Mental Health Measures Research Articles

Suitability of the DSM-5 social anxiety disorder severity scale for autistic adults.

Mental health measures used with autistic adults are often only evaluated for use with non-autistic adults, which may cause inaccurate measurement. This is important when measuring social anxiety disorder as some features overlap with social characteristics of autism. This study evaluated one self-report questionnaire measure of social anxiety disorder, the Severity Measure for Social Anxiety Disorder. The Severity Measure for Social Anxiety Disorder is based upon criteria for diagnosis of social anxiety disorder, and we aimed to understand its suitability for autistic adults. The Severity Measure for Social Anxiety Disorder was completed by 284 autistic adults and 80 non-autistic adults who were then asked five follow-up questions about ambiguous questions on the Severity Measure for Social Anxiety Disorder. We found that over half our sample of autistic adults, on at least one question, attributed their answer to something other than anxiety. Furthermore, in autistic adults, one underlying construct of social anxiety did not link their answers on the Severity Measure for Social Anxiety Disorder together, suggesting the Severity Measure for Social Anxiety Disorder might not be suited to capturing social anxiety disorder in autistic adults. To improve measurement, we rescored answers where participants said their response was due to something other than social anxiety, however, the rescored Severity Measure for Social Anxiety Disorder did not only capture social anxiety in autistic adults either. Finally, we analysed the reasons other than social anxiety autistic adults said influenced their answers. We grouped their responses into 10 categories, for example, 'fatigue', 'sensory overwhelm', and 'masking'. Overall, our findings suggest caution when using the Severity Measure for Social Anxiety Disorder with autistic adults, and the categories identified may suggest how to measure social anxiety more accurately in autistic adults.

Early motor developmental milestones and health outcomes in preadolescent children

IntroductionThe prevalence of depression and anxiety in children has risen in recent years, while childhood obesity and sedentary behavior continue to be a major public health concern. Existing evidence suggests early motor development and locomotor experiences contribute to psychosocial and physical development. By further understanding the far-reaching effects of early motor development, early life interventions aimed at preventing physical and mental health adversity may benefit from investigating early motor developmental milestones (MDM) attainment. The current study is the first to assess the longitudinal association between parent-reported gross MDM timing with objective measures of mental health, cardiorespiratory fitness (CRF), subcutaneous abdominal (SAAT), and visceral adipose tissue (VAT) outcomes later in childhood.MethodIn total, 131 children aged 8–11 years (46% female) were recruited. The parents of these children reported the age of attainment for five MDMs: holding their head unsupported, rolling over, sitting unsupported, standing, and walking independently. The study encompassed a comprehensive assessment, including measures of mental health, CRF (VO2 max), body–mass index (BMI), SAAT, and VAT. Data were analyzed using multiple stepwise linear regressions, adjusting for demographic and parental factors in Step 1 and including each MDM individually in Step 2.ResultsOur findings indicated earlier rolling over and walking were associated with higher CRF during preadolescence. Earlier rolling over was also linked to healthier BMI and lower levels of VAT, lower levels of trait anxiety, and fewer symptoms of depression.ConclusionThis study provides further evidence with potential clinical implications that parent-reported MDM age of attainment is related to later preadolescent physical and mental health. The age at which a child first rolls over emerges as a particularly predictive factor for various preadolescent health outcomes, highlighting the multi-finality of MDM timing in understanding developmental trajectories.

The importance of including a mental health dimension in a multimorbidity indicator: an analysis of Belgian health survey data

BackgroundMultimorbidity is a rising public health concern. Indicators that address these complex health conditions are often exclusively devoted to physical diseases. Because of their high disease burden, mental health disorders ought to be considered as well. This paper aims to measure the added value of including a mental health dimension in a population-based multimorbidity indicator and identify which mental health measures are most appropriate.MethodsSecondary analyses were conducted on data from the Belgian Health Interview Survey 2018. We compared the prevalence of different multimorbidity indicators (MIs) in relation to health impact measures, such as quality of life (EQ-5D score) and activity limitation (GALI). The MIs differed as to the health conditions involved: one was based on physical conditions only; the other three included mental health dimensions that were either self-reported or assessed by a scale (GAD-7, PHQ-9, and GHQ-12). We performed linear and logistic regressions to assess the association between the MIs and the health correlates and compared the goodness of fit of the different models.ResultsMI prevalence was higher when including a mental health dimension assessed with the GHQ-12 (42.0%) and with the GAD-7 or the PHQ-9 (39.4%) as compared to physical conditions only (35.0%). Associations between the MI and health correlates were consistently stronger if the MI included a mental health dimension. The regression models with MI including the GAD-7 and PHQ-9 showed the strongest association between MI and the health correlates and also had the best goodness-of-fit measures.ConclusionsMIs that only take physical conditions into account underestimate their impact on individuals’ lives. Including mental ill-health in an MI is key to linking it to health correlates.

