Stress Reduction Intervention Research Articles

Abstract PO5-11-09: Participants’ experience with an online mindfulness-based stress reduction intervention for anxiety management in breast cancer survivors: A secondary analysis of a randomized trial

Abstract Background Breast cancer (BC) diagnosis and treatment can lead to multiple symptoms with a negative impact on the quality of life of survivors. Mindfulness-based stress reduction (MBSR) interventions have shown to improve anxiety, depression, and stress in patients with cancer across multiple settings. However, the effectiveness of an online MBSR program has not been studied. Methods This is an explanatory qualitative sub-study of a randomized trial of an online MBSR intervention versus a waitlist control. Participants were Mexican women aged ≥18 years diagnosed with stage 0-III BC 1-5 years prior to inclusion, not currently undergoing chemotherapy or radiotherapy, with moderate to severe anxiety (baseline GAD-7 score ≥10). The intervention consisted of 8 weekly 2-hour Zoom sessions with body scan meditation and yoga practice led by a certified instructor. Participants received a digital manual with exercises, audio for guided practice, and a video of postures for balance and flexibility. The primary outcome of the trial was anxiety at 2, 5, and 8 months after the intervention. Two focus groups were conducted via Zoom; 21 participants from the intervention arm were selected and invited according to the difference in GAD-7 scores between baseline and 8 months. The first group consisted of 7 participants (median age 53 years, range 39-62) with a decrease in GAD-7 score of ≥4 points (mean -9.1, SD 3.7); the second group consisted of 7 participants (median age 54 years, range 44-64) with a decrease of < 4 points or an increase in GAD-7 score (mean -1.2, SD 1.9). Each focus group was conducted 14 and 9 months after the MBSR intervention, respectively, and had a duration of 110 and 113 minutes, respectively. Audio and video were recorded and transcribed verbatim. Transcripts were analyzed and themes were developed, focusing on participants’ experience with the online intervention and its perceived benefits. Results The weekly sessions and at-home practice functioned as a “personal haven” for participants. At-home deliberate practice and the additional audio and video materials were considered essential for the effectiveness of the intervention. Participants no longer needed to consciously follow step-by-step directions, as the practices had become a part of who they were, even several months after the intervention. Breathing exercises were frequently used by participants on a day- to-day basis. Regarding the mindfulness practice itself, some participants indicated that they noticed positive changes in their character and demeanor, and in their reactions to everyday and BC-related stressors, including situations such as medical consultations and possible news regarding their treatment. In that sense, they mentioned that all they learned is useful for their life in general, and not exclusive to BC survivors. Despite differences in improvement of anxiety by GAD-7 scores between the focus groups, most participants in both groups referred to the intervention as “life-changing”. Most participants in both groups perceived the online format of the intervention as positive: it allowed them to join in from any location and fit the program into their daily routine with less time commitment. Likewise, the privacy of their homes made them feel more comfortable expressing themselves during the weekly sessions. A high level of recognition, appreciation and gratitude towards the instructor was observed. Some participants noted that contact with the instructor and other participants was limited due to the online format, preventing them from forming friendships or a sense of community. Conclusion BC survivors’ opinion of an online MBSR program was largely positive regarding the benefits of the intervention and its delivery format. Moreover, the intervention was successful at facilitating participants’ adoption of mindfulness practice in their daily lives and at improving other aspects of their lives beyond BC. Citation Format: Haydee Cristina Verduzco-Aguirre, Maura Pompa Mansilla, Misael Salazar-Alejo, Javier Gutierrez Ornelas, Fernanda Mesa-Chavez, Ana Ferrigno Guajardo, Cynthia Villarreal-Garza. Participants’ experience with an online mindfulness-based stress reduction intervention for anxiety management in breast cancer survivors: A secondary analysis of a randomized trial [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-11-09.

Stress and cardiovascular disease: an update.

