Psychosocial Risk Profiles Research Articles

Psychosocial risk profiles to address future health emergencies: a country study during the COVID-19 lockdown period in Colombia.

The different strategies used worldwide to curb the COVID-19 pandemic between 2020 and 2021 had a negative psychosocial impact, which was disproportionately higher for socially and economically vulnerable groups. This article seeks to identify the psychosocial impact of the confinement period during the COVID-19 pandemic for the Colombian population by identifying profiles that predict the levels of different mental health indicators (feelings of fear, positive emotions or feelings during free time, and work impact) and based on them, characterize the risk factors and protection that allows us to propose guidelines for prevention or recovery from future health emergencies. This is an observational, cross-sectional, retrospective ex post facto study. Multistage cluster probabilistic sampling and binary logistic regression analysis were used to predict extreme levels of various mental health indicators based on psychosocial indicators of the COVID-19 confinement period and to identify risk and protection factors. A relationship was established between the combination of some of the different psychosocial factors evaluated (this combination being the predictive profile identified) with each of the three main variables: feeling of fear (n = 8,247; R = 0.32; p = 0.00; Poverall = 62.4%; 𝜔overall = 0.25; 1-𝛽overall = 1.00), positive emotions or feelings during free time (n = 6,853; R = 0.25; p = 0.00; Poverall = 59.1%; 𝜔overall = 0.18; 1-𝛽overall = 1.00) and labour impact (n = 4,573; R = 0.47; p = 0.63; Poverall = 70.4%; 𝜔overall = 0.41; 1-𝛽overall = 1.00), with social vulnerability determined by sociodemographic factors that were common in all profiles (sex, age, ethnicity and socioeconomic level) and conditions associated with job insecurity (unemployed, loss of health insurance and significant changes to job's requirements) and place of residence (city). For future health emergencies, it is necessary to (i) mitigate the socio-employment impact from emergency containment measures in a scaled and differentiated manner at the local level, (ii) propose prevention and recovery actions through psychosocial and mental health care accessible to the entire population, especially vulnerable groups, (iii) Design and implement work, educational and recreational adaptation programs that can be integrated into confinement processes.

Abstract P373: Psychosocial Risk and Resilience Profile in Rural Alabama: A Preliminary Analysis of Risk Underlying Rural Areas Longitudinal (RURAL) Study

Background: Given the disproportionate burden of cardiovascular disease risk and outcomes, there is an urgent need to understand the psychosocial drivers of these inequities. We characterized the psychosocial risk and resilience profiles of a cohort of rural-dwelling adults in the southeast U.S. Methods: This preliminary analysis includes 765 participants with complete covariate data (mean age 47.9 (SD=10.9), 70.7% self-reporting as women, 77.9% Black individuals, 41.4% with annual household income below $15,000; 43.7% possessing a high school diploma/GED or lower) residing in two rural counties in Alabama, part of the larger RURAL study. We evaluated participants across six crucial psychosocial domains: financial strain (continuous), financial adjustments (categorized as 0, 1-3, 4+), housing stability (tertiles), childhood adversity (including general, physical, and emotional trauma experienced before 18 years, categorized into tertiles), depression (measured using CES-D 16; yes/no), and resilience (measured using CD-RISC, categorized into tertiles). We examined the distribution of study outcomes and conducted race and sex-based comparisons. Results: Resilience was high overall and did not vary significantly by race or sex. Significant racial disparities were observed, with Black participants experiencing higher financial strain (mean: 2.84 Black vs. 2.34 White), housing instability (30.1% Black vs. 11.9% White), and elevated depressive symptoms (35.2% Black vs. 25.3% White). Conversely, White participants reported greater general trauma and depression (highest tertile: 17.8% Black, 23.8 % White for general trauma; 64.3% Black vs. 73.8% White for depression). Sex-based differences were statistically insignificant across most psychosocial factors, except for financial adjustments (highest tertile: 27.7% men vs. 36.0% women) and physical trauma (38.0% men vs. 22.0% women). When considering the intersection of race and sex, Black men had the highest prevalence of housing instability (highest tertile: 35.2% Black men, 27.8% Black women, 6.8% White men, 15.8% White women), and elevated depressive symptoms (35.8% Black men, 35% Black women, 15.3 % White men, 31.6% White women). White men had the highest prevalence of physical trauma (highest tertile: 35.8% Black men, 21.3% Black women, 44.1% White men, 25.3% White women), and White women had the highest prevalence of financial adjustments (highest tertile: 30.3% Black men, 33.9% Black women, 20.3% White men, 46.3% White women). Conclusion: Our preliminary analysis of the RURAL study underscores substantial psychosocial adversity in these Southern rural communities. Future investigations should explore the relationship between these psychosocial factors and CVD risk to help identify potential intervention targets to improve cardiovascular health in rural communities.