SOME ASPECTS OF PSYCHOLOGICAL FUNCTIONING IN STUDENTS DURING THE COVID-19 PANDEMIC

The aim of this study was to investigate the relationship between certain socio-demographic characteristics (gender, year of study), loneliness, personality traits (extraversion, neuroticism, openness, conscientiousness, agreeableness) and certain aspects of students' psychological functioning (depression, anxiety, stress, life satisfaction) during the COVID-19 pandemic. In addition, the study aimed to identify differences in certain aspects of mental health between male and female students and between students in lower and higher years of study. The study comprised 712 participants, including 563 female and 149 male students. The proportion of first-year students was 27.6%, the proportion of second-year students was 17.8%, the proportion of third-year students was 19.3%, the proportion of fourth-year students was 13% and the proportion of fifth-year students was 19.7%. The survey was conducted in June 2021 using an online questionnaire. The results show that female students have higher levels of anxiety and stress, while male students report higher levels of loneliness. In addition, students in lower years of study reported higher levels of depression, anxiety, stress and loneliness, while students in higher years of study reported higher levels of life satisfaction. A statistically significant positive correlation was found between neuroticism and loneliness with measures of mental health (depression, anxiety and stress), while a negative correlation was observed with life satisfaction. Extraversion and conscientiousness showed a significant negative correlation with measures of mental health and a positive correlation with life satisfaction. In addition, openness was negatively correlated with stress and agreeableness was negatively correlated with depression. As the study found significant differences in the determinants of mental health between lower and upper year students, it is important to ensure the availability of professional support for all students, especially lower year students who are still adjusting to the new living conditions. These findings suggest that strategic priorities need to be set across universities to protect and actively promote students' mental health.

The role of existential concerns in borderline personality disorder and their responsiveness to dialectical behaviour therapy

ABSTRACT Objectives Existential concerns (i.e. death anxiety, isolation, identity, meaninglessness, and guilt) have increasingly been linked to various mental health conditions. Two studies were conducted to examine whether these are relevant to borderline personality disorder (BPD) and whether they are ameliorated through dialectical behaviour therapy (DBT). Methods In Study 1, 175 people reporting a BPD diagnosis were administered measures of existential concerns and mental health difficulties. Correlational analyses were conducted to examine relationships between existential concerns and measures of mental health. In Study 2, these measures were completed at baseline and post-treatment by 22 outpatients undertaking a standalone 16-week DBT skills training (DBT-ST) group program. The percentage of participants who made a clinically reliable change on each existential concern was then calculated. Results Study 1 indicated that all five existential concerns were above community norms, and were significantly correlated with mental health outcomes in BPD (i.e. depression, anxiety, stress, emotion regulation difficulties). In Study 2, only 33.3% (4/12) of participants made a clinically reliable improvement in their overall existential concerns following a 16-week DBT-ST group intervention. Conclusions These findings suggest that existential issues are pronounced in BPD, but show low responsiveness to the DBT-ST group intervention examined in the current study. Further research should examine whether existentially-informed treatments may be more efficacious.

A new perspective on the causal pathway between maternal mental health and neonatal adversity.

