Psychological Risk Factors Research Articles

The Örebro Musculoskeletal Pain Screening Questionnaire-Short Form and 2-year follow-up of registered work disability.

The Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ) was developed to identify psychological and functioning-related risk factors among individuals with musculoskeletal pain at risk of work disability. This study aimed to examine whether the short version of the ÖMPSQ (ÖMPSQ-SF) can be used for this purpose, using registry-based outcomes. The ÖMPSQ-SF was completed by the members of the Northern Finland Birth Cohort 1966 at the age of 46 years (baseline). These data were enriched with national registers, including information on sick leaves and disability pensions (indicators of work disability). The associations between the ÖMPSQ-SF categories (low-, medium- and high risk) and work disability over a 2-year follow-up were analysed using negative binomial regression and binary logistic regression models. We made adjustments for sex, baseline education level, weight status and smoking. Overall, 4063 participants provided full data. Of these, 90% belonged to the low-risk, 7% to the medium-risk and 3% to the high-risk group. Compared to the low-risk group, the high-risk group had a 7.5 [Wald 95% confidence interval (CI) 6.2-9.0] times higher number of sick leave days and 16.1 (95% CI 7.1-36.8) times higher odds of disability pension after adjustments in the 2-year follow-up. : Our study suggests that the ÖMPSQ-SF could be used for predicting registry-based work disability at midlife. Those allocated to the high-risk group seemed to have a particularly great need of early interventions to support their work ability.

Prevalence and Risk Factors for Chronic Post-Surgical Pain Following Cardiac Surgery: A Single-center Prospective Cohort Study.

Chronic post-surgical pain is a common complication of surgery. The role of psychological risk factors like depression and anxiety is substantially understudied in cardiac surgery. This study sought to identify perioperative factors associated with chronic pain at 3, 6, and 12 months after cardiac surgery. We hypothesize that baseline psychological vulnerabilities have a negative influence on chronic post-surgical pain. We prospectively collected demographic, psychological, and perioperative factors in a cohort of 1059 patients undergoing cardiac surgery at the Toronto General Hospital between 2012-2020. Patients were followed and completed chronic pain questionnaires at 3, 6, and 12 months after surgery. We included 767 patients who completed at least one follow-up questionnaire. The incidence of postsurgical pain (> 0 out of 10) at 3, 6, and 12 months after surgery was 191/663 (29%), 118/625 (19%), and 89/605 (15%), respectively. Notably, among patients reporting any pain, the incidence of pain compatible with a neuropathic phenotype increased from 56/166 (34%) at 3 months, to 38/97 (39%) at 6 months and 43/67 (64%) at 12 months. Factors associated with postsurgical pain scores at 3 months include female sex, pre-existing chronic pain, previous cardiac surgery, preoperative depression, baseline pain catastrophizing scores, and moderate-to-severe acute pain (≥4 out of 10) within 5 postoperative days. Nearly one in three patients undergoing cardiac surgery reported pain at 3 months follow-up, with ~15% reporting persistent pain at 1 year. Female sex, pre-existing chronic pain, and baseline depression were associated with postsurgical pain scores across all three time periods.

Ergonomics and Prevention of Occupational Musculoskeletal Disorders

Background: Occupations have psychological risk factors for musculoskeletal disorders and diseases. Many of them are preventable. Occupational strains are one of the preventive occupational risk factors. Objective: Introduction of musculoskeletal disorders and prevention, kinds, diagnosis and treatment. Materials and Methods: In a review study the author research in related scientific literature, websites and journals about the musculoskeletal disorders. Job musculoskeletal disorders and prevention, kinds, diagnosis and treatment. Results: Musculoskeletal disorders can be classified to neck, upper limbs, spine, lower limbs and rheumatologic disorders. But the prevention is important in the workplaces. Conclusion: Musculoskeletal disorders are important and recognizing the risk factors is important. Prevention is necessary.

