Psychological Symptoms Research Articles

The Increase in Early Menarche is Associated with the Increase of Chronic Back Pain in Female Adolescents: The HBSC Study 2002-2014.

Research has shown that there has been an increase in the prevalence of chronic back pain in adolescents, especially in female adolescents. The purpose of the current study was to test the hypothesis that the observed increase in the prevalence of early menarche in female adolescents is contributing to the increase in the prevalence of chronic back pain over time in this population. Cross-sectional data from 251,390 female adolescents from 27 countries/regions were drawn from the Health Behaviour in School-aged Children questionnaire-based surveys conducted in 2002, 2006, 2010 and 2014. The Karlson-Holm-Breen method was used to examine the explanatory role of the increase in the prevalence of early menarche on the increase in the prevalence of chronic back pain whilst controlling for socioeconomic status, physical activity, body mass index, and psychological symptoms. The increase in the prevalence of early menarche between 2002 and 2014 was associated with the increase in the prevalence of chronic back pain (P<0.001). The percent of chronic back pain prevalence increase accounted for by the increase in early menarche was 2.2%. The increase in the prevalence of chronic back pain in female adolescents observed over the last decade may be explained, in part, by the decrease in the age of menarche. This finding, coupled with research showing a decline in early menarche worldwide, highlights the need to delve deeper into the underlying mechanisms of the association between early menarche and pain ‒ particularly chronic back pain ‒ in female adolescents.

Perceived health and working life in caregivers from nursing homes that used or did not use nighttime personalized non-pharmacological therapies to address residents’ behavioral and psychological symptoms of dementia

Dementia is frequent in nursing home (NH), affecting between 40 and 50 % of the residents and is associated in 90 % of the cases with behavioral and psychological symptoms (BPSD) which are detrimental to caregivers’ working life and perceived health. We compared perceived health and working life between NHs that used or did not use nighttime personalized non-pharmacological therapies (PNPT) to address BPSD. This anonymous survey included 96 caregivers from 25 NHs which used (n = 69) or not (n = 27) nighttime PNPT. Perceived health, nursing and medical care, quality of care and internal motivation were significantly higher, stress symptoms and workload were significantly lower and there was a tendency to enhanced satisfaction with work in caregivers from NHs which used nighttime PNPT. Our present data open a new window on the benefits of PNPT.

The association between different levels of depression and overactive bladder: A cross-sectional study of the 2005-2018 National Health and Nutrition Examination Survey.

There is growing evidence of a possible correlation between depression and overactive bladder (OAB). However, few studies have classified depression according to its severity. Whether there is an association between different levels of depression and OAB symptoms remains unclear. Participants with complete information about depression, OAB, and covariates in the National Health and Nutrition Examination Survey (NHANES) 2005-2018 were included in this study. Depression symptoms were assessed by the Patient Health Questionnaire-9. OAB symptoms were evaluated by the Overactive Bladder Symptom Score. Weighted multivariate logistic regression models were applied to analyze the relationship between depression and OAB. A total of 30 359 participants were included in this study, consisting of 6245 OAB patients and 24 114 non-OAB participants. The multivariate logistic regression suggested depression independently correlated with OAB (odds ratio [OR] = 2.764, 95% confidence interval [CI] = 2.429-3.146, p < 0.001). Further, mild (OR = 2.355, 95% CI = 2.111-2.627, p < 0.001), moderate (OR = 3.262, 95% CI = 2.770-3.841, p < 0.001), and moderately severe to severe depression (OR = 3.927, 95% CI = 3.246-4.752, p < 0.001) were all associated with OAB. Additionally, depression was also correlated with urgency urinary incontinence (OR = 2.249, 95% CI = 1.986-2.548, p < 0.001) and nocturia (OR = 2.166, 95% CI = 1.919-2.446, p < 0.001). This study indicated different levels of depression, even mild depression, were independent risk factors for OAB. Given the frequent coexistence and potential interactions between depression and OAB, clinicians should be aware of the importance of assessing both physical and psychological symptoms in these patients. Early diagnosis and holistic treatment may improve the treatment outcomes, particularly for those suffering from both conditions.

Applications and efficacy of radically open dialectical behavior therapy (RO DBT): A systematic review of the literature.

