Emotional Pain Research Articles

Collective ambiguous loss after mass hostage-taking in war: exploring public mental health outcomes and resilience

ABSTRACT Objective: Collective ambiguous loss can arise in communities facing the unresolved absence or presence of loved ones, marked by uncertainty and confusion. This study examines the impact of such loss on the general public in Israel after 251 individuals were taken hostage by Hamas on October 7 2023. Method: A diverse sample of 740 participants (ages 18–85, 58.2% women) took part in a comprehensive survey from December 2023 to January 2024. The survey measured boundary ambiguity (BA), separation distress related to disappearance (Ambiguous Loss Inventory Plus – ALI + - SD), general psychological distress (Mini-DASS), and personal resilience factors: ambiguity tolerance (Need for Closure Scale-Revised, NCSR) and psychological flexibility (PF). Results: Public stances indicated that 85% of respondents had moderate to very low confidence in the hostages’ return, coupled with high endorsement of psychological engagement indicators such as emotional pain, intrusive thoughts, and survivor guilt. Those acquainted with a hostage (12%) showed no differences in stances or ALI + -SD and Mini-DASS levels, except for higher BA and greater engagement in demonstrations activities for their return. SEM analysis showed that ALI + -SD mediated the relationship between BA and Mini-DASS (high BA related to high general distress). In this model, BA and ALI + -SD explained over half of the variation in general psychological distress (R2 = 53%). A second model revealed serial mediation by BA and ALI + -SD in the relationship between NCSR and Mini-DASS, with lower ambiguity tolerance related to increased general distress. However, no such mediation was observed in the relationship between PF and Mini-DASS, and overall, the effect of personal resilience on general distress was relatively small. Conclusions: Mass hostage-taking substantially impacts society’s mental health, extending beyond personal acquaintance with a hostage. The findings underscore the need to shift focus from personal resilience to community-based policies and therapeutic approaches to effectively address communal ambiguous loss amid collective trauma.

Communal Load Sharing of Miscarriage Experiences: Thematic Analysis of Social Media Community Support.

Miscarriage is a common experience, affecting 15% of recognized pregnancies, but societal ignorance and taboos often downplay the mental distress and personal impact following a miscarriage. Emerging stories on social media in which women express their miscarriage grief are breaking such taboos. Research in the area of online health communities is increasingly focused on studying how people share their health experiences on social media. However, a clear understanding on the social support involved in this type of sharing of health experiences is lacking. This study explored the use of Instagram in sharing miscarriage experiences, guided by the following research question: How is social community support given to women who share their miscarriage experiences on social media? Considering that social media is increasingly used as a source of social support, in this study, we chose Instagram as the social media platform. The purpose of this research was to create a better understanding of how social media provides support in expressing personal miscarriage experiences and how people engage with such posts. This study used a qualitative inductive research method in which a phenomenological strategy and thematic analysis were followed to create a comprehensive understanding of the social community support phenomenon. The dataset was established from a sample of 258 Instagram posts and 736 comments collected over a period of 6 months after initial posts and from 6 different women. These data were categorized and clustered through a thematic analysis. Three themes were identified: (1) storytelling of emotional turmoil and grief after miscarriage, (2) sharing positivity amidst miscarriage grief, and (3) mentioning personal medical information about miscarriage. Theme 1 represents the emotional experience of women who have had a miscarriage. It encompasses the initial posts that included miscarriage storytelling that express deep grief and mental distress and the emotional impact on both the posters and the commenters. Theme 2 highlights the importance of finding moments of joy and positivity in the midst of mental distress and pain. The posts shared with the online community convey a sense of moving forward and a refusal to let grief become the defining aspect of one's life. Theme 3 focuses on sharing medical and practical advice. This theme includes posts and comments about medications, in vitro fertilization procedures, hospital experiences, and personal physical symptoms. As an overarching theme for this social support phenomenon, we introduce the term communal load sharing to describe the therapeutic role of social media in helping women cope with miscarriage by providing a platform for sharing similar experiences, breaking social taboos, and fostering load sharing.

