正念压力管理短训课程改善精神科护理人员职业倦怠的效果

目的:评估正念压力管理短训课程(MBSS)干预精神科护理人员职业倦怠的效果。方法:选取某精神专科医院护士56名,随机分为干预组(n=27)和对照组(n=29),干预组参加2天MBSS集训和1个月的课后自主训练,对照组在研究期间内不做干预。在基线、2天集训后、1个月自主训练后3个访视点对两组进行正念注意觉知量表(MAAS)、通用职业倦怠问卷(MBI)、抑郁-焦虑-压力问卷(DASS)测评。结果:干预组在2天集训后、1个月自主训练后的MAAS得分均高于基线,而MBI总分及各分量表得分、DASS焦虑分量表得分低于基线(均P<0.01)。对照组MAAS得分在3个访视点差异均无.统计学意义(均P>0.05),而MBI、DASS得分在3个访视点有所升高(均P<0.05)。结论:对精神科临床护士实施MBSS课程的定式训练,可以降低职业倦怠和焦虑水平。     

Effects of a mindfulness-based intervention during pregnancy on prenatal stress and mood: results of a pilot study

Summary Stress and negative mood during pregnancy increase risk for poor childbirth outcomes and postnatal mood problems and may interfere with mother–infant attachment and child development. However, relatively little research has focused on the efficacy of psychosocial interventions to reduce stress and negative mood during pregnancy. In this study, we developed and pilot tested an eight-week mindfulness-based intervention directed toward reducing stress and improving mood in pregnancy and early postpartum. We then conducted a small randomized trial (n = 31) comparing women who received the intervention during the last half of their pregnancy to a wait-list control group. Measures of perceived stress, positive and negative affect, depressed and anxious mood, and affect regulation were collected prior to, immediately following, and three months after the intervention (postpartum). Mothers who received the intervention showed significantly reduced anxiety (effect size, 0.89; p < 0.05) and negative affect (effect size, 0.83; p < 0.05) during the third trimester in comparison to those who did not receive the intervention. The brief and nonpharmaceutical nature of this intervention makes it a promising candidate for use during pregnancy. Correspondence: C. Vieten, California Pacific Medical Center Research Institute, Rm. 514, 2200 Webster Street, San Francisco, CA 94115, U.S.A.     

Psychological and quality-of-life outcomes from a comprehensive stress reduction and lifestyle program in patients with coronary artery disease: results of a randomized trial

BACKGROUND: Stress reduction and comprehensive lifestyle modification programs have improved atherosclerosis and cardiac risk factors in earlier trials. Little is known about the impact of such programs on quality-of-life (QoL) and psychological outcomes. Given recent significant improvements in cardiac care, we evaluated the current benefit of stress reduction/lifestyle modification on QoL and emotional distress in patients with coronary artery disease (CAD). METHODS: 101 patients (59.4 +/- 8.6 years, 23 female) with CAD were randomized to a 1-year lifestyle/stress management program (n = 48) or written advice (n = 53). QoL and psychological outcomes were assessed with the SF-36, Beck Depression, Spielberger State/Trait Anxiety, Spielberger State/Trait Anger and Perceived Stress Inventories. Group repeated-measures analyses of variance were performed for all measures. RESULTS: Adherence to the program was excellent (daily relaxation practice 39 +/- 5 vs. 5 +/- 8 min, respectively; p < 0.001). Both groups improved comparably in most dimensions of QoL, and significantly greater improvements for the lifestyle group were found for physical function and physical sum score (p = 0.046 and p = 0.045). Depression, anxiety, anger and perceived stress were reduced similarly in both groups. However, intervention x gender interaction effects revealed greater benefits among women in the lifestyle intervention vs. advice group for depression and anger (p = 0.025 and p = 0.040), but no effects for men. CONCLUSIONS: A comprehensive lifestyle modification and stress management program did not improve psychological outcomes in medically stable CAD patients. The program did appear to confer psychological benefits for women but not men. Further trials should investigate gender-related differences in coronary patient responses to behavioral interventions.     