Radically open dialectical behaviour therapy (RO DBT) is a transdiagnostic treatment, originally developed as a variant of dialectical behaviour therapy (DBT), that emerged as a novel treatment approach for those presenting with excessive or maladaptive overcontrol. Despite RO DBT's growing popularity among clinicians as a treatment for chronic depression, personality disorders and eating disorders, to date, no systematic review has been conducted to summarise the evidence on this therapy. Therefore, the aim of this study was to systematically review the literature to provide a current and comprehensive summary of the available evidence on the clinical applications and efficacy of RO DBT. Articles were included if they were original research studies that described the use of RO DBT in the treatment of any psychological disorder, condition or symptom, published in the English language in a peer-reviewed journal. Four electronic databases were searched, and screening, selection, risk of bias assessment and data extraction were all conducted by two independent reviewers. Fourteen articles were included in this review, including two qualitative articles, one case study, five case series studies, four quasi-experimental studies, and two articles describing one randomized control trial. Findings indicated there is emerging evidence for the use of RO DBT in both adolescents and adults, for disorders characterized by excessive self-control, such as anorexia nervosa and autism, as well as for treatment-resistant depression. While RO DBT shows promise as a treatment for disorders of overcontrol, further research is needed. This review outlines current gaps and identifies areas for future research.

Effect of virtual-reality-based education program for managing behavioral and psychological symptoms of dementia: A randomized controlled trial

This study aims to evaluate the effect of the virtual-reality-based education program (VR-EduBPSD) for managing behavioral and psychological symptoms of dementia (BPSD). Sixty-six family caregivers of people with dementia were randomly assigned to either the experimental or control group following a 1:1 ratio. The experimental group received VR-EduBPSD while the control group received analogous paper-based educational materials. The outcome measures were competence in managing BPSD, dyadic relationship, caring self-efficacy, attitudes toward dementia, and behavior management skill. Only the ‘awareness of symptoms’ sub-scale score for competence in managing BPSD showed a significant group-by-time interaction. Significant time effects were also observed on the total and sub-scale scores for competence in managing BPSD, as well as on the dyadic relationship. This program, which utilizes high-immersion VR technology, offers a valuable learning experience for those new to the care of people with dementia. This study was registered at cris.nih.go.kr with number of KCT0006788.

Comparative cross-sectional study of comorbid depression in patients with irritable bowel syndrome and chronic gastritis at an urban outpatient clinic

This comparative cross-sectional study evaluates the prevalence of comorbid depression in patients with Irritable Bowel Syndrome (IBS) and chronic gastritis (CG) at an urban outpatient clinic. A total of 178 patients—89 diagnosed with IBS and 89 with CG—were assessed for depressive symptoms using the Beck Depression Inventory-II (BDI-II) and the 21-item Hamilton Depression Rating Scale (HDRS-21). Our findings indicate a significantly higher prevalence of depression in IBS patients, with 71.9% meeting criteria for depression based on the BDI-II and 70.8% based on the HDRS-21, compared to 10.1% in CG patients. The study highlights that retardation symptoms, including depressed mood and loss of interest, are central to depression and contribute to substantial impairment in daily activities and quality of life. Additionally, anxiety and somatization were prominent in the IBS cohort. This study emphasizes the need for integrated care approaches that address both gastrointestinal and psychological symptoms, fostering improved patient management and outcomes. Our results underscore the importance of regular psychological assessments in IBS patients, particularly those without overt depressive symptoms, to enhance their overall well-being.

Evaluation of a probiotic blend on psychosocial health and biomarkers of inflammatory, immune and stress response in adults with subthreshold depression: a double-blind, randomised, placebo-controlled trial.

