Social Adjustment Scale Research Articles

Trajectories of functional limitations, health-related quality of life and societal costs in individuals with long COVID: a population-based longitudinal cohort study

ObjectivesTo examine trajectories of functional limitations, fatigue, health-related quality of life (HRQL) and societal costs of patients referred to long COVID clinics.DesignA population-based longitudinal cohort study using real-time user data.Setting35...

CHARACTERIZATION OF BASELINE SYMPTOMS AND FUNCTIONAL IMPAIRMENTS IN A LARGE COHORT OF OUTPATIENTS ATTENDING A LONG COVID REHABILITATION CLINIC IN THE UNITED KINGDOM.

In response to the high prevalence and morbidity associated with long COVID (LC), outpatient rehabilitation programmes were created across jurisdictions. We aimed to characterize baseline symptoms and impairments of patients attending outpatient LC rehabilitation. This study was a retrospective quality-improvement analysis. Patients attending outpatient LC rehabilitation at the Oxfordshire Post-Covid Service. Data included age/sex and 6 questionnaires performed at baseline: Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Dyspnoea-12 (D12), Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Assessment-7 (GAD-7), Visual Analogue Scale (VAS) of self-rated health, and the Work And Social Adjustment Scale (WSAS). All scores were dichotomized (indicating presence/absence of clinically significant pathology). Potential differences between age (</≥ 50 years) and sex were assessed using χ2 tests. A total of 422 patients were included (mean/standard deviation [SD] age = 47.1/13.2;132/31.3% male). A total of 76% had significant fatigue (FACIT-F), 69% had breathlessness (D12), 55% had depression (PHQ-9), 34% had anxiety (GAD-7), 41% self-reported poor health (VAS), and 57% had work/social life dysfunction (WSAS). D12 scores differed between age groups (older > younger, χ2 = 3.19/p = 0.048), with no differences observed on other scales. In this preliminary study, a high proportion of LC outpatients had significant impairments across domains. The findings of this study reaffirm the need for high-quality, multidisciplinary LC rehabilitation, and may be used to help build a standardized set of outcome measures moving forward.

Correctional Programs in Reform and Rehabilitation Centers in the Southern Governorates of Palestine and Their Impact on the Level of Psychological and Social Adjustment from the Perspective of Recidivist Inmates

Objectives: This study investigated the impact of rehabilitation programs on the psychological and social adaptation of recidivists in Palestine which was achieved by examining the level of implementation of rehabilitation programs and the psychological and social adaptation in different correction and rehabilitation centres. Methods: A systematic research design was adopted to achieve the goal of objective normative inquiry. Data was collected through a questionnaire and analyzed using descriptive analysis and linear regression. This encompassed measuring correctional program effectiveness and psychological-social compatibility among 237 recidivist inmates in the southern governorates, chosen through simple random sampling. Results: The results of the study showed a high level of application of the correctional programs used from the point of view of the inmates of recidivism for crime, according to the relative weight of 73.6%. and social, by 12.3%, as well as a significant effect of the variable of age and the variable of educational level as extraneous variables on the relationship between the correctional programs scale and the psychological and social adjustment scale Psychological and social. Conclusions: The study concluded the presence of a high level of implementation of rehabilitation programs as perceived by recidivists, while also indicating a low level of psychological and social compatibility among recidivists. The study further concluded a significant impact of rehabilitation programs on psychological and social compatibility, as well as the influence of age and educational level. However, the study found no significant impact of social status and the duration of punishment.

What Mattered Most: Personal, Work-Related, and Psychopathological Characteristics Associated with Healthcare Workers’ Impairment of Functioning during COVID-19