焦点解决取向团体辅导对血液透析患者负面情绪及医学应对方式的干预效果

目的:探究焦点解决取向团体辅导对血液透析患者焦虑、抑郁情绪和医学应对方式的影响。方法:将60名血液透析患者分为对照组(n=30)和干预组(n=30),对照组接受常规护理,干预组在此基础上接受为期五周的焦点解决取向团体辅导。干预开始前和结束后,分别采用焦虑自评量表、抑郁自评量表、医学应对方式问卷评定被试情绪及医学应对方式。结果:干预后,干预组的抑郁和焦虑水平较同期对照组显著降低。在医学应对方面,干预后,干预组的面对水平较同期对照组显著提升;屈服水平较同期对照组显著下降。结论:焦点解决取向团体辅导能降低血液透析患者的焦虑、抑郁情绪,改善其医学应对方式。     

Postnatal depression and mother and infant outcomes after infant massage

BACKGROUND: Postnatal depression can be a long lasting condition which affects both the mother and her baby. A pilot study indicated that attending baby massage improved maternal depression and mother-infant interactions. The current study further investigates any benefits of baby massage for mothers with postnatal depression and their infants. METHODS: Mothers scoring (3)13 on the Edinburgh Postnatal Depression Scale (EPDS) at 4 weeks postpartum were randomly assigned to attend baby massage classes (n=31) or a support group (n=31). They completed depression, anxiety and Infant Characteristics Questionnaires and were filmed interacting with their infants before and after 6 intervention sessions, and at one year. Thirty four non-depressed mothers also completed the study. RESULTS: More of the massage than support group mothers showed a clinical reduction in EPDS scores between four weeks and outcome (p<0.05). At one year, massage-group mothers had non-depressed levels of sensitivity of interaction with their babies, whereas the support group did not. There were no other differences in either mother or child between the two intervention groups. Depressed mothers did not achieve control depression or anxiety scores at one year. LIMITATIONS: For ethical reasons, the study did not include a control group of depressed mothers who did not receive an intervention. CONCLUSIONS: Both intervention groups showed reductions in depression scores across the study period, but the massage group did better on some indices. They also had somewhat better interactions with their infants at one year, but these effects were limited.     

Preparing patients for total hip replacement: a randomized controlled trial of a preoperative educational intervention

Previous research indicates that giving appropriate information to patients before surgery yields many benefits. This randomized controlled trial evaluated a pre admission and postadmission intervention comprising a video, booklet and plastic models for patients undergoing total hip replacement. Seventy-eight patients participated in the study and were randomized into control and intervention groups. The intervention was implemented one month before surgery. Over the operative period, patients completed questionnaires including the Hospital Anxiety and Depression Scale, Nottingham Health Profile and Stress Arousal Checklist. Results showed no significant differences between control and intervention groups for the Hospital Anxiety and Depression Scale, Nottingham Health Profile and Stress Arousal Checklist. However, patients from the intervention group were more likely to know as much as they wanted to know before admission (p <.001) and felt less confronted by information on arrival for the hospital stay. In an era when patient satisfaction is of paramount importance, this preoperative intervention has applications in many settings.     

Depression and anxiety symptoms of mothers of preterm infants are decreased at 4 months corrected age with Family Nurture Intervention in the NICU

Preterm delivery can precipitate maternal psychological morbidities. Family Nurture Intervention (FNI) was designed to minimize these by facilitating the emotional connection between mother and infant, beginning early in the infant’s neonatal intensive care unit (NICU) stay. We examined depression and anxiety symptoms of mothers of preterm infants at 4 months infant corrected age (CA). One hundred fifteen mothers who delivered between 26 and 34 weeks gestational age were randomized to receive standard care (SC) or standard care plus FNI. Mothers’ self-reported depressive symptoms (Center for Epidemiologic Studies Depression Scale: CES-D) and state anxiety (Spielberger State-Trait Anxiety Inventory: STAI) symptoms were assessed at enrollment, near to term age, and 4 months (CA). At 4 months CA, mean CES-D and STAI scores were significantly lower in FNI mothers compared to SC mothers. Effectiveness of FNI can only be evaluated as an integrated intervention strategy as it was not possible to control all aspects of FNI activities. Although there was considerable loss to follow-up, analyses suggest that resulting biases could have masked rather than inflated the measured effect size for depressive symptoms. FNI may be a feasible and practicable way to diminish the impact of premature delivery on maternal depressive and anxiety symptoms.     