Factores de riesgo y protección del consumo de drogas ilícitas en adolescentes latinoamericanos

Introduction: illicit drug use is a public health problem associated with high rates of school, work, and social disability. The population with the highest rate of increase in illicit drug use are adolescents, due to their age and biological immaturity. Studies in Latin America mainly identify personal, biological, psychological, and sociocultural risk factors for illicit drug use. Objective: to analyze the scientific evidence on the risk and protective factors of illicit drug use in adolescents in Latin America. Method: the literature search was carried out in: Web of Science, CINAHL, PubMed, MEDLINE, LILACS, SCIELO. Results: in the initial search, a total of 1181 reports were obtained. For the full text evaluation, 147 potentially relevant articles were retrieved, selecting a total of 17 publications that met the inclusion criteria. The findings were grouped into two thematic categories: 1) Risk factors: biological, family, individual, socio-environmental, psychological, and socio-educational; 2) Protection factors: family, religious, psychological and socio-environmental. Discussion and conclusions: the findings of the scope review reveal that there are numerous investigations on the various risk and protective factors of illicit drug use in school adolescents. In addition, it was confirmed that united families and religiosity are protective factors for illicit drug use.

Risk factors and protective factors of acute postoperative pain: an observational study at a German university hospital with cross-sectional and longitudinal inpatient data

ObjectivesSurgical fear is one of the most important psychological risk factors for postoperative pain, but less is known about the contribution of protective factors. This study investigated somatic and psychological...

Anestezi Sağlık Çalışanlarının İş Sağlığı ve Güvenliği Konusunda Algı, Bilgi ve Tutumlarının Değerlendirilmesi

Objective: Anesthesia healthcare workers work under more intense hazard, risk and excessive workload specific to their field, in addition to the problems of other healthcare workers. This study aims to identify perception of occupational risks in the working environment, knowledge about occupational health and safety (OHS), and the use of personal protective equipment in the working environment among the anesthesia healthcare workers. Methods: This descriptive study was conducted with 153 anesthesia healthcare workers. The healthcare workers participating in the study were divided into 2 groups according to their work: physicians and non-physician healthcare workers. The questionnaire included sociodemographic, knowledge about occupational risks and Occupational Health and Safety Law (OHSL), use of personal protective equipment and knowledge of OHS in the institution questions. Results: The frequencies of the working conditions and professional practice areas of the group of doctors being not ergonomically appropriate (p=0.005), insufficient lighting (p=0.001), insufficient heat (p<0.015), chemical agent exposure (p=0.024), ionizing radiation exposure (p=0.003), exposure to biological agents (p=0.022), exposure to psychological risk factors (p=0.017) were found to be statistically significantly higher. In this study, it was found that the perception of working environment conditions and occupational risk factors was higher in doctors, and their knowledge of OHSL and OHS practices in the institution was higher in the non-physician group. Conclusion: The OHS trainings received by the health care workers were effective for the results. Increasing knowledge about occupational risks and preventive measures against them can reduce the incidence and consequences of possible occupational diseases. Keywords: Anesthesia, occupational health, occupational safety

Risk Factors for Postpartum Depression and Severe Distress among Mothers of Very Preterm Infants at NICU Discharge.

