Principles Of Biomedical Ethics Research Articles

Systematic review of ethics and legislation of a Global Patient co-Owned Cloud (GPOC)

Background The use of cloud-based storage for personal health records (PHRs) has significantly increased globally over the past thirty years. The four recently published GPOC Series articles introduced the concept of a Global Patient co-Owned Cloud (GPOC) for personal health records. The series includes a systematic review and meta-analysis, a summit, a sandbox, and a survey, with 100% participation from UN member states and key international health organisations. GPOC aims to establish patient co-ownership of PHRs, addressing integration and access challenges. Methods This study is built upon the published GPOC systematic review and meta-analysis that focused on examining cloud-based personal health records and elements such as data security, efficiency, performance, privacy and cost-based factors. However, this study selectively reviews the ethical, legislative and potential human rights dimensions of GPOC. Thus, it includes ethical aspects of co-ownership, rights, privacy, policies, and AI integration. The original study was PROSPERO registered with CRD42022342597, which serves as the foundation for the current study. Results This study offers a comprehensive global overview of ethics, legislation and initiatives by states and organisations. We analyse AI integration and future challenges for GPOC implementation. We present principles from ‘Ethics by Design’ and the ‘Principles of Biomedical Ethics’ by Beauchamp and Childress alongside the European General Data Protection Regulation (GDPR). The study presents a global overview of the relevant global latticework of legislation. Conclusions This study suggests that GPOC could potentially establish a new human right to patient co-ownership of personal health information. GPOC aims to facilitate global AI integration in healthcare and address existing challenges in PHR integration. A decentralised GPOC, supported by blockchain consensus, may offer benefits such as enhanced data security, interoperability, and equitable access to healthcare information globally. Thus, GPOC may have a positive impact on global health.

Comparison of the effectiveness of drug therapy and non-drug technology of post-COVID rehabilitation of workers with intensive computer load

Currently, there is sufficient evidence of the importance and clinical effectiveness of non-drug therapy. The scientific discussion on the priority of the clinical application of pharmacological and non-pharmacological methods of rehabilitation of patients with mononeuropathies has acquired particular importance against the background of neurological post-COVID complications in patients with COVID-19. The study aims to compare the effectiveness of drug therapy and non–drug technology of post-covid rehabilitation of workers with intensive computer workload based on the study of clinical and laboratory parameters. Scientists have conducted a survey of two groups of workers with intensive computer workload who underwent rehabilitation after COVID-19 with the use of drug therapy and non-drug technologies, including balneotherapy, drinking narcotherapy, aerosol inhalations, low-frequency magnetic therapy. The authors have evaluated the effectiveness of therapy based on the results of studies of asthenization, degree of fatigue, latent coronary insufficiency, the state of the blood microcirculation system, immune status, the state of the POL-AOSIS system and endogenous intoxication of patients. Asthenization, the degree of fatigue, and latent coronary insufficiency decreased in the majority of the examined patients after post-COVID non-drug measures. Whereas in patients of the drug group, a decrease in these indicators was noted in a small number of examined patients. The indicators of the immune status of patients after non-drug therapy returned to normal, after drug therapy they only approached the limits of the norm, but did not reach it. After the treatment, the indicators of lipid peroxidation in the group of patients undergoing post-COVID rehabilitation using non-drug technologies decreased more significantly than in the group receiving drug treatment. The content of the antioxidant enzymes catalase and ceruloplasmin and the fat-soluble antioxidant α-tocopherol after treatment increases in both groups, but in the group of drug treatment they do not reach the lower limit of the reference intervals. The decrease in the content of medium-molecular peptides is more pronounced when using non-drug technologies. The application of the proposed non-drug technology for the rehabilitation of patients with post-COVID syndrome who are subjected to intense computer loads during work showed a significantly more pronounced normalization of asthenization, fatigue, latent coronary insufficiency and the state of the blood microcirculation system, immune status, the state of the POL-AOSIS system and endogenous intoxication of patients. The data obtained indicate a high therapeutic effect of the use of non-drug technology. Limitations. The surveyed groups included only persons permanently registered in Kislovodsk. Ethics. The research was conducted in accordance with the principles of biomedical ethics and approved by the local Ethics Committee of the Izmerov Research Institute of Occupation Health, Moscow (Protocol No. 4 dated 04/14/2021). Each participant of the study submitted a voluntary written informed consent signed by him after explaining to him the potential risks and benefits.