Parental stress in mothers of boys with duchenne muscular dystrophy

OBJECTIVE: To examine parental stress in mothers of boys with Duchenne muscular dystrophy (DMD). METHOD: Stress and its predictors were examined in mothers of boys with DMD (n = 112). Comparisons were made with mothers of healthy children (n = 800), children with cerebral palsy (CP; n = 28), siblings of boys with DMD (n = 46), and longitudinally (n = 16). RESULTS: The presence of problem child behaviors consistently predicted maternal stress. Stress related to child behavior was higher in the DMD versus the normative group. No differences in stress were found in the DMD versus CP groups. Stress related to boys with DMD versus siblings was not significantly different. Over time, maternal stress related to child variables diminished. CONCLUSION: Stress in mothers of boys with DMD is elevated, possibly due to increased problem behaviors, particularly in social interactions, rather than due to the physical demands of the disease alone.     

Eating disturbances in girls with diabetes: the contribution of adolescent self-concept,maternal weight and shape concerns and mother-daughter relationships

BACKGROUND: This study examined the relative contribution of adolescent self-concept, maternal weight and shape concerns (WSC), and mother-daughter relationships to eating disturbances among girls with type 1 diabetes mellitus (DM). METHOD: Eighty-eight adolescent girls (mean = 15.0 years, S.D. = 2.2) and their mothers completed self-report measures of disordered eating and weight control behaviours, with teens also reporting on disturbed eating and body attitudes. Based on reported symptoms, adolescents were classified as highly (N = 18), mildly (N = 30) and non-eating disturbed (N = 40). Self-concept was assessed by adolescent self-report. Mother-daughter relationships were assessed by adolescent self-report and by observed mother-daughter interactions that were rated using a macroanalytic coding system that assesses intimacy and autonomy in these relationships. RESULTS: Hierarchical regressions illustrated that adolescent self-concept deficits, maternal WSC, and impaired mother-daughter relationships significantly predicted eating disturbances in girls with DM, accounting for 57% of the variance. Mothers who engaged in dieting and binge-eating were more impaired in their ability to support their daughters' emerging autonomy. The quality of mother-daughter relationships partly mediated the influence of maternal WSC on adolescent eating disturbances. Moreover, the impact of maternal WSC and mother-daughter relationships on eating disturbances was mediated by adolescent self-concept. CONCLUSIONS: Findings illustrate two pathways through which mother-daughter relationships may impact upon risk of eating disturbances in girls with DM and highlight the need to evaluate family-based interventions specifically tailored for this high-risk population.     

Cultivating mindfulness: effects on well-being

There has been great interest in determining if mindfulness can be cultivated and if this cultivation leads to well-being. The current study offers preliminary evidence that at least one aspect of mindfulness, measured by the Mindful Attention and Awareness Scale (MAAS; K. W. Brown & R. M. Ryan, 2003), can be cultivated and does mediate positive outcomes. Further, adherence to the practices taught during the meditation-based interventions predicted positive outcomes. College undergraduates were randomly allocated between training in two distinct meditation-based interventions, Mindfulness Based Stress Reduction (MBSR; J. Kabat-Zinn, 1990; n=15) and E. Easwaran's (1978/1991) Eight Point Program (EPP; n=14), or a waitlist control (n=15). Pretest, posttest, and 8-week follow-up data were gathered on self-report outcome measures. Compared to controls, participants in both treatment groups (n=29) demonstrated increases in mindfulness at 8-week follow-up. Further, increases in mindfulness mediated reductions in perceived stress and rumination. These results suggest that distinct meditation-based practices can increase mindfulness as measured by the MAAS, which may partly mediate benefits. Implications and future directions are discussed.     

Brief report: family-based group intervention for young siblings of children with chronic illness and developmental disability

OBJECTIVE: To evaluate the impact of a family-based group intervention for young siblings of children with chronic illness and developmental disability (CI/DD). METHODS: Forty-three healthy siblings (ages 4-7 years) of children with CI/DD and their parents participated in an intervention designed to address sibling challenges that cut across types of diagnostic conditions. The intervention consisted of six sessions of collateral and integrated sibling-parent groups. Measures of sibling knowledge, sibling sense of connectedness with other children in similar family circumstances, and sibling global functioning were collected before and after intervention. A subsample of 17 families completed a 3-month follow-up. RESULTS: Siblings' knowledge of the child's disorder and sibling connectedness increased significantly from pre- to posttreatment for both boys and girls, regardless of the nature of the brother or sister's condition. Sibling perceptions of self-competence increased from pre- to posttreatment, whereas parent reports of sibling behavioral functioning remained within the normal range. Improvements in sibling knowledge and connectedness maintained at follow-up. Parent satisfaction with the program was high. CONCLUSIONS: Results support more controlled evaluations of family-based intervention to improve young sibling adaptation to CI/DD.     

