A multilevel analysis of association between neighborhood social capital and depression: Evidence from the first South African National Income Dynamics Study

BackgroundAs neuropsychiatric disorders account for a great proportion of the total burden of disease in sub-Saharan Africa, depression is rapidly emerging as a public health issue in South Africa. Given the divisions enforced by a legacy of the apartheid spatial and economic policies, features of communities such as neighborhood-level social capital may play a critical role in depression. However, the extent to which neighborhood-level social capital is associated with depression in South Africa at the population-level is unknown.MethodsData from the first wave of the South African National Income Dynamics Study (SA-NIDS) was used to examine the association between the neighborhood-level social capital and individual depression using multilevel regression models.ResultsThere was a negative association between neighborhood-level social capital and depression score with social trust and neighborhood preference accounting for this association. Structural social capital, namely civic participation, was not related to depression. Individual predictors, including social class, self-rated health status and education, were strong covariates of depression.LimitationsThe cross-sectional design of the study limits our understanding of the temporal order of social capital and depression.ConclusionsIn post-apartheid South Africa, low social capital remains an important social determinant of health, including depression outcome. This is in addition to individual determinants related to class such as unemployment, education and social class which play an important role in influencing depression. Further research utilizing a longitudinal study design is warranted to examine the association between social capital and depression in South Africa.     

Older adults with chronic illness – Caregiver burden in the Asian context: A systematic review

IntroductionUpsurge in life expectancy, filial responsibility of caring, and healthcare advances have increased the older adult population in Asia. The last decade has witnessed nuclear families' proliferation in Asia, leaving family caregivers with more accountability and responsibility. This review explores the pattern of caregiver burden among caregivers of older adults with chronic illness in Asia.MethodsPRISMA guidelines serves as the framework for this systematic review. Studies from selected databases assessed caregivers' physical state, psychological dysfunction, and or burden as an outcome measure. The Newcastle - Ottawa Quality Assessment Scale appraised the quality of the selected studies.ResultsThe review included 12 research articles. Caregivers consistently report mild to a moderate burden. Care recipient with functional dependency, comorbidities, memory, and sleep impairments, escalate caregiver burden. Caregiver variables intensifying burden were advancing age, male gender, spouse as a care recipient, longer care provision duration, and no assistance.ConclusionOptimal levels of emotional well-being, significant family/social support, and self-preparedness among caregivers are grounds for their empowerment.Practical ImplicationsA paradigm shift from 'caregiver burden' to 'caregiver resilience' is advocated. Routine screening, preventive measures (skill-building and psychosocial empowerment), and restorative services (respite care and problem-based home visiting) for caregivers are forecasted.     

Depression and anxiety in patients with hereditary angioedema

BackgroundHereditary angioedema (HAE) is characterized by edematous swelling attacks of the face, extremities, abdomen, genitalia, and upper airway. The potential for laryngeal swelling makes the disease life-threatening, and the swelling elsewhere contributes to the significant burden of illness. The increased risk for mental health disorders in HAE is due to the burden of disease and possibly associated activation of the immune system.ObjectiveTo determine the prevalence of depression and anxiety in HAE patients and the most high-yield features of depression to target in a clinical encounter.MethodsDepression and anxiety symptoms were evaluated using the 29 items of the Hamilton Depression Rating Scale along with the 14-item Hamilton Anxiety Rating Scale. The sample size was 26 participants with a diagnosis of type 1 or 2 HAE drawn from a cohort of 60 adult patients. In addition, a literature search was performed regarding how immune modulation affects depression and anxiety.ResultsA total of 39% of participants were identified as experiencing depression of mild (50%), moderate (40%), or severe (10%) levels. Fifteen percent of participants displayed prominent anxiety, half of whom had mild anxiety, 25% moderate anxiety, and 25% severe anxiety. The literature on inflammation and depression suggests a possible link between HAE and depression.ConclusionOur data and the literature support that depression and anxiety symptoms are common in patients with HAE and may be secondary to chronic disease burden, associated pathophysiologic features, or both. Treatment that addresses the psychosocial and mental health of HAE patients is critical for best practice.     

Predictors of burden and infectious illness in schizophrenia caregivers.

