Occupational Impairment Research Articles

Socio-Demographic and Attitudinal Correlates of Problematic Social Media Use: Analysis of Ithra's 30-Nation Digital Wellbeing Survey

Time spent on social media continues to rise globally. For some individuals, social media use can become maladaptive and associated with clinically significant social and occupational impairments. This problematic social media use (PSMU) is also linked with poorer health and wellbeing. Much of our existing PSMU knowledge comes from single nation studies, heavily focused on adolescent and college-age samples. This study uses data from Ithra's 2021 global digital wellbeing survey to explore rates of PSMU and identify socio-demographic and attitudinal correlates. Participants (N = 15,000) were representative adult samples (N = 500) drawn from 30 nations. All participants provided socio-demographic data and completed a measure of PSMU, along with questions assessing attitudes toward social media and general usage patterns. PSMU prevalence was 6.82%, varying from 1.7 to 18.4% between nations. Multivariate logistical regression identified several correlates, including national culture, age, parenthood and frequency of use. These findings can help inform public policy and public health initiatives to reduce PSMU prevalence.

The relationship between major depressive disorder and employment status

Major depressive disorder is associated with executive dysfunction that includes impairment in problem-solving and decision-making,1 as well as with occupational impairment.2 One of the challenges during the COVID-19 pandemic has been to maintain employment status. It has been reported that employment status is associated with measures of quality of life as well as measures of

Prevalence of common mental disorders among Brazilian workers: systematic review and meta-analysis.

The aim of the present study was to summarize the prevalence of common mental disorders (CMD) among Brazilian workers through a systematic review and meta-analysis. Searches were conducted in SciELO, LILACS, PubMed, Scopus, and Web of Science. Articles were included if they had; an observational design, a sample of Brazilian workers, used a validated instrument and cut-off to assess CMD, and provided the prevalence value. A random-effect meta-analysis using professional categories as subgroups and a meta-regression were conducted. In total, 89 studies were included, with a total of 56,278 workers from 26 professional categories. The overall pooled prevalence of CMD was 0.30 (95%CI: 0.27-0.34), varying from 0.07 to 0.58. Professional categories that presented higher prevalences of CMD were: Prostitutes 0.58 (95%CI: 0.51-0.65), Social Educators 0.54 (95%CI: 0.50-0.59), Banking Workers 0.45 (95%CI: 0.44-0.47), Ragpickers 0.45 (95%CI: 0.40-0.49), and Teachers 0.40 (95%CI: 0.32-0.48). No other variable in addition to profession was associated with prevalence of CMD in the meta-regression analysis. Workers from the most affected professional categories should be monitored to prevent social, occupational, and health impairment from CMD.

Deep Learning Analyses of Brain MRI to Identify Sustained Attention Deficit in Treated Obstructive Sleep Apnea: A Pilot Study.

Persistent sustained attention deficit (SAD) after continuous positive airway pressure (CPAP) treatment is a source of quality of life and occupational impairment in obstructive sleep apnea (OSA). However, persistent SAD is difficult to predict in patients initiated on CPAP treatment. We performed secondary analyses of brain magnetic resonance (MR) images in treated OSA participants, using deep learning, to predict SAD. 26 middle-aged men with CPAP use of more than 6 hours daily and MR imaging were included. SAD was defined by psychomotor vigilance task lapses of more than 2. 17 participants had SAD and 9 were without SAD. A Convolutional Neural Network (CNN) model was used for classifying the MR images into +SAD and -SAD categories. The CNN model achieved an accuracy of 97.02±0.80% in classifying MR images into +SAD and -SAD categories. Assuming a threshold of 90% probability for the MR image being correctly classified, the model provided a participant-level accuracy of 99.11±0.55% and a stable image level accuracy of 97.45±0.63%. Deep learning methods, such as the proposed CNN model, can accurately predict persistent SAD based on MR images. Further replication of these findings will allow early initiation of adjunctive pharmacologic treatment in high-risk patients, along with CPAP, to improve quality of life and occupational fitness. Future augmentation of this approach with explainable artificial intelligence methods may elucidate the neuroanatomical areas underlying persistent SAD to provide mechanistic insights and novel therapeutic targets.