Clinicians' Perspectives and an Ethical Analysis of Safer Supply Opioid Prescribing.

In British Columbia, Canada, many physicians providing care to individuals with high-risk opioid use disorder adopted safer supply (SS) opioid prescribing in the spring of 2020 with the goal of facilitating public health measures for COVID-19. This prescribing practice continued after measures were lifted. This study aimed to explore prescribers' perspectives following several years of local experience in prescribing SS opioids, primarily in the form of hydromorphone tablets, and to apply ethical concepts to explore current challenges and ongoing sources of provider distress. Addiction medicine SS prescribers participated in individual or small group semi-structured interviews. Each interview was transcribed and analysed for recurrent themes. Themes were then integrated into a narrative ethics discussion. Eleven addiction medicine physicians practicing in various settings within Vancouver participated in this study. Six themes were identified: clinical assessment, clinician distress, gaps in care, models of safer supply, research, and special populations. Ethical dilemmas in prescribing SS are identified and explored through a discussion of biomedical ethics principles and the physician role.

Risk factors, timing and frequency of occurrence of post-COVID syndrome in workers with intensive computer workload

According to leading experts of the World Health Organization, the threat of a new strain of SARS-CoV-2 coronavirus remains, which will lead to a sharp increase in morbidity and mortality. The severity of complications after COVID-19 depends not only on how severe the disease was, but also on other factors: genetic predisposition, age, concomitant diseases, and working conditions. This makes it urgent to conduct further scientific research on the ranking of the factors of the production environment that accelerate the spread of COVID-19. The study aims to determine the degree of occupational risk, taking into account the timing and frequency of manifestations of post-COVID syndrome (U09.9; U10.9 according to ICD–X) in specialists with intensive computer workload. In the period 2020–2024, the researchers conducted a survey at the workplaces of Kislovodsk enterprises and examined 556 people with an intensive computer load associated with servicing the flows of mass consumers during the pandemic and in the post-pandemic period. We have studied the timing and frequency of the occurrence of post-COVID syndrome, objectified by the degree of health risk factors in various categories of workers with intensive computer workload. The timing and frequency of seven post-COVID syndrome manifestations ranked (according to the degree of occupational health risk factors) (U09.9; U10.9 according to ICD-X) that occur in workers with intensive computer workload in the first two weeks after discharge from the hospital during hospitalization for COVID-19 (occupational health risk factors category A) or arising within three to four weeks after discharge from the hospital during hospitalization for COVID-19 (occupational health risk factors of category B). Based on statistical and clinical and hygienic data obtained in the period from 2020 to 2024, post-COVID manifestations in the gradations of "high" and "moderately high" occupational health risk for employees (n=556) with intensive computer load were ranked by the timing and frequency of occurrence of the named syndrome, as well as by the degree of risk of potential COVID-19 infections of the named groups of specialists associated with servicing mass consumer flows infected with constantly mutating representatives of enveloped RNA viruses. According to the degree of occupational risk to the health of persons with intensive computer workload, six groups of specialists associated with servicing mass consumer flows, potentially infected with COVID-19 and other representatives of enveloped RNA viruses, were ranked. Limitations. Post-COVID syndromes that occur within one to two and three to four weeks after discharge from the hospital have been studied. Ethics. Scientists have conducted research in accordance with the principles of biomedical ethics and approved by the local Ethics Committee of Izmerov Research Institute of Occupation Health, Moscow (Protocol No. 4 dated 04/14/2021). Each participant of the study submitted a voluntary written informed consent signed by him after explaining to him the potential risks and benefits.

Ethical dimensions of clinical data sharing by US healthcare organizations for purposes beyond direct patient care: Interviews with healthcare leaders.