Literary Masculinities and Men’s Emotionality: Max Porter’s Grief Is the Thing with Feathers as a Case Study

This article examines grief and psychic pain in Max Porter’s Grief is the Thing with Feathers (2015). It is argued that the novel subverts the pervasive association between men’s suffering, psychopathology and violence in fiction, as the protagonist’s ‘split identity' transcends the deeply masculinised trope of the raging double. A review of approaches to emotionality in Critical Studies of Men and Masculinities is provided, with particular attention to the literary representation of men’s grief. Using psychoanalysis, Porter’s Crow is seen as representing a foray into the Kristevan maternal semiotic, taking the novel’s aesthetic innovation as politically significant in recasting masculinities as fundamentally fluid. Drawing on affect theory, grief is taken as a political emotion capable of transgressing traditional scripts of masculinity by severing its associations with wage labour and imperviousness, and reconfiguring it instead around vulnerability and an ethics of care.

Learning from poor leadership practice

Poor leadership practice is not inconsequential. It has material effects yet is rarely considered in leadership research and learning. We explore what poor leadership practice ‘looks and feels like’, provide space for those on the ‘receiving end’ to be heard and discuss leadership learners’ responses to the study. We illustrate poor leadership practice empirically as humiliation, chaos, lack of care, abdication and abandonment and extend conceptualisation of poor leadership practice to include ever-changing excessive decision-making and lack of care. The study contributes novel insights, empirically highlighting the practical implications and theorising the emotional pain, loss of respect, trust and dignity for those subject to the practice. With agency, people struggle, bargain with and work around poor leadership practice. The extended accounts are a rich learning resource for leadership learning, with utility in provoking learning, raising consciousness to and challenging poor leadership practice.

Asian Americans’ childhood emotional abuse, emotional neglect, and opioid use: Distress intolerance as moderator

Asian Americans are highly underrepresented in opioid use research, despite recent studies demonstrating the presence of opioid use behaviors in Asian Americans and distinct negative outcomes of opioid use among Asian Americans in comparison to White adults. Emotional abuse and emotional neglect are important risk factors that may impact opioid use. Thus, the purpose of this study was to investigate (a) the associations between childhood emotional trauma (emotional abuse and emotional neglect) and opioid use, and (b) the role of distress intolerance as a moderator. 279 Asian American participants completed an online remote survey. Our findings revealed that childhood emotional abuse and emotional neglect were both significantly and positively associated with opioid use. We found that distress intolerance moderated the association between childhood emotional abuse and opioid use such that at low levels of emotional abuse, participants who exhibited greater distress intolerance displayed greater opioid use. These findings indicate that emotional abuse and neglect are specific forms of childhood trauma that are significantly associated with opioid use, perhaps as a maladaptive coping mechanism that capitalizes on the analgesic effects of opioids on the psychological pain from childhood emotional trauma. Additionally, marginalized populations that demonstrate distress intolerance may suffer negative health outcomes such as opioid use.

Religiusitas dan Dukungan Sosial sebagai Penentu Konsep Diri: Studi Kasus pada Perempuan Korban Perselingkuhan

Infidelity is a complex social issue that has profound psychological impacts on its victims. Infidelity does not always involve sexual relationships; it can also manifest as emotional closeness. However, any form of infidelity has the potential to undermine the integrity of a marital bond. While infidelity can occur in both men and women, research identifies men as more likely to engage in such behavior. This study aims to analyze the impact of a husband’s infidelity on a wife’s self-concept. A qualitative phenomenological method was employed. The findings, based on interviews with four participants, reveal that infidelity within a marriage leads to feelings of anger, disappointment, and negative self-perceptions, such as feeling unwanted or unworthy and a loss of motivation to live with enthusiasm. Social support and religiosity were identified as critical factors in rebuilding the self-concept of victims of infidelity. Although religiosity does not instantly eliminate emotional pain, it serves as a significant source of strength, calm, and hope in the process of healing emotional wounds. Recovery from this emotional pain is not an easy process. Social support encompasses assistance in self-acceptance, emotional recovery, and the reconstruction of self-identity. Religiosity fosters self-awareness and reflection, helping individuals shift their focus from worldly concerns to spirituality and ultimate life goals. This facilitates adaptation accompanied by feelings of comfort, tranquility, optimism, and gratitude. Religiosity and social support are perceived as enhancing psychological well-being, providing emotional support, and helping individuals face life’s challenges with greater resilience.

