Lower Symptom Levels Research Articles

Relations among Maternal Employment, Depressive Symptoms, Breastfeeding Duration, and Body Mass Index Trajectories in Early Childhood

Purpose: The present study aimed to examine the longitudinal associations among maternal employment, breastfeeding duration, and body mass index (BMI) trajectories in early childhood. Drawing from the process model of the determinants of parenting, this study particularly focused on the mediating role of depressive symptoms in these links.Methods: This study analyzed the data of 2,059 mothers and their children from the panel study on Korean children. A latent growth curve analysis was conducted to investigate the paths linking maternal employment to BMI trajectories during the preschool years.Results: Maternal employment was associated with low levels of depressive symptoms, which in turn predicted a longer duration of breastfeeding. Second, maternal employment had direct adverse effects on the breastfeeding duration. We also found that longer duration of breastfeeding contributed to the low levels of BMI in early childhood.Conclusion: The findings highlight the importance of maternal mental health and breastfeeding duration to prevent obesity in early childhood. Moreover, the results suggest that a distinct approach for working and stay-at-home mothers needs to be considered for the promotion of breastfeeding.

How do different chronic condition comorbidities affect changes in depressive symptoms of middle aged and older adults?

BackgroundDifferent types of chronic condition comorbidities can have dissimilar effects on the improvements or deterioration of mental health in older adults. This study aims to examine the impacts of different types of chronic conditions on inter-temporal trends of depressive symptoms. MethodsData on 11,457 adults from age 45 in the China Health and Retirement Longitudinal Study (CHARLS) 2011–2015 were used to estimate the prevalence of comorbidities. We used latent class analysis to identify patterns of how depressive symptoms changed over time, then estimated the odds ratios of worsening or improved levels of depression by types of chronic conditions. ResultsPrevalence of depression differed by types of chronic condition comorbidities. Dyslipidemia, asthma, liver disease, kidney disease, stomach or other digestive disease, and arthritis or rheumatism were significant risk factors for worsening of depressive symptoms over time among people with low levels of depressive symptoms at baseline. Among people with higher levels of depression at baseline, arthritis, stroke, digestive, and memory-related diseases were risk factors for not improving. LimitationsFindings are unlikely to be generalizable to subpopulations with severe levels of physical or mental disabilities as they are unlikely to be captured in the surveys. ConclusionsGiven these specific physical health conditions’ effects on mental health, clinicians can consider patients’ mental health in their repertoire with regards to particular diseases.

Satisfaction with life and depressive symptoms in living organ donors and non-donors: New insights from the National Living Donor Assistance Center.

Previous studies indicate there may be psychological consequences of being unable to serve as a living donor, but these have not been explored in a large national cohort of low-income individuals who initiated living donor evaluation in US transplant centers. Using data from 6574 National Living Donor Assistance Center (NLDAC) participants (November 1, 2007-December 31, 2018), we utilized a cross-sectional study design to evaluate short-term depressive symptoms and satisfaction with life in living donors and non-donors (those who were declined or withdrew from evaluation) using the Satisfaction with Life Scale (SWLS) and the PHQ-8, with and without risk adjustment using linear regression. National Living Donor Assistance Center participants originated from 207 US transplant centers. 52% of NLDAC participants responded to the survey (n=3423; donors=2848 (58.6% of all donors), non-donors=575 (33.5% of all non-donors); ncenters =201)). Respondents were significantly older, more likely to be female, white, non-Hispanic, married, more educated, more full-time employed, and more likely to be unrelated to the recipient vs non-respondents (all, P<.001). Among survey respondents, donors were significantly younger, more likely to be non-Hispanic, employed, and related to the recipient compared to non-donors (all, P<.05). Higher PHQ-8 scores were correlated with lower SWL scores (r=-.32, P<.001). Both groups displayed high SWLS (donors vs non-donors: 27.1 vs 26.3, P=.002). Both groups had low levels of depressive symptoms overall, but donors had more symptoms than non-donors (3.5 vs 2.4, P<.001). After risk adjustment, non-donors had significantly less depressive symptoms by PHQ-8 (28% lower, P<.001), but had lower life satisfaction (1.2 points lower, P<.001). Donors and non-donors have high global levels of overall life satisfaction and low levels of depressive symptoms at 8weeks after donation or denial. While small effect sizes were observed between groups in these outcomes, being a non-donor was an independent risk factor for lower life satisfaction, which warrants further evaluation.