Companions in the Abyss: A Feasibility and Acceptability Study of an Online Therapy Group for Healthcare Providers Working During the COVID-19 Pandemic.

Introduction:In the context of the global pandemic of the SARS-CoV-2 coronavirus (COVID-19), healthcare providers (HCPs) have experienced difficult moral and ethical dilemmas. Research is highlighting the importance of moral injury (MI)–a trauma syndrome related to transgressing personal morals and values–in understanding the psychological harm and occupational impairment experienced by HCPs. To date, MI treatments have largely been developed for military personnel and veterans and rely on in-person one-on-one psychotherapy.Purpose:This project aims to explore the feasibility and acceptability of an evidence-informed online Acceptance and Commitment Therapy-based group therapy for MI in HCPs called “Accepting Moral Pain and Suffering for Healthcare Providers” (AMPS-HCP).Method:This feasibility and acceptability study included three separate phases with the first two phases focused on the development of the psychotherapeutic intervention and the third phase focused on the evaluation of the psychotherapeutic intervention. Eight participants (including registered nurses, practical nurses and respiratory therapists) completed seven 90-min sessions in an online group format. The focus of these sessions included ACT and MI psychoeducation and experientials. Qualitative semi-structured interview data was thematically analyzed while demographic and quantitative self-reported outcome data underwent descriptive analysis and non-parametric testing.Results:Results show that the intervention was highly feasible and acceptable to healthcare providers who worked on the frontline during COVID-19. Feasibility (referrals, eligibility, retention, participation engagement) was strong (8 out of 10 participants; 80% vs. desired >70% eligibility) and overall, 80% of participants completed 71% of the intervention. Data further supported the applicability and acceptability of the intervention. Preliminary data suggests that AMPS-HCP may supports HCPs to address MI.Discussion:This study is the first to report on the development and evaluation of an online MI group intervention for registered nurses, registered practical nurses, and respiratory therapists working during COVID-19. Results showed the use of both the online and group components of the intervention were acceptable and feasible during the third wave of COVID-19.

Abstract- Poster

Introduction-The utility of cognitive assessment has increasingly come to fore because the diagnostic categories in psychiatry are for the most part syndromal. As a consequence there is wide variation in the degree of disability and handicap within the same diagnostic category. PGI BBD is a validated tool for assessment of cognitive deficits and its utilisation will help in quantification of disability and rehabilitation.Method–The study was conducted at Tertiary care hospital. 200 male inpatients belonging to the 5 diagnostic groups- Alcohol Dependence Syndrome, Anxiety Disorders, Depressive Disorders, Bipolar Affective Disorder, Schizophrenia were included in the study after written informed consent. Analysis was performed by the SPSS version 20.0. Comparison among the five diagnostic groups was done using ANOVA and Tukey Post hoc pair wise comparison.Result-Patients of Alcohol Dependence Syndrome had impairment in remote memory, visual retention and recognition, performance quotient, verbal quotient and percepto motor functioning. Patients of Anxiety Disorder had deficit in attention concentration, verbal memory. Patients of Depressive Disorder had deficit in attention and concentration, immediate and delayed recall, verbal memory, comprehension and percepto motor functioning. Patient of BPAD had deficit in attention and concentration, visual memory. Patients of Schizophrenia had deficit in verbal and visual memory and performance tests.Conclusion:Patients in all diagnostic groups had significant impairment of cognitive function even while in remission when they were about to be discharged from hospital. Theses deficit will result in occupational impairment and cognitive retraining is necessary.