Health-related quality of life among extrapulmonary tuberculosis patients and inequalities by disease manifestations: a longitudinal study analysing the impact of TB treatment.

To understand the impact of extrapulmonary tuberculosis (EPTB) and its treatment on quality of life, we analysed patient-reported outcome measures (PROMs) among presumptive ETPB patients. EuroQol's five-dimensional three-level (EQ-5D-3L) questionnaire and the Visual Analogue Scale (EQ-VAS) were used to measure PROMs by 274 presumptive EPTB patients at pre- and post-treatment stages. The patients were categorised as TB and non-TB by using a composite reference standard. Following the EuroQol suggested analysis methods, we calculated the health utility summary measure at the pre- and post-treatment stages. The health state density curve and index were used to analyse inequality in reported health profiles. We investigated factors associated with EPTB patients' health utility through multivariable regression at the pre-treatment stage. The analysis of PROMs showed both physical (mobility, self-care, usual activities) and psychological (pain, discomfort, anxiety & depression) health affected by all EPTB manifestations (lymphadenitis, pleuritis, meningitis and others). Moreover, we found inequality in reported health profiles across disease manifestations at pre- and post-treatment stages. Post-treatment, we found improvement in PROMs and no reports of extreme-level health problems. However, some problems persisted across all dimensions of EPTB manifestations. We found 100% improvement in pleuritis and meningitis manifestations. Socioeconomic status, type of health facility attended, and patients' working capacity were associated with health utility. Despite post-treatment improvement in health, inequality of reported health states by EPTB manifestations persisted, though decreased. This highlights that holistic patient- and health system-level interventions addressing the impact of illness should consider EPTB by its manifestations, not as a single disease entity.

Identification of health trajectories of patients with persistent spinal pain syndrome type 2 using latent class trajectory methods.

Persistent spinal pain syndrome Type 2 (PSPS-T2) is a long-lasting condition that consists of persistent pain following spinal surgery. Although this condition has long-term effects, it is currently studied at a given time point or over a limited period of time, which does not reflect the true impact of pain patients. To bridge this gap, we used latent class trajectory models to extract clusters with different trajectories of patients with PSPS-T2. Data from the PREDIBACK study, an observational, multicentric, and longitudinal investigation carried out prospectively, were used. This study focuses on patients with PSPS-T2, tracking their outcomes at 3-month intervals over a one-year period. Health status was evaluated using a novel multidimensional clinical response index (MCRI). The trajectories of patients' health status were extracted using mixture of mixed effect models. Two hundred (200) PSPS-T2 patients were included. Two clusters were identified, including 'persistent low health' trajectories (63.1%) and 'improving health' trajectories (36.9%). Regarding the factors associated with these trajectories, our results showed that lower age, lower body mass index, lower pain intensity, lower functional disability, lower anxiety and less extended pain surface were associated with improving health status. Clustering methods provide an opportunity to identify two distinct clusters of pain-related health trajectories of PSPS-T2 patients. Persistence of the symptoms was not observed in one third of the PSPS-T2 study patients, who belong to the improving pain-related health cluster, while the other two thirds did not achieve improved health over a 1-year follow-up. Our study findings suggest that the use of trajectory-based methods could improve patient evaluation and pain management as it allows for obtaining a global view of patients during their care pathway compared to conventional methods, which only focus on specific visits. Our study also advocates for multidimensional assessment and management of pain by targeting not only pain intensity but also the psychological distress, functional capacity and pain surface at an early stage of pain onset after spine surgery.