Substantial evidence suggests a downstream impact of maternal mental health on birth outcomes. The roles of comorbid maternal physical health and familial confounding underlying this association remain unclear. This cohort study included a random sample of children born 1997-2008 within a health maintenance organization (HMO) in Israel, their parents, and siblings. Outcomes were ICD-9 diagnoses of neonatal adversities (birth complications and congenital anomalies) and exposures were maternal diagnoses of mental health disorders. Odds ratios (ORs) and their 95% confidence intervals for the associations between maternal mental health diagnoses and measures of neonatal adversity were calculated using logistic regression, adjusting for maternal age, child's year of birth, socioeconomic status, and maternal physical morbidity burden. We examined potential familial confounding using a negative control approach based on paternal exposure. In our sample of 74,533 children, 6,674 (9.1%) were born after birth complications and 14,569 (19.9%) with a congenital anomaly. Maternal mental health diagnosis around pregnancy was significantly associated with these measures of neonatal adversity after adjustment for potential confounders (birth complications: OR = 1.3 (1.2-1.4), p < 0.001; congenital anomalies: OR = 1.2 (1.1-1.3), p < 0.001). These associations became attenuated and non-significant after further adjustment for maternal physical morbidity burden. In a joint model, maternal and paternal diagnosis of a mental health disorder were independently associated with neonatal adversity (birth complications: ORmat=1.3 (1.1-1.4), p < 0.001; ORpat=1.2 (1.1-1.3), p = 0.004; congenital anomalies: ORmat=1.2 (1.1-1.3), p < 0.001; ORpat=1.1 (1.0-1.2), p = 0.01). Physical health and familial factors play a role in the associations between maternal mental health and neonatal adversity.

Dyadic Comparison of Pain and Stress in Alzheimer's Disease and Caregivers

BackgroundMillions of people live with dementia worldwide, relying heavily on family caregivers. Pain is common in both people living with Alzheimer's disease (PLWAD) and their caregivers, contributing to stress and burden. To our knowledge, this is the first study to examine the relationship between pain, stress, hair cortisol, and mental health in PLWAD and their caregivers, and how these factors are linked to caregiver burden. MethodsThis exploratory pilot study included five PLWAD-caregiver dyads. Participants completed questionnaires on pain, mental health, and demographics. Hair samples were collected for cortisol analysis. Pearson correlation coefficients (r) were used to assess relationships between various factors of the PLWAD and their caregiver. ResultsContrary to expectations, PLWAD's pain and mental health measures displayed a trend of negative correlation with their hair cortisol levels (HCC). Conversely, caregiver pain and mental health measures had a trend of positive correlation with their HCC. There was also a trend that higher pain in PLWAD was associated with higher caregiver burden. ConclusionThis exploratory pilot study found associational trends suggesting a complex relationship between pain, mental health, and stress in PLWAD-caregiver dyads. This preliminary work will inform future studies which can help advance targeted, tailored interventions.

Psychological and Educational Challenges of Immigrant Adolescents in Italy: Exploring Mental Health, Life Satisfaction, Student–Teacher Relationship, and Academic Disparities

Adolescence is a critical stage marked by identity formation and social challenges, especially for adolescents with migratory backgrounds who must reconcile their ethnic identities with the dominant culture. This study explores the mental health, life satisfaction, student–teacher relationship, and academic achievement of Italian-born, second-generation, and first-generation immigrants. The sample of 680 adolescents (M = 382; F = 280; Prefer not to say = 18; Mean age = 16.77 years) includes native-born Italians (n = 244), second-generation immigrants (n = 210), and first-generation immigrants (n = 226). Data were collected using self-report measures for mental health, life satisfaction, student–teacher relationship, and school achievement. A Multivariate Analysis of Variance identified significant group differences, followed by post-hoc tests to further explore differences between the groups. Second-generation immigrants reported significantly lower emotional well-being compared to their Italian-born peers. Both first- and second-generation immigrants exhibited lower life satisfaction, particularly in peer relationships. In terms of student–teacher relationship, second-generation immigrants perceived higher levels of school danger compared to Italian-born adolescents, possibly driven by discrimination. Academic outcomes revealed significant disparities, with Italian-born students outperforming second-generation immigrants, highlighting the impact of acculturative and bicultural stress. The findings highlight the unique challenges second-generation immigrants face in Italy in balancing cultural integration with preserving their heritage.

Project G-SPACE: protocol for exploring the influence of green space on sleep and mental health among children