This study examined the efficacy of a probiotic in reducing depressive symptom severity in people with subthreshold depression. In a double-blind, randomised, placebo-controlled trial, a probiotic (1 × 10^9 live cells per strain: Limosilactobacillus fermentum LF16 (DSM26956), Lacticaseibacillus rhamnosus LR06 (DSM21981), Lactiplantibacillus plantarum LP01 (LMG P-21021) and Bifidobacterium longum 04 (DSM23233)) or placebo was taken daily for 12 weeks. Data were collected at baseline, 6 and 12 weeks including psychological symptom severity (Beck Depression Inventory, BDI; Patient Health Questionnaire, PHQ; Hospital Anxiety Depression Scale, HADS; and Depression Anxiety and Stress Scale, DASS). Biomarkers of glycaemia, inflammation (high-sensitivity C-reactive protein, hs-CRP), antioxidant status (total glutathione (GSH)) and stress (cortisol awakening response, CAR) were also measured. Thirty-nine participants (nineteen probiotic;twenty placebo) were enrolled. There were no significant between-group differences in the examined psychological symptom severity scores, despite certain significant within-group changes observed in both groups from baseline to 6 and/or 12 weeks of follow-up. Regarding biomarkers, the probiotic group showed reduced hs-CRP (-1520; 95 % CI -273·7, -2766·2 ng/dl) and CAR (-0·28; 95 % CI -0·05, -0·51 μg/dl) at 12 weeks, but increased total GSH (3·9; 95 % CI 0·1, 7·5 ng/dl) at 6 weeks, compared with the placebo. The current study reported favourable decreases in depressive symptoms in both groups. Although the within-group changes observed in the probiotic group were supported by favourable inflammatory, antioxidant status and stress biomarker changes compared with the placebo, further research is required to shed more light on the role of gut microbiota modulation on emotional regulation.

The Effect of Seated Baduanjin Exercise on Psychological State, Fatigue Symptoms, and Quality of Life in Maintenance Hemodialysis Patients

Objective: To evaluate the intervention effects of seated Baduanjin exercise on patients undergoing maintenance hemodialysis (MHD). Methods: A total of 108 MHD patients admitted between July 2022 and July 2023 were selected. They were randomly assigned into two groups: the experimental group, with 55 patients, who received seated Baduanjin exercise combined with leg exercises during dialysis; and the control group, with 53 patients, who only performed leg exercises during dialysis. The psychological state, fatigue symptoms, quality of life, and sleep quality scores were compared between the two groups, and exercise endurance was recorded. Results: After the intervention, the psychological state scores in the experimental group were lower than those in the control group, the fatigue symptom scores were lower, the quality of life scores were higher, the sleep quality scores were lower, and the exercise endurance was higher (P &lt; 0.05). Conclusion: Seated Baduanjin exercise can improve the negative psychological state and fatigue symptoms of MHD patients, enhance their quality of life and sleep quality, and effectively increase their exercise endurance.

Knowledge, Attitude, and Practice of Care Providers Toward Non-Pharmacological Intervention for Managing Behavioural and Psychological Symptoms in Australian Aged Care Residents with Dementia: A Cross-Sectional Survey

ABSTRACT Objectives This study aimed to assess the knowledge, attitude, and practice of the healthcare professionals and paid caregivers toward non-pharmacological interventions (NPIs) for managing behavioural and psychological symptoms of dementia (BPSD) in Australian residential aged care homes (RACHs). Methods A cross-sectional, online survey was completed by RACH staff and physicians over the period 6 March-31 August 2023. Descriptive statistics were used to present the results. Results Ninety-six respondents participated (41.7% aged 35–54 years, 80.2% female, 38.5% nurses). While 50–65% of the respondents were extremely familiar with 15 of NPIs, only 22% believed there was a sufficient funding for their implementation, and 6% felt there were sufficient human resources. Although 66% of the respondents viewed NPIs as more useful than medications, only 46% expected consistent positive outcomes from NPIs. The most used NPIs were redirection, behaviour management, and validation therapy. Conclusions The study highlights that barrier such as inadequate funding, limited human resources, skepticism about NPIs’ effectiveness, unfamiliarity with certain NPIs, and unfavourable attitude toward NPIs are likely to slow NPI adoption for BPSD management. Clinical implication To improve practice, it is essential to address these barriers through targeted education, and training, increased funding, and enhancement of the workforce.