Pemaafan Pasca Perceraian pada Perempuan Korban Perselingkuhan di Yogyakarta

Forgiveness is a change in the attitude of an individual who has been hurt so that he does not retaliate with the same action towards the person who has hurt him. This provides more peace in the heart. Forgiveness consists of three aspects which include Avoidance motivation, Revenge motivation and Beneviolence motivation. Female victims of infidelity tend to feel negative emotions for longer than male victims. Therefore, to eliminate negative emotions that cause psychosomatic symptoms in the victim, forgiveness is necessary. Through forgiveness, the heart of a woman who is a victim of infidelity no longer bears the psychological pain resulting from the injustice she experienced. This research is qualitative research that describes forgiveness among women victims of infidelity after divorce. The subjects of this research were women who were cheated on and divorced and their nieces The interview results from this research explained that the subjects had forgiven the perpetrator as evidenced by the absence of avoidance, desire for revenge and being able to empathize with the perpetrator. It was also found that forgiveness is influenced by several factors including emotional intelligence, the emergence of empathy, relationship quality, rumination, and personal factors. After forgiving the subject felt more at peace.

Intranasal oxytocin alleviates postsurgical pain and comorbid anxiety in mice: Participation of BK(Ca) channels in the hippocampus

The affective dimension in postsurgical pain is still poorly understood. Since neuropeptide oxytocin (OXT) has been implicated in a broad spectrum of pain and negative emotion, we investigated the potential therapeutic effect of intranasal OXT on postsurgical pain and associated anxiety in a mice model of plantar incision. The role of large conductance Ca(2+)-activated K(+) (BK(Ca)) channels was explored by using behavioral pharmacology experiments. We reported that plantar incision in mice induced anxiety-like behaviors and mechanical pain hypersensitivity, with a concurrent decrease of the oxytocin receptor (OTR) in the hippocampus. The immunofluorescence staining showed that the OTR were enriched in pyramidal neurons in CA3 subregion of hippocampus and which were highly co-expressed with the BK(Ca) channels in CA3 subregion. Intranasal OXT significantly ameliorated this postsurgical pain and associated anxiety in a dose-dependent manner, while Intra-CA3 microinjection of OTR antagonist atosiban or the BK(Ca) channel blocker paxilline reduced the effect of OXT in incisional mice. Moreover, intra-CA3 microinjection of BK(Ca) channel opener NS1619 produced a similar effect on postsurgical pain and associated anxiety-like behaviors as those observed following intranasal OXT administration. Conversely, intra-CA3 microinjection of BK(Ca) channel blocker paxilline in normal mice was sufficient to evoke mechanical pain hypersensitivity. Taken together, our data suggested that intranasal OXT administration exerted analgesic and anxiolytic effects in incisional mice by opening BK(Ca) channels in the CA3 subregion of hippocampus.

애착 장애 유아의 의식발달 과정에 대한 모래놀이 치료 사례연구

The purpose of this study is to study the process of how consciousness develops through sand play in infants and toddlers with serious attachment difficulties throughout infancy and by incorporating Kalff’s theory of ego-development from the perspective of ego-development. Based on reception, interviews, HTP, and mother’s reports, sand play therapy was performed 24 times for 8 months. Through the analysis of the sand play box process, it was based on the psychological change according to the progress of the sand play treatment process and Kalff’s theory of ego-development. The first was viewed as the stage of the animal and the plant, the second as the stage of struggle, and the third as the stage of group adaptation. In this study, the client revealed his psychological pain and showed stability as the treatment session progressed, expressing his inner language through the sandbox and the experience of a safely protected space in the sand play treatment process. Based on that sense of stability, the sand play change shown by the client showed the process of ego-developmental transformation, and confirmed the development of consciousness and psychological growth. Through counseling, the client’s unstable emotions were stabilized, and in the past, he avoided playing with friends in kindergarten, but now he does not shrink in peer relationships, adapts well, and plays actively among peer relationships. As a result, it shows that sand play treatment is effective in developing children’s consciousness.