Background: The COVID-19 pandemic greatly impacted healthcare workers (HWs) around the world. Italy was the first Western country hit by the pandemic, and several studies have been published targeting the mental health burden held by Italian HWs. Notwithstanding, only a few studies focused on the impact of COVID-19 on HWs’ levels of functioning. Methods: An online survey was distributed to HWs in Italy through physicians’ and nurses’ associations, social networks, and researchers’ direct contacts, between 4 April and 13 May 2020. Participants provided sociodemographic, work-related, and pandemic-related data and filled out a set of psychometric questionnaires (Patient Health Questionnaire-9—PHQ-9, General Anxiety Disorder-7—GAD-7, Impact of Event Scale—Revised—IES-R, and Work and Social Adjustment Scale—WSAS). Results: The final sample included 1041 HWs (mean age 45.01 ± 11.62, 63.9% females). In total, 58.1% of the subjects screened positive on the GAD-7, 27.5% on the PHQ-9, and 25.9% on the IES-R. Furthermore, 67.4% showed a significant level of impairment in functioning according to the WSAS, while 35.8% reached scores of moderate or worse impairment. In the multiple linear regressions, screening positive on any of the psychometric scales and being exposed to unusual suffering significantly predicted worse scores in all WSAS domains (p &lt; 0.05). Having a history of mental disorders significantly predicted worse scores in the WSAS domain of work ability (p = 0.002), while being the parent of children younger than 18 years significantly predicted worse WSAS family functioning scores (p &lt; 0.001). Conclusions: Our results corroborate extant data about the impact of the COVID-19 pandemic on HWs’ mental health and shed light on its detrimental effect on functioning. Tailored interventions should be designed in order to support HWs during times of crisis.

Towards active health: A study on the relationship between physical activity and body image among college students

AimsActive health is a new concept, model, and system for maintaining a state of whole-person health. In the context of the increasing severity of college students' mental health, it is of great significance to explore the relationship between physical activity and college students' body image based on an active health perspective. MethodsA survey was conducted among 853 college students in Zhejiang province using the physical activity rating scale, body image scale, sense of acquisition of sports body shaping scale and social adjustment scale. Using SPSS25.0 and Amos 24.0 software for data processing and analysis. Results(1) There is a significant positive correlation between physical activity, body image, sense of acquisition of sports body shaping, and social adjustment. There is a significant positive correlation between physical activity and body image among college students; The sense of acquisition of sports body shaping a significant mediating role between physical activity and the promotion of college students' body image. The effects of physical activity on body image were mainly achieved through the following three mediating pathways: (1) physical activity → sense of acquisition of sports body shaping → body image, the mediating effect value of this pathway was 0.18, which accounted for 31.6 % of the total effect, with a confidence interval of [0.08, 0.28], (2) physical activity → social adaptation → body image, the mediating effect value of this pathway was 0.09, which accounted for 15.8 % of the total effect of 15.8 %, with a confidence interval of [0.03, 0.15], and (3) physical activity → sense of acquisition of sports body shaping → social adaptation → body image, a pathway with a mediated effect value of 0.09, accounting for 15.8 % of the total effect, with a confidence interval of [0.01, 0.17]. ConclusionsPhysical activity is an important factor in promoting the body image of college students, and there is a chain intermediary effect between physical activity and body image. School sport has its own disciplinary value and unique strengths in advancing the development of body image in adolescents, and the significant mediating effects of sense of acquisition of sports body shaping and social adaptation in this process provide theoretical support for the body image turn to move from theory to practice in the field of school sport.

Social Adjustment among Adolescents

Introduction: Humans vare social creatures by nature. A person's personality is mostly determined by how well they fit into society1. Aim: Determine the level of social adjustment among adolescents. Methods: Descriptive design was adopted. 50 adolescents studying higher secondary education from selected higher secondary schools were selected for the study. Demographic profile and social adjustment scale was used to collect data. The data analyzed by descriptive and inferential statistics. Results: The study findings revealed that, maximum 31(62%) adolescents were having High level of Social Adjustment, followed by 10(20%) of adolescents has above average level and 4(8%) of adolescents has average and extremely high level of social adjustment. The place of living, education and occupational level of mother got associated with the level of social adjustment. Conclusion: The study findings show that, the maximum adolescents has the high level of social adjustment and the place of living, education and occupational level of mother has got association with adolescents social adjustment. Implications for practice: Educators must be aware of the difficulties teenagers are having integrating into society. The best method to improve teenagers' abilities to socially adapt is to understand them, their difficulties, and how to care for them.