Psychosocial Risk Profiles and Colorectal Cancer Screening: a Latent Profile Analysis in a Colorectal Cancer Screening Intervention Setting.

Health behavior theories have identified predictors of colorectal cancer (CRC) screening. This study aimed to determine the psychosocial profiles of a predominantly Hispanic population of primarily Mexican origin receiving a CRC screening intervention and whether a specific combination of psychosocial profiles modified the effect of CRC screening intervention on CRC screening uptake. 467 participants aged 50 -75 years due for CRC screening received an educational intervention. Latent profile analysis was performed on baseline psychosocial constructs to identify the homogenous clustering of individuals with similar psychosocial constructs. In addition, CRC screening rates and changes in psychosocial scores between the latent groups were compared. Three psychosocial profiles, including a low benefit and high susceptibility group (LBHS), a high benefit and low susceptibility group (HBLS), and a high barrier and high susceptibility group (HBHS), were identified in this study. The HBLS group had the lowest susceptibility, with no improvement in benefits and barriers. This group had the lowest screening rate (80.85%) compared to 88.8% in LBHS and 86.3% in HBHS following the intervention. Finally, the intervention effect size on psychosocial score changes was smaller in HBLS than in other groups. This subgroup analysis suggests that CRC educational interventions should be tailored to improve the benefits and barriers among individuals with high susceptibility scores.

Associations between the stanford integrated psychosocial assessment for transplant and one-year lung transplant medical and psychosocial outcomes.

The Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) is a standardized measure of the psychosocial risk profile of solid organ transplant candidates. While studies have found associations between this measure and transplant outcomes, to date this has not been examined in lung transplant recipients. We examined relations between pre-transplant SIPAT scores and 1-year lung transplant medical and psychosocial outcomes in a sample of 45 lung transplant recipients. The SIPAT was significantly associated with 6-minute walk test (χ2(1) = 6.47, p = .010), number of readmissions (χ2(1) = 6.47, p = .011), and mental health services utilization (χ2(1) = 18.15, p < .001). It was not a significantly associated with the presence of organ rejection or mortality (ps > 0.10). Results suggest that the SIPAT can help identify patients who are at an elevated risk for transplant complications and thus would benefit from services to mitigate risk factors and improve outcomes.

Dose-dependent changes in real-life affective well-being in healthy community-based individuals with mild to moderate childhood trauma exposure

BackgroundChildhood trauma exposures (CTEs) are frequent, well-established risk factor for the development of psychopathology. However, knowledge of the effects of CTEs in healthy individuals in a real life context, which is crucial for early detection and prevention of mental disorders, is incomplete. Here, we use ecological momentary assessment (EMA) to investigate CTE load-dependent changes in daily-life affective well-being and psychosocial risk profile in n = 351 healthy, clinically asymptomatic, adults from the community with mild to moderate CTE.FindingsEMA revealed significant CTE dose-dependent decreases in real-life affective valence (p = 0.007), energetic arousal (p = 0.032) and calmness (p = 0.044). Psychosocial questionnaires revealed a broad CTE-related psychosocial risk profile with dose-dependent increases in mental health risk-associated features (e.g., trait anxiety, maladaptive coping, loneliness, daily hassles; p values < 0.003) and a corresponding decrease in factors protective for mental health (e.g., life satisfaction, adaptive coping, optimism, social support; p values < 0.021). These results were not influenced by age, sex, socioeconomic status or education.ConclusionsHealthy community-based adults with mild to moderate CTE exhibit dose-dependent changes in well-being manifesting in decreases in affective valence, calmness and energy in real life settings, as well as a range of established psychosocial risk features associated with mental health risk. This indicates an approach to early detection, early intervention, and prevention of CTE-associated psychiatric disorders in this at-risk population, using ecological momentary interventions (EMI) in real life, which enhance established protective factors for mental health, such as green space exposure, or social support.

Behavioral factors predict all-cause mortality in female coronary patients and healthy controls over 26 years - a prospective secondary analysis of the Stockholm Female Coronary Risk Study.