Psychological stress is generally accepted to be associated with an increased risk of cardiovascular disease (CVD), but results have varied in terms of how stress is measured and the strength of the association. Additionally, the mechanisms and potential causal links have remained speculative despite decades of research. The physiological responses to stress are well characterized, but their contribution to the development and progression of CVD has received little attention in empirical studies. Evidence suggests that physiological responses to stress have a fundamental role in the risk of CVD and that haemodynamic, vascular and immune perturbations triggered by stress are especially implicated. Stress response physiology is regulated by the corticolimbic regions of the brain, which have outputs to the autonomic nervous system. Variation in these regulatory pathways might explain interindividual differences in vulnerability to stress. Dynamic perturbations in autonomic, immune and vascular functions are probably also implicated as CVD risk mechanisms of chronic, recurring and cumulative stressful exposures, but more data are needed from prospective studies and from assessments in real-life situations. Psychological assessment remains insufficiently recognized in clinical care and prevention. Although stress-reduction interventions might mitigate perceived stress levels and potentially reduce cardiovascular risk, more data from randomized trials are needed.

Prenatal perceived stress and urinary cortisol as risk factors for ASD and non-typical developmental outcomes in the MARBLES study

BackgroundFindings for prenatal stress, previously measured through stressful life event surveys items or biomarkers, in association with ASD are inconsistent. We prospectively examined prenatal perceived stress and prenatal urinary cortisol (PUC) in association with ASD and other non-typical developmental (Non-TD) outcomes in the child in a high familial likelihood cohort. MethodsThe Perceived Stress Scale questionnaire was used to measure perceived stress in the longitudinal Markers of Autism Risk in Babies: Learning Early Signs (MARBLES) Study. Cortisol was measured through 24-hr urine collections. At three years of age, an algorithm consisting of scores from the Autism Diagnostic Observation Schedule (ADOS) and Mullen Scales of Early Learning (MSEL) was used to classify children with ASD, Non-TD, or typically developing (TD) outcomes. Relative risk ratios (RRR) with TD as the reference were estimated using multinomial logistic regression. ResultsIncreased perceived stress was associated with Non-TD in trimester 1 (RRR 1.10; 95% CI: 1.00, 1.21) and ASD in trimesters 2 and 3 (RRR 1.08; 95% CI: 1.02, 1.14 and RRR 1.08; 95% CI: 1.03, 1.14, respectively). Results with PUC were non-significant but were in the direction consistent with previous findings suggesting that decreased cortisol levels are associated with higher likelihood of ASD. ConclusionsFindings support the hypothesis that higher perceived stress is associated with increased likelihood of ASD and possibly Non-TD, relative to TD. This suggests that stress reduction interventions during pregnancy could serve as preventative measures that help optimize the child’s long-term health. Larger studies are needed to replicate these findings.

Therapeutic Touch: A Brief Intervention for Stress Reduction in Healthcare Workers

Therapeutic Touch: A Brief Intervention for Stress Reduction in Healthcare Workers

IJCM_343A: Mindful Beginnings: Evaluating the Effects of Mindfulness-Based Stress Reduction on Mental Health and Academic Performance in First-Year Medical Students- A Randomized Controlled Trial

Background: The demanding nature of medical education poses unique challenges to the mental health and academic performance of first-year medical students. The transition into the rigorous medical curriculum, coupled with the high-stakes environment of healthcare, often leads to increased stress levels and potential negative impacts on well-being. Mindfulness-Based Stress Reduction (MBSR) has emerged as a promising intervention to address these challenges. Objective: To evaluate the effect of Mindfulness-Based Stress Reduction on the Mental health and Academic performance of first-year medical students in a teaching medical institute by randomized controlled trial (RCT) Methodology: An RCT was conducted from May 2023 to July 2023, involving first-year medical students in a self-financing medical college. A total of 227 students participated, randomly assigned to either the intervention group, which underwent an eight-week MBSR program incorporating mindfulness meditation and stress reduction techniques, or the control group, receiving conventional medical education without mindfulness training. Data collection for both pre-and post-tests utilized a comprehensive questionnaire-based interview, incorporating validated instruments such as the Perceived Stress Scale (PSS), the Pittsburgh Sleep Quality Index (PSQI), and The Epworth Sleepiness Scale (ESS). The collected data will be analyzed using SPSS version 26. Descriptive and Inferential statistics will be applied to compare outcomes between the intervention and control groups, with statistical significance set at p < 0.05. Results: A total of 227 students participated, with 110 in the control arm and 117 in the intervention arm. Further data analysis is currently in progress and will be presented during the upcoming presentation. Conclusion: Stress is prevalent in medical students and has adverse effects on students mental health. Mindfulness practice has wide-ranging positive effects and would be beneficial as a stress reduction and preventative mental health intervention.