To identify psychological, medical, and socioenvironmental risk factors for maternal postpartum depression (PPD) and severe psychological distress (SPD) at intensive care nursery discharge among mothers of very preterm infants. We studied 562 self-identified mothers of 641 infants born <30 weeks who were enrolled in the Neonatal Neurobehavior and Outcomes in Very Preterm Infants Study (NOVI) conducted in nine university-affiliated intensive care nurseries. Enrollment interviews collected socioenvironmental data, depression, and anxiety diagnoses prior to and during the study pregnancy. Standardized medical record reviews ascertained prenatal substance use, maternal and neonatal medical complications. The Edinburgh Postnatal Depression Scale and Brief Symptom Inventory were administered at nursery discharge to screen for PPD and SPD symptoms, respectively. Unadjusted analyses indicated mothers with positive screens for depression (n = 76, 13.5%) or severe distress (n = 102, 18.1%) had more prevalent prepregnancy/prenatal depression/anxiety, and their infants were born at younger gestational ages, with more prevalent bronchopulmonary dysplasia, and discharge after 40 weeks postmenstrual age. In multivariable analyses, prior depression or anxiety was associated with positive screens for PPD (risk ratio [RR]: 1.6, 95% confidence interval [CI]: 1.1-2.2) and severe distress (RR: 1.6, 95% CI: 1.1-2.2). Mothers of male infants had more prevalent depression risk (RR: 1.7, 95% CI: 1.1-2.4), and prenatal marijuana use was associated with severe distress risk (RR: 1.9, 95% CI: 1.1-2.9). Socioenvironmental and obstetric adversities were not significant after accounting for prior depression/anxiety, marijuana use, and infant medical complications. Among mothers of very preterm newborns, these multicenter findings extend others' previous work by identifying additional indicators of risk for PPD and SPD associated with a history of depression, anxiety, prenatal marijuana use, and severe neonatal illness. Findings could inform designs for continuous screening and targeted interventions for PPD and distress risk indicators from the preconception period onward. · Preconceptional and prenatal screening for postpartum depression and severe distress may inform care.. · Prior depression, anxiety, and neonatal complications predicted severe distress and depression symptoms at NICU discharge.. · Readily identifiable risk factors warrant continuous NICU screening and targeted interventions to improve outcomes..

Psychological Aspects of Infertility - Results from an Actor-Partner Interdependence Analysis.

Introduction For some patients, undergoing medical treatment for infertility is a cause of major emotional stress which the couple needs to deal with together; it can be said that infertility is a shared stressor. From the literature it is known that a subjectively perceived sense of self-efficacy supports the patient's ability to cope adaptively with an illness. As the basis for this study, we assumed that high levels of self-efficacy are associated with low psychological risk scores (e.g., for anxiety or depressiveness), both in the patient themselves and in their partner. Accordingly, in infertility patients, targeted support to promote helpful self-efficacy expectations could represent a new counselling strategy that could enable psychologically vulnerable patients to better cope with the treatment procedure and treatment failures of medically assisted reproduction, making these patients less at risk with regard to psychosocial factors. Methods 721 women and men attending five fertility centers in Germany (Heidelberg, Berlin), Austria (Innsbruck), and Switzerland (St. Gallen, Basel) completed the SCREENIVF-R questionnaire to identify psychological risk factors for amplified emotional problems, as well as the ISE scale to measure self-efficacy. Using paired t-tests and the actor-partner interdependence model, we analyzed the data of 320 couples. Results Considering the study participants as couples, women had a higher risk score than men for four out of five risk factors (depressiveness, anxiety, lack of acceptance, helplessness). In all of the risk areas, it was possible to identify a protective effect from self-efficacy on the patient's own risk factors (actor effect). There was a negative correlation between the men's self-efficacy level and the women's feelings of depressiveness and helplessness (partner effect, man → woman). The women's self-efficacy levels had a positive correlation with acceptance and access to social support in the men (partner effect, woman → man). Conclusion Because infertility is generally something that a couple has to deal with together, future studies should focus on couples as the unit of analysis instead of just analyzing the men and women separately. In addition, couples therapy should be the gold standard in psychotherapy for infertility patients.

Morally injurious events among aid workers: examining the indirect effect of negative cognitions and self-care in associations with mental health indicators.

