BioPsychoSocial Medicine最新文献

Background: Primary prevention of depressive symptoms among independent older adults is a critical public health challenge. Lifestyle factors and social support networks are increasingly recognized as pivotal determinants of mental health in this population. However, few longitudinal studies have examined these relationships, and little attention has been directed to gender-based differences. We investigated the associations between lifestyle factors and social support networks and the depressive symptoms of community-dwelling independent older adults in a sex-stratified 3-year longitudinal study.

Methods: This study used data from the Japan Gerontological Evaluation Study. Participants were functionally independent individuals aged 65 years and older. Our final analysis included data for 6,929 individuals collected between 2019 and 2022. A logistic regression analysis was conducted with depressive symptoms in 2022 as the dependent variable. Lifestyle factors and social support networks were treated as independent variables, with age, chronic diseases, and household income included as covariates. The effects of interactions between lifestyle factors and social support networks on depressive symptoms were also analyzed.

Results: The prevalence of depressive symptoms was 10.7% in men and 11.6% in women in the 3-year follow-up. The incidence rate of newly developed depressive symptoms (per 1,000 person-years) was 35.6 for men and 38.8 for women. Sex-based differences were found in lifestyle and social support network factors associated with depressive symptoms. In men, walking for more than 30 min per day, insomnia, and emotional support were significantly associated with the risk for depressive symptoms. In women, walking for more than 30 min per day, insomnia, and instrumental support were significantly associated with the risk for depressive symptoms. No interaction effects between lifestyle factors and social support networks on depressive symptoms were observed in either men or women.

Conclusion: These findings underscore the importance of preventing depressive symptoms among older adults, particularly through the lens of gender-specific differences in lifestyle factors and social support networks associated with depressive symptoms. This study highlights the potential for developing targeted and effective primary prevention strategies by identifying modifiable determinants of depressive symptoms.

Background: Although seated isometric yoga has been shown to reduce the fatigue and pain of patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), some patients who are for the most part bedridden have difficulty practicing it. Many patients with this disease also suffer from fibromyalgia (FM). We developed a recumbent isometric yoga program for patients who were for the most part bedridden, including patients with comorbid FM. The aim of this study was to investigate the effect of this recumbent isometric yoga intervention with such patients.

Methods: This was a randomized, controlled trial of 48 adult patients (7 male, 41 female, age 20-70 years) with ME/CFS without satisfactory improvement after ≥ 3 months of conventional therapy. They were divided randomly into a yoga group (n = 24) and a control group (n = 24). The yoga group received conventional therapy with recumbent isometric yoga practice for ~ 12 weeks (25-min sessions with a yoga instructor at hospital visits and daily in-home sessions). The control group received conventional therapy alone. The effect of recumbent isometric yoga on the level of functioning was assessed by measuring Performance Status (PS). Fatigue was assessed with self-rated questionnaires, including the Chalder Fatigue Scale (FS) and Profile of Mood States (POMS). Adverse events and benefits were recorded for the yoga group.

Results: After the intervention period, the PS score of the yoga group was significantly lower than that of the control group (P < 0.001), suggesting an improvement in functioning level. The Chalder FS score decreased in both groups, but the decrease was greater in the yoga group than in the control group (P < 0.01). Subgroup analysis showed that the Chalder FS score was reduced significantly only in the yoga group in patients with severe disease (P < 0.001) and those with comorbid FM (P < 0.01), although the PS scores did not differ significantly. In the yoga group, a single practice session with a yoga instructor significantly reduced fatigue and increased vigor in patients with severe disease and patients with comorbid FM. Patients reported no serious adverse effects and many benefits of recumbent isometric yoga, including improvements in physical symptoms and brain fog, enhanced awareness of their limits to activities that cause post-exertional malaise, and promotion of behavioral changes to live better within their limits.

Conclusions: Recumbent isometric yoga is an effective adjunctive therapy for patients with ME/CFS, including those for the most part bedridden and those who have FM.

Trial registration: University Hospital Medical Information Network (UMIN CTR) UMIN000023472 (Registered Aug. 4, 2016) and UMIN000030051 (Registered Nov. 20, 2017).