Development of a bereavement intervention for spousal carers of persons with dementia: The Reclaiming Yourself tool.

A dearth of supportive interventions exists for bereaved spouses who were carers of persons with dementia, despite an identified need for such supports. The purpose of the current work was to develop and evaluate a supportive writing intervention for this population that was informed by the experiences of spouses who were bereaved and was specific to the unique context of dementia. Following development of the Reclaiming Yourself tool, a mixed methods design was utilized to assess its effects on grief, depressive symptoms, and balance between restoration and loss. Fifteen participants residing in Saskatchewan and Manitoba were provided the writing intervention and visited three times approximately four weeks apart, completing quantitative measures (for grief, depressive symptoms, and finding balance) at each visit and an exit interview about the intervention. Paired-sample t-tests illustrated trivial effect sizes and no significant differences in grief, depressive symptoms, or balance orientation, with overall means suggesting low levels of depressive symptoms and grief, and a slight orientation towards restoration. Thematic analysis illustrated benefits from the tool, with participants reporting that it provided a structured approach to grief, was a catalyst for emotional expression, and facilitated reflection. The format and timing of the intervention was not ideal for all participants. Although Reclaiming Yourself did not affect quantitatively measured grief, depressive symptoms, and balance, carers accrued benefits from the tool that align with beneficial processes observed in other writing interventions. While more research on the effectiveness of this tool is needed, such interventions are valuable to support the well-being of carers who are bereaved following the death of a spouse with dementia.

Predeployment neurocognitive functioning predicts postdeployment posttraumatic stress in Army personnel.

The Fort Campbell Cohort study was designed to assess predeployment biological and behavioral markers and build predictive models to identify risk and resilience for posttraumatic stress disorder (PTSD) following deployment. This article addresses neurocognitive functioning variables as potential prospective predictors. In a sample of 403 soldiers, we examined whether PTSD symptom severity (using the PTSD Checklist) as well as posttraumatic stress trajectories could be prospectively predicted by measures of executive functioning (using two web-based tasks from WebNeuro) assessed predeployment. Controlling for age, gender, education, prior number of deployments, childhood trauma exposure, and PTSD symptom severity at Phase 1, linear regression models revealed that predeployment sustained attention and inhibitory control performance were significantly associated with postdeployment PTSD symptom severity. We also identified two posttraumatic stress trajectories utilizing latent growth mixture models. The "resilient" group consisted of 90.9% of the soldiers who exhibited stable low levels of PTSD symptoms from pre- to postdeployment. The "increasing" group consisted of 9.1% of the soldiers, who exhibited an increase in PTSD symptoms following deployment, crossing a threshold for diagnosis based on PTSD Checklist scores. Logistic regression models predicting trajectory revealed a similar pattern of findings as the linear regression models, in which predeployment sustained attention (95% CI of odds ratio: 1.0109, 1.0558) and inhibitory control (95% CI: 1.0011, 1.0074) performance were significantly associated with postdeployment PTSD trajectory. These findings have clinical implications for understanding the pathogenesis of PTSD and building preventative programs for military personnel. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

My new normal: A patient's perspective on polymyalgia rheumatica

My new normal: A patient's perspective on polymyalgia rheumatica

Sex-Related Differences in Sleep-Related PSG Parameters and Daytime Complaints in a Clinical Population.