Potentially morally injurious events (PMIE) are events that violate one's deeply held moral values or beliefs, and that have the potential to create significant inner conflict and psychological distress. PMIE have been recognized as an important psychological risk factor in many high-risk occupational groups. However, no study to date has investigated how PMIE relate to the mental health of aid workers. Furthermore, little is known about the mechanisms by which PMIE might be associated with mental health indicators. Participants were 243 aid workers (72% female; M age = 39.31) who had completed at least one aid assignment (M = 8.17). They completed an online questionnaire about their PMIE, trauma history, and mental health. A structural equation model was constructed to examine the roles of negative cognitions and subsequent self-care behaviors in the relationship between PMIE and PTSD symptoms, depression symptoms, and posttraumatic growth, above and beyond the contribution of potentially traumatic events. Within the model, the indirect effect through negative cognitions fully accounted for the associations between PMIE and symptoms of PTSD and depression. For the association between PMIE and posttraumatic growth, two indirect effects emerged: the first through negative cognitions and subsequent self-care and, the second, through self-care alone. This study highlighted PMIE as a novel psychological risk factor for aid workers and pointed to two possible mechanisms by which these events may lead to PTSD, depression, and posttraumatic growth. This study adds to the current understanding of how high-risk occupational groups adapt psychologically to PMIE.

The effect of group support psychotherapy on adherence to anti-retroviral therapy and viral suppression among HIV positive young people: Study protocol for a pilot randomized controlled trial.

Several studies have demonstrated an association between psychological risk factors and HIV disease progression. However, there is limited information on the use of psychological interventions to improve HIV treatment outcomes in young people living with HIV. This pilot trial aims to evaluate the feasibility, acceptability and preliminary effectiveness of group support psychotherapy in improving adherence to anti-retroviral therapy and viral suppression in young people living with HIV in Uganda. We recruited 120 young people with HIV, aged 10-18 years, who had non-viral suppression 6 months after initiating first-line anti-retroviral therapy (ART) from community based HIV clinics in Kitgum district, northern Uganda. Participants were randomly assigned to receive GSP plus IAC (N = 60) or IAC alone (N = 60). Primary outcomes will be indicators of feasibility and acceptability as well as preliminary effectiveness of GSP in improving ART adherence and viral suppression analysed by intention to treat using cluster-adjusted t tests and permutation tests. Secondary outcomes will be measures of depression, anxiety and cost-effectiveness. The trial has been approved by the Makerere College of Health Sciences School of Health Sciences Research Ethics Committee, and the Uganda National Council of Science and Technology. Recruitment began in June 2021 and 120 young people living with HIV with their adult caregivers have been recruited to the trial. An analysis of baseline and 6-month data is in progress. The results of this trial will not only be presented at national and international conferences but also submitted for publication in peer-reviewed journals and as a report to the funding agencies. This pilot trial will provide critical evidence to support the ongoing mental health integration into routine HIV care in Uganda. Pan African Clinical Trials Registry (PACTR): 202006601935462.

The framework for systematic reviews on psychological risk factors for persistent somatic symptoms and related syndromes and disorders (PSY-PSS).

Numerous psychological factors are believed to play a pivotal role in the development and maintenance of persistent somatic symptoms (PSS) in all fields of medicine. However, very few of these factors have been empirically investigated in relation to PSS. The aim of this study is firstly to propose a framework and define search terms for systematic reviews on the empirical evidence and diagnostic value of psychological risk factors for PSS and PSS-related outcomes (PSY-PSS). Secondly, the application of the framework is illustrated using the example of a systematic review on the relevance of psychological factors in somatic symptom disorders (SSD; DSM-5) and bodily distress disorders (BDD; ICD-11). Following a narrative review approach, two comprehensive lists of search terms to identify studies in (1) relevant patient groups with PSS and (2) relevant psychological factors were generated by reviewing the current literature and employing an iterative process of internal revision and external expert feedback. We identified 83 relevant symptoms, syndromes and disorders for which we defined a total of 322 search terms (list 1). We further comprised 120 psychological factors into 42 subcategories and 7 main categories (list 2). The introduced lists can be combined to conduct systematic reviews on one or more specific psychological factors in combination with any symptom, syndrome or disorder of interest. A protocol of the application of this framework in a systematic review and meta-analysis on psychological etiological factors of SSD and BDD is presented following the PRISMA guidelines. This framework will help to gather systematic evidence on psychological factors in order to improve the understanding of the etiology of PSS, to refine future diagnostic conceptualizations of PPS, and to develop optimized mechanism-based interventions for individuals with PPS and related syndromes and disorders.