Objective: Screening tools such as the Patient Healthcare Questionnaire (PHQ) and Hospital Anxiety and Depression Scale (HADS) are useful for detecting poststroke depression (PSD). However, validation of these tools has yet to be conducted in the Singapore stroke population.

Method: A total of 138 adults were administered the HADS and both two- and nine-item versions of the PHQ. Receiver operating characteristic (ROC) analyses were utilized to validate these scales against the gold standard diagnosis of PSD through the Structured Clinical Interview for DSM-IV (SCID-IV).

Results: All the tools examined in this study had good convergent validity (rs = 0.55-0.89) and discriminative power (Area Under Curve: 0.849-0.887). The optimal cut-off scores were ≥ 7 for the HADS depression and anxiety subscales, ≥ 10 for the total score, ≥ 2 for the PHQ-2 and ≥ 8 for the PHQ-9. Additional analyses suggest that the use of both the PHQ and the HADS in specific combinations further improved diagnostic performance.

Conclusion: Both the PHQ and the HADS are acceptable tools for screening for poststroke depression in Singaporean inpatient rehabilitation care settings. Furthermore, our findings lead us to recommend using PHQ-9 with HADS-A for superior screening performance at sensitivity = 83.33%, specificity = 88.33%, positive predictive value = 51.72%, and negative predictive value = 97.25%.

Background: In Japan, approximately 20% of young women are underweight, a rate higher than that of other developed countries. For women, being underweight at a young age has been associated with amenorrhea, eating disorders, osteoporosis, and adverse pregnancy outcomes. We investigated young women's knowledge of these risks and associated factors.

Methods: A web-based survey was conducted among 984 Japanese women aged 18-29 years. The survey included questions about actual body weight, perceived healthy weight, body image, eating disorder tendency, knowledge of various risks and factors associated with being underweight, and sources of this knowledge. Participants were divided into underweight (< 18.5 kg/m²), normal weight (18.5-25 kg/m²), and obese (≥ 25 kg/m²) groups based on their body mass index (BMI). The body image and knowledge of health risks associated with being underweight were compared across the three groups and with women with and without an eating disorder tendency.

Results: Among the participants, 31.5% were underweight (BMI < 18.5 kg/m²). Of these, 87.4% considered their subjective ideal weight to be underweight, and 66.1% viewed their subjective healthy weight similarly. Underweight women reported greater body satisfaction than did those in other body shape groups. While 73.2% recognized amenorrhea as a risk of being underweight, only approximately half identified infertility, eating disorders, and osteoporosis as risks and associated factors, and few were aware of adverse pregnancy outcomes. Knowledge levels did not differ between underweight and normal-weight women. Conversely, women with a tendency toward an eating disorder were more aware of the risks of osteoporosis (58.6% vs. 49.0%) and eating disorders (66.8% vs. 55.2%) than were women without a tendency toward an eating disorder.

Conclusions: Young Japanese women had insufficient knowledge about the adverse pregnancy outcomes associated with being underweight. Underweight women are not less aware of the health risks and associated factors associated with underweight than normal-weight women. The body shape of young women may not be influenced by their knowledge of health issues associated with being underweight.

Background: Our previous studies demonstrated that the regular practice of recumbent isometric yoga reduced the fatigue of patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Some patients with ME/CFS have postural orthostatic tachycardia syndrome (POTS); however, the effects of recumbent isometric yoga on orthostatic cardiovascular responses and whether recumbent isometric yoga improves POTS remain unknown. This pilot study was done to investigate the effect of recumbent isometric yoga on the orthostatic cardiovascular response of patients with ME/CFS.

Main body: Ten adult female patients with ME/CFS performed recumbent isometric yoga for 12 weeks. Changes in their systolic blood pressure (SBP), diastolic blood pressure (DBP), and the pulse rate (PR) during an active standing test were compared before and after the 12-week regimen. Among the 10 patients, 8 manifested a normal orthostatic response and 2 manifested POTS before the yoga intervention. Patients who manifested a normal orthostatic response before yoga also manifested the normal orthostatic pattern after the yoga intervention. In contrast, the two patients who manifested POTS before the regimen showed a normal orthostatic response after completing the yoga intervention.