Web-Based Psychotherapy for Posttraumatic Stress Disorder in War-Traumatized Arab Patients: Randomized Controlled Trial

BackgroundIn recent years, armed conflicts in the Middle East have resulted in high rates of exposure to traumatic events. Despite the increasing demand of mental health care provision, ongoing violence limits conventional approaches of mental health care provision. Internet-based interventions for posttraumatic stress disorder (PTSD) have proved feasible and effective in Western countries, but their applicability and efficacy in war and conflict regions remains unknown.ObjectiveThis study investigated the efficacy of a cognitive behavioral Internet-based intervention for war-traumatized Arab patients, with focus on Iraq.MethodsA total of 159 individuals with PTSD participated in a parallel group randomized trial. Participants were randomly allocated by a computer-generated sequence to a treatment group (n=79) or a waiting list control group (n=80). The treatment group received 2 weekly 45-minute cognitive behavioral interventions via Internet over a 5-week period (10 sessions in total). The primary outcome was recovery from posttraumatic stress symptoms.ResultsPosttraumatic stress symptoms were significantly reduced from baseline to posttreatment (intention-to-treat analysis) in the treatment group relative to the control group (F_1,157=44.29, P<.001, d=0.92). Treatment effects were sustained at 3-month follow-up. Completer analysis indicated that 29 of 47 patients (62%) in the treatment group had recovered from posttraumatic stress symptoms at posttreatment (reliable change and Posttraumatic Stress Diagnostic Scale score <20) versus 1 patient (2%) in the control group (OR 74.19, 95% CI 9.93-585.8, P<.001) indicating that the chance of recovering was 74.19 times higher in the treatment than in the control group.ConclusionsThe results indicate, even in unstable and insecure settings with ongoing exposure to human rights violations through war and dictatorships, people with posttraumatic stress symptoms benefit from a cognitive behavioral treatment provided entirely through the Internet. This method of delivery could improve patients’ access to humanitarian aid in the form of e-mental health services.

Trial Registration

Australian New Zealand Clinical Trial Registry, ACTRN12611001019998; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=347505 (Archived by WebCite at http://www.webcitation.org/6Wto4HCdH).     

Stability and change in level of maternal depressive symptomatology during the first postpartum year

BACKGROUND: This study evaluated stability and change in the level of maternal depressive symptomatology over the course of the first postpartum year in a community cohort of 106 first-time mothers of full-term, healthy infants. Effects of diagnosed depression and infant gender were also assessed. METHODS: At 2 months postpartum (intake), mothers were classified into one of two symptom groups on the basis of their total score on the Center for Epidemiological Studies-Depression Scale (CES-D): high (CES-D score > or = 16, 46%) or normative (CES-D score = 2-12, 54%). Mothers completed the CES-D again at 3, 6, and 12 months postpartum. At 12 months, maternal diagnostic status for major depression and related disorders was evaluated using the Diagnostic Interview Schedule-III-Revised. RESULTS: Mothers in the High symptom group at intake continued to have significantly higher CES-D scores at 3, 6, and 12 months than mothers in the Normative symptom group at intake, and a third in the High symptom group at intake had a subsequent CES-D score above the clinical cutoff (> or = 16). Maternal CES-D scores were significantly correlated across visits. In regressions controlling for diagnostic status and infant gender, mothers' CES-D score at the most recent prior assessment contributed significant unique variance to mothers' CES-D score at each subsequent assessment. CES-D scores were higher at 3 months if mothers had diagnosed depression and were parenting a son, and higher at 12 months if mothers had both diagnosed depression and a prior, high CES-D score. LIMITATIONS: Findings may not generalize to multipara or high-risk cohorts. CONCLUSIONS: First-time mothers with high levels of depressive symptomatology at 2 months postpartum (especially those with diagnosed depression) are at increased risk of continuing to experience high levels of depressive symptomatology throughout the first postpartum year. Implications for preventative intervention services are discussed.     