Effectiveness of Virtual Reality-Based Well-Being Interventions for Stress Reduction in Young Adults: Systematic Review.

Adolescents can be especially vulnerable to various stressors as they are still in their formative years and transitioning into adulthood. Hence, it is important for them to have effective stress management strategies. This systematic review investigates current well-being interventions that are aimed at reducing stress among young adults. In particular, interventions using the medium of virtual reality (VR) are explored. This mixed methods systematic review follows the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) guidelines, and papers were gathered from databases such as PsycINFO, PubMed, Science Direct, Web of Science, OpenGrey, and Edutopia. Predetermined criteria and specific keywords were used to search for the papers. Search results were screened and extracted with all article screening or extraction delegated among all authors. Any disagreements after reconciliation were settled by a third author. The quality and risk of bias of included studies were assessed using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) Tool for Quantitative Studies. Studies were analyzed qualitatively. In total, 20 studies were included, and qualitative analysis was performed to evaluate the effectiveness of VR-based interventions in 3 domains: nature, stress, and academics. Studies using VR interventions, overall, promoted a reduction in stress and an increase in well-being. The findings suggest that VR may serve as an accessible and affordable medium of stress reduction for students and young adults. Larger sample sizes, and a greater number of included studies, may be required in future directions.

Abstract P233: Leveraging Community-Engaged Research Methods to Improve Recruitment and Retention of Midlife Black Women in Cardiovascular Research

Introduction: Midlife Black women (ages 45-64) are more likely to die of a cardiovascular disease (CVD)-related cause compared to White women of the same age and less likely to be optimally controlled for upstream chronic conditions like hypertension or dyslipidemia. Black women are also 58% less likely than White women to identify heart disease as their greatest health risk. Recruitment and retention of Black women in research trials has been historically difficult, contributing to the paucity of interventions designed to address the unique sociocultural factors that contribute to the existing health disparities. The Midlife Black Women’s Stress Reduction and Wellness intervention (B-SWELL) was created to lower stress and increase CVD awareness and adoption of healthy lifestyle behaviors to lower CVD risk in midlife Black women. Hypothesis We hypothesized that a theoretically based intervention co-developed with midlife Black women from the community would yield a culturally appropriate and appealing intervention, resulting in high retention, low attrition, and high satisfaction. Methods: Mixed methods and community-engaged methods were used in the preliminary research that supported the B-SWELL feasibility trial. Each step (i.e., conceptualization, development, intervention design and delivery) was viewed through a Black Feminist lens, giving voice to midlife Black women. The B-SWELL materials and content were co-developed with an existing community research advisory board (C-RAB) and midlife Black women from the community to produce a culturally tailored and targeted product that was rated highly by experts. A randomized feasibility study was conducted. Recruitment was led by the C-RAB and other community partners. Satisfaction was measured using a 9-item tool ranging from 1 (strongly disagree) to 5 (strongly agree) and a maximum score of 45. Narrative feedback responses were also obtained. Results: Recruitment (N=52) was completed within 30 days and attrition was low (8%). Four participants withdrew prior to the start of the feasibility trial. The remaining 48 participants completed the trial, and none were lost to follow up. Participant satisfaction ratings were high with a mean of 41. Narrative feedback responses were positive. Participant responses indicated an increase in CVD awareness and motivation to adopt healthier behaviors: “Sisterhood is very important to Black women's health." “Never too late in your life to make changes and better choices.” “I need to be a cheerleader and I need to be checked on as well". Conclusions: Theoretically based interventions that employ community-engaged methods have potential to increase recruitment and retention of midlife Black women in research studies. We recommend integration of community-engaged methods at each level of development and for delivery of interventions targeted to at-risk subpopulations like midlife Black women.