Smoking patterns and the intention to quit in German patients with cancer: study protocol for a cross-sectional observational study

IntroductionPatients who continue to smoke cigarettes after a cancer diagnosis can experience poorer treatment tolerance and outcomes than those who quit immediately. Identifying risk factors specific to patients with cancer...

Investigating the Psychological Risk and Protective Factors Related to Fear of COVID-19 During the COVID-19 Pandemic in Iran

Objective: The current COVID-19 pandemic is associated with numerous psychological issues, such as anxiety and distress as a result of individual, health-related, social, and economic issues. This study aims to assess the general population in Iran for the negative impacts of the current pandemic on psychological well-being and to find possible protective and risk factors when facing such situations in the current COVID-19 pandemic. Methods: A total of 317 people participated in an online survey in Iran from August 3, 2020, to September 20, 2020. Anxiety, depression, fear of COVID-19, emotion regulation, intolerance of uncertainty, illness perception, neuroticism, social support, and self-efficacy were evaluated. Results: The results showed that measures that assess anxiety, depression, emotion regulation, intolerance of uncertainty, illness perception, neuroticism, social support, and self-efficacy were significantly related to fear of COVID-19. Meanwhile, the results of regression analysis demonstrated that neuroticism, intolerance of uncertainty, and illness perception could predict fear of COVID-19 beyond and above anxiety and depression. Conclusion: Some factors, including neuroticism, illness perception, and intolerance of uncertainty are considered risk factors for mental health during this pandemic.

Psychological distress in a Portuguese sample of cancer patients during the COVID-19 pandemic: a cross-sectional study

Abstract Objective: Considering the lack of studies exploring the psychological impact of COVID-19 on patients living with and beyond cancer, this study aimed to explore the levels of emotional distress, anxiety, and depression in patients with cancer and survivors during the COVID-19 pandemic and to identify psychological risk factors. Methods: Data for this cross-sectional study were collected through an online questionnaire comprised a self-report questionnaire and the Hospital Anxiety and Depression Scale (HADS). Descriptive statistics and linear regression models were used to characterize the sample and identify the determinants of emotional distress, depression, and anxiety. Statistical analyses were performed using R, version 4.1.1. Results: The sample included 940 patients with cancer and survivors, mostly female (87.1%), with a mean age of 49.7 years. More than half of the patients were survivors (55.1%); 56.7% were diagnosed with breast cancer, and 35.0% had other chronic diseases. Most participants believed that they were more likely to be infected with COVID-19 (53.9%) and that they may have more complications if they were infected (76.7%). Approximately half of the participants revealed significant emotional distress (49.3%), 18.1% revealed significant depression, and 29.2% revealed significant anxiety. Female patients, participants with lower education levels, unemployed/lay-off, or in a medical leave with a chronic disease, taking care of someone with a chronic disease, or perceiving a higher risk of being infected with COVID-19 had higher levels of emotional distress, depression, and anxiety. Conclusions: This study provides useful information regarding the impact of the COVID-19 pandemic on the mental health of patients with cancer and survivors, showing that an increased number of patients experienced significant emotional distress during the pandemic.

The interaction between attachment, trauma and cannabis in creating vulnerability for psychosis

ABSTRACT Background and Method Research has shown that psychotic illness is more prevalent in frequent cannabis users, even though many people enjoy cannabis recreationally without major concerns. Therefore, understanding what creates vulnerability for dangerous cannabis use patterns and psychosis is of major importance. Result Psychological risk factors such as exposure to trauma/adversity and attachment style have been shown to create risk for both harmful patterns of cannabis use and psychosis. Discussion However, evidence regarding the individual and cumulative effects of these factors on psychosis onset and severity is lacking. Understanding the role of trauma and attachment in creating vulnerability for cannabis overuse might lead to incorporation of trauma and attachment-oriented therapies in the treatment of suitable individuals with early psychosis and cannabis misuse, and the development of more effective prevention.