Exploring the Links Between Social Media Addiction, Body Satisfaction, and Subjective Well-Being Among Adolescents

The current study examined Social media addiction, body satisfaction, and subjective well-being among adolescents. For this purpose, the sample for the current study was calculated by the G power formula (F, t, χ2, Z, and exact tests) 300 participants were selected through the convenient sampling technique (139 Boys and 161 Girls), adolescents with the age range of 10-19 from different colleges and universities of Faisalabad. The Co-relational research design was used in the current study. The variables under research were measured using the following scales: The Bergen Social Media Addiction Scale (Andreassen et al., 2016), the Body Shape Questionnaire (Cooper et al., 1987), the Rosenberg Self-Esteem Scale (Rosenberg,1965), the Work &amp; Social Adjustment Scale (Marks et al., 2002), ICP Subjective Well-Being Scale (Diener's, 1984). Using SPSS version 26, descriptive statistics, correlation, and t-tests were used to evaluate the current research hypothesis. Results of the correlation analysis revealed that there is a significant negative relationship between social media addiction and body satisfaction. In contrast, body satisfaction and subjective well-being were significantly positively related, and subjective well-being with body satisfaction showed no ties. The findings will benefit adolescents and management in schools and universities by providing a healthy environment and social skills to reduce social media addiction. Excessive social media use negatively impacts adolescents' body satisfaction and overall well-being. For adolescents, there is a need for educational programs and open communication to promote healthy online habits and to reduce social media's negative effects, with parental support playing a crucial role.

Validation of the Danish Version of the Overall Depression Severity and Impairment Scale (ODSIS): A Reliable Instrument for Assessing Depression Symptoms and Functional Impairment.

In psychotherapy, having a reliable tracking tool is vital for effective treatment. We have validated the Danish version of the 'Overall Depression Severity and Impairment Scale' (ODSIS), which is used in the Unified Protocol for Emotional Disorders (UP) and other cognitive behavioural therapies. This five-item self-rating scale is expected to correspond closely to the gold-standard Beck Depression Inventory-II (BDI-II), but also to self-rating scales addressing daily functioning and well-being. Internal consistency is assessed using Cronbach's alpha and McDonald's omega. Criterion validity is explored through Pearson's correlation coefficient with BDI-II, the Work and Social Adjustment Scale (WSAS), the Five-Item World Health Organization Well-Being Index (WHO-5) and scatter plots, and an optimal cut-off score is determined using a receiver operating characteristic curve. The study included 340 respondents: 234 from a recent clinical trial, 56 psychiatric patients from inpatient/outpatient units and 50 healthy volunteers. ODSIS demonstrates strong internal consistency (Cronbach's alpha: 0.887-0.956, McDonald's omega: 0.888-0.957). Correlations with BDI-II, WSAS and WHO-5 highlight its strong criterion validity (BDI-II: 0.847, WSAS: 0.751, WHO-5: 0.771). The optimal cut-off score (> 7.5) for detecting depression shows great sensitivity (0.862) and specificity (0.731). The Danish version of ODSIS proves to be a reliable instrument for quantification of a combination of depression level and functional impairment from the symptoms. Its high correlation with established BDI-II makes it a brief and handy tool for repeated measurement in clinical and research settings.

Comparing the effectiveness of behavioral activation in group vs. self-help format for reducing depression, repetitive thoughts, and enhancing performance of patients with major depressive disorder: a randomized clinical trial

BackgroundBehavioral activation has gained increasing attention as an effective treatment for depression. However, the effectiveness of Behavioral Activation Group Therapy (BAGT) in controlled conditions compared to its self-help programs requires more investigation. The present study aimed to compare their effectiveness on depressive symptoms, repetitive negative thinking (RNT), and performance in patients with major depressive disorder (MDD).MethodsIn this randomized clinical trial, 40 patients diagnosed with Major Depressive Disorder (MDD) were recruited based on a structured clinical interview for DSM-5 (SCID-5). Participants were allocated to BAGT (n = 20) and self-help behavioral activation (SBA; n = 20) groups. BAGT received ten weekly sessions (90 min), while the SBA group followed the same protocol as the self-help intervention. Participants were evaluated at pre-treatment, post-treatment, and the 2-month follow-up using the Beck Depression Inventory-II (BDI-II), repetitive thinking questionnaire (RTQ-31), and work and social adjustment scale (WSAS).ResultsThe results of a Mixed ANOVA analysis revealed that participants who underwent BAGT showed significant improvement in depression, rumination, work, and social functioning post-treatment and at the 2-month follow-up. However, the SBA group did not show significant changes in any outcome. The study also found that, based on clinical significance, 68% of the BAGT participants were responsive to treatment, and 31% achieved a high final performance status at the 2-month follow-up.DiscussionBAGT was more effective than SBA in MDD patients. Participants’ engagement with self-help treatment is discussed.Trial registrationThe present trial has been registered in the Iranian Registry of Clinical Trials Center (IRCT ID: IRCT20181128041782N1|| http://www.irct.ir/) (Registration Date: 04/03/2019).