BackgroundThe prevention of pediatric mental health disorders is a growing health priority in the United States. While exposure to green space, such as outdoor vegetation, has been linked with improved mental health outcomes in children, little is known about the impact of green space on children’s sleep. Sleep has many benefits, but the factors affecting both sleep and mental health as they relate to green space exposure are not well understood in children. This study aims to investigate how green space can affect sleep in children and contribute to the promotion of mental health and wellbeing.MethodsProject Green Space, Sleep, and Mental Health (G-SPACE) aims to recruit 250 elementary school-children from first, second, and third grade in Rhode Island to examine the influence of green space exposure on sleep, physical activity, and mental health over a five-year period. Objective measures of sleep, physical activity, and daily activity space will be assessed using an actigraph and a GPS (Global Positioning System) unit. Subjective measures of sleep duration, sleep quality, and mental health will be assessed using daily sleep diaries from parents, in addition to a range of survey items, including PROMIS® (Patient Reported Outcome Measurement Information System) pediatric scales, and the Children’s Sleep Habits questionnaire, among others. Green space exposure will be based on measures of green space from the normalized difference vegetation index (NDVI) aligned with the daily activity trajectory of children. Additionally, saliva and DNA samples will be collected to examine epigenetic mechanisms linking green space to sleep and mental health. A subset of participants (n = 50) will be followed longitudinally to evaluate the long-term impact of green space on sleep and mental health among children. Multi-level models will be used to assess the association between green space exposure, sleep behaviors, and mental health.DiscussionProject G-SPACE will evaluate whether green space utilization influences sleep and mental health in early elementary school children, and the possible mechanistic pathways through which these associations emerge.

Gamified Digital Mental Health Interventions for Young People: Scoping Review of Ethical Aspects During Development and Implementation.

Young people are particularly at risk of developing mental health problems, a challenge exacerbated by the COVID-19 pandemic. Digital tools such as apps and chatbots show promise in providing accessible, cost-effective, and less stigmatized ways of strengthening their mental health. However, while these interventions offer benefits, they extend mental health measures beyond traditional therapeutic settings and relationships, which raises ethical concerns due to the absence of established guidelines and regulations. This is particularly notable for technologies incorporating serious gaming elements. In addition, adolescents are in a sensitive and at times vulnerable phase, which shows great potential for the effective use of preventive and sensitizing mental health measures. Considering the lack of an integration into existing mental health structures among many young users, ethical considerations become crucial. This scoping review aims to build a knowledge base on the ethical aspects of developing and implementing gamified digital mental health interventions for young people. We conducted a search on research articles and conference papers from 2015 to 2023 in English, German, and Spanish. We identified 1815 studies using a unique combination of keywords in the databases Scopus, Web of Science, MEDLINE, and PsycINFO. After removing duplicates (741/1816, 40.8%), we included a total of 38 publications in this review following a double screening process. This review found that ethically relevant aspects were discussed with regard to (1) research ethics, (2) ethical principles (including privacy, accessibility, empowerment and autonomy, cultural and social sensitivity, and co-design), (3) vulnerable groups, and (4) social implications (including implementation using facilitators in specific social contexts, relationship with other therapeutic options, economic aspects, and social embeddedness of technologies). This scoping review identified a prevailing limited interpretation of "ethics" as research ethics across the included publications. It also shows a lack of discussion on the social embeddedness of technologies and that co-design is frequently viewed in instrumental terms and vulnerability is mostly addressed pragmatically. Through providing concrete examples of how mental health researchers and game designers thus far have addressed and mitigated ethical challenges in specific interventions, this review illustrates how ethical issues do or do not prompt diverse reflections, mitigation strategies, and actions. It advocates for ethics to be integrated as an ongoing practice throughout all stages of developing and implementing serious game elements in mental health interventions for young people.

Cognitive impairments associated with schizophrenic psychoses : Diagnostics, course and therapy

Longitudinal outcome studies confirm that the majority of patients with schizophrenic psychoses develop cognitive impairments associated with schizophrenia (CIAS). To provide an overview of the epidemiology, diagnostics and evidence for various treatment options for CIAS. Literature review of the current level of evidence regarding the efficacy of different treatment strategies for CIAS. Up to 85% of patients with schizophrenic psychoses exhibit CIAS, in some cases even before the development of positive or negative symptoms. The CIAS are associated with extensive individual burden due to impairments in many areas of cognitive and psychosocial functioning relevant to daily life. Various test instruments are available for clinical assessment with the Mental Health's Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) consensus cognitive battery (MCCB) as an established standard for clinical trials and special clinical issues. The treatment of CIAS warrants amultimodal approach with non-drug strategies (e.g., cognitive remediation, exercise) currently providing the best level of evidence. Noninvasive neurostimulation procedures and dopaminergic antipsychotic drugs of the first and second generations have demonstrated low effectiveness on cognitive function disorders in schizophrenic psychoses. The CIAS is a frequent disease-immanent symptom in schizophrenic psychoses that should be considered in the clinical routine as it substantially impairs those affected in the functional level and quality of life. Current treatment options are limited but innovative psychosocial interventions show low to moderate effects. In addition, new medications developed based on current neurobiological findings and combinations with psychosocial and neurostimulation procedures could open up new perspectives.