Poetry in Pandemic: A Multimodal Neuroaesthetic Study on the Emotional Reaction to the Divina Commedia Poem

Poetry elicits emotions, and emotion is a fundamental component of human ontogeny. Although neuroaesthetics is a rapidly developing field of research, few studies focus on poetry, and none address its different modalities of fruition (MOF) of universal cultural heritage works, such as the Divina Commedia (DC) poem. Moreover, alexithymia (AX) resulted in being a psychological risk factor during the Covid-19 pandemic. The present study aims to investigate the emotional response to poetry excerpts from different cantica (Inferno, Purgatorio, Paradiso) of DC with the dual objective of assessing the impact of both the structure of the poem and MOF and that of the characteristics of the acting voice in experts and non-experts, also considering AX. Online emotion facial coding biosignal (BS) techniques, self-reported and psychometric measures were applied to 131 literary (LS) and scientific (SS) university students. BS results show that LS globally manifest more JOY than SS in both reading and listening MOF and more FEAR towards Inferno. Furthermore, LS and SS present different results regarding NEUTRAL emotion about acting voice. AX influences listening in NEUTRAL and SURPRISE expressions. DC’s structure affects DISGUST and SADNESS during listening, regardless of participant characteristics. PLEASANTNESS varies according to DC’s structure and the acting voice, as well as AROUSAL, which is also correlated with AX. Results are discussed in light of recent findings in affective neuroscience and neuroaesthetics, suggesting the critical role of poetry and listening in supporting human emotional processing.

Attitudinal and Behavioral Loyalty: Do Psychological and Political Factors Matter in Tourism Development?

The growth of tourism in the Middle East suffers from ongoing political unrest and conflicts across the region. While previous studies have discussed the impact of psychological factors and political unrest on the tourism industry in the Arab world at an aggregated level, the role of major and dominant political factors such as perceived risks, media, and neutral diplomatic foreign relations on tourism have not yet been investigated. The objectives of this study are to compare the differences between local and international tourists, in the psychological and political risk factors affecting their loyalty to Oman as a tourist destination; investigate how attitudinal and behavioral loyalty is influenced by tourists’ satisfaction, perceived value, attachment, familiarity, and motivations; and measure the extent to which political factors could mitigate the risk of political instability in the region, thereby enhancing the tourism industry in the case of Oman. This study employed qualitative (descriptive and comparison analyses) and quantitative (multiple regression and ordinal logistic models) techniques in the analyses. Findings reveal that international tourists have developed both attitudinal and behavioral loyalty toward Oman in which its neutrality does matter, despite risk perceptions of the region. International tourists significantly report higher satisfaction than locals’ satisfaction with Oman as a tourism destination. It can be concluded that the psychological factors of Omani tourists have outperformed the risk factors associated with the region. Results are important for decision-makers as they reveal the best practices to increase the quantity and quality of tourists based on their characteristics, knowledge, and behaviors. This study reveals potential reforms to increase re-visitations that contain important implications for tourism agencies and private sectors—improving services around tourism sites; investing in sports, wildlife, and adventure tourism; hiring public relations firms for tourism marketing; eliminating any bureaucracy around investors and businesses and welcoming competition; and enhancing domestic tourism in stimulating the economy during downturns.

Associations of premenstrual symptoms with daily rumination and perceived stress and the moderating effects of mindfulness facets on symptom cyclicity in premenstrual syndrome