The prognosis of coronary artery disease (CAD) is related to its severity and cardiovascular risk factors in both sexes. In women, social isolation, marital stress, sedentary lifestyle and depression predicted CAD progression and outcome within 3 to 5 years. We hypothesised that these behavioral factors would still be associated with all-cause mortality in female patients after 26 years. We examined 292 patients with CAD and 300 healthy controls (mean age of 56 ± 7 y) within the Fem-Cor-Risk-Study at baseline. Their cardiac, behavioral, and psychosocial risk profiles, exercise, smoking, and dietary habits were assessed using standardized procedures. Physiological characteristics included a full lipid profile, the coagulation cascade and autonomic dysfunction (heart rate variability, HRV). A new exploratory analysis using machine-learning algorithms compared the effects of social and behavioral mechanisms with standard risk factors. Results: All-cause mortality records were completed in 286 (97.9%) patients and 299 (99.7%) healthy women. During a median follow-up of 26 years, 158 (55.2%) patients and 101 (33.9%) matched healthy controls died. The annualized mortality rate was 2.1% and 1.3%, respectively. After controlling for all available confounders, behavioral predictors of survival in patients were social integration (HR 0.99, 95% CI 0.99-1.0) and physical activity (HR 0.54, 95% CI 0.37-0.79). Smoking acted as a predictor of all-cause mortality (HR 1.56, 95% CI 1.03-2.36). Among healthy women, moderate physical activity (HR 0.42, 95% CI 0.24-0.74) and complete HRV recordings (≥50%) were found to be significant predictors of survival. CAD patients with adequate social integration, who do not smoke and are physically active, have a favorable long-term prognosis. The exact survival times confirm that behavioral risk factors are associated with all-cause mortality in female CAD patients and healthy controls.

Psychosocial Risk Differences Among Veteran Organ Transplant Groups: Rehabilitation Targets to Promote Transplant Listing Outcomes

Research Objectives To investigate differences in psychosocial risk profiles among Veteran transplant groups during mental health (MH) pre-transplant evaluations to inform rehabilitation targets to promote transplant listing and general outcomes. Design Cross-sectional study. Setting VA Hospital. Participants 76 male Veterans ranging in age from 29–86 (M=62.9, SD=8.8) undergoing kidney (n=29), liver (n=31), or stem cell (SCT; n=16) transplantation work-up. Sixty-two percent identified as white, 30% Black, 5% Latinx, and 1% American Indian/Alaska Native (1% declined to answer). Interventions N/A. Main Outcome Measures Psychosocial risk assessed using the Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) to derive subscales of Patient's Readiness (PR), Social Support, Psychological Suitability and Psychopathology, and Lifestyle and Effect of Substance Use (LESU), with higher scores signifying greater psychosocial risk. Results Four ANOVA models were run (SIPAT subscale=dependent variable; transplant type=independent variable). Significant effects were found for PR, F(2, 73) = 3.98, p = .023, and LESU, F(2, 73) = 6.18, p = .003. Nonparametric bootstrapped t-tests using 10,000 resamples revealed higher mean scores for liver compared to kidney and SCT groups for PR (95% CI: 0.53 – 3.73, p = .009; 95% CI: 0.27 – 3.84, p = .025, respectively) as well as LESU (95% CI: 1.81 – 6.73, p < .001; 95% CI: 0.28 – 5.88, p = .030, respectively). Confidence intervals for differences among SCT and kidney groups contained zero (PR 95% CI: -1.45 – 1.58, LESU 95% CI: -1.85 – 1.98). Conclusions Patients from different transplant populations may require different rehabilitation/intervention needs to ensure potential listing and general success. Specifically, liver transplant patients may benefit from additional education on the transplant process and encouraging changes in substance use/lifestyle factors. Future research should investigate differences in psychosocial risk as well as the predictive validity of the SIPAT for long-term treatment outcomes (i.e., transplantation) across transplant groups. Author(s) Disclosures N/A. To investigate differences in psychosocial risk profiles among Veteran transplant groups during mental health (MH) pre-transplant evaluations to inform rehabilitation targets to promote transplant listing and general outcomes. Cross-sectional study. VA Hospital. 76 male Veterans ranging in age from 29–86 (M=62.9, SD=8.8) undergoing kidney (n=29), liver (n=31), or stem cell (SCT; n=16) transplantation work-up. Sixty-two percent identified as white, 30% Black, 5% Latinx, and 1% American Indian/Alaska Native (1% declined to answer). N/A. Psychosocial risk assessed using the Stanford Integrated Psychosocial Assessment for Transplant (SIPAT) to derive subscales of Patient's Readiness (PR), Social Support, Psychological Suitability and Psychopathology, and Lifestyle and Effect of Substance Use (LESU), with higher scores signifying greater psychosocial risk. Four ANOVA models were run (SIPAT subscale=dependent variable; transplant type=independent variable). Significant effects were found for PR, F(2, 73) = 3.98, p = .023, and LESU, F(2, 73) = 6.18, p = .003. Nonparametric bootstrapped t-tests using 10,000 resamples revealed higher mean scores for liver compared to kidney and SCT groups for PR (95% CI: 0.53 – 3.73, p = .009; 95% CI: 0.27 – 3.84, p = .025, respectively) as well as LESU (95% CI: 1.81 – 6.73, p < .001; 95% CI: 0.28 – 5.88, p = .030, respectively). Confidence intervals for differences among SCT and kidney groups contained zero (PR 95% CI: -1.45 – 1.58, LESU 95% CI: -1.85 – 1.98). Patients from different transplant populations may require different rehabilitation/intervention needs to ensure potential listing and general success. Specifically, liver transplant patients may benefit from additional education on the transplant process and encouraging changes in substance use/lifestyle factors. Future research should investigate differences in psychosocial risk as well as the predictive validity of the SIPAT for long-term treatment outcomes (i.e., transplantation) across transplant groups.

