International Journal of Psychiatry in Medicine最新文献

Introduction: Providers working with children who are dying are especially prone to burnout. The enhancement of human flourishing in providers may mitigate burnout and improve quality of care. However, the relationship between job satisfaction and human flourishing has not been well studied. This project explores factors that promote human flourishing among caregivers working with children in pediatric palliative care in South Africa.

Methods: A convenience sample of caregivers working in pediatric palliative care were invited to complete an anonymous, confidential survey . The survey also included open-ended questions to explore opinions and attitudes about job satisfaction, struggles, and coping.

Results: Twenty-nine people from a variety of occupations and work environments completed the survey. The prevalence of burnout was 3/29 (10%). Life satisfaction (an indicator of flourishing) was associated with private religious activities (r = .38, P < .05), and carrying religion into all aspects of life (r = .44, P < .05). Burnout was not associated with life satisfaction, although power was limited. Qualitative analysis of open-ended questions revealed the following themes as factors contributing to satisfaction at work (flourishing): being able to make a difference, finding meaning and purpose, having a relationship with the children and their families, and working within the context of a multi-disciplinary team. A number of challenges to this work were also identified, including lack of resources, problems within the team, and the emotional demands of care.

Conclusions: Despite job stress and the difficult work of caring for terminally ill children, several factors were associated with flourishing. These findings may help to enhance the flourishing of caregivers in the resource-challenged setting of pediatric palliative care in South Africa.

Objective: Elder Mistreatment (EM) occurs in approximately 10% of older adults and is associated with trauma-related outcomes including depression, anxiety, posttraumatic stress disorder, and early mortality. Low screening and older adult self-reporting, especially within emergency departments, represent missed opportunities for identify and mitigate future EM occurrences and consequences. To date, no studies have obtained EM survivors' perspectives on EM screening and response practices in emergency departments.

Methods: Semi-structured interviews with 19 EM survivors of those with Adult Protective Services validated EM were completed in older adults' homes. The Elder Mistreatment Emergency Department Screening and Response Tool (EM-SART) was used to guide the interview questions. All interviews were recorded, transcribed, and analyzed using qualitative thematic analyses.

Results: The participants were mostly female (63%) and white (58%) with an average age of 74 years. Physical abuse accounted for 67% of the EM incidents. Three themes emerged indicating the survivor preference for (1) building rapport and approaching the older adult with compassion and care, (2) setting the context before asking the EM questions, and (3) allowing mutuality, collaborative work, and shared decision-making during the response.

Conclusions: Older adults are agreeable and willing to self-report and actively engage in the EM screening and response practices in the emergency department if trauma-informed care principles are utilized.

Objective: The purpose of this study was to investigate the correlation between lipid accumulation products (LAP) and depression among adults in the United States.

Methods: We analyzed data from 13,051 persons participating in the NHANES 2005-2018 cycle. The LAP index was calculated using the waist circumference (WC) and serum triglyceride (TG) levels, which reflect lipid toxicity. Participants who scored ≥10 on the Patient Health Questionnaire-9 (PHQ-9) were considered depressed. Multivariate logistic regression analyses were conducted to explore the association between the LAP index and depression. Subgroup analysis was also conducted to identify sensitive populations. Smoothed curve fitting and generalized additive model (GAM) regression were performed to verify the association between the LAP index and depression.

Results: After adjusting for all potential confounders, the risk of depression increased with increasing LAP index (odds ratio [OR]=1.0011, 95% confidence interval [CI]= 1.0001-1.0021). Compared to participants in LAP quartile 1, participants in LAP quartile 3 exhibited the highest risk for depression (OR=1.43, 95% CI: 1.03-1.99). Subgroup analysis demonstrated a stronger association between the LAP index and depression in men (OR= 1.002, 95% CI= 1.001-1.004) and in those with hypertension (OR=1.002, 95% CI=1.000-1.003). Additionally, smoothed curve fitting and GAM regression demonstrated a positive linear correlation between the LAP index and depression.

Conclusions: These findings suggest that individuals with a higher LAP index may be at greater risk for depression, particularly among men and those with hypertension. Further studies are required to confirm these findings.