Prevalence of Intimate Partner Violence: A Comparative Analysis of a Rural and Urban Area in Ekiti State

Globally ubiquitous, violence against women is a general threat that is often recognized by the victims' loved ones. Men in positions of authority, acquaintances, lovers, and other companions are all possible abusers. However, women are more susceptible to victimization at the hands of an intimate partner. Because of the topic's delicate nature, intimate partner violence is generally underreported; occurrences of such violence are typically not reported to the appropriate authorities. The study examined the prevalence of intimate partner violence in Ado-Ekiti and Ilogbo Ekiti which is a representation of a rural and urban area in the State. The study was carried out on 400 selected respondents in total, 200 respondents in each of the study areas. Data was collected through semi-structured questionnaires using the purposive sampling technique on 400 married respondents. The findings revealed that one out of every two (56%) respondents in the urban area had experienced intimate partner violence however the same could not be said about the rural area where (28%) had had the experience. The further revealed economic stress to be the most potent factor (70%) causing intimate partner violence in the urban area while patriarchy and rigid cultural practices are most cited (63%) in the rural area. In summary, the findings showed emotional pains as the highest consequence (62.5%) of intimate partner violence in the urban area and deteriorating physical health (68.5%) in the rural area Consequently, the study recommends prompt speaking up by abused persons to relevant authorities; training and re-training of agencies who receive intimate partner violence complaints on globally acceptable gender-based response(s), especially in the rural areas.

The relationship between positive and painful emotions and cognitive load during an algebra learning task

The mechanism through which emotional states impact learning is not yet fully understood. Through the lens of cognitive load theory, this study examines the relationship between emotional valence and learning during an algebra-based mathematics task and explores cognitive load as a potential mechanism through which emotions impact learning. Using structural equation modelling and path analysis of Australian Year 7 and 8 Secondary School students completing an algebraic learning task, we test a hypothesised model whereby extraneous cognitive load mediates the relationship between positive emotions, painful emotions, and learning. This model was tested against an alternative model with emotions mediating the relationship between extraneous cognitive load and learning. Results demonstrate that extraneous cognitive load mediates the relationship between painful emotions and learning. Alternatively, positive emotions were related to learning but not mediated by extraneous cognitive load. Implications of these findings for teachers and educators are also discussed.

Роль межличностных отношений в суицидальном поведении подростков: качественный анализ результатов полуструктурированного интервью

<p>This article presents the results of a qualitative analysis based on semi-structured interviews conducted with adolescents (n=13, aged 13–17), who were admitted to an inpatient psychiatric facility after attempted suicide. Content analysis yielded groups of words describing the circumstances of the suicide attempt based on semantic proximity. The following groups emerged (ordered by descending frequency of use): words describing one's psychological state, descriptions of family and relatives, words related to studies, school or college, and descriptions of relationships with peers. Within the framework of the thematic analysis, two superordinate themes and nine subthemes were identified, revealing the subjective experience of the suicide attempt. The first superordinate theme, <em>psychological distress</em>, includes the subthemes of “negative thoughts and emotions”, “mental pain” and “fear of surviving”. The second superordinate theme, <em>interpersonal vulnerability</em>, includes the subthemes of “feeling misunderstood by loved ones”, “conflicts”, “loneliness”, “experiencing the loss of important relationships”, “self-destructive way of communicating problems”, “the excessive importance of emotional relationships with peers” and “sensitivity”. These findings suggest that interpersonal relationships may play a significant role in adolescents’ suicide attempts, including both family relationships (primarily relationships with mothers) and relationships with peers; moreover, the state of psychological distress is described by adolescents in direct connection with dissatisfaction with interpersonal relationships (conflicts, rejection, neglect). Thus, interpersonal vulnerability, along with psychological distress, is one of the key characteristics of adolescent suicides.</p>

Multiple pathways to suicide: A network analysis based on three components of psychological pain