Platelet Levels of Brain-Derived Neurotrophic Factor in Adults with Autism Spectrum Disorder: Is There a Specific Association with Autism Spectrum Psychopathology?

To date, although several studies have investigated the circulating levels of brain-derived neurotrophic factor (BDNF) in children with autism spectrum disorder (ASD), only a few authors have addressed their evaluation in adults. Furthermore, an important limitation of these studies lies in the fact that circulating BDNF is stored in platelets and released into the circulation when needed. To the best of our knowledge, a very limited number of studies have related peripheral BDNF values to platelet counts, and yet no study has evaluated intra-platelet BDNF levels in adults with ASD. In this framework, the aim of the present work is to pave the way in this field and evaluate platelet BNDF levels in adult ASD patients, as well as their correlation with autistic symptoms and related psychopathological dimensions. We recruited 22 ASD and 22 healthy controls, evaluated with the Adult autism subthreshold spectrum (AdAS Spectrum), the Social Anxiety Spectrum-self report (SHY-SR), the Trauma and loss spectrum-self report (TALS-SR), the Work and Social Adjustment Scale (WSAS), and the Mood Spectrum-self report for suicidality. Intra-platelet BDNF levels were also assessed. The results highlighted lower BDNF levels in the ASD group; moreover, AdAS Spectrum and WSAS total score as well as AdAS Spectrum Restricted interest and rumination, WSAS Private leisure activities, TALS-SR Arousal, and SHY-SR Childhood domains were significant negative predictors of platelet BDNF levels.

Minding mentalizing - convergent validity of the Mentalization Breakdown Interview.

Mentalizing difficulties are central to borderline personality disorder (BPD), have severe consequences, and are an explicit focus in mentalization-based treatment. The significance of mentalizing capacity as a predictor or mediator of change is however still uncertain due to a scarcity of research. The Mentalization Breakdown Interview (MBI) was developed as a time saving tool for studying psychotherapy processes and outcome in borderline pathology. This study aimed to investigate the convergent validity of reflective functioning (RF) ratings based on the MBI (MBI-RF) by a comparison with the gold standard, i.e., RF assessments based on the Adult Attachment Interview (AAI-RF). A secondary aim was to investigate how MBI-RF relates to core symptoms of BPD, levels of functional impairment and symptom distress compared with AAI-RF. Forty-five patients with BPD or significant BPD traits were included. MBI-RF and AAI-RF were rated using the Reflective Functioning Scale. Levels of MBI-RF and AAI-RF and the correlation between the measures were calculated, as well as their associations with the Difficulties in Emotion Regulation Scale, Levels of Personality Functioning-Brief Form 2.0, Work and Social Adjustment Scale, Patient Health Questionnaire, Depression, Generalized Anxiety Disorder-7, self-harm, suicide attempts, and PD diagnostics. The correlation between MBI-RF and AAI-RF was 0.79 (p<0.01), indicating high convergent validity. There were few significant associations between MBI-RF and AAI-RF and clinical measures. The study provides support for the convergent validity of the MBI as a BPD-focused RF assessment method. The MBI has the potential as a time saving, reliable and valid method to be applied in treatment research on patients with borderline pathology. The results indicate that measures of MBI-RF and AAI-RF are different from clinical symptoms. ClinicalTrials.gov ID NCT04157907.

Clinical effectiveness and cost-effectiveness of Structured Psychological Support for people with probable personality disorder in mental health services in England: study protocol for a randomised controlled trial

IntroductionEvidence-based psychological treatments for people with personality disorder usually involve attending group-based sessions over many months. Low-intensity psychological interventions of less than 6 months duration have been developed, but their...