Cohort Profile: Baseline Characteristics of Veterans from Improving Veteran Access to Integrated Management of Back Pain (AIM-Back) - an Embedded Pragmatic, Cluster Randomized Trial in the United States.

AIM-Back is an embedded pragmatic clinical trial (ePCT) with cluster randomization designed to increase access and compare the effectiveness of two different non-pharmacological care pathways for low back pain (LBP) delivered within the Veteran Administration Health Care System (VAHCS). This manuscript describes baseline characteristics of AIM-Back participants as well as the representativeness of those referred to the AIM-Back program by sex, age, race, and ethnicity, relative to Veterans with low back pain at participating clinics. To be eligible for AIM-Back, Veterans were referred to the randomized pathway at their clinic by trained primary care providers (Referral cohort). Veterans from the Referral cohort that participated in the study included: 1) an Electronic Health Record (EHR) sample of Veterans enrolled in the program (i.e., attended initial AIM-Back visit with no consent required) and a Survey sample of Veterans that were consented for further study. Descriptive statistics for age, race, ethnicity, sex, high-impact chronic pain (HICP), a comorbidity measure, post-traumatic stress diagnosis (PTSD) and opioid exposure were reported for the Referral cohort and by sample; mean baseline PROMIS pain interference, physical function and sleep disturbance scores were reported by sample. Additional measures of pain, mental health and social risk were reported on the Survey sample. Participation to prevalence ratios (PPRs) were calculated for sex, age, race, and ethnicity by clinic to describe representativeness of the Referral cohort. Across 17 randomized primary care clinics, the Referral cohort included 2767 unique Veterans with n=1817 in the EHR sample, n=996 in the Survey sample and n=799 of the EHR sample (44%) were also in the Survey sample. High rates of HICP were observed in the EHR and Survey samples (>59%). Mean scores (SD) based on self-reported PROMIS Pain Interference (63.2 (6.8), 63.1 (6.6)) and PROMIS Physical Function (37.1 (5.3), 38.1 (5.8)) indicated moderate impairment in the EHR sample and Survey sample respectively. Approximately 10% of the EHR sample had documented opioid use in the year leading up to the AIM-Back referral. At most clinics, older Veterans (>=65 years) were underrepresented in the Referral cohort compared to those with LBP visits at clinics (PPRs < 0.8). The AIM-Back trial will conduct analysis to examine the comparative effectiveness of the two care pathways and identify individual characteristics that may improve responses to each pathway. The trial is expected to complete 12-month follow-up data collection by December 2024, with subsequent analyses and publications providing insights into optimizing non-pharmacological care for Veterans with LBP. NCT04411420 ( clinicaltrials.gov ). Strengths: Embedded features (e.g., EHR documentation and clinical staff serving as interventionist) of the AIM-Back trial have potential to facilitate implementation of these care pathways more broadly in Veteran's Health Administration clinics and in health systems outside the Veteran's Health AdministrationParticipating clinics were in 10 states providing regional geographic representation across the study.Trial was delivered within an integrated health system optimal for consistent documentation templates and data extraction across the trial sites.Limitations: Due to clinical personnel's role in participant recruitment, sample biases may exist in those referred to the program and/or those who agreed to participate in additional surveysThese findings may not be generalizable to older aged Veterans due to our lower enrollment of those 65+.

Pedagogical shift and parental mental health during the COVID-19 pandemic: Evidence from the United states

The COVID-19 pandemic has presented significant challenges for parents dealing with pedagogical shifts in their children’s education. This study utilizes data from the Household Pulse Survey conducted between April and December 2020 to examine the associations between pedagogical shifts, including class cancellations and distance learning, and the mental health of young and middle-aged parents in the United States during the pandemic. Through multivariate regression analyses, we found that both class cancellations and distance learning were significantly associated with increased parental mental struggles. Notably, class cancellations exhibit a stronger correlation with higher severity of anxiety and depression among parents compared to distance learning. These findings are consistent and robust across alternative models and various mental health measures. Moreover, our heterogeneous analysis indicates that the associations between pedagogical shifts and parental mental health vary based on gender, race, working status, and the political affiliation of the state in which parents reside. Overall, our findings reveal a stronger positive association between pedagogical shifts and mental health struggles among fathers, white parents, individuals who are employed, and those residing in states with Republican leadership. The study highlights the urgent need for policymakers to address the widening mental health disparities among U.S. parents during these challenging times.