Sense of community, life satisfaction and psychological distress among seniors – HUNT4 study, Norway

Abstract Background Strong sense of community with one’s neighbors may benefit psychosocial well-being. Moreover, local communities with high level of belonging and social cohesion can have a positive impact on public mental health. This study aims to investigate associations between sense of community and life satisfaction - at both an individual and local community level in a Norwegian county. Methods Data from Trøndelag Health Study 4 (HUNT4: 2017-2019) on 22 939 participants were linked to geographic data of residence from Statistics Norway. The basic statistical unit in Norwegian, known as “grunnkrets,” serves to identify participants’ local communities. These units are subdivisions of municipalities, covering geographically contiguous areas that typically include a few hundred inhabitants. This population-based study enables investigation of variation in sense of community, trust, life satisfaction and psychological distress on individual and community level. Results Seniors (median age 70.3 years) with strong sense of community with their neighbors had more than three times higher odds (95%CI 3.08-3.93) of high level of life satisfaction and less than 0.3 times lower odds (95%CI 0.26-0.33) of psychological distress symptoms vs those with low sense of community, adjusted to sociodemographic variables. The average sense of community varied between local communities (N = 284). At this local geographical unit, strong sense of community was associated with high level of trust, enjoying the neighborhood and high life satisfaction. Conclusions The study can inform public health policy to consider development of social infrastructures that bolster sense of community among seniors within neighborhoods. Policy and action plans targeting to increase the overall sense of community in neighborhoods may contribute to create mental health-promoting and age-friendly local communities in Norway. Key messages • At individual level, sense of community with neighbors are associated with life satisfaction and psychological distress among Norwegian seniors. • The average sense of community varies between geographic local areas and are associated with level of trust, enjoying the neighborhood, average life satisfaction, and psychological distress.

HCA PIECESTM Care Coach Program: Peer to peer approach to promote person-centred care in long-term care

In Long-Term Care (LTC) settings, the potentially inappropriate use of antipsychotics for behavioural and psychological symptoms of dementia is a persistent issue, with high rates despite limited benefit and serious risk. Best practice is a non-pharmacological, person-centred approach to care, though this can be challenging in LTC settings. To help address this gap, we developed the PIECESTM HCA Care Coach Program and described its implementation and outcomes observed at 13 LTC homes. This program empowers Health Care aides with training, tools, and processes to practice the principles of person-centred care and provide peer mentorship to the care team. After 1 year, we found declining antipsychotics use (by 4.4%) and positive indicators of improved staff experience and improved resident quality of life. The Care Coach Program can be adapted and spread to a variety of LTC settings to help reduce potentially inappropriate antipsychotic use and better support people living with dementia.

The impact of childhood abuse on future military sexual assault and PTSD symptomology in Australian veterans.

The trauma most commonly associated with the military is combat-related trauma. It is increasingly recognised that childhood sexual and physical abuse and military sexual assault may influence or exacerbate posttraumatic stress disorder (PTSD) when military members are exposed to combat. The study aimed to determine whether a history of childhood sexual and physical abuse would increase the likelihood of military sexual assault (MSA) and determine whether a history of sexual abuse (childhood or military) impacted the incidence and severity of post-trauma sequelae compared to veterans without this history. A retrospective correlational analysis was performed on baseline data collected from clinical case records of a cohort of 134 Australian veterans with PTSD who had attended an outpatient Military Service Trauma Recovery Day Programme between October 2020 and May 2022. Almost half (48.5%) of veterans reported a history of abuse. Prevalence rates of military sexual abuse, child sexual abuse and child physical abuse were 14.9%, 13.4% and 23.1% respectively. The relationship between those who experienced childhood abuse and those who experienced military sexual abuse was not significant. No significant differences were observed between those who experienced any sexual abuse and those who did not on intake scores of psychological symptoms. This is the first Australian study to investigate the prevalence of childhood abuse and military sexual abuse and its impact on PTSD and associated psychopathology in a sample of veterans seeking mental health treatment. No additional risks of experiencing military sexual assault were found for those who had survived childhood sexual abuse.

Discontinuation of Alzheimer Disease Medications in Patients Receiving Home Care Medicine.