Conclusions: This study found that the patients who manifested POTS and performed recumbent isometric yoga for 12 weeks had a reduced increase in PR after standing up. This pilot study suggests that recumbent isometric yoga would be useful as an adjunctive nonpharmacological intervention for improving POTS in patients with ME/CFS. This finding should be confirmed in a larger number of cases.

Background: Obesity is a chronic disease influenced by genetic, cultural, environmental, and psychosocial factors, making it difficult to manage through individual effort alone. Despite this complexity, obesity is often attributed to a lack of willpower and poor control over eating behaviors, contributing to stigma. However, research on this issue remains limited. This study quantified the extent to which multidimensional eating behaviors statistically explained the association between obesity and grit, which shared characteristics with self-control.

Methods: We conducted a cross-sectional study involving Japanese adults across a wide range of age groups. Grit was measured using the 8-item Short Grit Scale. Multidimensional eating behaviors were measured using the Japanese version of the 21-item Three-Factor Eating Questionnaire-R21, including uncontrolled eating, emotional eating, and cognitive restraint. Obesity was defined as a body mass index ≥ 25.0 kg/m². A series of logistic regression models were created to analyze the association between grit and obesity with and without eating behaviors. Mediation analyses using the Karlson-Holm-Breen method were performed.

Results: Of the 1,641 adults, 26.8% had obesity. Higher grit level was associated with a lower likelihood of obesity, less uncontrolled and emotional eating, and higher cognitive restraint. Grit was positively associated with cognitive restraint and negatively associated with uncontrolled and emotional eating; these multidimensional eating behaviors statistically accounted for the association between grit and obesity. Uncontrolled and emotional eating fully accounted for the association, whereas cognitive restraint partially accounted for it. These findings are consistent with the possibility of mediation through eating behavior in the relation between grit and obesity.

Conclusions: Our findings suggest that healthcare providers and policymakers should prioritize addressing multidimensional eating behaviors that explain the link between grit and obesity rather than on grit itself. Identifying and managing impairments in eating behavior rather than attributing obesity to an individual's lack of willpower may help reduce stigma and support effective obesity prevention strategies.

Background: Psychosocial factors are involved in all types of chronic pain but seem to play a more prominent role in non-specific pain, such as chronic musculoskeletal pain (CMP), compared to a specific pain condition, such as osteoarthritis (OA). We explored if diagnose and the pain experience in patients with CMP predicted more problematic interpersonal relationships compared to patients with OA.

Methods: Nineteen patients with CMP and 16 unmatched clinical controls with OA were measured with the Core Conflictual Relationship Theme coding of clinical interviews (CCRT) and the Inventory of Interpersonal Problems (IIP).

Results: Significant differences in age, work status, and pain experience were found between the groups. Controlling for these variables, components of CCRT were significantly more likely to be disharmonious in patients with CMP compared to patients with OA. Patients with CMP also reported more interpersonal distress in general and socially avoidant-nonassertive problems in particular as their pain experience increased. Conversely, scores of dominant-intrusive behaviours increased as their pain experience decreased. These interaction effects between pain experience and interpersonal problems were not seen in patients with OA.

Conclusions: The impact of interpersonal issues may differ depending on type of pain diagnosis. This study show that interpersonal distress seems to play a more prominent role in non-specific chronic pain compared to a specific pain condition. It is possible that patients whose pain-processing system is burdened by interpersonal problems are more prone to non-specific pain, such as CMP. It could also be that primary pain is a greater challenge to interpersonal relationships. Whether interpersonal distress is a precursor or an additional stressor, it may worsen the condition of primary pain with implications for treatments.

Background: Cognitive behavioral therapy for insomnia (CBT-I) has a high potential for improving insomnia and depressive symptoms; however, it is unclear whether the improvement of symptoms reaches the level of healthy people without these symptoms. We aimed to examine whether digital CBT-I can improve the insomnia and depression symptoms of workers to healthy levels.