Subthreshold premenstrual symptoms can be impairing even if the diagnostic criteria for premenstrual dysphoric disorder (PMDD) are not reached. Previous research suggests shared psychological risk factors without a clear differentiation of premenstrual syndrome (PMS) from PMDD. This study focuses on a sample with a wide range of premenstrual symptoms not reaching PMDD-criteria and aims to investigate within-person associations of premenstrual symptoms with daily rumination and perceived stress during the late luteal phase as well as cycle-phase specific associations of habitual mindfulness including present-moment-awareness and acceptance with premenstrual symptoms and impairment. Fifty-six naturally cycling women with self-reported premenstrual symptoms completed an online diary on premenstrual symptoms, rumination and perceived stress over two consecutive menstrual cycles, and baseline questionnaires on habitual present-moment-awareness and acceptance. Multilevel analyses revealed cycle-related variations in premenstrual symptoms and impairment (all ps < .001). Higher within-person levels of core and secondary premenstrual symptoms during the late luteal phase predicted increased daily rumination and perceived stress (all ps < .001) and increased somatic symptoms predicted increased rumination (p ≤ .018). Higher habitual present-moment-awareness was linked to lower premenstrual symptom and impairment levels toward the late luteal phase whereas higher habitual acceptance was associated with lower premenstrual functional impairment (p ≤ .015). Premenstrual symptom increases during the late luteal phase in women with PMS seem to be linked to increased daily rumination and perceived stress. Trait present-moment-awareness and acceptance in turn seem to reflect protective factors against premenstrual distress and may represent useful targets for interventions.

Does Anxiety Affect Survival in Patients with Coronary Heart Disease?

Behavioral and physiological risk factors worsen the prognosis of coronary heart disease (CHD). Anxiety is known to be a psychological predictor of CHD. In this study, we investigated whether this factor is associated with all-cause mortality in CHD patients in the long term. We studied 180 patients (mean age 60.6 SD 9.2 years, 26% women) with CHD from the Berlin Anxiety Trial (BAT) and the Stepwise Psychotherapy Intervention for Reducing Risk in Coronary Artery Disease (SPIRR-CAD) study. Their cardiac and psychological risk profile was represented by standardized procedures, including the Hospital Anxiety and Depression Scale (HADS) questionnaire. Mortality outcomes were assessed using a community-based registry. Of 180 patients, we obtained information on all-cause mortality in 175 (96.7%) after a mean follow-up of 12.2 years (range 10.4-16.6 years). Of all participants, 54.4% had prior myocardial infarction, 95.3% had percutaneous transluminal coronary angioplasty and 22.2% had prior coronary artery bypass graft. Most of the patients (98.4%) had New York Heart Association class I and II, 25.6% had diabetes and 38.2% were smokers. Patients had a mean HADS anxiety score of 9.7 SD 4.1 at study entrance. We found the highest HADS anxiety quartile all-cause mortality in 14%, 30.2% in the middle quartiles and 58.7% in the lowest quartile (chi2 20.8, p = 0.001). Related to psychological mechanisms, a low level of anxiety, seemed to be a significant predictor of all-cause mortality. We found no advantage for patients who had received psychosocial therapy in terms of survival. These first data confirmed our hypothesis about the association of psychological risk factors with the long-term outcome of CAD patients. Future studies will clarify whether the severity of disease, age or a particular type of coping or denial mechanism are associated with the presented outcome in low-anxious patients.

INTRODUCTION OF A MULTIMODAL PAIN REHABILITATION INTERVENTION IN PRIMARY CARE: A PILOT STUDY.

To evaluate patient-reported outcome measures in patients with chronic musculoskeletal pain 1 year after participation in a case manager-led multimodal rehabilitation intervention in a Finnish primary care centre. Changes in healthcare utilization (HCU) were also explored. A prospective pilot study with 36 participants. The intervention consisted of screening, multidisciplinary team assessment, a rehabilitation plan and case manager follow-up. Data were collected through questionnaires filled in after the team assessment and 1 year later. HCU data 1 year before and 1 year after team assessment were compared. At follow-up, satisfaction with vocational situation, self-reported work ability and health-related quality of life (HRQoL) had improved and pain intensity had diminished significantly for all participants. The participants who reduced their HCU improved their activity level and HRQoL. Early intervention by a psychologist and mental health nurse was distinctive for the participants who reduced HCU at follow-up. The findings demonstrate the importance of early biopsychosocial management of patients with chronic pain in primary care. Identification of psychological risk factors at an early stage may lead to better psychosocial wellbeing, improve coping strategy and reduce HCU. A case manager may free up other resources and thereby contribute to cost savings.