There is no consensus on how long antidementia medications should be administered to patients with Alzheimer disease (AD). To clarify this issue, we investigated the discontinuation of antidementia medications in Japanese home care settings, including community-dwelling and institutionalized patients. Using medical records from April 2017 to March 2022 at 3 clinics in Tokyo and Chiba prefectures, we selected patients with AD who started receiving home care medicine. Forty-nine patients discontinued antidementia medications during the observation period, there was no apparent deterioration in cognitive function or new occurrence of behavioral and psychological symptoms of dementia caused by the discontinuation of medications. More aggressive discontinuation of AD medications probably is recommended for patients with activities of daily living dysfunction, such as those receiving home care medicine.

Factors Associated with Unmet Supportive Needs in Adult Cancer Survivors in South Korea

Abstract Purpose As the number of cancer survivors increases, addressing their unmet supportive care needs (USCNs) has become crucial. This study aimed to evaluate the influence of financial toxicity on USCNs and identify comprehensive factors associated with USCNs among adults’ cancer survivors. Methods A cross-sectional survey using convenience sampling from the 2022 Korean Population Census. Data were collected online between November 17 and December 15, 2022. The study included 1,038 cancer survivors aged 19 years or older who had completed primary treatment. Multivariable logistic regression was analyzed to identify factors associated with USCNs. Results Two-thirds (65.7%) of cancer survivors experienced severe financial toxicity, correlating with high unmet supportive care needs. Among those who reported a severe financial burden, a substantial 170 out of 187 respondents, or approximately 90.9%, were identified as having high unmet supportive care needs. Cancer survivors had the highest needs in the order of ‘management of psychological symptoms’ and ‘coping and emotional needs’. Cancer survivors diagnosed between 5 and 10 years ago were found to be less likely to report unmet supportive care needs compared to those diagnosed more recently, with an odds ratio of 0.14. Additionally, breast cancer survivors and individuals who were unemployed at the time of diagnosis had a higher likelihood of experiencing unmet supportive care needs, with adjusted odds ratios of 1.68 (95% confidence interval: 1.088-2.603) and 1.80 (95% CI: 1.125-2.891), respectively. Conclusions Cancer survivors with moderate to severe financial distress were more likely to be at risk of experiencing a high level of unmet supportive care needs. Coping and emotional needs are the most important concerns among the unmet needs of cancer survivors regardless of the time since cancer diagnosis. Key messages • Cancer survivors in South Korea with moderate to severe financial distress are twice as likely to face a high level of unmet supportive care needs. • The most significant unmet supportive care needs among South Korean cancer survivors relate to coping and emotional support, highlighting the need for enhanced mental health services.

Investigating the Relationship between Emotion Regulation Strategies and Anxiety Caused by COVID-19 in Employees of Rehabilitation Centers

Background and Objectives: In the current situation, it is essential to determine the level of anxiety in medical and non-medical employees due to the pandemic. Therefore, this research aims to assess the relationship between corona anxiety, emotion regulation strategies, and stress tolerance among the staff of rehabilitation centers in Tehran Province, Iran. Methods: This study was descriptive, cross-sectional, and correlational. The statistical population of the present study included the entire staff of rehabilitation centers served by the Welfare Organization of Tehran Province in 2022. Using simple random sampling, 10 rehabilitation centers were selected as study centers. Subsequently, 200 employees of these centers were selected and tested using Morgan’s sampling table (the male age of the participants was 31.5 years). The data collection instruments included the corona disease anxiety scale, the emotional distress tolerance questionnaire (2005), and the March emotional self-regulation strategies scale (2007). Data were analyzed by SPSS software, version 26. Results: The results showed that the mean of corona anxiety was 18.94 out of a maximum of 54 and the proportion of psychological symptoms of corona anxiety was higher than physical symptoms. The highest score from the participant’s point of view from dimensions of distress tolerance was assigned to the subjective assessment of distress. The mean score for distress tolerance was 52.68 out of a maximum of 75 points and the mean score for employees’ emotion regulation strategies was 134.37 points, which shows that the use of emotional self-regulation strategies is strong. The results of the current research showed that corona anxiety decreases significantly by increasing distress tolerance, absorption of negative emotions, regulation of efforts to relieve distress and distress tolerance, and corona anxiety also decreases significantly. Also, with the increase in the level of emotion regulation strategies, the anxiety of corona decreases significantly. Distress tolerance showed a negative correlation with corona anxiety, and with the improvement of distress tolerance, corona anxiety decreased (P=0.014). Conclusion: Based on the results, increasing and improving distress tolerance and emotional regulation strategies significantly reduced corona anxiety. Also, the experiences and work of experts with more work experience alongside the younger and less experienced forces and their cooperation prepared the ground to reduce the effects of corona anxiety, as well as to improve the level of stress tolerance and emotion regulation strategies of employees.