Objective: Both structural (e.g., ageism) and personal (e.g., stigma) barriers hinder older adults' access to and engagement with mental health care. These barriers are particularly problematic for those vulnerable to interpersonal violence and abuse (e.g., due to social isolation). This study presents a quality improvement program aimed at older adults who have experienced significant stressful events, particularly elder mistreatment, within a larger trauma specialty clinic. Leveraging home-based telemedicine, the clinic provides evidence-based psychotherapy tailored to the needs of older adults.

Methods: From 2021 through 2023, the authors retrospectively examined treatment initiation, engagement, completion, and clinical outcomes among 231 older adults age 60+ who reported trauma that met DSM-5 criterion A criteria for post-traumatic stress disorder, depression, or other mental health comorbid conditions related to their traumatic event. The clinic uses an automated measurement-based care approach that facilitates Quality Improvement projects, allowing the tracking of treatment initiation, engagement, completion, and clinical outcomes for all patients.

Results: The results indicated high treatment completion, high engagement with telemedicine-delivered interventions, and, most importantly, significant changes in clinical outcomes.

Conclusion: These findings highlight the importance of expanding telemedicine-based mental health services for older adults, challenging ageist norms, and prioritizing older adults' mental health needs by providing tailored services to this patient population.

Objective: While depression associated with disability has been extensively studied, how depression could differ depending on whether the disability is congenital or acquired remains to be investigated. The objective of this study was to compare depression and related factors among people with congenital and acquired physical disabilities.

Methods: We used the 2016 Panel Survey of Employment for the Disabled in Korea, a population-based survey for people with disability registered with the Korean government. Among 4577 participants, a total of 2128 participants with physical disability were analyzed using chi-square and binary logistic regression analysis.

Results: The prevalence of depression was 12.9% in those with congenital physical disability and 16.0% in those with acquired physical disability. Stress due to disability and family relationship satisfaction were associated with higher and lower odds of depression, respectively, in both disability groups. Discrimination due to disability, divorce, social participation, and subjective social status were significant predictors of depression only in people with acquired disability.

Conclusions: Compared to those with congenital disability, individuals with acquired disability can be more susceptible to issues relating to social relationships, social standing and discrimination. Findings of this study suggest that acquired disability and adapting to changes associated with it can be a source of mental distress in addition to living with it. Efforts are needed to address discrimination, provide supportive social relationships, and provide supportive living conditions in order to reduce depression in persons living with disability, especially those with acquired disability.

Objective: Major depressive disorder (MDD) affects 300 million people globally. Because dysbiosis may alter the central nervous system, it plays a potential role in this disorder. Dysbiosis is characterized by a decrease in microbial diversity and an increase in proinflammatory species. The human gut microbiota refers to the trillions of microbes, such as bacteria, that live in the human gut. The purpose of this study was to compare the gut microbiota of patients with MDD with that of healthy controls.

Methods: This case-control study involved 35 MDD cases and 35 healthy age- and sex-matched controls. Stool samples were collected and subjected to quantitative real-time PCR. Four intestinal bacterial phyla (firmicutes, bacteroidetes, actinobacteria, and proteobacteria) were investigated by 16SrRNA analysis.

Results: The findings indicated a relative abundance of bacteroidetes to firmicutes in the control and case groups was 0.66 vs. 1.33, respectively (p < .05). There were no significant differences in actinobacteria or proteobacteria among those in the MDD group compared to the healthy control group.

Conclusions: Gut microbiota dysbiosis may contribute to the onset of depression, underscoring the importance of understanding the relationship between MDD and gut microbiota. Firmicutes, which produce short-chain fatty acids, are crucial for intestinal health. However, dysbiosis can disrupt the gut microbiota, impacting the central nervous system and contributing to the onset of depression.

Objectives: The psychological effects of the COVID-19 pandemic have been shown to include anxiety. However, the association between demographic and physiological factors in COVID-19-associated anxiety symptoms is poorly understood. Therefore, the present cross-sectional study was conducted to examine anxiety symptoms and associated factors among patients with the SARS-CoV-2 Omicron variant during the quarantine period in Shanghai.

Methods: The study was conducted between April 16, 2022, and May 21, 2022, at Fangcang Shelter Hospital in Shanghai, China. Data were collected using an anonymous online questionnaire. Demographic characteristics, respiratory symptoms, vaccine dose, comorbidities (such as hypertension and diabetes), type of work, and mental health symptoms were evaluated. Logistic regression was used to examine the relationship between anxiety symptoms and risk factors. Stratified analyses were performed to investigate potential interactions.