BackgroundRecent research suggested that perception of sleep impairments might present sex-related effects (ie, women appear to be more prone to report fatigue rather than sleepiness). The latter has been evidenced in sleep-related breathing disorders (SRBD). Differently, it has been suggested that sleep-related movement disorders may also be associated to fatigue rather than to sleepiness. Whether sex-related differences would be similar irrespective of diagnosis remains unclear.MethodsDuring a one-year period, systematic clinical evaluation, by means of structured symptom scales, was performed for a cohort of 921 consecutive patients attending an academic sleep center for polysomnography. The Brugmann Fatigue Scale (BFS), an instrument designed for the assessment of rest propensity was used among other scales (ie, Epworth Sleepiness Scale, ESS). According to inclusion and exclusion criteria, 420 men and 376 women were finally included in the study and retained for data analysis.ResultsWhile men and women presented with similar age, BMI, total sleep time and sleep efficiency, men presented with higher levels of respiratory events and more periodic limb movements. Irrespective of diagnosis, women presented with significantly higher levels of sleep-associated complaints on all scales. Comparative stratifications of daytime symptoms, per diagnostic groups (SRBD, Movement Disorders (SRMD) and Insomnia), revealed significant main effects for diagnosis alongside with main effects of biological sex. Associations between common markers of disease severity for SRBD or SRMD and sleep or rest propensity, respectively, only showed significant correlation between periodic limb movements and rest propensity. The strength of association was similarly significant for both sexes.ConclusionWhile men displayed more objective impairment on polysomnography (PSG) and lower symptom levels, the opposite was true in women. However, both men and women present with statistically significant associations between SRMD severity (PLMS index) and physical fatigue.

Anxiety, depression and personality traits in Italian medical students.

Anxiety and depressive symptoms are common worldwide and, according to the World Health Organization, their prevalence has increased in the last decades. Further, dysfunctional personality traits are frequently coupled with anxiety and depressive symptoms. The prevalence of these symptoms is particularly relevant in medical students. This study assessed the prevalence of anxiety and depressive symptoms in Italian medical students from the University of Modena and Reggio Emilia, by using the Hospital Anxiety and Depression Scale (HADS). Personality traits were assessed as well by employing the Personality Inventory for DSM-5, Brief Form (PID-5-BF), to explore their association with anxiety and depressive symptoms. A self-administered questionnaire was sent by e-mail to all the 944 students and 459 (48.6%) were enrolled. Besides the HADS and the PID-5-BF, the questionnaire included items concerning everyday life activities such as sports and academic features such as the years of attendance and average marks. A high prevalence of anxiety (n=92; 20%), depression (n=32; 7%), and comorbid anxiety-depressive symptoms (n=218; 47%) was reported. Multiple binary logistic analysis showed increased levels of anxiety and depression to be associated with personality traits, namely detachment and negative affect, and use of cognitive enhancers. On the other hand, sports activities, social activities and distraction were related to lower levels of symptoms. Symptoms of depression and anxiety are common among Italian medical students and specific interventions should be implemented to target them.

Prepared for transition? A cross-sectional descriptive study of the gains attained in early psychosis programs.

To examine the degree to which youth identified as ready for discharge from three Canadian early psychosis intervention (EPI) programs had achieved optimal outcomes (ie, symptom remission, quality of life, self-esteem and functioning). This cross-sectional descriptive study is part of a larger study assessing the effectiveness of an evidence-based intervention to sustain the gains acquired in EPI programs in two Canadian provinces (Ontario and Nova Scotia), as youth transition from EPI services to community-based care. Baseline data collected from 39 participants receiving usual treatment in these three EPI programs comprised the comparison group. Participants completed measures to assess symptoms, quality of life, self-esteem and functional level just prior to discharge. Participants demonstrated lower levels of symptoms, greater quality of life, greater self-esteem and greater levels of functioning, following EPI treatment when compared to similar youth described in the literature. These findings suggest that study participants had achieved optimal outcomes following EPI treatment. The study findings have laid the ground work for the current Canadian Institutes of Health Research partnership study in which our research group is assessing the effectiveness of an evidence-based transitional intervention in order to address critical psychosocial issues of identity, stigma, effective relationships and meaningful life goals, along with the development of an individualized 'passport for transition'. It is anticipated that implementing an evidence-based transitional intervention will support participants to maintain the gains made in EPI programs once they transition to community-based care and will inform future research addressing this challenging issue.

Exploring Developmental and Behavioral Heterogeneity among Preschoolers with ASD: A Cluster Analysis on Principal Components.