Postpartum hair loss is associated with anxiety.

This study examined the relationship between postpartum hair loss and psychological symptoms. This questionnaire-based, cross-sectional study included postpartum women who had delivered at two facilities and completed the questionnaire 10-18 months after delivery. Study protocols were sent by mail in two parts. Baseline characteristics and information regarding the pregnancy, delivery, childcare, and postpartum hair loss were obtained via a questionnaire. Psychological symptoms were assessed via the Whooley Questions, Generalized Anxiety Disorder 2-item, and Edinburgh Postnatal Depression Scale. Participants were divided into two groups based on psychological symptoms. Multivariate analyses were performed. In total, 331 responses were analyzed. Women with very much hair loss felt significantly more anxious than those with no postpartum hair loss, as reported on the Generalized Anxiety Disorder 2-item anxiety subscale (odds ratio: 4.47). Multiple logistic regression analysis revealed that primiparity, greater amount of postpartum hair loss, and higher Athens Insomnia Scale scores were predictors of Generalized Anxiety Disorder 2-item anxiety. Adjusted odds ratio of having anxiety among those with very much postpartum hair loss was 4.58 (95% confidence interval, 1.18-17.74) compared to those with no postpartum hair loss. A greater amount of postpartum hair loss was independently associated with postpartum anxiety on the Generalized Anxiety Disorder 2-item.

Psychological predictors of incident subjective cognitive complaints in community dwelling older adults

Background Subjective cognitive complaint (SCC) is associated with future cognitive decline and may be a marker for clinical intervention in the progression to dementia. Among the viable predictors of SCC, psychological factors are clinically relevant, non-invasive early indicators of older adults at elevated risk. This aim of this study is to determine whether psychological symptoms: dysphoria and apathy precede incident SCC in the dementia pathway. Methods Participants (n = 592) enrolled in the Central Control of Mobility in Aging Study were includes in the analyses, with prevalent cases excluded. Apathy and dysphoria scale scores were derived using confirmatory factor analysis of the Geriatric Depressive Scale. Cox regression analyses was used to determine the association between apathy and dysphoria scores and incident SCC. Results Over a mean follow up of 1.90 years, 44 individuals (9.26%) developed incident SCC. Baseline apathy scale score was significantly associated with 4-fold increased risk of SCC (HR 4.39, 95%CI: 1.32–14.67), adjusted for cognition but not age and dysphoria scale score. Baseline dysphoria scale score was not associated with increased risk of SCC in adjusted analyses. Conclusion In this longitudinal analysis of community dwelling older adults, apathy was associated with an increased risk of SCC, when adjusting for cognition but not dysphoria. Finally, this study highlights apathy as an early risk factor, which may precede SCC in the progression to dementia and consequently, may identify a high risk group for clinical screening and intervention.

Prevalence of Anxiety and Suicidal Ideation in Nurses Working in COVID-19 Wards Compared to Nurses From Other Hospital Wards During the Pandemic

Background and Objectives: Investigating the level of anxiety and suicidal thoughts in nurses during the COVID-19 pandemic can play an important role in helping them clinically to prevent the development of psychological symptoms in them. In this regard, this study aims to investigate the prevalence of anxiety and suicidal ideation in nurses working in COVID-19 wards compared to nurses from other departments. Methods: In this analytical cross-sectional study, participants were 347 nurses from two hospitals (Shahid Beheshti and Kamkar) in Qom, Iran in 2021. Nurses were divided into two groups working in COVID-19 and non-COVID wards. The data collection tools were a demographic form, Beck’s anxiety inventory, and the Beck scale for suicidal ideation. The data was analyzed in SPSS software version 22 using independent t-test or ANOVA for quantitative data and chi-square test for qualitative data. The significance level was set at 0.05. Results: Among participants, 139(40.1%) were in the COVID group and 208(59.9%) were in the non-COVID group. Nurses in the COVID group had significantly higher anxiety scores than nurses in the non-COVID group (P&lt;0.001), but there was no significant difference between COVID and non-COVID groups in suicidal ideation (P=0.979). Conclusion: There is a high prevalence of anxiety among nurses working in COVID-19 wards compared to nurses from other wards. Therefore, it is recommended to use psychological treatments to reduce the anxiety and suicidal thoughts of these nurses during the COVID-19 pandemic.