Empirically investigate current practices and analyze ethical dimensions of clinical data sharing by healthcare organizations for uses other than treatment, payment, and operations. Make recommendations to inform research and policy for healthcare organizations to protect patients' privacy and autonomy when sharing data with unrelated third parties. Semi-structured interviews and surveys involving 24 informatics leaders from 22 US healthcare organizations, accompanied by thematic and ethical analyses. We found considerable heterogeneity across organizations in policies and practices. Respondents understood "data sharing" and "research" in very different ways. Their interpretations of these terms ranged from making data available for academic and public health uses, and to HIEs; to selling data for corporate research, to contracting with aggregators for future resale or use. The nine interview themes were that healthcare organizations: (1) share clinical data with many types of organizations, (2) have a variety of motivations for sharing data, (3) do not make data sharing policies readily available, (4) have widely varying data sharing approval processes, (5) most commonly rely on HIPAA de-identification to protect privacy, (6) were concerned about clinical data use by electronic health record vendors, (7) lacked data sharing transparency to the general public, (8) allowed individual patients little control over sharing of their data, and (9) had not yet changed data sharing practices within the year following the US Supreme Court 2022 decision denying rights to abortion. Our analysis identified gaps between ethical principles and healthcare organizations' data sharing policies and practices. To better align clinical data sharing practices with patient expectations and biomedical ethical principles, we recommend: updating HIPAA, including re-identification and upstream sharing restrictions in data sharing contracts, better coordination across data sharing approval processes, fuller transparency and opt-out options for patients, and accountability for data sharing and consequent harms.

Ethical Issues in Living Donor Kidney Transplantation: An Update from a Psychosocial Perspective.

Living donor kidney transplantation (LDKT) currently represents the treatment of choice for patients with end-stage renal failure. LDKT is a serious event with profound psychological, interpersonal, familial, and social implications. Over the last few years, there has been an exponential growth in living donation programs involving genetically and emotionally related donors, as well as people who donate to an unrelated and unknown subject. The implementation of paired exchange programs, Samaritan donation, and preemptive transplantation raise further ethical issues, which are inextricably linked to the unique psychosocial context of both the donor and the recipient. The present narrative review aims to provide an update on the main ethical challenges related to LDKT. We conducted a comprehensive literature search in PubMed/Medline. The results of the most relevant studies were narratively synthesized from a psychosocial perspective around the four principles of biomedical ethics: autonomy, beneficence, non-maleficence, and justice. Finally, we discussed the potential future directions to provide an effective, patient-centered, and ethical psychosocial assessment and follow-up of living donors and recipients that underwent LDKT.

Ethics in Patients' Health Literacy: a scoping review and a critical discussion.

A growing body of literature has acknowledged that a high number of populations with low Health Literacy (HL) is related to poor health outcomes, inequities in healthcare and high economic costs. Those findings have formulated the research questions of this review: (i) what ethical issues arise within the context of patients' HL and (ii) What is the relationship between HL and quality of life? This review followed the guidelines of Joanna Briggs Institute (JBI) and the Preferred Reporting Items for Scoping Reviews (PRISMA-ScR) and it was conducted in five databases: PubMed, CINAHL, MEDLINE, Scopus and Science Direct between June 2022 and December 2023. Out of the 3164 titles retrieved, 285 abstracts were eligible to proceed. Following a thorough examination of the full text of 61 papers, 45 sources were identified that met the inclusion criteria. The data analysis process was guided by the research questions, employing a thematic approach. Four themes were identified: the use of language and patient understanding, human rights, the principlism approach (justice, beneficence, non-maleficence and autonomy) and quality of life. The first theme mainly focused on the relation of HL with the notion of consent forms and national action plans. Human rights in relation to HL were discussed as a minor issue. The bioethical framework by Beauchamp and Childress (Principles of Biomedical Ethics, 6th edn. Oxford University Press, New York, NY, 2009), was addressed by several studies, with a particular focus on justice and the loss of autonomy. Quality of life indicated a positive correlation with HL by most of the authors, while few studies revealed a moderate correlation.

Legal Certainty of Patients’ Right to Autonomy Protection in High-Risk Health Services

The relationship between medical personnel and patients in health services should be viewed as a legal relationship between humans who have equal rights. There are two basic human rights in health services, the right to autonomy and the right to information. The results of the study indicate that the protection of patients' autonomy rights is one of the principles in biomedical ethics used as the moral basis for the provision of health services. The form of protection of patients' autonomy rights in health services is realized through regulations related to Informed Consent in Law Number 17 of 2023 Concerning Health and Minister of Health Regulation Number 290 of 2008 Concerning Consent to Medical Actions. Meanwhile, regulations related to the protection of patients' autonomy rights for high-risk health care actions have not met legal certainty because the health care actions are not classified as high-risk.

An ethics analysis of antipsychotic dose reduction and discontinuation: Principles for supporting recovery from psychosis.