Children with autism spectrum disorder (ASD) present with heterogeneous levels of abilities and deficits. The identification of subgroups within a specific age range could be useful for understanding prognosis and treatment planning. We applied Hierarchical Clustering on Principal Components (HCPC) with a sample of 188 preschoolers with ASD and identified three distinct subgroups based on multiple developmental and behavioral domains. Cluster 1 was characterized by relatively high cognitive, language and adaptive abilities, and relatively low levels of social symptoms, repetitive behaviors, and sensory issues within the sample. Cluster 2 was characterized by similarly high cognitive, language and adaptive abilities compared to Cluster 1, but more severe social deficits as well as repetitive and sensory behaviors. Finally, Cluster 3 was characterized by lower cognitive, language and adaptive abilities, and more severe social, repetitive, and sensory symptoms. These findings provide insights into how considering multiple developmental and behavioral domains and core autism symptoms simultaneously can distinguish subgroups of young children with ASD and provide more comprehensive developmental profiles. Moreover, the unique profile of children in Cluster 2 highlighted the usefulness of including different measures and informants when evaluating the abilities and deficits of preschoolers with ASD and the importance of understanding the relationships among different developmental and behavioral factors in this specific population. Autism Res 2020, 13: 796-809. © 2020 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Children with autism exhibit a range of abilities and deficits in different developmental and behavioral areas, making it difficult to tailor treatment and predict outcomes. We identified three distinct subgroups among 188 preschoolers with autism spectrum disorder distinguished by the combination of measures from multiple developmental and behavioral domains. The findings revealed the importance of comprehensive profiling of the child's abilities and deficits to inform subgrouping within autism.

Associations between children's self-system functioning and depressive and posttraumatic stress symptoms following disaster.

This study examined correlates of posttraumatic stress symptoms (PTSS) and depressive symptoms among 6- to 10-year-olds affected directly by Hurricane Katrina and its aftermath. Research on the sequelae of disaster exposure for children has focused largely on aspects that contribute to increased distress or risk for disorder; fewer studies have investigated influences that may serve a positive function. This study sought to address that gap by examining the association between key children's socioemotional resources reflecting the self-system (perceived competence, future expectations, coping competency beliefs) and postdisaster symptomatology (PTSS, depressive symptoms) at approximately 12 and 22 months posthurricane. Participants included 66 caregiver-child dyads at Time 1 (T1) and 51 at Time 2 (T2), recruited in Louisiana and Mississippi. Study results indicate that higher levels of child self-system resources and self-views were associated with lower symptom levels. Although results were mixed across time points, the study's key findings were: (a) children's T1 levels of coping competency beliefs predicted lower PTSS at T2; and (b) children's positive future expectations at T1 predicted lower levels of depressive symptoms at T2. Results support the value of incorporating child socioemotional resource variables in disaster research and building on children's self-system resources via intervention pre- and postdisaster. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Relationship of body mass index, abdominal obesity, and metabolic parameters with depression among reproductive-age women

Background and objective: Obesity has been widely regarded as a public health concern because of its adverse impact on health. The aim of this study is to examine the relationship of body mass index, abdominal obesity, and metabolic parameters with depression among reproductive-age women. Subjects and methods: Two hundred and seventy-one women who admitted to the Endocrine and Diet Polyclinic of Izmir Bozyaka Training and Research Hospital, Turkey were included. Sociodemographic characteristics were gathered using a data collection form. Biochemical findings were examined in fasting blood samples and anthropometric measurements were taken. Depressive symptoms of participants were measured with Beck Depression Inventory. This study was performed with the permission from Chief Physician of Izmir Bozyaka Training and Research Hospital (No. 4.35.94.02-003) and approval from the Senate Ethics Committee of Hacettepe University Faculty of Medicine (Decision No. 431-1305). Results: Mean score of participants for Beck Depression Inventory was 17.8 ± 11.8. Body weight, body mass index and waist circumference were higher in the group with high level of depressive symptoms than in the group with low level of depressive symptoms (P Conclusion: In this study, it was determined that the level of depressive symptoms was higher in overweight or obese women than women with normal body weight. It may be useful to monitor women who apply for weight control in terms of risk of depression.