Diagnostic classification systems for disorders of gut-brain interaction should include psychological symptoms.

The group of disorders known as Disorders of Gut Brain Interaction (DGBI) were originally labeled functional GI disorders and were thought to be disorders of the gastrointestinal tract that had several psychological conditions as comorbidities. Despite mounting evidence that psychological morbidity plays an innate role in the etiology and maintenance of DGBI, none of the Rome IV criteria include any measure of psychological symptoms. This study tested the hypothesis that individuals would cluster differently if GI symptoms alone were considered versus GI symptoms combined with measures of psychological symptoms. Data were obtained from the Rome Foundation Global Epidemiology Study measuring Rome IV GI symptoms, psychological measures and demographic characteristics. Latent profile models were used to cluster individuals based on (i) GI symptoms only (GI only) and then (ii) GI and psychological measures (GI + Psych). Individuals clustering into the same group of individuals whether formed via GI only or GI + Psych, ranged from 96% for a 2-class solution (the most simplistic) to 76% with 6 classes (the parsimonious system) and 59% with twenty-two classes (mimicking Rome IV). The generalisability of this finding between six geographic regions was confirmed with agreement varying between 95%-97% for 2 clusters and 71-79% for 6 classes and 51%-63% for 22 classes. These findings were also consistent between DGBI (range 94% with 2 classes to 50% with 22 classes) and non-DGBI (range 97% with 2 clusters to 65% with 22 classes) groups. Our data suggest that considering psychological as well as gastrointestinal symptoms would lead to a different clustering of individuals in more complex, and accurate, classification systems. For this reason, future work on DGBI classification should consider inclusion of psychological traits.

Functional Capacity, Functional Performance, and Symptoms in People With Heart Failure: An Integrative Review.

Heart failure (HF) is a clinical syndrome that has a negative effect on functional status, a multidimensional concept characterizing one's ability to provide for the necessities of life. Symptoms might be associated with different aspects of functional status in HF. However, the terms functional capacity and performance have been misused interchangeably, and no previous review has focused on the extent to which symptoms contribute to functional capacity and performance among people with HF. The aim of this study was to comprehensively review and synthesize the existing literature on the relationship between symptoms, functional capacity, and functional performance in people with HF. We conducted an integrated review of observational studies in which authors examined the relationship between at least 1 symptom and at least 1 aspect of functional capacity or performance in people with HF 18 years or older. The Joanna Briggs Institute's critical appraisal tools were used to analyze the quality of studies. We included 23 studies with 7219 participants and an age range of 40 to 86 years. Fifteen symptom measures were used to measure dyspnea, fatigue, pain, insomnia symptoms, depressive symptoms, and anxiety symptoms. Three functional capacity measures were assessed in 9 studies, and 7 functional performance measures were assessed in 17 studies. As often measured with the Six-Minute Walk Test, functional capacity was inversely associated with pain/discomfort, insomnia symptoms, and psychological symptoms. Functional performance, often measured by the New York Heart Association functional class and Medical Outcome Scale Short Form 36, was associated with sleep difficulties, fatigue, depressive symptoms, and anxiety. Four studies combined functional capacity and performance measures to elicit functional status. Depressive symptoms, fatigue, pain, and insomnia symptoms are associated with decreased functional performance and capacity. Commonly, symptoms experienced in HF are associated with declining functional status. However, this finding depends on the measures or metrics used to assess symptoms, functional capacity, and performance. The observed dissimilarities in the relationship between symptoms and functional capacity and performance highlight the conceptual distinctions, suggesting that authors of future studies should judiciously select appropriate dimensions and measures of functional status based on the study's purposes, design, and available resource.