Effectiveness of Mindfulness-Based Stress Reduction (MBSR) Interventions on Mindfulness and Stress Symptoms for Cancer Patients: A Quantitative Assessment

The aim of this article is to provide a quantitative assessment of the correlation between heightened mindfulness and stress reduction among cancer patients and survivors who engaged in Mindfulness-Based Stress Reduction (MBSR) interventions. Utilizing data from eight studies, we conducted quantitative analyses to provide the effectiveness scores of MBSR interventions on mindfulness, assessed using the Mindful Attention Awareness Scale (MAAS), and stress symptoms, evaluated through standardized self-reported questionnaires. The effectiveness scores are standardized as percentages relative to baseline (pre-intervention) levels, which allows for the comparison of two variables: mindfulness and perceived stress, on a common scale, facilitating a regression analysis to generate a correlation trendline. The findings reveal that MBSR interventions yielded an average increase in mindfulness levels of 7.93%, with a standard deviation of 4.97%, while concurrently reducing stress or stress-like symptoms by an average of 22.58%, with a standard deviation of 8.77%. Subsequent linear regression analyses were performed on these effectiveness metrics to establish a correlation trendline, demonstrating a robust negative correlation between mindfulness and stress among cancer patients and survivors. In conclusion, MBSR interventions are effective in enhancing mindfulness and alleviating stress or stress-like symptoms in cancer patients and survivors. This finding suggests a causal relationship between mindfulness and stress reduction, endorsing the integration of MBSR as a complementary therapy for cancer management.

Alleviating Stress in Parkinson's Disease: Symptomatic Treatment, Disease Modification, or Both?

Psychological stress, a state of mental strain caused by mentally or physically threatening situations, plays a significant role in Parkinson's disease (PD). Motor symptoms worsen during acute stress and common non-motor symptoms in PD, such as anxiety and depression, are linked to chronic stress. Although evidence in humans is lacking, animal models of PD suggest that chronic stress can accelerate dopaminergic cell death. This suggests that stress-reducing interventions have not only symptomatic, but perhaps also disease-modifying effects. Our objective was to identify the most promising strategies for stress-reduction in PD and to analyze their potential value for disease-modification. An unstructured literature search was performed, primarily focusing on papers published between 2020-2023. Several large clinical trials have tested the efficacy of aerobic exercise and mindfulness-based interventions on PD symptoms. The evidence is promising, but not definitive yet: some exercise trials found a reduction in stress-related symptoms, whereas others did not or did not report it. In the majority of trials, biological measures of stress and of disease progression are missing. Furthermore, follow-up periods were generally too short to measure disease-modifying effects. Hence, mechanisms underlying the intervention effects remain largely unclear. These effects may consist of attenuating progressive neurodegeneration (measured with MRI-markers of substantia nigra integrity or cortical thickness), or a strengthening of compensatory cerebral mechanisms (measured with functional neuroimaging), or both. Lifestyle interventions are effective for alleviating stress-related symptoms in PD. They hold potential for exerting disease-modifying effects, but new evidence in humans is necessary to fulfill that promise.

Examining the feasibility and acceptability of an online mindfulness-based stress reduction program for frontline child protection social workers in England

ABSTRACT This study explores the feasibility and acceptability of an online mindfulness-based intervention (O-MBI) for stress prevention and reduction among frontline child protection social workers (F-CPSWs) in England. In Phase I, a non-randomized, one-arm feasibility study (N=104) demonstrated post-O-MBI reductions in perceived stress and increased mindfulness. Phase II employed a phenomenological approach using semi-structured interviews (n=7). Participants suggested adjustments to content, delivery, and design, highlighting the need for customization. Despite promising results, the study underscores the importance of tailoring interventions to individual needs and circumstances. Future research should delve into O-MBI effectiveness with a more diverse F-CPSW sample.

The Impact of Outdoor in Nature Mindfulness on the Mental Well-being of Children and Adolescents. A Mental Health and Cross-cultural Approach.