Within-person, longitudinal associations between neighborhood cohesion and adult mental health: A test of bidirectional relations.

There is theory and evidence supporting a relationship between neighborhood cohesion and mental health among adult people. However, most studies have used a cross-sectional design, and longitudinal studies have provided mixed support for this hypothesis. Moreover, while neighborhood cohesion is assumed to be a consistent predictor of mental health, the possibility of a reciprocal relation has been overlooked. The aim of the current study was to investigate the within-person reciprocal associations between neighborhood cohesion and adult mental health. This study used data from Understanding Society: the UK Household Longitudinal Study including waves 1, 3, 6, 9, and 12 (n = 81,895). A short version of Buckner's Neighborhood Cohesion Instrument was used, along with two well-established measures of mental health: the 12-item General Health Questionnaire and the mental component summary score of the 12-item Short-Form Health Survey. Hierarchical Bayesian continuous time dynamic modeling revealed significant reciprocal within-person cross-effects (i.e. deterministic effects) between neighborhood cohesion and adult mental health, a larger standardized effect of mental health on neighborhood cohesion than than vice versa. Moreover, peak standardized cross-lagged effects were found for a time interval of approximately 1 year. Finally, the combined stochastic and deterministic interpretation revealed effects of neighborhood cohesion on mental health that were opposite to what was expected, suggesting a faster dissipation of some initially correlated change. Although neighborhood cohesion has traditionally been conceptualized in terms of its contribution to mental health, there is greater support for the view that mental health precedes neighborhood cohesion rather than the reverse.

Abstract 4121039: Refining the American Heart Association Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) equations using depression and anxiety disorder

Background: Growing evidence has suggested associations of common mental health conditions including depression and anxiety disorder with CVD, but no studies have examined their incremental predictive values in PREVENT (AHA Predicting Risk of CVD EVENTs). Research questions: Does including anxiety and/or depression improve the PREVENT predictive performance? Aims: We used a range of measures of anxiety and depression and combinations to examine whether these conditions improved the prediction performance of PREVENT. Methods: New risk prediction models were developed and internally validated using 60% and 40% of the UK Biobank cohort data, respectively. Mental health predictors included: depressive symptom score based on the four-item Patient Health Questionnaire and self-reported and record-based anxiety and depression diagnoses before baseline. CVD events were ascertained through hospital admission and death certificate data after baseline. The Cox proportional hazards models were used to calculate coefficients and 95% confidence intervals. The incremental predictive values were examined by adding the mental health predictors to the PREVENT predictors based on Harrell’s C-indices, sensitivity, specificity, positive and negative predictive values, and net reclassification improvement indices (NRIs). Results: Of the 502,366 UK Biobank participants, 195,489 were included in the derivation set and 130,326 were included in the validation set. In the validation set, the inclusion of each mental health measure produced an increase in C-index and higher sensitivity, specificity, and positive and negative predictive values compared with the PREVENT equations, with the greatest improvements for depressive symptom score. Depressive symptom score produced the greatest improvements in net reclassification overall (NRI 0.84, 95% CI 0.46–1.20) and this was further improved by adding recorded anxiety and depression (NRI 0.89, 95% CI 0.52–1.24). In addition, depressive symptom score showed better discrimination and NRI in both female and male validation sets. Conclusions: Our findings suggest that including depressive symptom score in PREVENT could improve the prediction of CVD with low cost and without invasive procedures.

The prevalence and effect of poor sleep amongst paramedics: a systematic review.

