lumbar discectomy improves both the physical and mental health subscale of the quality of life in patients with chronic disc herniation.

Quality-of-Life Evaluation of Patients Undergoing Lumbar Discectomy Using Short Form 36.

Background:Back pain is one of the most common health problems for which physicians are consulted, and it can considerably decrease the quality of life of patients during a great part of their lives.Objectives:Our study was designed for assessing the improvement in the quality of life of patients undergoing lumbar discectomy for chronic low back pain.Patients and Methods:We included 148 patients with chronic low back pain in the analytic observational study. Using the 36-Item Short-Form Health Survey (SF-36), we evaluated the quality of life before and 6 and 12 months after lumbar discectomy.Results:Physical and mental health scores of patients significantly improved after 6 and 12 months of lumbar discectomy. The mean improvement in physical health scores was significantly higher in female patients than in male patients. However, the improvement in mental health scores was not significantly difference between the 2 sexes and the educational and body mass index (BMI) groups.Conclusions:Lumbar discectomy improves both the physical and mental health subscale of the quality of life in patients with chronic disc herniation.