Methods: The study included 752 workers who were divided into four groups by the use of the cutoff scores of insomnia and depression scales: insomnia alone, depression alone, combined insomnia with depression (COMB), and healthy. All groups were administered digital CBT-I for 2 weeks, and changes were compared post-treatment and at 1- and 3-month follow-ups.

Results: A significant decrease in insomnia symptoms from post-treatment to the 3-month follow-up was found in the insomnia alone (Hedges' g: 1.07-1.52) and COMB groups (g: 1.17-1.41). The COMB group also showed a significant decrease in depressive symptoms (g: 0.38-0.70). Moreover, there were significant differences in insomnia symptoms between both of the insomnia groups and the healthy group and in depressive symptoms between the COMB group and the healthy group, post-treatment and at the 1- and 3-month follow-ups.

Conclusions: Digital CBT-I effectively reduced insomnia and depressive symptoms but did not achieve the levels of healthy people within 3 months.

Trial registration: UMIN, UMIN000050353. Registered 15 February 2023-Retrospectively registered, umin.ac.jp/ctr.

Objective: To study how common are disordered eating behaviors among medical residents in different specialties and how certain preceding factors might contribute to that risk.

Methods: Self-administered questionnaires were administered to residents from each year and specialty using the Eating Attitudes Test-26 (EAT-26) and the Sick, Control, One, Fat, Food (SCOFF) questionnaires. We used binary logistic regression to study the relationship between individuals at high risk and possible triggers of eating disorders.

Results: Among the 399 participants, the risk of disordered eating behavior was 8% using the EAT-26 and 14.3% using SCOFF. There was no difference in the risk according to sex or specialty except for dermatology (p = 0.004). BMI was also among the affecting factors (p < 0.05), in addition to a positive family and personal history of mental disorders (p < 0.001). Recent exposure to stressors, living and marital status did not prove to affect risk.

Conclusion: We found that a percentage of medical residents in different specialties are at greater risk for developing eating disorders and exhibit alarming behaviors related to feeding habits. This risk stems from a number of variables, a few of which were studied in this article. Our results demonstrate a need for better awareness of mental health.

Background: The prolonged COVID-19 pandemic has significantly affected the clinical care and the mental health of patients in psychosomatic medicine. Between late 2021 and early 2022, the Japanese Society of Psychosomatic Medicine (JSPM) and the Japanese Society of Psychosomatic Internal Medicine (JSPIM) conducted a nationwide physician survey to assess these effects. The survey identified difficulties in outpatient and inpatient care, increased use of telemedicine, and rises in patient numbers and symptom severity. Due to inconsistent findings in prior studies on long-term mental health effects of the pandemic, a follow-up survey was needed.

Methods: This study is the one-year follow-up survey conducted by JSPM and JSPIM. A cross-sectional, web-based survey was conducted among physicians of the two societies from December 21, 2022, to February 14, 2023. The questionnaire examined trends in outpatient and inpatient care, telemedicine use, and changes in the mental health of patients with psychosomatic disorders, eating disorders, adjustment disorders, mood disorders, and anxiety disorders. Descriptive statistical analyses were performed.

Results: A total of 251 physicians responded. While outpatient numbers showed partial recovery, 28% of the respondents reported persistent declines compared to pre-pandemic levels. Telemedicine remained in use at 62% of their institutions, but 70% of the respondents reported difficulties in symptom assessment. Compared to the previous year, more respondents reported an increase in the number of patients across all surveyed disorders. Regarding the psychosocial factors that affected patients, fear of infection was the predominant factor for anxiety disorders, as in the previous survey, whereas restrictions on daily and social activities were the most influential for psychosomatic disorders, mood disorders, and adjustment disorders.

Conclusions: The COVID-19 pandemic has had a lasting effect on patients receiving psychosomatic treatment. Outpatient numbers are gradually recovering, and telemedicine has contributed to the continuity of care. However, concerns about patient assessment in telemedicine persist. The impact of the prolonged pandemic on mental health appears to have evolved, with shifts in the psychosocial factors that influence different aspects of mental health deterioration. Future studies that incorporate clinical data will provide valuable insights into the long-term consequences of the pandemic and help guide future clinical practice.