“A RANDOMIZED CONTROLLED TRIAL OF OPEN CARPAL TUNNEL RELEASE SURGERY VS LOCAL STEROID INJECTION FOR CARPAL TUNNEL SYNDROME”

BACKGROUND: Carpal tunnel syndrome (CTS) is the most prevalent form of peripheral nerve entrapment and a leading cause of occupational impairment. Non-surgical and surgical treatment options are the two basic types of treatment. Steroid injection does not improve symptoms like surgery according to the previous researches. Nevertheless, additional research is required to further evaluate the comparative studies. OBJECTIVES: To compare the clinical and functional results of open carpal tunnel release (CTR) surgery VS local steroid injection (LSI) for carpal tunnel syndrome. METHODS: This is prospective randomized, single blind, controlled study. Forty patients who were clinically and electrophysiologically conrmed to have idiopathic CTS were enrolled in the study after informed consent. Patients were randomized and assigned into 2 groups of 20 patients each. Group-1 was managed by and Group-2 was managed by open carpal tunnel release single injection of steroid. Patients were followed every 4 weeks up to 24 week. They were assessed clinically and functionally based on Boston Carpal Tunnel Assessment Questionnaire (BCTQN). CONCLUSION: In our study we used Boston Carpal Tunnel Assessment Questionnaire (BCTQN), due to its ease of administration and responsiveness to clinical change, which can be considered as a valuable tool to evaluate functional outcome. Our ndings suggest that both local steroid injection and surgical decompression are effective treatments in alleviating symptoms in primary CTS at 24 weeks follow-up. Surgery group had statistically signicant improvement in comparison with steroid injection in terms of objective functional score in the 24 weeks followup, although clinical relevance of those differences remains to be dened. Hence we conclude, The steroid injection is a feasible non-expensive and effective therapy in most of the cases of CTS on the other hand surgical release is a day care, safe and effective treatment even in mild to moderate CTS. But cost effectiveness, cost benet analysis and surgery related morbidity should be evaluated in further clinical trials with larger sample size and longer follow up period.

“A PROSPECTIVE COMPARATIVE STUDY OF LOCAL STEROID INJECTION VS DRY NEEDLING FOR PLANTAR FASCIITIS”

BACKGROUND: Plantar fasciitis is one of the most common conditions of heel pain among adults. Most common affected age group being 40-60 years and it is a leading cause of occupational impairment. Non-invasive and invasive modalities are the two basic types of treatment. Invasive treatment modalilities like local injections, surgical treatment are advised for patients non-responding to non-invasive conservative treatment modalities. Local Steroid Injection (LSI) is the most common invasive treatment used whereas Dry Needling (DN) is proposed as a new modality of treatment recently. OBJECTIVES: The aim of this study is to evaluate the effectiveness of Dry Needling versus Local Steroid Injection for Plantar Fasciitis using short form of Foot Function Index Revised (FFI-R). METHODS:This is prospective randomized, single blind, controlled study. Fifty patients who were clinically and radiologically (USG) conrmed to have idiopathic plantar fasciitis were enrolled in the study after informed consent. Patients were randomized and assigned into 2 groups of 25 patients each. Group I was managed by Local Steroid Injection (LSI) and Group II was managed by Dry Needling (DN). Patients were followed every 4 weeks up to 12 weeks. They were assessed clinically and functionally based on short form of FFI-R CONCLUSION: Short form of Foot Function Index Revised (FFI-R) is a quick, reliable and patient friendly outcome measurement tool for plantar fasciitis. Both Local Corticosteroid Injection and Dry Needling are effective treatment in refractory cases of Plantar Fasciitis in adjunct to non-invasive conservative treatment modalities. Dry Needling is a safe and reliable procedure for treating refractory cases of Plantar Fasciitis. Even though corticosteroid injection is the most effective treatment for short term symptomatic relief (at 4 weeks), it is found that outcomes of Dry Needling are comparable with the efcacy of corticosteroid injection in the medium term follow-up (12 weeks). Dry Needling has greater physiological compatibility than corticosteroid injection in terms of ability to induce possible healing process in plantar fasciitis and devoid of any long term complication associated with corticosteroid injection.