INFLUENCE OF DURATION OF UNTREATED PSYCHOSIS ON THE SHORT-TERM OUTCOME IN FIRST-EPISODE SCHIZOPHRENIA

Objectives: Schizophrenia is a devastating disease and many patients present late for treatment due to difficulty in identifying symptoms by family members. The objective of this study is to find if there is an association between a longer duration of untreated psychosis (DUP) and poor treatment outcome in first-episode Schizophrenics and to find if there is an association between premorbid social adjustment on DUP. Methods: Anti-psychotic-naïve patients with an international classification of diseases-10 schizophrenia were evaluated 12 weeks after their first in-patient hospitalization. Association between untreated initial psychosis duration (measured from the beginning of first symptom as well as from first hospital admission) was examined by conducting the clinical interview, symptom severity by positive and negative syndrome scale, and clinical global impression scale, pre-morbid social adjustment by premorbid social adjustment (PSA) scale; and symptoms improvement after treatment by CGI-I scale. Results: Of the 57 patients studied, 57.9% showed improvement after treatment, paranoid type was more common, patients responded better when treated with combined typical and atypical antipsychotics and improvement was better when DUP was &lt;2 years. There was a major negative correlation between positive syndrome scores and DUP. There was no association of DUP with negative syndrome score, psychopathology score and PSA score. Conclusion: DUP was an independent predictor of treatment outcome and early intervention is necessary for better prognosis.

Perspective taking as a transdiagnostic risk factor for interpersonal dysfunction

ObjectiveNumerous psychiatric populations have demonstrated reduced tendency to adopt others’ perspectives relative to those without psychiatric illness; yet, the clinical implications of these deficits remain unclear. We examined whether impairments in perspective-taking are prospectively associated with symptom severity and functional outcomes in an acute psychiatric sample. We hypothesized that poorer perspective-taking would prospectively predict more severe depressive symptoms, functional impairment, and relationship problems. MethodParticipants were 421 adults seeking psychiatric treatment at a partial hospital program. Participants completed the following self-report questionnaires at admission and discharge: Interpersonal Reactivity Index, Patient Health Questionnaire, Work and Social Adjustment Scale, and Behavior and Symptom Identification Scale. We conducted cross-lagged panel models to estimate directional effects. ResultsConsistent with hypotheses, more frequent perspective-taking was significantly and prospectively associated with less overall functional impairment (β = −0.08, p = 0.04) and fewer relationship problems (β = −0.11, p = 0.02). When modelled together, perspective-taking remained a significant and bidirectional predictor of relationship problems, but not overall functional impairment. Inconsistent with hypotheses, perspective-taking did not prospectively predict depressive symptoms. ConclusionsResults suggest that perspective-taking deficits are uniquely associated with relationship problems among adults with severe mental illness and highlight a potential target for future intervention.

Emotion Regulation and Mentalization in Patients With Depression and Anxiety

ABSTRACTObjectiveTheoretical conceptualizations of emotion and affect regulation have a considerable common ground. However, mentalization theory considers the ability to regulate affects as being contingent on the ability to mentalize. The aim of the present study is to examine the association between emotion regulation and mentalization, operationalized as reflective functioning, in a sample of patients with depression and/or anxiety.MethodsThe study used data from the TRAns‐diagnostic Cognitive behavioural Therapy versus standard cognitive behavioural therapy (TRACT‐RCT) trial. Patients with depression and/or anxiety (N = 291; 64.4% female; Mage = 32.2; SD = 11.0) completed the Emotion Regulation Strategies Questionnaire (ERSQ) and the Reflective Functioning Questionnaire (RFQ‐6). Correlation and regression analyses were performed to determine associations of the measures of ERSQ and RFQ‐6 in relation to the outcome variables, global well‐being (World Health Organization Well‐being Index; WHO‐5) and social functioning (Work and Social Adjustment Scale; WSAS).ResultsOverall, the patients had a reduced level of emotion regulation (MERSQ_Total = 1.77; SD = 0.59). However, only mildly impaired reflective functioning was found (MRFQ‐6 = 3.57; SD = 1.26). ERSQ correlated significantly with RFQ‐6 (r = −0.31), that is, more frequent use of emotion regulation strategies was associated with less hypomentalization. ERSQ was a stronger predictor of well‐being and social function than RFQ‐6.ConclusionIn patients with anxiety and/or depression, hypomentalization as measured by the RFQ‐6 is not a major problem, but emotion regulation is. It seems that these two, theoretically related constructs, do not necessarily co‐occur. Alternatively, the RFQ‐6 scale might not capture the mentalization construct in a valid way. Emotion regulation strategies are highly related to symptomatology; therefore, they are likely to be an important target for psychotherapy.

A pilot randomised controlled trial of acceptance and commitment therapy for medication decision-making and quality of life in women with breast cancer: The ACTION trial.