Mindfulness, originating from ancient meditation practices, has garnered substantial scientific interest in recent decades due to its potential to enhance various aspects of well-being. The rise of scientific interest in mindfulness has led to the development of Mindfulness-Based Stress Reduction (MBSR) and other mindfulness-based interventions (MBIs), which have demonstrated positive effects on stress reduction, emotional regulation, and cognitive flexibility. This study aimed to explore the characteristics and applications of mindfulness, investigate its impact on mental health, and assess the potential benefits of combining mindfulness with nature-based interventions in promoting the well-being of children and adolescents. This review draws from existing literature, scholarly articles, and empirical studies related to mindfulness, nature exposure, and their effects on mental health. The results highlight the manifold benefits of mindfulness in different populations, including health professionals, patients, children, adolescents, and the general public. Mindfulness practice has been associated with notable reductions in stress, anxiety, and depression, and has shown positive effects on brain plasticity and cognitive functioning. Furthermore, the integration of mindfulness with exposure to natural environments holds potential for enhanced stress reduction and cognitive restoration. The findings underscore the potential of mindfulness as a cost-effective and accessible intervention to promote mental health across diverse age groups and settings. Further research should explore the specific mechanisms and long-term effects of this integrated approach to optimize its benefits.

Effect of Mindfulness-based Stress Reduction Intervention on Job Stress Among Primary School Teachers in Nigeria

Effect of Mindfulness-based Stress Reduction Intervention on Job Stress Among Primary School Teachers in Nigeria

Exploring the potential of stratum corneum biomarkers for assessing psychological distress in health care workers: An observational pilot study.

The detection of biomarkers of a stress response in the stratum corneum (SC) could be used as objective assessment of early stress symptoms and monitoring of stress reduction interventions in health care workers (HCWs). The aim of this study is to explore SC biomarkers of immune and hormonal response and skin barrier for assessment of psychological distress (PD) in HCWs. Twenty-five female HCWs and 25 non-HCWs participated. SC samples were collected using adhesive tapes at baseline and 3-5 days later (T1). We analyzed 24 biomarkers (immunological, vascular, hormones, and natural moisturizing factors). Stress symptoms were assessed using three scales of Copenhagen Psychosocial Questionnaire. The study involved: identifying SC biomarkers, correlating stress symptoms and biomarkers at baseline and T1, examining stress symptoms between the groups with a Mann-Whitney test, comparing stress symptoms and biomarkers between groups using Ordinary Least Regression and investigating temporal variability of SC biomarkers at baseline and T1 using a Wilcoxon-signed rank. Fourteen SC biomarkers were identified. We found correlations between general stress and "IL18" (r = 0.55) physical stress and "IL1b" (r = 0.36) and cognitive stress and "MIP3a" (r = 0.38) at baseline and general stress and cortisol (r = -0.49), physical stress and cortisol (r = -0.60) and cortisone (r = -0.67) at T1. We found no differences in stress symptoms and biomarkers between the groups, except for "MIP3a" at baseline. Differences in the biomarker levels between two time points were found for "TARC," "VEGFA," "ILRA," "IL1RA/IL1a," "NMF," and "DHEA." The SC can be suitable biological material to assess biomarkers related to immune response, hormonal response, and skin barrier function. The SC biomarkers, showed strong, moderate and weak correlations with stress symptoms. Notably, these associations include cytokines of innate immunity and well-known stress hormones, cortisol and cortisone.

269 Stress-reducing interventions in pregnancy for prevention of preterm birth: a systematic review and meta-analysis.

269 Stress-reducing interventions in pregnancy for prevention of preterm birth: a systematic review and meta-analysis.

Affiliate Stigma and Parental Stress Among Parents of Children With Autism Spectrum Disorder: The Mediating Role of Shame

Parental stress among parents of children with autism spectrum disorder (ASD) is well-documented in the literature. This study used the mediation model to investigate the relationship between the phenomenon of affiliate stigma and parental stress among parents of children diagnosed with ASD. This cross-sectional study involved 196 parents between 22 and 65 years of age with a child diagnosed with ASD whose age was between 2 and 22 years. The correlations between affiliate stigma, shame, and parental stress were confirmed. Therefore, affiliate stigma was positively associated with shame and parental stress. The results also indicated that the relationship between the phenomenon of affiliate stigma and parental stress is mediated by shame. A practical implication of our findings is that parents of children with ASD participating in stress-reducing interventions should be trained on how to cope with feelings of shame.

Evaluation of a Modified Mindfulness-Based Stress Reduction Intervention for Adults with Cerebral Palsy and Anxiety and/or Emotion Regulation Difficulties-A Randomised Control Trial.