Effects of a Total Worker Health® leadership intervention on employee well-being and functional impairment.

Although evidence has been mounting that supervisor support training interventions promote employee job, health, and well-being outcomes, there is little understanding of the mechanisms by which such interventions operate (e.g., Hammer et al., 2022; Inceoglu et al., 2018), nor about the integration of such organizational-level interventions with individual-level interventions (e.g., Lamontagne et al., 2007). Thus, the present study attempts to unpack the mechanisms through which supervisor support training interventions operate. In addition, the present study examines an integrated Total Worker Health® intervention that combines health protection in the form of supervisor support training (i.e., family supportive supervisor behaviors and supervisor support for sleep health) with a health promotion approach in the form of feedback to improve sleep health behaviors. Using a cluster randomized controlled trial drawing on a sample of 704 full-time employees, results demonstrate that the Total Worker Health intervention improves employee job well-being (i.e., increased job satisfaction and reduced turnover intentions), personal well-being (i.e., reduced stress before bedtime), and reduces personal and social functional impairment at 9 months postbaseline through employee reports of supervisors' support for sleep at 4 months postbaseline, but not through family supportive supervisor behaviors. Effects were not found for general stress or occupational functional impairment outcomes. Implications are discussed, including theoretical mechanisms by which leadership interventions affect employees, supervisor training, as well as the role of integrated organizational and individual-level interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Effectiveness of Photodynamic Therapy for Management of Primary Palmar Hyperhidrosis

Abstract Background Hyperhidorsis is a condition in which sweat production exceeds that which is needed for thermoregulation, and can affect the hands, feet, axiall, face, back, grain, and legs. It is adisabling condition that affect, both children and adults, with in audience rate of 1-3% and onset usually during childhood or adokscne. Although not a dangerous condition, hyperhidrosis can cause social and occupational impairment and emotional distress and facilitate the development of secondary morbidity. Objectives So our aim to study the efficacy and safety of photodynamic therapy in management of primary palmar hyperhidrosis using two photosensitizers [MB2% and eosin]. Patients and Methods Twenty patients with primary palmar hyperhidrosis were recruited from the outpatient clinic of the Dermatology and Venereology department, Faculty of Medicine – Ain Shams University during the period from 2017 to 2018. The protocol was approved by Faculty of Medicine, Ain Shams University ethical committee (FWA000017585). An informed written consent was obtained from all patients prior to enrolment in the study. It is a right-left controlled study which included 20 patients with primary palmar hyperhidrosis. Results Our study showed that the PDT had positive treatment outcome in palmar hyperhidrosis with sustainable efficacy for at least twelve weeks after treatment stoppage. Conclusion Photodynamic therapy is an effective, safe and cheap method for management of primary palmar hyperhidrosis. Both eosin and methylene blue 2% can be used effectively as photosensitizers for photodynamic therapy with good results for treatment of primary palmar hyperhidrosis with minimal tolerable side effects.

The Clinical Characteristics of Patients With Borderline Personality Disorder in Different Treatment Settings.

The present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) Project compares patients with borderline personality disorder (BPD) in an outpatient practice (n = 390) and a partial hospital setting (n = 358) on diagnostic comorbidities, symptoms experienced, suicidality, and occupational impairment. The patients in the partial program were diagnosed with significantly more psychiatric disorders and were more frequently diagnosed with dysthymia, generalized anxiety disorder, alcohol and substance use disorders, adjustment disorders, and posttraumatic stress disorder. Those at the partial hospital had significantly higher levels of suicidal ideation than those in the outpatient practice. The samples did not differ on utilization of disability or suicide attempts. Treatment setting may have implications in the recognition of the disorder in clinical practice, the development and support of etiological theories, identification of core deficits, and evaluation of psychosocial morbidity associated with BPD.