Non-adherence to adjuvant endocrine therapy (AET) in women with breast cancer is common and associated with medication side-effects and distress. We co-designed an Acceptance and Commitment Therapy intervention (ACTION) to enhance medication decision-making and quality of life (QoL). We undertook a pilot trial of ACTION to inform the feasibility of a phase III trial, and to examine intervention acceptability. This was a multi-site, exploratory, two-arm, individually randomised external pilot trial. Women with early breast cancer prescribed AET were randomised (1:1) to receive usual care (UC) or UC+ACTION. The ACTION intervention comprised a remotely delivered one-to-one ACT session followed by three group sessions delivered by clinical psychologists, alongside a website containing ideas for the self-management of side effects. Of the 480 women screened for eligibility, 260 (54.2%) were approached and 79 (30.4%) randomised. 71 (89.9%) women provided data at 3-month and 70 (88.6%) at 6-month 40 women were randomised to receive UC+ACTION and 32 (80.0%) completed the intervention. Most (75.0%) accessed the website at least once. ACTION was acceptable to participants (Borkovec & Nau Scale: mean=7.8 [SD=2.7] out of 10). Signals of effectiveness in favour of the UC+ACTION arm were observed for medication adherence (Adherence Starts with Knowledge questionnaire-12), QoL (work and social adjustment scale), health-related QoL (functional assessment of cancer therapy[FACT] general and FACT-ES-19/23), distress (generalised anxiety disorder -7, patient health questionnaire-9) and psychological flexibility (valuing questionnaire). The ACTION intervention was acceptable to patients. There were promising signals for effectiveness on primary and secondary outcomes. A phase III randomised controlled trial is feasible. ISRCTN12027752.

Assessing functional impairment in university students: psychometric study of the Portuguese Work and Social Adjustment Scale in a help-seeking sample

Background: It has been advocated that higher education settings should promote a supporting environment devoted to improving several dimensions of well-being of their communities. Particularly in clinical services, the assessment of functional impairment is of outmost importance. Goals: The present study aimed at analysing factor structure and psychometric properties of the Work and Social Adjustment Scale (WSAS), a 5-item scale developed to assess the patients’ perceived functional impairment resulting from a health problem in five dimensions: work, social leisure activities, private leisure activities, and relationships with others. Methods: A sample of 207 university students that sought mental health support (22 years old of mean age; majority female and undergraduate) answered a set of self-report questionnaires including the WSAS and measures of anxiety, depression and quality of life. Results: Confirmatory factor analysis indicated an adequate fit to the single-factor structure, and the scale presented very good reliability. Concurrent, convergent and incremental validity were also found, and the WSAS differentiated groups with different levels of anxiety and depressive symptoms. Discussion: Overall, our results corroborate that WSAS is a brief, reliable and valid measure, useful in research and clinical settings. Further research is needed particularly regarding temporal stability, discriminative power between clinical and nonclinical populations, and within clinical samples between different diagnosis.

Schema therapy versus treatment as usual for outpatients with difficult-to-treat depression: study protocol for a parallel group randomized clinical trial (DEPRE-ST)

BackgroundAbout one third of patients with depression are in a condition that can be termed as “difficult-to-treat”. Some evidence suggests that difficult-to-treat depression is associated with a higher frequency of childhood trauma and comorbid personality disorders or accentuated features. However, the condition is understudied, and the effects of psychotherapy for difficult-to-treat depression are currently uncertain. The aim of this trial is to investigate the beneficial and harmful effects of 30 sessions of individual schema therapy versus treatment as usual for difficult-to-treat depression in the Danish secondary, public mental health sector.MethodsIn this randomized, multi-centre, parallel-group, superiority clinical trial, 129 outpatients with difficult-to-treat depression will be randomized (1:1) to 30 sessions of individual schema therapy or treatment as usual; in this context mainly group-based, short-term cognitive behaviour or psychodynamic therapy. The primary outcome is the change from baseline in depressive symptoms 12 months after randomization, measured on the observer-rated 6-item Hamilton Rating Scale for Depression. The secondary outcomes are health-related quality of life assessed with the European Quality of Life 5 Dimensions 5 Level Version, functional impairment assessed with the Work and Social Adjustment Scale, psychological wellbeing assessed with the WHO-5 Well-being Index, and negative effects of treatment assessed with the Negative Effects Questionnaire. Exploratory outcomes are improvement on patient self-defined outcomes, personal recovery, anxiety symptoms, anger reactions, metacognitive beliefs about anger, and perseverative negative thinking. Outcomes will be assessed at 6, 12, and 24 months after randomization; the 12-month time-point being the primary time-point of interest. Outcome assessors performing the depression-rating, data managers, statisticians, the data safety and monitoring committee, and conclusion makers for the outcome article will be blinded to treatment allocation and results. To assess cost-effectiveness of the intervention, a health economic analysis will be performed.DiscussionThis trial will provide evidence on the beneficial and harmful effects, as well as the cost-effectiveness of schema therapy versus treatment as usual for outpatients with difficult-to-treat depression. The results can potentially improve treatment for a large and understudied patient group.Trial registrationClinicalTrials.gov NCT05833087. Registered on 15th April 2023 (approved without prompts for revision on 27th April 2023).