Results: A total of 2132 patients with confirmed Omicron variant SARS-CoV-2 infection were enrolled. The results demonstrated that female gender (OR = 1.47, 95% CI = 1.11-1.94), nonmanual labor (OR = 1.62, 95% CI = 1.25-2.09), respiratory symptoms (OR = 3.19, 95% CI = 2.30-4.43), and having other comorbidities (OR = 1.65, 95% = 1.09-2.50) were positively associated with anxiety symptoms. A significant interaction was found between gender and (a) nonmanual labor (OR = 1.54, 95% = 1.29-1.85), (b) respiratory symptoms (OR = 2.06, 95% = 1.72- 2.48), and (c) comorbidities (OR = 1.57, 95% = 1.16-2.12), such that the relationship with anxiety symptoms was stronger in women compared to men. There were also significant interactions between age group and (a) nonmanual labor (stronger in those ages >46) and (b) respiratory symptoms (stronger in those ages 36-45) regarding the association with anxiety symptoms.

Conclusions: Alleviation of respiratory symptoms, addressing comorbidities, and implementation of both psychological and psychopharmacological treatments may help reduce anxiety symptoms following infection with the SARS-CoV-2 Omicron variant in mainland China.

Objective: Many antipsychotic drugs have cardiac side effects due to their pharmacological actions. Heart rate variability (HRV) analysis can be used as a potential indicator of cardiotoxicity in cases where a decrease in HRV occurs after the administration of antipsychotics such as clozapine. The purpose of this study was to explore the effects of 6 antipsychotic drug regimens on short-term HRV in patients with schizophrenia.

Methods: Data from 164 patients with schizophrenia between January 2018 and June 2023 were retrospectively analysed. Based on the drug used for treatment, the patients were categorised into clozapine combination (clozapine combined with aripiprazole, risperidone or ziprasidone), clozapine alone, olanzapine, aripiprazole, ziprasidone or risperidone groups. Heart rate variability indices were calculated using time domain analysis, including the standard deviation of the RR intervals (SDNN), the root mean square of successive RR interval differences (RMSSD) and the percentage of successive RR intervals over 50 ms (PNN50).

Results: Compared with the pretreatment period, the SDNN, RMSSD and PNN50 were significantly lower in the clozapine combination, clozapine, olanzapine and aripiprazole groups at the end of weeks 2 and 4 of treatment (P < 0.05). However, these indicators in ziprasidone and risperidone groups did not show this significant decrease (P > 0.05).

Conclusion: The effects of clozapine combination and clozapine on HRV were greater than for olanzapine, aripiprazole, ziprasidone or risperidone. Attention should be paid to controlling the dosage of clozapine combination and clozapine and monitoring the patient's electrocardiogram during administration.

Objective: This study investigates the association between Jewish religious observance and several indicators of mental health and psychological well-being among Jewish Israeli adults.

Method: Data are from adult (18+) Jewish respondents in the Israeli sample (N = 2958) of the first wave of the Global Flourishing Study (GFS), a 22-nation population survey which will eventually consist of five annual waves of panel data. The GFS Israeli data were collected via a randomized, stratified, probability-based sampling design, and contained dozens of indicators of sociodemographic, socioeconomic, political, religious, health-related, and other constructs.

Results: Measures of Jewish religious observance, including religious service attendance, prayer, scripture reading, belief in God, and importance of Judaism, are statistically significant predictors of several single-item indicators of mental health (overall mental health, depression, anxiety) and psychological well-being (suffering, happiness, life satisfaction). Greater religious observance is associated with a higher self-rating of overall mental health, less depression and anxiety, less suffering, and greater happiness and life satisfaction. Nearly all results withstood adjusting for effects of several sociodemographic covariates.

Conclusion: These results offer confirmation of prior studies using smaller samples or non-population-based designs and with fewer mental health and religious indicators. They suggest that evidence for a salutary association between religious observance and mental health or psychological well-being among Israeli Jewish adults is consistent with findings in this literature for adherents to other faith traditions throughout the world.