A stress management program for university students

This study examined the effects of a stress management program for university students related to their stressors, problem-solving abilities (problem-solving confidence, approach-avoidance style, and personal control), knowledge of stress, and stress responses. Participants (n = 27) were randomly assigned to either an intervention or a waiting list control group. The program, including small group discussions, completion of a workbook, and follow-up interviews, was conducted for the intervention group for three weeks. Participants (n = 8 and n = 12 for the intervention and waiting list control groups, respectively) responded to three waves of questionnaires (pre, post, and follow-up). The results showed significant favorable intervention effects for knowledge of stress, problem-solving confidence, and stress responses on the post-tests, while no intervention effects were found at the follow-up.     

Pediatric asthma management in the family context: the family asthma management system scale

OBJECTIVE: To examine psychometric properties of a revised version of the Family Asthma Management System Scale (FAMSS), a clinical interview to assess asthma management. METHODS: The FAMSS was administered to 115 children with asthma and their primary caregivers, along with a measure of asthma morbidity. A subset of families (n = 53) participated also in objective-adherence monitoring and completed measures of asthma knowledge and self-efficacy. RESULTS: The FAMSS demonstrated good internal consistency (alpha = .84). The FAMSS summary score was unrelated to age, gender, race, or minority status, but was related to socioeconomic status (SES) and to functional morbidity at baseline and prospectively. Convergent validity of the FAMSS was documented. The FAMSS explained additional variance in concurrent-asthma morbidity beyond self-reports or objective adherence monitoring. CONCLUSION: The FAMSS is a valuable tool to assess family-based asthma management that addresses gaps in available assessment methodologies and holds promise for research and clinical applications.     

Predictors of postpartum depressive symptoms in Icelandic women

Summary Objective: The aim of the survey was to investigate the prevalence of postpartum depressive symptoms among Icelandic women and the predictive capacity of parental stress and infant difficulty. Method: A sample of women (n = 734), 2–3 months after giving birth was studied by mailed questionnaires that included the Edinburgh Postnatal Depression Scale (EPDS); Parent Stress Index/Short Form (PSI/SF) and the Infant Difficulty Index (IDI). Demographic questions were also included. Results: The mean for depressive symptoms was 6.5, with 14% of the women experiencing frequent symptoms. Maternal stress and worries about health of the infant predicted depressive symptoms best. These variables explained 34% of the variance and social variables did not add to prediction. Conclusion: Maternal stress and worries about infant health are suggested as powerful predictors of postpartum depressive symptoms and are useful indicators for planning health care of mothers with young infants.     

巴林特小组改善医护人员职业压力与职业倦怠

目的:探讨巴林特小组在改善医护人员职业压力和职业倦怠方面的效果,降低医护人员负性情绪体验,有效预防医护人员职业倦怠。方法:选取潍坊市某中医院124名医护人员,采用知觉压力量表(CPSS)、职业倦怠量表(MBI-HSS)、正性负性情绪量表(PANAS),选取量表高分端的27%中的20人为研究对象,随机划分成10人的实验组,进行为期3个月的巴林特小组干预,10人的对照组,无任何干预,在干预前后分别对实验组和对照组进行测量。结果:实验组被试在CPSS总分、紧张感、失控感、MBI-HSS总分、情绪疲惫感、工作冷漠感、负性情绪水平维度上后测得分低于前测,差异有统计学意义(t=4.58,4.58,3.58,4.92,5.60,3.34,8.17;P0.01);无工作成就感、正性情绪维度上后测得分高于前测,差异有统计学意义(t=-3.00,P0.05;t=-4.58,P0.01)。对照组被试在3个量表的各个维度前后测得分,差异无统计学意义(P0.05)。结论:巴林特小组可以改善医护人员职业压力和职业倦怠。     

Mothers' remembrances of newborn intensive care: a predictive study

Six months after discharge, 94 mothers described their memories of their infant's hospitalization on an NICU. Mothers of sicker infants, those who had claimed difficulties with NICU staff, and those who felt less attached to their infant more often described painful reminders of this crisis. Pleasurable reminders were reported more often by mothers who had perceived greater personal control over their infant's recovery and had construed a purpose in this crisis. Mothers described several benefits of their memories and were more likely to do so when they had perceived a purpose in their misfortune.