A web-based survey on the occurrence of emotional blunting in patients with major depressive disorder in Japan: Patient perceptions and attitudes.

To determine the prevalence and impact of emotional blunting (EB) in patients with major depressive disorder (MDD) in Japan, and identify treatment needs for EB using patients' perceptions and attitudes. Eligible patients in Japan (aged 18-59 years) who reported a diagnosis of MDD and antidepressant medication use for >3 months were eligible to complete an online survey. The primary outcome was the prevalence of EB, self-reported using a validated screening question. Secondary outcomes included the correlation between EB symptoms (measured by the Oxford Depression Questionnaire [ODQ]) and scores on the Patient Health Questionnaire 9-item (PHQ-9), Generalized Anxiety Disorder 7-item (GAD-7), Work and Social Adjustment Scale (WSAS), and the EuroQol 5-Dimension 5-Levels questionnaire (EQ-5D-5L). Descriptive questions were used to explore patients' perceptions and attitudes toward EB. In total, 3376 patients were included in the analysis (56% male; 48% aged 50-59 years). Overall, 67.1% of patients self-reported symptoms of EB, with 10% rating these as severe. The mean (SD) ODQ total score was 78.2 (21.5), which increased with worsening EB symptoms. There were correlations between ODQ total scores and the PHQ-9, GAD-7, WSAS, and EQ-5D-5L scores (correlation coefficients: 0.67, 0.55, 0.56, -0.51, respectively; all p < 0.0001). Descriptive analyses showed that one-third of patients reporting EB symptoms did not tell their physician, with two-thirds finding these symptoms distressing and likely to affect recovery. EB is an important clinical issue in Japan that needs to be considered alongside functional recovery when managing treatment of patients with MDD.

The association between trajectory of change in social functioning and psychological treatment outcome in university students: a growth mixture model analysis

IntroductionAttendance at university can result in social support network disruption. This can have a negative impact on the mental health of young people. Demand for mental health support continues to increase in universities, making identification of factors associated with poorer outcomes a priority. Although social functioning has a bi-directional relationship with mental health, its association with effectiveness of psychological treatments has yet to be explored.ObjectivesTo explore whether students showing different trajectories of change in social function over the course of treatment differed in eventual treatment outcome.Methods Growth mixture models were estimated on a sample of 5221 students treated in routine mental health services. Different trajectories of change in self-rated impairment in social leisure activities and close relationships (Work and Social Adjustment Scale (WSAS) items 3 and 5) during the course of treatment were identified. Associations between trajectory classes and treatment outcomes were explored through multinomial regression.Results Five trajectory classes were identified for social leisure activity impairment (Figure 1), and three classes were identified for close relationship impairment (Figure 2). For both measures the majority of students remained mildly impaired (Class 1). Other trajectories included severe impairment with limited improvement (Class 2), severe impairment with delayed improvement (Class 3), and, in social leisure activities only, rapid improvement (Class 4), and deterioration (Class 5). There was an association between trajectories of improvement in social functioning over time and positive treatment outcomes. Trajectories of worsening or stable severe impairment were associated with negative treatment outcomes.Image:Image 2:ConclusionsChanges in social functioning impairment are associated with psychological treatment outcomes in students, suggesting that these changes may be associated with treatment effectiveness or recovery experiences. Future research should look to establish whether a causal link exists to understand if additional benefit for students can be gained through integrating social support within psychological treatment.Disclosure of InterestNone Declared