New thinking about old ways: Cultural continuity for improved mental health of young Central Australian Aboriginal men.

Decades of reports and policy have drawn attention to the significant social and occupational impairment of many young Aboriginal men in Central Australia. However, the role of mental ill-health as a contributing factor to this impairment, and culturally appropriate intervention targets have received insufficient attention in the psychiatry literature. Despite having the worst health outcomes of any population in Australia, Aboriginal men chronically underuse primary health care services. It's proposed that interventions ensuring cultural continuity through Identity-strengthening with a particular focus on positive Aboriginal masculinities will address a critical mental health gap for young men. In Central Australian and broader Indigenous populations, tangible and measurable kinship, language, religious and economic (KLRE) activities are catalytic vehicles for restoring traditional knowledge that suffer ongoing pressures as a result of colonization and assimilationist Government policy. By transforming KLRE knowledge content from ethnographic archives, these culturally rich repositories may be utilized to create education and engagement materials that will support young Aboriginal men's efforts to obtain and maintain positive mental health. This proposal focuses on building resilience through the acquisition of KLRE knowledge which young Aboriginal men can utilize as resources for enhancing positive identity and mental health outcomes.

Associations Between Mental and Physical Health Conditions and Occupational Impairments in the U.S. Military.

Prior studies have identified associations between specific health conditions and occupational impairments in the U.S. military, but little is known about the relative magnitude of impairments associated with different mental and physical health conditions among military service members. The goal of this study is to comparatively assess occupational impairment associated with mental and physical conditions among active duty military service members. Data on 11,055 U.S. active duty service members were from the Department of Defense 2015 Health Related Behaviors Survey, an anonymous online health survey. Items assessed common mental and physical health conditions. Absenteeism was assessed as number of lost work days and presenteeism was assessed as number of work days with impaired functioning in the past 30 days. This research was approved by the RAND Human Subjects Protections Committee. Back pain (23%) and anxiety (14%) were the most prevalent conditions in the sample. Mental health conditions (anxiety, depression, and PTSD) were associated with more absentee and presentee days than physical conditions. Adjusting for physical health conditions, anxiety, depression, and PTSD showed robust associations with both absenteeism and presenteeism. Common mental health conditions such as anxiety, depression, and PTSD showed robust associations with absenteeism and presenteeism among active duty U.S. military service members. Efforts to rigorously evaluate and improve existing military screening programs and reduce barriers to accessing and engaging in mental healthcare may help to reduce work absenteeism and presenteeism among active duty service members.

Assessment of severity, quality of life and suicidal ideation in patients with depressive disorders

Depression is estimated to be the third leading cause of disability and about 350 million people suffer from depression worldwide. Various biological, social, economic, cultural factors and environmental factors contribute for depression. A total of 102 patients were enrolled in the study. Majority of the patients (64, 62.74%) included in the study were female. The mean age of the study subjects was found to be 20.4±11.88 years. The severity of symptoms in depressed patients evaluated using Hamilton Depression Rating Scale (HDRS) shows that 33.33% of the subjects were very severely depressed, followed by 29.41% of the subjects with moderate depression, 23.52 % with severe depression and 11.76% with mild depression. Quality of life was evaluated using WHOQOL BREF Scale in the study population. 51.96 % of subjects were having low quality of life (QoL) followed by 48% of subjects with medium QoL and 0.98% subjects with high QoL. Modified Scale for Suicidal Ideation (MSSI) was used to evaluate severity of suicidal ideation in study population. Interpretation of results shows that 74.50% were having low suicidal ideation and few subjects (8.82%) were found to have severe suicidal ideation. Depression negatively impacts individual’s functioning, work satisfaction, relationships, leisure, physical and mental health, sexual functioning, sleep patterns and overall sense of fulfilment and contentment with life. Severe form of depression can lead to suicidal risk, increased risk of morbidity, mortality, substantial imbalance on individual’s occupational potential, significant physical and psychosocial impairment.