Exposure to fumigants in containers: a questionnaire assessment on 125 French dockers.

Cases of intoxications to gas from container's atmosphere have been described. For diagnosis, Fum Ex 2 questionnaire has been developed by the European Society for Environmental and Occupational Medicine. The aim of this study was to enhance knowledge on health effects of toxic substances in containers and to validate this questionnaire in medical follow-up and diagnosis. In 2014, 125 French dockers answered the questionnaire in a face-to-face interview. 83.5% declared no exposure to fumigants or pesticides. Most frequently declared symptoms were fatigue and neurological disorders for dockers and respiratory irritation for refrigeration technicians. Only 28 workers wore regularly individual protection equipment. A "healthy worker" effect could explain low level of symptoms. Fum Ex 2 questionnaire is relevant for diagnosis. Workers in all steps of the logistic transport chain and consumers are exposed to containers' atmosphere.

Disentangling the Relationship Between Self-Esteem and Problematic Alcohol Use Among College Students: Evidence From a Cluster Analytic Approach.

Investigation of the relationship between self-esteem and alcohol use among college students has yielded discrepant results. We hypothesized that these discrepancies could originate from a potential heterogeneity of self-esteem patterns among young adult with an alcohol use disorder (AUD). A community sample of 343 college students was recruited and categorized with or without AUD using the Alcohol Use Disorders Identification Test cut-offs. College students were compared on the dimensions of the Coopersmith Self-Esteem Inventory (CSEI) as well as mood, impulsiveness, alcohol- and other substance-related measures, including drinking motives. A cluster analysis conducted among college students with AUD highlighted two subgroups characterized by contrasting patterns on the CSEI: one group with a high level of self-esteem and low levels of anxiety and depression symptoms and one group with a low level of self-esteem and high levels of impulsiveness, mood symptoms and drinking to cope motives. Findings caution against assuming that AUD is associated with low self-esteem, as reported in previous studies. These results rather emphasize a heterogeneity of self-esteem in college students, showing that high self-esteem was also related to AUD. Implications of these results are major for prevention purposes and clinical practice.

THE EFFECT OF DISPOSITIONAL OPTIMISM ON SUCCESSFUL AGING OF OLDER ADULTS AND THEIR PARTNERS

The purpose of the study was to examine how dispositional optimism of an older adult influences both the individual’s and the spouse’s successful aging. Data from the Health and Retirement Study were included in this analysis. The age of participants ranged from 18 to 104 (M = 67.91, SD = 11.26). The successful aging components included low levels of depressive symptoms and low levels of difficulties in activities of daily living, subjective health, and cognition. A structural equation model was computed including optimism as a latent variable and four components of successful aging for older adults and their spouses, all from the same wave in 2014. The results of the study revealed that higher dispositional optimism of older adults significantly predicted lower depressive symptoms, lower difficulties with activities of daily living, better cognitive function, and higher subjective health, for older adults and their spouses. The results, in conclusion, support the notion that dispositional optimism not only plays a significant role in well-being for oneself but also benefits the partner’s well-being as well. Further research need to include other components of successful aging, such as social engagement, loneliness, and life satisfaction. In addition, including covariates, such as gender, educational attainment, race/ethnicity, and household income, will also further examine the effect of optimism above and beyond the demographic factors.

Psychological distress profiles in expectant mothers: What is the association with pregnancy-related and relational variables?