Families following pediatric traumatic medical events: identifying psychosocial risk profiles using latent profile analysis

ABSTRACT Background: Post-traumatic stress symptoms (PTSS) are often experienced by children and family members after pediatric traumatic medical events (PTMEs). Assessing families’ psychosocial risk factors is a crucial part of trauma-informed practice as it helps identify risk for PTSS in the aftermath of PTME. Objectives: Using the Psychosocial Assessment Tool 2.0 (PAT2.0), this study describes the psychosocial risk of families following PTMEs in two ways: 1. Describing the psychosocial risk defined by the PAT2.0 based on three-tiered risk levels; 2. Using latent profile analysis (LPA); identifying psychosocial risk profiles and examining how child- and injury-related factors can affect profile membership. Methods: Caregivers of 374 children following PTMEs admitted to a pediatric rehabilitation department in Israel completed the PAT2.0. Total PAT2.0 score and the seven PAT2.0 subscales (family structure/resources, social support, child problems, sibling problems, family problems, caregiver stress reactions, and family beliefs) were included in the first analysis. Mean PAT2.0 scores of three risk categories (universal, targeted, clinical) were calculated; LPA, which allows for cross-sectional latent variable mixture models to identify heterogeneity within a population, and multinomial logistic regressions using six out of the seven PAT2.0 subscales, were used to determine distinct profile differences and predictors of profile membership. Results: The three-tiered risk levels revealed were relatively high, as compared to levels in families of children with other clinical diagnoses. LPA yielded a three-profile solution: low family risk (63.53%); high caregiver stress, above-average levels of family risk (22.5%); and sibling problems, above-average levels of family risk (13.94%). Ethnicity and type of injury predicted group membership. Conclusion: Families of children following PTMEs are at increased psychosocial risk. A clinically useful approach to identifying and preventing PTSS may be to evaluate specific domain patterns rather than just the total PAT2.0 risk level alone, based on the PAT2.0 subscales.

Psychopathological and Psychosocial Risk Profile, Styles of Interaction and Mentalization of Adolescent and Young Mother-Infant Dyads.

This study examined the psychopathological and psychosocial risk profile and the quality of mother–infant interaction in 98 adolescent and young mother–infant dyads. At their infant’s age of 3 months, mothers filled in a socio-demographic form and completed a test battery: EPDS for depression, STAY-I for anxiety, PSI-SF for parenting stress, MPSS for social support, AAI for maternal attachment and reflective functioning, CECA for adverse childhood experiences, Care-Index and Mind-mindedness coding system for mother–infant interaction. Results showed that motherhood in adolescence was associated with several psychosocial risk factors. Adolescent and young mothers have depression (25%), anxiety (29%) and insecure attachment (65%), with low reflective functioning, of whom 18% have disorganized attachment. A total of 54% of the mothers had at least one adverse childhood experience. Furthermore, adolescent mothers had low sensitivity and mind-mindedness and high intrusiveness, and their infant had low responsiveness and high passive behaviors. Mothers under 18 have experienced more sexual abuse, are more likely to be single and have been followed by child social services more than mothers aged 18–21. Adolescent mothers have a high-risk psychopathological and psychosocial profile that affects their ability to mentalize and build an adequate relationship with the child. It appears to be important to support the adolescent mother–child relationship.