Sleep of inadequate quality, duration or regularity has potential negative physical and mental health outcomes. The impacts of poor sleep within the paramedic occupation are not well understood. This review aimed to determine the prevalence of insomnia, excessive daytime sleepiness and poor sleep quality amongst paramedics, and to identify any relationships between insomnia, excessive daytime sleepiness, poor sleep quality and other health-related outcomes. A systematic search identified studies that measured excessive sleepiness, insomnia or poor sleep quality using validated measures. The population was limited to paramedics in Australia, New Zealand or the UK owing to the similar nature of the workload, education standards, shift patterns and scope of practice. Four studies were included. All used the Pittsburgh Sleep Quality Index, two used the Epworth Sleepiness Scale and one used the Insomnia Severity Index. Sample sizes ranged between 60 and 342. The weighted mean prevalence of excessive daytime sleepiness was 30 %, and poor sleep quality reported as 71%. Only one study measured the association between sleep and other health-related outcomes; this study reported an association between sleep quality and multiple measures of mental health. The findings of this review suggest that paramedics experience both poor-quality sleep and excessive daytime sleepiness, and further suggest that there may be an association between poor sleep quality and mental health. Given sleep impacts a variety of health outcomes, as well as impacts work performance, research on the specific components of sleep is important.

Impacts of demographic factors and the COVID-19 pandemic on job stress inJapanese childcare workers.

Japan has a shortage of childcare personnel, and the high levels of stress causing turnover in childcare workers must be urgently resolved. However, there is a lack of knowledge regarding the characteristics and influencing factors of job stress in Japanese childcare workers. This study aimed to evaluate the job stress of childcare workers and explore the influence of demographic factors and the COVID-19 pandemic on such stress. The data were collected through an Internet survey from 2,472 respondents. A 23-item version of the Brief Job Stress Questionnaire was used to measure occupational stress in childcare workers. The instrument is recommended in the stress-check program implemented as a mental health measure in workplaces in Japan. The percentage of childcare workers with high stress exceeded that of general workers. Multiple regression analyses showed that the only factor affecting all job stressors and social support was the fear of contracting COVID-19. Job stressors and the COVID-19 pandemic had a significant large effect on stress responses. Additionally, being married and having children moderated childcare workers' stress. This study provided basic data regarding job stress in Japanese childcare workers and compared them with those of other professionals. In the future, it will be necessary to clarify how stress is related to turnover intention and turnover in Japanese childcare workers to promote their career continuity.

Virtual Coach-Guided Online Acceptance and Commitment Therapy for Chronic Pain: Pilot Feasibility Randomized Controlled Trial.

Veterans are disproportionately affected by chronic pain, with high rates of pain diagnoses (47%-56%) and a 40% higher rate of prevalence of severe pain than nonveterans. This is often accompanied by negative functional outcomes and higher mortality. Combined with research suggesting medical treatments for chronic pain are often insufficient, there is an urgent need for nonmedical pain self-management programs. An interactive online platform to deliver an efficacious treatment for chronic pain such as acceptance and commitment therapy (ACT) could be a valuable option to assist veterans with pain care at home. This study aims to evaluate the virtual coach-guided Veteran ACT for Chronic Pain (VACT-CP) online program compared to a waitlist and treatment as usual (WL+TAU) control group through a small pilot feasibility randomized controlled trial. The primary aim was to evaluate the feasibility and acceptability of VACT-CP and study procedures, such as ease of recruitment, treatment receptivity, attrition and retention, sustained participation, system usability, and assessment of trial procedures. Secondary aims explored differences in the VACT-CP and WL+TAU groups on pre- and posttest (week 7) outcome measures for pain, mental health, functioning, and ACT processes. Veterans with chronic pain were recruited and randomized to either the VACT-CP (n=20) or the WL+TAU (n=22) group in a parallel group trial design. Self-report surveys were administered to participants at baseline (week 0), at the intervention midpoint (week 3), immediately after the intervention (week 7), and at the 1-month follow-up (week 11). We used Wilcoxon signed rank tests with the intention-to-treat sample to describe changes in secondary outcomes from pre- to postintervention within each group. Study procedures showed good feasibility related to recruitment, enrollment, randomization, and study completion rates. Participants reported that VACT-CP was easy to use (System Usability Scale: mean 79.6, SD 12.8; median 82.5, IQR 70-87.5); they completed an average of 5 of the 7 total VACT-CP modules with high postintervention satisfaction rates. Qualitative feedback suggested a positive response to program usability, content tailoring, veteran centeredness, and perceived impact on pain management. Although the pilot feasibility trial was not powered to detect differences in clinical outcomes and significant findings should be interpreted with caution, the VACT-CP group experienced significant increases in chronic pain acceptance (P<.001) and decreases in depressive symptoms (P=.03). VACT-CP showed encouraging evidence of feasibility, usability, and acceptance, while also providing promising initial results in improving a key process in ACT for chronic pain-chronic pain acceptance-after online program use. A full-scale efficacy trial is needed to assess changes in clinical outcomes. ClinicalTrials.gov NCT03655132; http://clinicaltrials.gov/ct2/show/NCT03655132. RR2-10.2196/45887.