IntroductionResearch has progressively focused on antenatal psychological disease of expectant mothers, showing that anxiety and depression as well as fear of childbirth occur frequently during pregnancy. Some studies have investigated the connection between anxiety, depression, and fear of childbirth with contrasting results. Several authors have analyzed the association between psychological disease of pregnant women and numerous medical-obstetric and relational variables, still reporting inconclusive findings. The present study had three aims: 1) to investigate the psychological well-being of pregnant women based on their levels of anxiety, depression, and fear of childbirth, by identifying psychological profiles; (2) to analyze the association between the emergent psychological profiles and some medical-obstetric variables related to pregnancy; and (3) to examine the association between these profiles and couple's adjustment and social support. Methods410 Italian primiparous pregnant women in the 7th-8th month of pregnancy completed a questionnaire packet on site that included the following scales: Wijma Delivery Expectancy Questionnaire, Edinburgh Postnatal Depression Scale, State-Trait Anxiety Inventory, Dyadic Adjustment Scale, Multidimensional Scale of Perceived Social Support. ResultsFindings revealed the presence of three different clusters: “psychologically healthy women” (34.9%), comprised of women characterized by low levels of symptoms on all the scales; “women experiencing pregnancy- and childbirth-related anxiety” (47.3%), which groups women with an average state anxiety over the clinical value; and “psychologically distressed women” (17.8%), comprised of women who reported high levels of symptoms on all the scales, some above the clinical cut-offs. These profiles were not related to the medical-obstetric variables. On the other hand, findings revealed a significant association between marital adjustment as well as social support and cluster membership. DiscussionThese results support the importance of early and multilevel psychological screening in order to understand the experience of pregnant women and to develop targeted and increasingly personalized interventions.

Greater mindfulness associated with lower pain, fatigue, and psychological distress in women with metastatic breast cancer.

Women with metastatic breast cancer (MBC) report high levels of disease-related symptoms including pain, fatigue, psychological distress, and sleep disturbance. Mindfulness may be particularly relevant to women with MBC given the high symptom burden and psychological toll of this disease; however, the topic is understudied among this patient population. Therefore, we aimed to test the associations between mindfulness and patient-reported symptoms among a sample of women with MBC. Sixty-four women with MBC completed baseline questionnaires of mindfulness (Five Facet Mindfulness Questionnaire-Short Form [FFMQ-SF]) and symptoms of pain severity and interference, fatigue, psychological distress, and sleep disturbance as part of a randomized controlled trial of a Mindful Yoga intervention. Correlational analyses of data collected at baseline tested associations between the five mindfulness facets (observing, describing, acting with awareness, nonjudging, and nonreactivity) and patient-reported measures of symptoms. Overall, higher mindfulness was associated with lower symptom levels including lower pain severity, pain interference, fatigue, anxiety, depression, and sleep disturbance. However, degree of association varied by mindfulness facet. Nonreactivity, nonjudging, and describing showed the most frequent associations and largest effect sizes across symptoms, while observing showed the least frequent associations and lowest effect sizes. Mindfulness-and in particular nonreactivity, nonjudging, and describing-may be a personal resource for women with MBC in coping with complex symptoms of this life-threatening illness. Findings are discussed relative to their implications for interventions aimed at increasing mindfulness in this vulnerable population.

Psychological risk factors for exercise dependence

The main aim of this study was to investigate if exercisers' personality characteristics were associated with exercise dependence. Specifically, the purpose was to examine if anxiety, obsessive passion, and physical appearance orientation were associated to an increased risk for exercise dependence. Participants were 330 exercisers from exercise groups, sport clubs and university sport science classes in the southwest of Sweden. Data were analysed using CHAID (Chi-squared Automatic Interaction Detection) analysis. The CHAID analysis indicated that anxiety was the main predictor of exercise dependence. More specifically, 12.7% more exercisers who experienced high levels of anxiety symptoms (i.e. scores above 6), were, in comparison to the exercises experiencing low levels of anxiety, classified as “at risk for exercise dependence”. For exercisers that reported low levels of anxiety symptoms (i.e. scores below 7), obsessive passion for exercise was a positive statistically significant predictor (absolute risk difference = 8.6%). Overall, the results highlight anxiety as a main risk factor behind exercise dependence. Also, the risk of exercise dependence may increase either from obsessive passion or as a coping strategy for anxiety. Furthermore, results may illustrate two types of exercise dependence; “primary” exercise dependence driven mainly by an obsessive passion for exercise and “secondary” exercise dependence where exercise function as a strategy to cope with anxiety.