RENaBack: low back pain patients in rehabilitation—study protocol for a multicenter, randomized controlled trial

BackgroundMillions of people in Germany suffer from chronic pain, in which course and intensity are multifactorial. Besides physical injuries, certain psychosocial risk factors are involved in the disease process. The national health care guidelines for the diagnosis and treatment of non-specific low back pain recommend the screening of psychosocial risk factors as early as possible, to be able to adapt the therapy to patient needs (e.g., unimodal or multimodal). However, such a procedure has been difficult to implement in practice and has not yet been integrated into the rehabilitation care structures across the country.MethodsThe aim of this study is to implement an individualized therapy and aftercare program within the rehabilitation offer of the German Pension Insurance in the area of orthopedics and to examine its success and sustainability in comparison to the previous standard aftercare program.The study is a multicenter randomized controlled trial including 1204 patients from six orthopedic rehabilitation clinics. A 2:1 allocation ratio to intervention (individualized and home-based rehabilitation aftercare) versus the control group (regular outpatient rehabilitation aftercare) is set. Upon admission to the rehabilitation clinic, participants in the intervention group will be screened according to their psychosocial risk profile. They could then receive either unimodal or multimodal, together with an individualized training program. The program is instructed in the clinic (approximately 3 weeks) and will continue independently at home afterwards for 3 months. The success of the program is examined by means of a total of four surveys. The co-primary outcomes are the Characteristic Pain Intensity and Disability Score assessed by the German version of the Chronic Pain Grade questionnaire (CPG).DiscussionAn improvement in terms of pain, work ability, patient compliance, and acceptance in our intervention program compared to the standard aftercare is expected. The study contributes to provide individualized care also to patients living far away from clinical centers.Trial registrationDRKS, DRKS00020373. Registered on 15 April 2020

Concurrent Use of E-cigarettes, Combustible Cigarettes, and Marijuana.

Subgroups of adolescent single and dual e-cigarette and cigarette users have been identified, but usage patterns have changed in recent years, and there has been an increase in marijuana use. Research is needed with current data to identify subgroups of use including marijuana and determine their behavioral correlates. We cross classified ever and recent use of e-cigarettes, combustible cigarettes, and marijuana among US high school students in the 2019 Youth Risk Behavior Survey (YRBS), providing 8 different groups. Levels of 14 risk and protective factors were compared across groups in general linear models with demographic covariates using omnibus tests, pairwise comparisons, and planned contrasts. Replicability was tested through identical analyses for 2017 YRBS data. The nonuser group was 43.9% of the sample. The most frequent user groups were triple users (ever-use proportion: 16.9%), dual (e-cigarette and marijuana) users (15.8%), and exclusive e-cigarette users (13.2%). For risk profiles on levels of psychosocial variables, the triple-user group was typically elevated above all other groups. Exclusive e-cigarette users were above nonusers in risk profile but below dual users (both cigarettes and marijuana). Results were similar for ever use and recent use. The patterning of results in 2019 YRBS data were closely replicated in 2017 YRBS data. Co-occurrence of e-cigarette, cigarette, and marijuana use is currently substantial among adolescents and is associated with an elevated psychosocial risk profile. This has implications for both epidemiology and prevention studies. Further research is needed to study prevalence and identify pathways to triple use.

Validity and reliability of the Norwegian version of the Musculoskeletal Health Questionnaire in people on sick leave

BackgroundThe Musculoskeletal Health Questionnaire (MSK-HQ) is a recently developed generic questionnaire that consists of 14 items assessing health status in people with musculoskeletal disorders. The objective was to translate and cross-culturally adapt the MSK-HQ into Norwegian and to examine its construct validity and reliability in people on sick leave with musculoskeletal disorders.MethodsA prospective cohort study was carried out in Norway on people between 18 and 67 years of age and sick leave due to a musculoskeletal disorder. The participants were recruited through the Norwegian Labour and Welfare Administration during November 2018–January 2019 and responded to the MSK-HQ at inclusion and after four weeks. Internal consistency was assessed by Cronbach’s alpha, and structural validity with a factor analysis. Construct validity was assessed by eight “a priori” defined hypotheses regarding correlations between the MSK-HQ and other reference scales. Correlations were analyzed by Spearman’s- or Pearson’s correlation coefficient and interpreted as high with values ≥ 0.50, moderate between 0.30–0.49, and low < 0.29. Reliability was tested with test–retest, standard error of measurement (SEM) and smallest detectable change (SDC).ResultsA total of 549 patients, mean age (SD) 48.6 (10.7), 309 women (56.3%), were included. The mean (SD) MSK-HQ sum scores (min–max 3–56) were 27.7 (8.2). Internal consistency was 0.86 and a three-factor structure was determined by factor analysis. Construct validity was supported by the confirmation of all hypotheses; high correlation with HRQOL, psychosocial risk profile, and self-perceived health; moderate correlation with physical activity, self-perceived work ability, and work presenteeism; and low correlation with the number of sick days. The test–retest reliability was good with an intraclass correlation coefficient of 0.83 (95% CI, 0.74–0.89), SEM was 2.3 and SDC 6.5.ConclusionsThe Norwegian version of the MSK-HQ demonstrated high internal consistency, a three-factor structure, good construct validity and good test–retest reliability when used among people on sick leave due to musculoskeletal disorders.