Assessing depression, anxiety, stress and associated factors during COVID-19 lockdown among adult population in Al Ahsa, Saudi Arabia

Background: Depression, anxiety, and stress are challenging constraints that can greatly affect mental well-being leading to social, occupational, and physical impairments. Lockdown and social distancing have come to be the norms for preventing and controlling COVID-19, however maintaining these preventive measures for months could add to the burden of mental health. This study aims to assess the prevalence of depression, anxiety, and stress during COVID-19 lockdown and to identify associated factors among adult individuals in Al Ahsa, Saudi Arabia.Methods: The study utilized a quantitative descriptive design and data were gathered by means of online survey during the 10th week of lockdown. The survey contained demographic queries and other questions helping in identifying possible factors that may led to the three stressors along with DASS-21. A total of 1874 respondents participated in the study. Results: Results revealed the prevalence of depression was (55.2%), anxiety was (64.5%) and stress was (45%), with degrees ranging from mild to extremely severe. Age was noted to negatively correlate with depression, anxiety and stress. The prevalence of DAS is found to be positively correlated with having a family history of depression or anxiety. Additionally, having chronic illnesses has been noted to have a positive relationship with both anxiety and stress. Taking care of an elderly or sick family member have a positive correlation with anxiety.Conclusions: This study highlights the impact of COVID-19 lockdown on depression, anxiety and stress levels among adult population. The findings of this study revealed mild depression, moderate anxiety and mild stress. In more details, near to third of respondents were having moderate to extremely severe depression level. Participants with moderate to extremely severe anxiety comprised nearly half of the sample and one third of respondents were having moderate to extremely severe stress.

Identifying and Managing Anxiety Disorders in Primary Care

Anxiety disorders are among the most common psychiatric diagnoses and present in patients as excessive fear and worry. Many seeking care for symptoms of anxiety disorders have a chief concern other than anxiety. Because most individuals first seek treatment for anxiety disorders in primary care, it is important to screen, assess, diagnose, and potentially initiate treatment for them in these settings. If left untreated, anxiety disorders can cause significant personal, social, and occupational impairment. Elevated anxiety levels can lead to a fight-or-flight fear response. Evidence-based treatment options are available in both primary care and specialty clinic settings.

Predictors of Functional Outcome in Patients With Bipolar Disorder: Effects of Cognitive Psychoeducational Group Therapy After 12 Months

Background: Cognitive deficits are known as a core feature in bipolar disorder. Persisting neurocognitive impairment is associated with low psychosocial functioning. The aim of this study was to identify potential cognitive, clinical and treatment-dependent predictors for functional impairment, symptom severity and early recurrence in bipolar patients, as well as to analyze neurocognitive performance compared to healthy controls.Methods: Forty three remitted bipolar patients and 40 healthy controls were assessed with a neurocognitive battery testing specifically attention, memory, verbal fluency and executive functions. In a randomized controlled trial, remitted patients were assigned to two treatment conditions as add-on to state-of-the-art pharmacotherapy: cognitive psychoeducational group therapy over 14 weeks or treatment-as-usual. At 12 months after therapy, functional impairment and severity of symptoms were assessed.Results: Compared to healthy controls, bipolar patients showed lower performance in executive function (perseverative errors p < 0.01, categories correct p < 0.001), sustained attention (total hits p < 0.001), verbal learning (delayed recall p < 0.001) and verbal fluency (p-words p < 0.002). Cognitive psychoeducational group therapy and attention predicted occupational functioning with a hit ratio of 87.5%. Verbal memory recall was found to be a predictor for symptom severity (hit ratio 86.8%). Recurrence in the follow-up period was predicted by premorbid IQ and by years of education (hit ratio 77.8%).Limitations: Limitations of the present study result mainly from a small sample size. The extent of cognitive impairment appears to impact occupational disability, clinical outcome as well as recurrence rate. This result must be interpreted with caution because statistical analysis failed to show higher significance.Conclusions: Bipolar patients benefit from cognitive psychoeducational group therapy in the domain of occupational life. Deficits in sustained attention have an impact on occupational impairment. Implications for treatment strategies are discussed. Further evaluation in larger studies is needed.