1618P - Internet-based stepped care for individuals with cancer and concurrent anxiety or depression symptoms: Results from a randomized controlled trial

BackgroundSymptoms of anxiety and depression are common in patients with cancer, and associated with impaired quality of life (QoL). The aim was to evaluate the effect of internet-based stepped care (iCAN-DO) on symptoms of anxiety and depression and QoL in patients with cancer, compared to standard care (SC). MethodsiCAN-DO was developed in cooperation between professionals and patients with cancer. Consecutive patients (N=245), with self-reported symptoms of anxiety and/or depression, according to the Hospital Anxiety and Depression Scale, were randomized to iCAN-DO or SC. iCAN-DO comprised interactive support, including psycho-education and self-care strategies (Step 1), and cognitive behavioural therapy (Step 2) for those with persistent symptoms 1, 4 and/or 7 months post randomization. Data was collected before randomization and at 1, 4, 7 and 10 months post randomization. ResultsOne-hundred and five of 124 patients (85%) used iCAN-DO to some extent and 49% completed the 10 months assessment. Patients randomized to iCAN-DO reported lower levels of symptoms of depression (mean 7.3 vs 6.2), and a clinically significant decrease of depression from baseline to 10 months (decrease 23% vs 8%), compared to standard care (p<0.05). In addition, the proportion of patients with clinical depression was smaller in iCAN-DO (15% vs 23%) compared to SC, at 10 months (p<0.05). There was now difference between iCAN-DO and SC with regard to symptoms of anxiety and QoL. ConclusionsInternet-based stepped care for patients with cancer who self-report symptoms of anxiety and/or depression is effective to decrease depression, for some patients. Further studies are needed to develop internet-based support to suit different needs, and competence to use information technologies. Clinical trial identificationNCT01630681. Legal entity responsible for the studyUppsala University Psychosocial Care Programme. FundingSwedish government, Forte Research Council, Swedish Cancer Society, Uppsala County Council. DisclosureAll authors have declared no conflicts of interest.

Knowledge regarding Heart Failure: A Reflection on Current Disease Knowledge State among Iranian Patients with Heart Failure

Background: Heart failure (HF) is a serious problem with an increasing prevalence globally. Low level of HF knowledge may cause low compliance and low quality of life and, poor self-care. On the other hand, assessing the level of HF knowledge is necessary in order to apply educational programs. Aims and objectives: the aim was to determine knowledge regarding HF among Iranian patients with HF. Study Design: This was a cross sectional study. Setting: We conducted this study at the HF clinic of Tehran Heart Center (THC) affiliated with Tehran University of Medical Sciences (TUMS, Tehran, Iran). Materials and Methods: In this cross-sectional study, 190 patients older than 18 years old, with confirmed diagnosis of HF for at least 3 months by an HF specialist, NYHA function class II to IV and an ability of reading and writing Farsi language were included during June 2017 and January 2018 by consecutive sampling. Data were gathered in a short form, including demographic and clinical variables. Knowledge regarding HF was measured by the Dutch HF knowledge scale (Cronbach’s alpha=0.62) with 15- multiple choice item. The score range varied between 0 (no knowledge) and 15 (optimum knowledge). Scores were reported totally and in 3 areas of knowledge. Scores higher than the median was considered as higher knowledge. Statistics: The SPSS software version 16 was used to describe data. Normality of continuous variables was checked by the Kolmogorov-Smirnoff test. Frequency and partial frequency distribution were used to describe Categorical variables. While, we used mean, median, standard deviation, and IQR for describing continuous variables. Results: From June 2017 to January 2018, 160/190 patients with median age (IQR) of 59 (16) years old participated in the study (response rate of 84.2%). 67.5% of study patients were male (83.5%). 87.5% of then were married. The majority of patients were with NYHA function class II (60.6%), and with an etiology of ischemic heart disease (65.0%). The median and IQR of total, general, HF treatment, and symptoms/ symptom recognition knowledge were 8 (7-10), 12 (9-14), 2 (1.25-3), and 4 (3-5), respectively. Low level of total, general, HF treatment, and symptoms and symptom recognition knowledge among Iranian patients with HF were 55%, 60%, 58.8%, and 71.9%, respectively. Conclusion: Patients with HF had low levels of total, general, HF treatment, and symptoms/symptom recognition knowledge. Thus, there is an essential need to be improved by an appropriate intervention, especially on knowledge of symptoms /symptom recognition.