To examine the evidence and practice of antipsychotic dose reduction from the lens of biomedical ethics (specifically principlism) to support evidence-based practice and patient choice and self-determination. An overview of the evidence from randomized controlled trials of antipsychotic dose reduction versus maintenance is presented. This is followed by a theoretical examination of the four key biomedical ethical principles of autonomy, nonmaleficence, beneficence, and justice and how they apply in the case of antipsychotic dose reduction. Existing clinical trial research is dominated by relapse as the primary outcome, with dose reduction associated with a higher risk of relapse than maintenance. Few studies have measured other patient-centered outcomes but have shown preliminary evidence for superior cognitive functioning, lower negative symptoms, and better functioning following dose reduction. Respect for autonomy is a cornerstone of psychiatric rehabilitation, and this includes the right of people to choose to reduce or discontinue antipsychotic medication. Reduced capacity for treatment decision making can be supported. Autonomy and appraisal of nonmaleficence and beneficence associated with dose reduction can be facilitated through shared or supported decision making. Clinicians should continue to strive for justice through the fair allocation of resources to support all people who request antipsychotic dose reduction. Clinicians have a responsibility to balance the four core ethical principles to the best of their ability when supporting a person in their recovery journey. Exploring, trialing, and supporting antipsychotic dose reduction may be part of this process if that is the patient's choice. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Algorithm of complex therapy and prevention of emotional burnout in doctors-psychiatrists during the war and its effectiveness

Abstract. The purpose - to develop and determine the effectiveness of the algorithm of complex therapy and prevention of emotional burnout (EB) among psychiatrists during the war, to resolve the issue of its recommendation for wide implementation in the system of mental health care institutions. The research sample, which was formed in compliance with the principles of biomedical ethics and based on informed consent, included 120 psychiatrists who worked in the city of Kyiv in the period from February 24, 2022. During 2022, the persons under examination were divided into three groups: the first group included 37 persons (30.8%) – doctors with no signs of professional maladjustment (PMA), and a low level of EB; the second group consisted of 57 persons (47.5% ) with signs of professional PMA, and a moderate level of EB; the third group consisted of 26 persons ( 21.7%) and they were respondents with clinically established and pronounced PMA, and a high level of EB. As a result of the study, the personal, psychopathological, psychosocial, professional and emotional-interpersonal factors of the formation and progression of EB among psychiatrists during the war were established, and their interrelationships in its genesis, on the basis of which the basic principles of a comprehensive approach to the therapy and prevention of EB were formulated for psychiatrists (complexity, personalization, phasing and availability), the main goals of treatment and prevention measures are defined and 4 therapeutic strategies of diagnosis, therapy and prevention are proposed within the framework of providing specialized medical care to psychiatrists during the war. These are recommended to be implemented taking into account the degree PMA as a key descriptor of EB, and in accordance with the key vectors of pathological changes in the respondents. The implementation and further evaluation of the effectiveness of the mentioned measures proved their effectiveness in eliminating manifestations of EB and PMA, normalization of mental state with levelling of psychopathological symptoms, improvement of social and psychological adaptation and quality of life of psychiatrists. The results obtained make it possible to recommend this algorithm for wide implementation in the practice of mental health care institutions.

Refusal of transfusion: What is the right place for the principle of respect for autonomy?

Nineteen people refusing a blood transfusion in anticipation of thoracic surgery were met at the Clinical Ethics Center (AP-HP, Paris, France). The article reflects on the right place that respect for autonomy plays in medical decisions regarding (non)transfusion when medical practice would recommend it. Three patient profiles emerge: "categorical refusals", "refusals while affirming the need to live" and "refusals accompanied by doubt". Without neglecting the arguments relating to other principles of biomedical ethics (beneficence, non-maleficence, justice), the idea is to enable healthcare professionals to better assess the different situations they face and in particular those in which respect for autonomy seems essential. If the majority of people concerned by the issue are Jehovah's Witnesses, and although this religion is sometimes stigmatized, this work sheds light on the place of their wishes hold in medical decisions on (non)transfusion. Healthcare professionals could contact ethics units and ask them to carry out this same assessment in their own different.