Influence of Psychological Biomarkers on Therapeutic Adherence by Patients with Non-Alcoholic Fatty Liver Disease: A Moderated Mediation Model

Our aim was to analyze whether depressive symptoms mediated the association between physical quality of life (QoL) and adherence to physical activity in patients with non-alcoholic fatty liver disease (NAFLD), as well as the association between social support and adherence to diet. We also examined whether self-efficacy exerted a moderating role in these associations. QoL (SF-12), social support (MSPSS), depressive symptoms (HADS), self-efficacy (GSE), physical activity (IPAQ) and diet (MEDAS) were evaluated in 413 biopsy-proven NAFLD patients. Mediation and moderated mediation models were conducted using the SPSS PROCESS v3.5 macro. Results showed that depressive symptoms mediated the relationship between physical QoL and adherence to physical activity (indirect effect = 6.248, CI = 1.917–10.727), as well as the relationship between social support and adherence to diet (indirect effect = 0.148, CI = 0.035–0.275). Self-efficacy also moderated the indirect effects of QoL and social support on therapeutic adherence through depressive symptoms. Specifically, the higher self-efficacy was, the lower the negative impact on the NAFLD patient’s mental health. In conclusion, self-efficacy is defined as a protective factor for therapeutic adherence by NAFLD patients with a psychosocial risk profile. Self-efficacy should, therefore, be a main psychological target in future multidisciplinary NAFLD approaches.

Psychosocial risk profiles among older adults living alone in South Korea: A latent profile analysis

Objectives. This study explored the psychosocial risk profiles and various characteristics associated with profile membership among Korean older adults living alone.Methods. Our analyses were based on a cross-sectional cohort of 1030 community-dwelling older adults (≥ 65 years) living alone in one Korean city. Latent profile analysis was used to identify psychosocial risk profiles across a wide range of psychosocial dimensions (depressive symptoms, suicidal ideation, cognitive dysfunction, loneliness, and perceived social support). We then explored the characteristics associated with distinct profiles by conducting bivariate and regression analyses.Results. The three-profile was selected as the best solution: a group with high cognitive dysfunction, high loneliness, and low social support (profile 1), a group with low psychological risks and high social support (profile 2), and a group with high depression and high suicidal ideation (profile 3). Regression analyses showed that a lower frequency of interaction with neighbors or families, a greater frailty score, and lower quality of life were significantly associated with profile 1 or profile 3 than with profile 2 (p < .05). Further, being male and having a poorer nutritional status was more significantly related to profile 3 than profile 2 (p < .05).Conclusions. Findings provide evidence for healthcare professionals when developing interventions to prevent and reduce these psychosocial risks for older individuals living alone. In particular, factors associated with profile membership identified in the study may facilitate more tailored interventions.

Attitudes and Engagement of Pregnant and Postnatal Women With a Web-Based Emotional Health Tool (Mummatters): Cross-sectional Study.