Mindfulness-Based Stress Reduction (MBSR) has not yet been evaluated for people with cerebral palsy (CP). The aims of this randomised control trial were to investigate whether a modified telehealth MBSR program could improve mindfulness and reduce depression, anxiety, and emotion regulation difficulties among adults with CP with elevated anxiety and/or emotional regulation difficulties. Participants (n = 31) with elevated anxiety and/or emotion regulation difficulties and no/mild intellectual impairment were randomised to a modified telehealth MBSR program (90 min weekly, 9 weeks) group or a wait-list group. Measurements were collected prior to (T1), after (T2), and 8 weeks post-intervention (T3). The primary outcome was the mean between-group difference in the change in Cognitive and Affective Mindfulness Scale-R (CAMS-R) scores in T1-T2. The secondary outcomes included mean within-group differences over time for the CAMS-R total scores, Depression Anxiety and Stress Scale-21 subscales, and Difficulties in Emotion Regulation Scale (DERS) total t-score. We found no statistically significant between-group difference in mean change in mindfulness scores for T1-T2 (primary outcome). Secondary outcomes: The MBSR intervention group had improved CAMS-R scores with respect to T1-T2 and T1-T3; improved mean scores for Depression and Stress subscales for T1-T2; and improved DERS t-scores for T1-T2 and T1-T3. In conclusion, this study found no significant between-group difference for the primary outcome of mindfulness. The MBSR program was successfully modified for adults with CP and was effective in improving depression, stress, and emotion regulation. ACTRN12621000960853.

Efficacy and Implementation of Stress-Reduction Interventions for Underserved Families of Autistic Preschoolers Across In-Person and Virtual Modalities

Abstract Objectives Parents of autistic children experience elevated stress relative to parents of children with neurotypical development and children with other intellectual and developmental disabilities. Adverse effects of parenting stress on parent, child, and family functioning may be especially heightened for marginalized families. We conducted a randomized controlled trial that demonstrated the efficacy of Mindfulness-Based Stress Reduction (MBSR) relative to psychoeducational support (PE) for reducing stress in diverse and underserved parents of autistic preschoolers. This paper presents implementation data, and examines efficacy across in-person and virtual intervention modalities. Method Primary caregivers (n = 117; 91% female, 51% Latinx, 44% income < US $50,000) of 3- to 5-year-old autistic children (80% male, 68% with intellectual disability) were randomly assigned to MBSR (n = 59, 46% virtual) or PE (n = 58, 41% virtual). Assessments were conducted at baseline, immediately post-intervention, and at 6 and 12 months post-intervention. Results Both MBSR and PE demonstrated strong feasibility, acceptability, and utility for our diverse families. Comparable efficacy was observed across modalities. However, attendance was significantly better for virtual groups than for in-person groups. Parents participating in virtual MBSR also reported less difficulty completing homework and utilizing learned skills in everyday life than did in-person MBSR participants. Conclusions MBSR and PE appear feasible, acceptable, and efficacious for diverse and underserved parents of young autistic children. Preliminary evidence of comparable efficacy across virtual and in-person modalities indicates the potential to expand access to vital stress-reduction interventions through use of telehealth technology. Preregistration ClinicalTrials.gov Identifier: NCT03459625.

Association Between Mental Health Burden, Clinical Presentation, and Outcomes in Individuals With Symptomatic Peripheral Artery Disease: A Scientific Statement From the American Heart Association.

Along with the rising burden of peripheral artery disease (PAD), mental health concerns are increasingly being recognized as a comorbidity to address in the chronic disease management of symptomatic PAD. Apart from a high prevalence of comorbid mental health conditions, the role of pain and changing health behaviors and the broader impacts of illness and adaptation to living with PAD require specialized behavioral health expertise. This scientific statement builds a case that this expertise should be integrated within the multidisciplinary PAD team. Furthermore, areas such as cognitive dysfunction and palliative care are highlighted as needing psychological interventions. Although much of the evidence of the efficacy of psychological and psychotropic interventions has been extrapolated from other cardiovascular populations, evidence for the role of psychological interventions for behavior change, for example, uptake of exercise regimens, is increasingly being accrued within PAD. Areas for behavioral health needs and interactions with PAD treatment are discussed, including the use of opioids, depression management, anxiety and stress reduction interventions, the use of benzodiazepines and antidepressants, smoking cessation, rehabilitation trajectories after amputation, and the role of cognitive decline for PAD treatment and outcomes. A case summary highlights the stigma around mental health and vascular disease and the fragmentation of care. This scientific statement provides remarks for building a road map for integrated behavioral PAD care and potential solutions to overcome these barriers. Instrumental to reaching these changes are interprofessional advocacy efforts and initiatives that help break down the stigma around mental health and promote evidence-based collaborative, nonhierarchical, and multidisciplinary PAD care.