BackgroundPsychological pain is a multidimensional structure that has long been recognized as an important risk factor for suicidal ideation and behavior. The roles of interactions among psychological pain subfactors at different stages of suicidality remain unclear. MethodsA relatively large sample of outpatients with major depressive disorder (N = 501) was recruited to complete the Three-Dimensional Psychological Pain Scale (TDPPS). Exploratory graphical analysis (EGA) was conducted to explore the factor structure of TDPPS, thereby ensuring that the psychological pain subfactor was measured accurately. Network analysis included all TDPPS items, depression, passive suicidal ideation (PSI), active suicidal ideation (ASI), and history of suicidal action (SA) to identify key loops of suicidality. ResultsEGA disclosed a three-factor structure of TDPPS comprising cognitive, affective, and motivational factors. Network analysis revealed that items of motivational factors, but none of the items of cognitive and affective factors, were directly linked to PSI, ASI, and SA. Furthermore, three communities were identified by a “walktrap” algorithm. Depression and cognitive factor coalesced into a ‘cognitive’ community, affective factor constituted an ‘affective’ community, and motivational factor, PSI, ASI, and SA comprised a ‘suicidal’ community. LimitationsThis study used a cross-sectional design that cannot provide information on causal relationships among variables in the network. ConclusionsPsychological pain avoidance may be a direct driver of suicidality, and therefore its assessment and intervention in clinical practice is necessary.

Cross-Cultural Adaptation and Psychometric Validation of the Suicide Cognitions Scale-Revised (SCS-R) in Spanish Adolescents in Residential Care.

The Suicide Cognitions Scale (SCS) has demonstrated considerable promise as a risk screening tool, although it has yet to be validated for use with adolescents or in Spanish-speaking populations. The aim of this study was to develop a Spanish version of the 16-item SCS-Revised (SCS-R) and to examine its psychometric properties in a sample of adolescents. Participants were 172 adolescents aged between 12 and 18 years (M = 15.32, SD = 1.57) and currently in residential care. They completed the Spanish SCS-R and a series of other psychological measures. The psychometric properties of the SCS-R were examined through factor analyses and testing of convergent/discriminant validity and construct validity. Factor analyses supported a bifactor structure, indicating that SCS-R items were primarily measuring a common underlying latent variable. SCS-R scores were positively correlated with multiple indicators of psychopathology and other suicide risk factors (e.g., depression, hopelessness) but negatively correlated with protective factors (e.g., believing that one's mental pain will eventually end). Importantly, SCS-R scores differentiated adolescents in residential care who had previously attempted suicide from those who had only thought about suicide. Scores also differentiated adolescents who had previously attempted suicide from those who had previously only engaged in non-suicidal self-injury. This constitutes further evidence that the SCS-R measures a construct that distinguishes suicidal thought from action and is specific to suicidal forms of self-harm. Overall, the results suggest that the Spanish SCS-R is a potentially useful tool for identifying adolescents at risk of attempting suicide in residential care.

Reassessing the Neural Correlates of Social Exclusion: A Replication Study of the Cyberball Paradigm Using Arterial Spin Labeling.

The cyberball paradigm has been used in numerous neuroimaging studies to elicit activation in neural substrates of social exclusion, which have been interpreted in terms of activity associated with "social pain". The objectives of the study were to assess not only the replicability but also the specificity of the areas activated by this paradigm. Functional imaging with arterial spin labeling, an approach to image longer mental states. We replicated findings of previous meta-analyses of this paradigm in the inferior frontal gyrus and ventral cingular cortex. However, these areas were also active in a watch condition (in which participants were not excluded), although less so. These findings relativize a simple and specific interpretation of these areas as the neural substrates of social exclusion and social pain, as in previous studies. In a broader experimental context, similar activations have been reported by neuroimaging studies when semantic disambiguation and evaluation of action goals are required, an interpretation that may also apply to the effects elicited by this paradigm.

Emergency Medical Services Provider-Perceived Alzheimer’s Disease and Related Dementias in the Prehospital Setting