Medical Ethics in Perspective of Islamic Teachings

Summary: Islam as a universal religion, presents a comprehensive and practical system of ethics for the entire humanity in every field of life. Medical ethics is one of the most important components of this extensive ethics system. Islamic medical ethics is the approach of dealing with and handling the healthcare practice and process according to the Islamic moral system and legislative sources (primarily ‘The Quran’ and ‘Hadith’). It is also adopted and promoted by several international organizations. Islamic ethics endorses the basic principles of biomedical ethics, i.e. Beneficence, non-maleficence, confidentiality, justice, truth-telling, autonomy and informed consent, which have been mainly derived from the “Hippocratic Oath”, with some additions and modifications. Moreover, Islamic teachings present some additional moral values over these basic ethical principles. The present manuscript aims to concisely highlight the evolution and history of bio-medical ethics, briefly describe its basic concepts and focus on the influence of teachings, principles and characteristics of Islam on this important aspect of medical practice. In the end, some important relevant topics such as the general responsibilities of the doctor, protection of life, legal status of treatment and status of treatment with prohibited substances, in the light of Islam, are also discussed briefly. Keywords: Medical ethics, Hippocratic Oath, basic principles of ethics, Islamic perspective.

Bioethics-CSR Divide

Bioethics-CSR Divide

Fostering Medical Students’ Commitment to Beneficence in Ethics Education

Fostering Medical Students’ Commitment to Beneficence in Ethics Education

Caring for Pregnant Patients with Cancer: A Framework for Ethical and Patient-Centred Care.

(1) Background: Caring for pregnant cancer patients is clinically and ethically complex. There is no structured ethical guidance for healthcare professionals caring for these patients. (2) Objective: This concept paper proposes a theoretically grounded framework to support ethical and patient-centred care of pregnant cancer patients. (3) Methodological approach: The framework development was based on ethical models applicable to cancer care during pregnancy-namely principle-based approaches (biomedical ethics principles developed by Beauchamp and Childress and the European principles in bioethics and biolaw) and relational, patient-focused approaches (relational ethics, ethics of care and medical maternalism)-and informed by a systematic review of clinical practice guidelines. (4) Results: Five foundational discussion themes, summarising the key ethical considerations that should be taken into account by healthcare professionals while discussing treatment and care options with these patients, were identified. This was further developed into a comprehensive ethics checklist that can be used during clinical appointments and highlights the need for a holistic view to patient treatment, care and counselling while providing ethical, patient-centric care. (5) Conclusion: The proposed framework was further operationalised into an ethics checklist for healthcare professionals that aims to help them anticipate and address ethical concerns that may arise when attending to pregnant cancer patients. Further studies exploring clinicians' attitudes towards cancer treatment in the course of pregnancy and patient experiences when diagnosed with cancer while pregnant and wider stakeholder engagement are needed to inform the development of further ethical, patient-centred guidance.

Gender Affirming Hormone Treatment for Trans Adolescents: A Four Principles Analysis

Gender affirming hormone treatment is an important part of the care of trans adolescents which enables them to develop the secondary sexual characteristics congruent with their identified genders. There is an increasing amount of empirical evidence showing the benefits of gender affirming hormone treatment for psychological health and social well-being in this population. However, in several countries, access to gender affirming hormone treatment for trans adolescents has recently been severely restricted. While much of the opposition to gender affirming hormone treatment for trans adolescents has in part been ideologically motivated, it also reflects a debate about whether there are harms that outweigh the benefits of the treatment. Accordingly, a systematic and comprehensive philosophical analysis of the ethics of gender affirming hormone treatment for trans adolescents is needed. Herein, I offer such an analysis that draws on the four principles of biomedical ethics by Tom Beauchamp and James Childress. Based on the considerations of beneficence, nonmaleficence, autonomy, and justice, I argue that the provision of access to gender affirming hormone treatment for consenting trans adolescents is ethically required and that the current restrictions to such treatment are ethically wrong.