TREATMENT-RESISTANT OBSESSIVE COMPULSIVE DISORDER: AN EVALUATION STUDY OF THE AUGMENTATION EFFECT OF LOW-FREQUENCY REPETITIVE TRANSCRANIAL MAGNETIC STIMULATION

Background: Thelifetime prevalence of obsessive-compulsive disorders (OCD) is estimated to be around 3% in the general population. Selective serotonin reuptake inhibitors (SSRIs) are considered to be the primary treatment strategy of OCD in addition to psychotherapy. Unfortunately, current medications, augmentation strategies, and behavioral therapies fail to provide adequate benefits in many cases. A large percentage of patients (40-60%) do not show satisfactory response to the standard treatments, some of them experiencing a chronically deteriorating course, leading to marked interpersonal and occupational impairments. In recent years, non-invasive neuromodulatory techniques such as repetitive transcranial magnetic stimulation have been increasingly studied as potential adjunct or alternative therapies for a wide range of neurological and psychiatric conditions including pain disorder, depression, and stroke rehabilitation and OCD. Aims: the aim of this work to evaluate rTMS as an augmentation strategy in treatment-resistant OCD, to test the potential value oflow frequency rTMS to SMA,orbitofrontal cortex and right DLPFC in the treatment of resistant OCD and to compare between the therapeutic values of applying the TMS coil to those different areas of the cortex. Patients and Methods: This study was carried out in Psychiatry, Neurology and Neurosurgery Center, Tanta University from September 2017 to November 2019. Eighty patients (52 females and 28 males) aging between 18 and 65 years underwent complete psychiatric evaluation, including full medical history, psychiatric and physical examination and diagnosed as having OCD accordingto DSM-5 with failure of at least two adequate therapeutic trials of SRIs. Results: Before rTMS sessions there was no statistical significant difference between the three active groups and the sham group regarding the scores onYale-Brown obsessive compulsive scale,Hamilton anxiety rating scale, Hamilton depression rating scale and Clinical global impression scale. Results after rTMS sessions revealed the following: Active rTMS on the SMA, the left OFC and right DLPFC was associated with marked improvement in YBOCS, Hamilton anxiety rating scale, Hamilton Depression rating scale and clinical global impression scale. The most significant improvement in Yale Brown Obsessive Compulsive scale was obtained when the brain target was the SMA. The most significant improvement in anxiety rating scale and depression ratingscale was obtained when the brain target was the left OFC. Sham group didnt have significant improvement through the study. Conclusions: We can thus conclude that low frequency rTMS is significantly effective as an adjunctive treatment for resistant OCD and that the SMA is the most effective brain target.

Effect of the Wingman-Connect Upstream Suicide Prevention Program for Air Force Personnel in Training