BackgroundMummatters is a web-based health tool that allows women to self-assess the symptoms of depression and the presence of psychosocial risk factors throughout pregnancy and the postnatal period. It aims to increase women’s awareness of their own symptoms or risk factors and their knowledge of the available support options, to encourage engagement with these support options (as appropriate), and to facilitate communication about emotional health issues between women and their health care providers.ObjectiveThe aim of this study is to report the uptake of mummatters; the sociodemographic and psychosocial risk profiles of a subsample of users; and the acceptability, credibility, perceived effect, and motivational appeal of the tool. The help-seeking behaviors of the subsample of users and barriers to help seeking were also examined.MethodsMummatters was launched in November 2016. Women who completed the mummatters baseline assessment were invited to complete a web-based follow-up survey 1 month later.ResultsA total of 2817 women downloaded and used mummatters between November 13, 2016, and May 22, 2018, and 140 women participated in the follow-up study. Approximately half of these women (51%; 72/140) were Whooley positive (possible depression), and 43% (60/140) had an elevated psychosocial risk score on the Antenatal Risk Questionnaire. Mummatters was rated favorably by pregnant and postnatal women in terms of its acceptability (94%-99%), credibility (93%-97%), appeal (78%-91%), and potential to affect a range of health behaviors specific to supporting emotional wellness during the perinatal period (78%-93%). Whooley-positive women were more likely to speak with their families than with a health care provider about their emotional health. Normalizing symptoms and stigma were key barriers to seeking help.ConclusionsAlthough mummatters was rated positively by consumers, only 53% (19/36) to 61% (22/36) of women with possible depression reported speaking to their health care providers about their emotional health. There was a trend for more prominent barriers to seeking help among postnatal women than among pregnant women. Future studies that investigate whether social barriers to seeking help are greater once a woman has an infant are warranted. Such barriers potentially place these women at greater risk of remaining untreated, as the demands on them are greater.

Heart and brain interactions : Pathophysiology and management of cardio-psycho-neurological disorders.

Cardiovascular diseases (CVD) and mental health disorders (MHD; e.g. depression, anxiety and cognitive dysfunction) are highly prevalent and are associated with significant morbidity and mortality and impaired quality of life. Currently, possible interactions between pathophysiological mechanisms in MHD and CVD are rarely considered during the diagnostic work-up, prognostic assessment and treatment planning in patients with CVD, and research addressing bidirectional disease mechanisms in a systematic fashion is scarce. Besides some overarching pathogenetic principles shared by CVD and MHD, there are specific syndromes in which pre-existing neurological or psychiatric illness predisposes and contributes to CVD development (as in Takotsubo syndrome), or in which the distorted interplay between innate immune and central nervous systems and/or pre-existing CVD leads to secondary MHD and brain damage (as in peripartum cardiomyopathy or atrial fibrillation). Clinical manifestations and phenotypes of cardio-psycho-neurological diseases depend on the individual somatic, psychosocial, and genetic risk profile as well as on personal resilience, and differ in many respects between men and women. In this article, we provide arguments on why, in such conditions, multidisciplinary collaborations should be established to allow for more comprehensive understanding of the pathophysiology as well as appropriate and targeted diagnosis and treatment. In addition, we summarize current knowledge on the complex interactions between the cardiovascular and central nervous systems in Takotsubo syndrome and peripartum cardiomyopathy, and on the neurological and psychiatric complications of atrial fibrillation.

Psychosocial Health Status of Adolescent Girls in a Rural Area of Guntur District

Background: Adolescence is a distinct phase of complex developmental and psychological needs. UNICEF states that suicide is the second leading cause of death in this age group of young girls. A myriad of social, economic and health factors undermine the ability of the adolescents to lead full and productive lives. There is a need to study these factors as they are bound to health-related outcomes. Objective: To assess the psycho-social health of adolescent girls (15-19 years) living in a rural area using WHO HEEADSSS questionnaire and to compare their psychosocial risk profiles and demographic profiles to identify important risk factors. Methodology: This cross-sectional study was conducted from April to August 2017 on a convenient sample of 180 adolescent girls of 15-19 years residing in the rural field practice area of NRI Medical College, Guntur. The WHO’s HEEADSSS (Home and Environment, Education and Employment, Activities, Drugs, Sexuality, Suicide &amp; Depression and Safety) questionnaire was used to assess the psychosocial risk profile of the subjects. The findings were subjected to multiple regression and chi-square test at 5% level of significance. Results and Discussion: Only 6.11% of the girls had scores within the normal range. 10% were at severe risk and 1.11% were in the very severe risk category. The following factors accounted for 75% of the psycho social risk: Age, Marital Status, Occupation, Positive History of Smoking or Alcohol intake in Family, Having Sleep Problems, Thoughts of inflicting self-hurt and Thoughts of inflicting physical hurt on others. Conclusion: HEEADSSS questionnaire is a useful tool to assess the psycho-social health of adolescent girls. Most girls didn’t have adequate knowledge regarding family panning methods or STDs. Qualitative methods would give further insight into these issues.

Psychosocial Mechanisms of Cognitive-Behavioral-Based Physical Therapy Outcomes After Spine Surgery: Preliminary Findings From Mediation Analyses.