An introduction to dental ethics Part 4 - The four principles of biomedical ethics. Part 1

An introduction to dental ethics Part 4 - The four principles of biomedical ethics. Part 1

Principlism and contemporary ethical considerations for providers of transgender health care

Background : Transgender health care is a subject of much debate among clinicians, political commentators, and policy-makers. While the World Professional Association for Transgender Health (WPATH) Standards of Care (SOC) establish clinical standards, these standards contain implied ethics but lack explicit focused discussion of ethical considerations in providing care. An ethics chapter in the SOC would enhance clinical guidelines. Aims : We aim to provide a valuable guide for healthcare professionals, and anyone interested in the ethical aspects of clinical support for gender diverse and transgender people of all ages. Recognizing that the WPATH is a global association, we address broad challenges. We offer a reflection on general ethical principles, providing conceptual tools for healthcare providers, patients, and families to navigate the specific challenges they might encounter in transgender health care, in line with WPATH’s worldwide mission and scope. Method : This article employs a descriptive analysis, and our framework of reference is the four principles of biomedical ethics: respect for autonomy, beneficence, nonmaleficence, and justice. Results : The article presents a discussion on the four ethical principles as applied to transgender health care. We address issues such as respect for patient autonomy in decision-making, the role of beneficence and nonmaleficence in clinical interventions, and the importance of justice in equitable treatment and access to care. Some of the ethical concerns we address in this article pertain to the current sociopolitical climate, where there has been increasing legal interference, internationally, for transgender and nonbinary people, particularly youth, seeking medical care. Discussion : We highlight the interplay between ethical principles and clinical practice, underscoring the need for ethical guidance in addressing the diverse challenges faced by healthcare providers and patients in transgender health care. We advocate for continuous refinement of ethical thinking to ensure that transgender health care is not only medically effective but also ethically sound.

Health teachers' ethical conflict experiences in the COVID-19 situation: a qualitative content analysis.

In the context of the COVID-19 pandemic, health teachers who are responsible for the health of school staff and students are experiencing many ethical conflicts, and research on this is needed. This study was to investigate and explore the ethical conflicts experienced by health teachers during the COVID-19 pandemic situation. This was a qualitive study using directed content analysis applied to the four principles of biomedical ethics. Study participants were a total of 26 health teachers in Seoul, South Korea. In-depth individual interviews were conducted with 14 health teachers, and focus group interviews were conducted with the other 12 (2 teams with each 6 persons). Data were collected between May-June 2022, and analyzed using a deductive approach among the qualitative content analysis of Elo and Kyngäs. This study satisfied the four aspects of credibility, transferability, dependability, and confirmability presented by Guba and Lincoln (1989) to secure the reliability of qualitative research. The ethical conflicts related to the four principles of biomedical ethics advocated by Beauchamp and Childress (autonomy, non-maleficence, beneficence, and justice), and the ethical conflicts in which overlap with the two principles of autonomy and non-maleficence, and the ethical conflicts related to miscellaneous matters or relationships, which were not included in the four principles, were investigated as the main 6 categories of ethical conflicts experienced by health teachers. Based on this, 10 generic categories and 17 subcategories were derived. This study could be used as primary data for policy development and intervention research. Such engagements can help identify ethical conflicts faced by health teachers in infectious disease crises, thus improving their ability to cope.

Structure and features of psychopathological symptoms in forced migrants and internally displaced persons

Aim: To study the structure and characteristics of psychopathological symptoms in FM who left Ukraine as a result of the full-scale armed aggression of the Russian Federation against Ukraine, and internally displaced persons, in a comparative aspect. Materials and Methods: Examination was performed in compliance with the principles of biomedical ethics, based on informed consent. Research was provided on the basis of the Ternopil Regional Clinical Psychoneurological Hospital. Inclusion criteria were women who were forced to leave the territory of Ukraine as a result of hostilities after February 24, 2022, and who left for temporary residence in the territory of the Republic of Poland (Poland) (FM), and women who were temporarily relocated within Ukraine in connection with connection with hostilities (IDP). Exclusion criteria from the study were presence of language disorders, pronounced cognitive disorders, severe somatic condition. The examination was organized by the method of a semi-structured clinical interview according to the developed by us protocol and was conducted remotely. During the examination, depressive, anxiety-phobic, asthenic and dyssomnic disorders, addictive behavior and symptoms of PTSDwere identified and verified. Statistical and mathematical processing a was carried out using Fisher’s exact test. Results: The data we obtained indicate a significant spread of psychopathological symptoms in FM and IDP. Conclusions: FM and IDP are characterized by a high incidence of psychopathological symptoms. The most frequent were: depressed mood (FM – 67.2%, IDP – 58.5%), feelings of anxiety and fear (FM –52.5%, IDP – 43.6%), obsessive thoughts (FM – 58.9 %, IDP – 49.5%).