Suicide has been a leading manner of death for US Air Force personnel in recent years. Universal prevention programs that reduce suicidal thoughts and behaviors in military populations have not been identified. To determine whether the Wingman-Connect program for Airmen-in-training reduces suicidal ideation, depression, and occupational problems compared with a stress management program and to test the underlying network health model positing that cohesive, healthy units are protective against suicidal ideation. This cluster randomized clinical trial was conducted from October 2017 to October 2019 and compared classes of personnel followed up for 6 months. The setting was a US Air Force technical training school, with participants studied to their first base assignment, whether US or international. Participants in 216 classes were randomized, with an 84% retention rate. Data analysis was performed from November 2019 to May 2020. The Wingman-Connect program used group skill building for cohesion, shared purpose, and managing career and personal stressors (3 blocks of 2 hours each). Stress management training covered cognitive and behavioral strategies (2 hours). Both conditions had a 1-hour booster session, plus text messages. The primary outcomes were scores on the suicidal ideation and depression scales of the Computerized Adaptive Test for Mental Health and self-reports of military occupational impairment. Class network protective factors hypothesized to mediate the effect of Wingman-Connect were assessed with 4 measures: cohesion assessed perceptions that classmates cooperate, work well together, and support each other; morale was measured with a single item used in other studies with military samples; healthy class norms assessed perceptions of behaviors supported by classmates; and bonds to classmates were assessed by asking each participant to name classmates whom they respect and would choose to spend time with. A total of 215 classes including 1485 individuals (1222 men [82.3%]; mean [SD] age, 20.9 [3.1] years) participated; 748 individuals were enrolled in the Wingman-Connect program and 737 individuals were enrolled in the stress management program. At 1 month, the Wingman-Connect group reported lower suicidal ideation severity (effect size [ES], -0.23; 95% CI, -0.39 to -0.09; P = .001) and depression symptoms (ES, -0.24; 95% CI, -0.41 to -0.08; P = .002) and fewer occupational problems (ES, -0.14; 95% CI, -0.31 to -0.02; P = .02). At 6 months, the Wingman-Connect group reported lower depression symptoms (ES, -0.16; 95% CI, -0.34 to -0.02; P = .03), whereas the difference in suicidal ideation severity was not significant (ES, -0.13; 95% CI, -0.29 to 0.01; P = .06). The number needed to treat to produce 1 fewer participant with elevated depression at either follow-up point was 21. The benefits of the training on occupational problems did not extend past 1 month. The Wingman-Connect program strengthened cohesive, healthy class units, which helped reduce suicidal ideation severity (estimate, -0.035; 95% CI, -0.07 to -0.01; P = .02) and depression symptom scores (estimate, -0.039; 95% CI, -0.07 to -0.01; P = .02) at 1 month. Wingman-Connect is the first universal prevention program to reduce suicidal ideation and depression symptoms in a general Air Force population. Group training that builds cohesive, healthy military units is promising for upstream suicide prevention and may be essential for ecological validity. Extension of the program to the operational Air Force is recommended for maintaining continuity and testing the prevention impact on suicidal behavior. ClinicalTrials.gov Identifier: NCT04067401.

Gender-based differential item functioning in the Cannabis-Associated Problems Questionnaire: A replication and extension

BackgroundGender bias in measures of cannabis problems may differentially affect how men and women endorse items. This gender invariance might mask, exaggerate, or otherwise obscure true distinctions in experiences of cannabis consequences. MethodsThe Cannabis-Associated Problems Questionnaire (CAPQ), a measure of interpersonal deficits, occupational impairment, psychological issues, and physical side effects related to cannabis use, contained items with gender-based differential item functioning (DIF) in previous work—a finding we aim to replicate and extend (Lavender, Looby, & Earleywine, 2008). ResultsIn a sample of 4053 cannabis users, gender differences were apparent in global scores on the CAPQ. A DIF analysis revealed two gender-biased items, including one identified previously. Removal of these items did not significantly alter the scale’s relation to cannabis use. Gender differences on the CAPQ persisted after removal of the two problematic items, indicating true gender differences still exist in men and women’s experiences of cannabis-related consequences. Gender appeared to significantly contribute to scores on the full CAPQ and the short-form of the CAPQ with biased item removed, even after controlling for indices of cannabis use. ConclusionsThese findings suggest that the CAPQ evidences less gender bias than previously thought, perhaps due to diminishing gender-based stereotypes. Future work might opt to use the short form of the CAPQ to minimize gender-based DIF. In addition, potential biases in measures of substance use problems deserve more attention.