OBJECTIVE: The objective of the study was to test predictive models of schizophrenia caregiver burden and infectious illness episodes for caregivers who had regular contact with their mentally ill family members. METHODS: A nurse interviewer, blind to the patient's symptoms, caregiver burden, and psychosocial status, administered the Health Review to 70 caregivers. A second family interviewer, blind to caregiver health status and patient symptoms, assessed caregiver resources (eg, active coping and social support), vulnerabilities (eg, anger expression and passive coping) and burden. Concurrently, independent patient raters, blind to caregiver health and psychosocial status, assessed caregiver stressors. The Brief Psychiatric Rating Scale and the Modified Scale for the Assessment of Negative Symptoms were used to assess the severity of positive (eg, hallucinations and delusions) and negative (eg, anhedonia and asociality) symptoms, respectively. RESULTS: Predictive models, including measures of stressors, resources, and vulnerability factors for caregiver burden and for presence of infectious illness, were each highly significant, accounting for 40% and 29% of the variance, respectively. However, the specific measures that predicted burden and infectious illness differed. Greater burden was predicted by more severe patient negative symptoms (stressor), greater anger control and blame self-coping (vulnerability), and decreased tangible social support (resource). Presence of infectious illness episodes was predicted by more severe patient positive symptoms (stressor) and less satisfaction with social support while controlling for the frequency of reporting on the Health Review. When scores from the Brief Psychiatric Rating Scale (stressors) were categorized into quartiles, it was found that the frequency of infectious illness in the highest quartile was four times that in the lowest quartile. Other results indicated that even though burden was not associated with infectious illness, it was associated with "continuing health problems," perceived stress, and depression. CONCLUSIONS: These data indicate that although schizophrenia caregiver burden and infectious illness are predicted by measures of patient stressors, vulnerabilities, and resources, the specific measures predicting these outcomes differ. The results also call attention to the powerful influence of patient symptoms as a predictor of burden and the presence of infectious illness among caregivers.     

Understanding cancer caregiver burden over time: Dyadic assessments of family cohesion,conflict and communication

ObjectivePreviously we identified three distinct cancer communication concordance groups among cancer patient-caregiver dyads. This secondary analysis examined patient and caregiver reports of family functioning (cohesion and conflict) as associated with cancer communication concordance and assessed each as independent predictors of perceived caregiver burden among hematological cancer caregivers.MethodsA case series of hematological cancer patient-caregiver dyads (n = 171) were recruited from oncology clinics in Virginia and Pennsylvania and followed for 2 years. Using the previously identified communication groups this analysis prospectively examines patient and caregiver perceptions of family cohesion and conflict and the association with burden over time.ResultsCaregiver burden decreased over time. Caregiver, but not patient perceptions of family cohesion decreased over time; decreased cohesion and increased conflict was associated with greater cancer communication discordance.ConclusionsThis work lends further support to the use of cancer communication congruence typologies for identifying potentially vulnerable dyads. Discordant cancer communication and declining caregiver perceptions of family cohesion may represent opportunities to intervene using family focused supportive services.Practice implicationsOnly caregiver perceptions of family functioning were associated with burden therefore identifying and supporting those caregivers with worsening communication and family function is important.     

Factors Related to Anxiety and Depression Among Adolescents During COVID-19: A Web-Based Cross-Sectional Survey

BackgroundThe coronavirus disease 2019 (COVID-19) outbreak and subsequent disease-containment measures (such as school closures) significantly affected the lives of adolescents. We evaluated the mental-health status and factors associated with anxiety and depression among South Korean adolescents.MethodsA nationwide online survey was conducted to evaluate the mental-health status of South Korean adolescents during the COVID-19 pandemic. In total, 570 adolescents aged 13–18 years were surveyed between May 27 and June 11, 2021. The participants completed the Generalized Anxiety Disorder Scale (GAD-7) and Patient Health Questionnaire (PHQ-9) to determine anxiety and depression symptoms, respectively. Stepwise logistic regression models were constructed to determine factors related to anxiety and depression.ResultsAmong the study participants, 11.2% and 14.2% had anxiety and depression, respectively. The results suggested that several factors, such as the experience of COVID-19 infection and quarantine of oneself, a family member or an acquaintance, physical and mental health problems, and fear of one’s local community being discriminated against as a COVID-19 area were related to anxiety and depression.ConclusionThe present study identified COVID-19-related factors associated with anxiety and depression among adolescents, and provides insights regarding potential interventions to improve the mental health of adolescents. To promote the mental health of adolescents during the COVID-19 pandemic, special attention should be paid to individuals with physical or mental-health problems, and efforts should be made to reduce the negative social and emotional impacts of infection-control measures.     