Challenges in measurement of adolescent mental health: how are gender patterns affected when level of symptoms is analysed simultaneously with impairment?

BackgroundAdolescent mental health surveys in public health are sometimes questioned because of their main focus on self-reported symptoms, lacking data on impairment, e.g. the consequences on everyday life of the mental health problems. While public health studies typically reveal higher prevalence rates of internalising problems for girls than boys, there are indications that the gender pattern may change when self-reported data on symptoms are analysed simultaneously with impairment. The purpose is to determine how gender patterns of adolescent mental health solely based on symptoms are affected when level of symptoms is analysed simultaneously with impairment.MethodsQuestionnaire data on adolescent mental health were collected in schools by Statistics Sweden in the autumn of 2009 as part of a national total population study in grades 6 and 9 in Sweden. In this study only data from grade 9 students are used (n = 91 627; response rate = 80 per cent). Psychosomatic symptoms were measured with the Psychosomatic Problems scale including eight items. Impairment was measured with four items included in the SDQ impact supplement. The associations between these key constructs were analysed with logistic regression and contingency tables.ResultsWhen analysing variables on psychosomatic symptoms and impairment independently, the results are consistent with typical findings of gender patterns in adolescent internalising mental health. Girls report both more psychosomatic symptoms, and more negative consequences in everyday life, than boys. The gender patterns are, however, strongly affected when impairment is conditioned on level of psychosomatic symptoms. Except for the Home Life setting, in the settings of Friendships, Classroom Learning and Leisure Activities, the previously reported gender pattern favoring higher disturbances among girls becomes partly reversed implying that boys report more negative consequences than girls. Hence, while girls report a higher prevalence of psychosomatic symptoms, boys appear to suffer from such symptoms more than, or as much as, girls in three out of four everyday life settings.ConclusionsThe study confirms the insufficiency of solely including data on symptoms in the measurement of adolescent mental health. Regardless of the causes of the complex gender pattern shown in this study, the results highlight the importance of simultaneous inclusion of indicators of impairment as well as symptom counts and frequency in the measurement of adolescent mental health.

Applying an osteopathic intervention to improve mild to moderate mental health symptoms: a mixed-methods feasibility randomised trial.

The increasing prevalence of mental health disorders in the United Kingdom necessitates the exploration of novel treatment modalities. This study aimed to assess the feasibility and acceptability of conducting a randomised controlled trial (RCT) evaluating the efficacy of four osteopathic interventions on psychophysiological and mental health outcomes. A mixed-methods feasibility study with an explanatory sequential design was implemented. The quantitative phase involved randomising 42 participants into four intervention groups: (1) high-velocity and articulation techniques (HVAT), (2) soft-tissue massage (STM), (3) craniosacral therapy (CST), and (4) a combination approach. Primary outcome measures encompassed recruitment rate, assessment duration, questionnaire completion, intervention attrition, and adverse events. Secondary outcomes included validated assessments of depression, anxiety, stress, psychological flexibility, heart rate variability (HRV), and interoception, administered pre- and post-intervention. Analysis of variance (ANOVA) was employed to evaluate pre-post intervention changes. The qualitative phase comprised semi-structured interviews analysed using thematic analysis. The study achieved a recruitment rate of 21 eligible participants per month, with 54.8% of respondents meeting eligibility criteria. All 33 participants who completed the study underwent interventions and assessments within the allocated one-hour timeframe, with full questionnaire completion. The attrition rate was 21%. No adverse events were reported. Qualitative analysis revealed positive participant experiences, with themes highlighting good practitioner communication, intervention accessibility, and increased bodily awareness. Some participants found the questionnaire battery burdensome. Exploratory quantitative analyses showed variations in effects across interventions for heart rate variability, interoceptive accuracy, and mental health measures, but these results should be interpreted cautiously due to the small sample size. This study provides evidence supporting the feasibility and acceptability of a larger-scale RCT investigating osteopathic interventions for individuals presenting with mild psychological symptoms. The preliminary findings suggest potential efficacy in improving mental health outcomes, warranting further investigation. Trial registration NCT05674071, registered 06/01/2023.