Changing Behavior through Physical Therapy (CBPT), a cognitive-behavioral-based program, has been shown to improve outcomes after lumbar spine surgery in patients with a high psychosocial risk profile; however, little is known about potential mechanisms associated with CBPT treatment effects. The purpose of this study was to explore potential mediators underlying CBPT efficacy after spine surgery. In this secondary analysis, 86 participants were enrolled in a randomized trial comparing a postoperative CBPT (n=43) and education program (n=43). Participants completed validated questionnaires at 6weeks (baseline) and 3 and 6months following surgery for back pain (Brief Pain Inventory), disability (Oswestry Disability Index), physical health (12-Item Short-Form Health Survey), fear of movement (Tampa Scale for Kinesiophobia), pain catastrophizing (Pain Catastrophizing Scale), and pain self-efficacy (Pain Self-Efficacy Questionnaire). Parallel multiple mediation analyses using Statistical Package for the Social Sciences (SPSS) were conducted to examine whether 3- and 6-month changes in fear of movement, pain catastrophizing, and pain self-efficacy mediate treatment outcome effects at 6months. Six-month changes, but not 3-month changes, in fear of movement and pain self-efficacy mediated postoperative outcomes at 6months. Specifically, changes in fear of movement mediated the effects of CBPT treatment on disability (indirect effect=-2.0 [95% CI=-4.3 to 0.3]), whereas changes in pain self-efficacy mediated the effects of CBPT treatment on physical health (indirect effect=3.5 [95% CI=1.2 to 6.1]). This study advances evidence on potential mechanisms underlying cognitive-behavioral strategies. Future work with larger samples is needed to establish whether these factors are a definitive causal mechanism. Fear of movement and pain self-efficacy may be important mechanisms to consider when developing and testing psychologically informed physical therapy programs.

Psychosocial Risk Profiles Among American and Dutch Families Affected by Pediatric Cancer.

Little is known about relations between domains of psychosocial risk among pediatric cancer populations. The Psychosocial Assessment Tool 2.0 (PAT2.0) is one internationally validated screening measure that can examine these relations. This study aimed to examine risk profiles and predictors of these patterns exhibited by American and Dutch families. Caregivers of children newly diagnosed with cancer (N = 262; nUSA=145, nNL=117) completed the PAT2.0 as part of larger studies conducted in the United States and the Netherlands. Latent profile analysis and multinomial logistic regression examined differences in demographic and medical variables across risk profiles. Domains assessed included Family Structure/Resources, Child Problems, Sibling Problems, Family Problems, Caregiver Stress Reactions, and Family Beliefs. Four groups were identified: "Low-Risk" (n = 162) defined by generally low risk across domains; "Moderate-Caregiver" (n = 55) defined by elevated Caregiver Stress Reactions domain; "Moderate-Children" (n = 25) defined by elevated Child Problems and/or Sibling Problems, and "Elevated-Risk" (n = 20) marked by generally high overall risk. Dutch families had higher odds of being in the Elevated-Risk group, compared to the Low-Risk group. Caregiver age, gender, and educational attainment predicted group membership. Families classified as Targeted or Clinical had higher odds of being in the Moderate or Elevated risk groups. The PAT2.0 appears to identify largely similar patterns of risk, suggesting that families experience common psychosocial difficulties in both American and Dutch societies. The two Moderate groups demonstrated specific risk sources, suggesting that evaluation of domain patterns, rather than reliance on PAT2.0 risk level, could be of clinical benefit.

Medical and Psychosocial Risk Profiles for Low Birthweight and Preterm Birth.

Low birthweight and preterm birth are risk factors for infant mortality and persistent problems. This study uses representative data to assess whether distinct latent profiles of co-occurring medical and psychosocial factors have implications for preterm birth and low birthweight. Data are from the Pregnancy Risk Assessment Monitoring System, a cross-sectional survey constituting representative data on pregnancies from 2012 to 2013. Latent class analysis derived classes of pregnant women potentially at risk for low birthweight and/or preterm birth. Latent class analysis identified five homogenous profiles of interrelated psychosocial and medical factors. Risk was greatest for the profile marked by high rates of medical factors, followed by a high risk for a profile marked by a combination of very low income and psychosocial factors. Two profiles involving low income and very low income also indicated greater risk for adverse birth outcomes related to socioeconomic status. More attention should be paid to screening for and addressing psychosocial risk in concert with prenatal care. Women who show high-risk profiles can be monitored and supported by an interdisciplinary care team, when warranted.