The search for determinants of chronic depression: a review of six factors

While strides have been made in the classification, assessment and identification of chronic depression, there remains a limited understanding of the factors underlying chronicity. This review focuses on six putative determinants of chronic depression: developmental factors, personality and personality disorders, psychosocial stressors, comorbid disorders, biological factors and cognitive factors. The strongest support was found for the role of developmental factors in the chronicity of depression. Some support was found for the role of chronic stressors and certain personality features such as stress reactivity. Few other factors found support. The determinants of chronic depression do not differ qualitatively from acute depression. Rather, the development of chronic depression may involve increased levels of childhood adversity, protracted environmental stress and heightened stress reactivity. However, it is difficult to determine to what extent these putative determinants might reflect retrospective bias in data collection, or even parental reaction to children with subthreshold depressive traits. Detailed etiological models await further research attention to understudied areas and improved research designs. Suggestions for future research include greater specification of criteria for chronicity, use of more appropriate comparison groups and longer term prospective follow-up studies.     

A systematic scoping review of psychosocial and psychological factors associated with patient activation

ObjectivePatient activation has been identified as an important predictor of how patients manage their own health, but little is known about its determinants. In this scoping review, we aim to address this research gap by (1) identifying literature on psychosocial/psychological factors associated with patient activation, and (2) extracting and synthesizing major results reported on that relationship.MethodsUsing a systematic search of four electronic databases (Web of Science, PubMed, PsychInfo, CINAHL), our search algorithm combined related terms for “psychosocial factors” or “psychological factors” and “patient activation”.ResultsOf the 1128 records identified, we included 13 studies in this scoping review. In these, we identified 21 psychosocial/psychological factors that were significantly associated with patient activation. The four most frequently investigated factors were depression, self-efficacy, hope, and health status. Overall, the methodological quality of studies was low. The majority were cross sectional in design, and only one assessed causality.ConclusionsOur results suggest that psychosocial/psychological factors explain variations in patient activation. However, further research is needed to identify causal relationships between psychosocial/psychological factors and patient activation.Practice ImplicationsThe insights from our review could be used for designing and evaluating interventions to improve patient activation.     

What are we doing to support informal caregivers? A scoping review of caregiver education programs in cancer care

ObjectivesThe cancer system is experiencing a rise in cancer prevalence, a workforce shortage, and is resource-stretched. In this environment, informal caregivers (unpaid family caregivers of cancer patients) are required to take on expanded care roles and experience the debilitating effects of caregiver burden. Education programs are increasingly being developed to support caregivers. The aim of this review is to summarize what is known about these programs.MethodsA scoping review was conducted from May 2019 to January 2020. The literature search yielded 34,906 articles.Results119 articles were included, and ninety-two (77%) were focused on in-person psychoeducational programs.ConclusionMost caregiver programs have a unidimensional focus on psychoeducational training, demonstrating a need for more comprehensive programming to address the full spectrum of caregiver needs.Practice implicationsClinicians and educators must collaborate to create accessible, equitable education programs that comprehensibly address the needs of unpaid family caregivers beyond addressing psychological aspects of cancer care. This will ensure that a broader range of patients and caregivers are equipped with the knowledge and skills needed to cope with a cancer diagnosis, navigate the health system and to maintain their quality of life.     

Parental Mental Health and Children's Behaviors and Media Usage during COVID-19-Related School Closures