Objective: Our goal was to assess emergency medical services (EMS) provider-perceived Alzheimer’s disease and related dementias (ADRD) by patient sociodemographic characteristics and ZIP code tabulation areas (ZCTA) in the prehospital setting. Methods: We conducted a retrospective descriptive analysis of EMS calls with patient contact for adults ≥ 65 years of age who were provided prehospital care between February 1, 2020 and January 31, 2022, using data from the San Francisco Department of Emergency Management and the 2021 American Community Survey. Logistic regression models assessed the associated between EMS providerperceived ADRD and patient sociodemographic characteristics, including age, race/ethnicity, incident location, and ZCTA-level socioeconomic status. Results: A total of 55,129 patient encounters were recorded, with EMS provider-perceived ADRD recorded in 4,112 (7.5%). Among cases with EMS provider-perceived ADRD, the most common primary impressions were mental disorders (17.1%), weakness (17.0%), injury (15.7%), and pain (13.1%). Increasing age was associated with higher odds of EMS provider-perceived ADRD among both sexes. Among females, EMS provider-perceived ADRD was higher among Hispanics (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.11–1.52), Blacks (OR 1.20, 95% CI 1.03–1.40), Asians (OR 1.18, 95% CI 1.06–1.31), and Native Hawaiian and Pacific Islanders (OR 1.48, 95% CI 1.05–2.08]), while among males, only Asians (OR 87, 95% CI .76–.99) had lower odds, all compared to Whites. Females in lowand medium-income ZCTAs had lower odds of EMS provider-perceived ADRD relative to high-income ZCTAs, with no significant findings in males. Conclusion: Our findings suggest a higher prevalence of EMS provider-perceived Alzheimer’s disease and related dementias among minoritized and socioeconomically disadvantaged populations, including the oldest adults, and racial and ethnic minority communities. Future research and more precise data collection is needed to ensure equity for older adults who access emergency care in the prehospital setting.

Classifying chronic pain using ICD-11 and questionnaires-reported characteristics in Japanese patients with chronic pain.

The new ICD-11 code for chronic pain indicates a direction to divide chronic pain into two categories: chronic secondary pain, which has a clear underlying disease, and chronic primary pain, which is associated with significant emotional distress or functional disability and cannot be explained by another chronic condition. Until now, epidemiological studies have been hampered by the lack of a clear classification, but we believe that this new code system will provide a new perspective on the diagnosis and treatment of chronic pain, and we have begun work on this code system. We studied 2,360 patients at Aichi Medical University, the largest pain center in Japan, and asked them to answer questionnaires on pain severity (NRS), pain-related functional impairment (PDAS, Locomo25), quality of life (EQ-5D), and psychological state and pain cognition (HADS, PCS, PSEQ, AIS) while their attending physicians were giving diagnoses according to ICD-11 and the results of the study were used to determine the coding of pain severity. The ratio of primary to chronic secondary pain was almost 50%, and the group of patients with MG30.01 classification, which included fibromyalgia, had the highest severity among chronic primary pain. The MG30.01 classification of patients was also found to experience more severe pain compared to other classifications of chronic primary pain patients. The classification of patients with a major psychiatric component was not always clear, and some patients in the secondary category also had a clear psychiatric component, suggesting the need to develop complementary tools to support pain diagnosis.

My grief app for prolonged grief in bereaved parents: a randomised waitlist-controlled trial

ABSTRACT A minority of bereaved adults experiences prolonged grief disorder, depression, and/or posttraumatic stress disorder, with heightened risks observed among bereaved parents. Cognitive-behavioural therapies, both face-to-face and online, have demonstrated efficacy in treating post-loss mental health problems. Mobile phone applications potentially offer an efficient and cost-effective way to deliver self-help to bereaved adults, yet controlled effectiveness studies are lacking. Therefore, we examined the short-term efficacy of the My Grief app, based on cognitive-behavioural therapy, in 248 bereaved parents, in a randomised controlled trial (Clinicaltrials.gov, identifier: NCT04552717). Participants were randomly allocated to access to the My Grief app (n = 126) or a waitlist (n = 122). At baseline and post-assessment, symptoms of prolonged grief, posttraumatic stress, and depression, negative grief cognitions, rumination, and avoidance were assessed. Reductions in prolonged grief and posttraumatic stress symptoms and negative cognitions in the intervention group were larger than in the control group, albeit with small effect sizes. Fifteen app users reported negative experiences with the app; for example, some mentioned that it elicited painful memories and emotions related to their loss. My Grief appears to achieve modest improvements in mental health in bereaved parents. Given that it is accessible and low-cost, it is an important addition to the suite of prolonged grief interventions.