Impact of Psychological Distress on Physiological Indicators of Healing Prognosis in Patients with Chronic Diabetic Foot Ulcers: A Longitudinal Study.

Objective: Diabetic foot ulcers (DFUs) are devastating complications of diabetes, responsible for a high number of amputations worldwide. Due to its impact on chronic inflammation, psychological distress may negatively impact the healing process. Thus, this study evaluated the influence of psychological distress on physiological indicators of healing prognosis and the potential of stress-reducing therapies for DFU healing. Approach: Patients with chronic DFU were recruited and assessed at enrollment and two months later. According to psychological scores at enrollment, participants were allocated into groups without (group 1) or with (group 3) psychological distress. Participants who reported clinical distress were then randomly allocated into a control (no stress-reducing intervention - group 4) or experimental (with stress-reducing interventions - group 5) group. Subsequently, indicators of healing prognosis were measured. Results: Groups 1 and 3 presented no differences in the Perfusion, Extent, Depth, Infection and Sensation (PEDIS) score, glycated hemoglobin (HbA1c) or inflammatory and angiogenic markers. However, the immune cell ratio was increased by more than 2-fold in group 3, compared to group 1. Importantly, the expression of circulating microRNAs was significantly increased in group 3 [miR-21-5p, miR-155-5p, miR-146a-5p, and miR-221-3p (p<0.05)], compared to group 1. Two months later, group 5 displayed a significant improvement in the Perceived Stress Scale (PSS) and Hospital Anxiety and Depression Scale (HADS) scores (p<0.01), and the immune cell ratio was decreased by more than 2.5-fold. Innovation: This study helped to identify which variables and psychological interventions are more successful in promoting DFU healing. Conclusion: Psychological distress influenced clinical and physiological parameters, leading to compromised DFU healing and consequently underlining the potential of adjuvant stress-reducing approaches.

Interventions to reduce stress and prevent burnout in healthcare professionals supported by digital applications: a scoping review.

Healthcare professionals are at increased risk of burnout, primarily due to workplace-related stressors. The COVID-19 pandemic has further increased this risk. Different interventions exist with varying degrees of effectiveness; little is reported on the content and implementation of such programs. This review fills this gap, with attention to recent programs using digital components. PubMed, Embase, PsycInfo, and Google Scholar were searched between January 24th and 28th, 2022, limited to the last 5 years (≥2017). Articles were included if they (1) focused on stress reduction or burnout prevention for nurses and medical doctors within workplace health promotion for nurses or medical doctors, (2) included a digital program component, (3) were conducted in high-income country contexts, and (4) were clinical studies published in English or German. Data was extracted using a priori designed spreadsheets. A group of at least 2 authors at each stage carried out the screening, selection, and data extraction. The search strategy identified 153 articles, all except 7 were excluded. Two studies were conducted in the USA, two in Spain, one in the Netherlands, Poland, and Korea each. Four studies used a randomized study design, all but one had a control group. A wide range of outcome measures was used. The types of interventions included an adapted mindfulness-based stress reduction program combined with aspects of behavioral therapies, cognitive behavioral therapy, or acceptance and commitment therapy. The digital components used were apps (4 studies), a digital platform, blended learning, and a web-based intervention (1 study each). Six studies focused on individual interventions, one included organizational interventions. Despite an acute burnout crisis in the healthcare sector, only seven recent interventions were found that integrated digital components. Several problems emerged during the implementation of the interventions that made it clear that organizational support is urgently needed for successful implementation. Although interventions for stress reduction and burnout prevention should combine individual and organizational measures to be as successful as possible, this was only partially the case in one of the intervention programs. The results of this scoping review can be used to further develop or optimize stress and burnout prevention programs.