BackgroundCoronavirus disease 2019 (COVID-19) is different from previous disasters in that it continues to the present and has affected all aspects of family life. During epidemics, psychosocial support is not less important than infection control. During COVID-19-related school closures, prolonged partial closures of schools could have detrimental social and health consequences for children and may increase the burden on the family. Based on a community sample in Korea, this study identified parental concerns, children''s media usage, other various factors and examined whether parental stress level or depression were positively associated with problem behaviors, media exposure, and sleep problems of the primary school children during school closure under COVID-19.MethodsParticipants were 217 parents residing in Suwon, South Korea, who had primary school children and responded to a web-based questionnaire on parental concerns from school closure under COVID-19, subjective stress, depression, whether having received mental health services, and family characteristics; children''s sleep patterns, problem behaviors, media usage during the online-only class period, and changes in activity level following the pandemic.ResultsDuring school closure, children gained body weight, spent less time in physical activities and more in media usage. Besides online learning content (97.2%), YouTube was highly used content (87.6%), and games followed (78.3%). Parental subjective stress index was highly associated with parental depression (Pearson correlation 0.439, P < 0.001), children''s sleep problems (0.283, P < 0.001), tablet time (0.171, P = 0.012) and behavior problems (0.413, P < 0.001). Parental depression was associated with children''s sleep problems (0.355, P < 0.001), TV time (0.153, P = 0.024), tablet time (0.159, P = 0.019), and behavior problems (0.524, P < 0.001). Parents who previously received mental services seemed to be more concerned about the problems their children already have getting worse because of COVID-19 than the disease itself. Children''s sleep problem was associated with tablet (0.172, P = 0.011) and smartphone time (0.298, P < 0.001), but not its frequency.ConclusionDuring COVID-19-related school closures, many parents and children had various difficulties relating to mental health. Ongoing monitoring of mental health of high-risk groups and multiple support systems may need to be expanded to cover those parents having difficulty in caring for their children.     

Attachment Disorder behavior in early and middle childhood: associations with children’s self-concept and observed signs of negative internal working models

ABSTRACT

Most research on attachment in childhood is based on observation. In contrast, research on reactive attachment disorder (RAD) is mainly based on caregiver reports. Moreover, little is known about self-concept or internal working models (IWMs) of self and others in children with RAD. The present study examined whether caregiver reports and the frequency of observed signs of RAD reveal differences between children at risk for developing RAD symptoms and healthy controls in middle childhood. In addition, children’s self-concept, observable signs of negative IWMs, and mental health were assessed. Results revealed that the RAD risk group showed increased reported and observed signs of RAD, a more negative self-concept, and more signs of negative IWMs compared to healthy controls. Signs of RAD in middle childhood were expressed trans-relational to both caregivers and strangers. Moreover, RAD symptoms were associated with negative self-concept, observed signs of negative IWMs, and poor mental health.     

Women’s use of online resources and acceptance of e-mental health tools during the perinatal period

ObjectivesThe women’s professional help-seeking rate for perinatal depression is low, despite the prevalent and disabling nature of this condition. Therefore, new approaches should be implemented to increase women’s access and utilization of treatment resources, namely e-mental health tools. This study aimed to characterize women’s current pattern of use of online resources for mental heal issues and women’s acceptance of e-mental health tools during the perinatal period, and to investigate its main determinants.MethodsThis study used an online cross-sectional survey that was completed by 546 women during the perinatal period.Results31.3% had prior knowledge of websites targeting mental health illness. Women presenting an actual need for help (i.e., a positive screen for depression) reported greater use of online resources and greater engagement in e-health behaviors related to mental health (d = 0.46–0.61), and being more accepting of e-mental health tools, particularly of informative websites. Women’s perceptions concerning the e-mental tools were found to predict their intentions to use them.ConclusionsThe results seem to globally support Portuguese women’s acceptance of e-mental health tools. To improve the level of acceptance, women should be involved as stakeholders in the development of new e-mental health tools and provided with specific information before their utilization.     

The impact of maternal depression on child mental health treatment and models for integrating care: a systematic review

Maternal depression negatively impacts child mental health and is a well-known risk factor for child psychopathology. However, maternal depression treatment and child mental health treatment are rarely integrated. The purpose of this review was to assess the impact of maternal depression on child mental health treatment, including (1) how treatment of maternal depression affects child mental health outcomes, (2) the impact of maternal depression on children receiving mental health care, and (3) emerging models that address maternal depression in primary-care pediatrics and child mental health settings. A systematic literature review was conducted using PubMed and PsycInfo. Initial search yielded 224 records, and after exclusion, 29 papers were reviewed. Effective treatment of maternal depression is associated with a significant decrease in child psychiatric symptoms. Maternal depression negatively affects child mental health treatment in that there is a high rate of untreated mental illness among mothers of psychiatrically ill children, and maternal depression impedes effective child mental health treatment. Current models to address maternal depression in child settings include screening in pediatric primary care, psychotherapy for depressed mothers of psychiatrically ill children, and emerging models that integrate maternal and child mental health treatment. Effective treatment of maternal depression significantly improves child mental health and should be better integrated into child treatment. Opportunities to improve care include more robust screening for parental mental illness, supports to refer parents to psychiatric care, and on-site services for parents. Such interventions hold promise, but require significant support from a multidisciplinary team.

     

Factors associated with patient activation in a socially deprived population: Evidence from Germany

ObjectivePatient activation has been identified as a crucial determinant of health, but little is known about its own determinants, particularly in low socioeconomic status populations. To address this research gap, we analyzed factors that might explain variation in patient activation in such a population.MethodsWe conducted a cross-sectional patient survey (n = 582) in a low socioeconomic status urban district in Germany in 2017. Using multivariate linear regressions, we examined the association between patient activation and a range of psychological, sociodemographic, and health-related factors. To assess the relative importance of these factors, we used dominance analysis.ResultsOur results suggest that age, employment status, linguistic acculturation, health status, and self-efficacy were significantly associated with patient activation. Dominance analysis indicated that self-efficacy was the most important factor explaining variation in patient activation.ConclusionsAge, employment status, linguistic acculturation, health status, and self-efficacy are important determinants of patient activation.Practice implicationsOur results can inform decision makers about approaches for more targeted and effective interventions to improve patient activation in low socioeconomic status populations. Much might be gained by investing in interventions that focus on age, employment status, linguistic acculturation, and health status. Interventions that improve self-efficacy may represent a particularly promising approach.     

Managing life during the pandemic: communication strategies,mental health,and the ultimate toll of the COVID-19

Background/aim The purpose of this review was to present the ultimate toll of the COVID-19 pandemic by focusing on the communication strategies and mental health.Materials and methods We unsystematically reviewed the studies published between 2020 and 2021 from databases such as Google Scholar, Web of Science and ScienceDirect. Firstly, “new-normal” life challenges during the pandemic were discussed along with the public risk communication strategies. Later, mental health problems, posttraumatic growth, and protective factors were reviewed. Results Literature highlighted that individuals mainly experience COVID-19 related fear, anxiety, stress, negative emotions and sleep problems. Furthermore, the rates of clinically significant depression, anxiety, obsessive compulsive disorder, and posttraumatic stress disorder suggest an increase. Specifically, COVID-19 stress syndrome, loneliness, and sleep problems were associated with mental health problems in the pandemic. However, some individuals seem to be resilient to the COVID-19 trauma and experience posttraumatic growth. Brief online intervention studies are promising for reducing the emotional toll of the COVID-19 as well as for making individuals more resilient.Conclusion To conclude, the negative conditions of the pandemic seem to make some people, but not all, vulnerable to mental illness. In addition, framing the public warnings in an optimal emotional tone seems to be more effective to comply with the precautions.     

Artificial intelligence–assisted phenotype discovery of fragile X syndrome in a population-based sample

PurposeFragile X syndrome (FXS), the most prevalent inherited cause of intellectual disability, remains underdiagnosed in the general population. Clinical studies have shown that individuals with FXS have a complex health profile leading to unique clinical needs. However, the full impact of this X-linked disorder on the health of affected individuals is unclear and the prevalence of co-occurring conditions is unknown.MethodsWe mined the longitudinal electronic health records from more than one million individuals to investigate the health characteristics of patients who have been clinically diagnosed with FXS. Additionally, using machine-learning approaches, we created predictive models to identify individuals with FXS in the general population.ResultsOur discovery-oriented approach identified the associations of FXS with a wide range of medical conditions including circulatory, endocrine, digestive, and genitourinary, in addition to mental and neurological disorders. We successfully created predictive models to identify cases five years prior to clinical diagnosis of FXS without relying on any genetic or familial data.ConclusionAlthough FXS is often thought of primarily as a neurological disorder, it is in fact a multisystem syndrome involving many co-occurring conditions, some primary and some secondary, and they are associated with a considerable burden on patients and their families.     

Online resources for family caregivers of cognitively competent patients: A review of user-driven reputable health website content on caregiver communication with health professionals

ObjectiveMost patients want their family involved in consultations and decisions, however some family caregivers report feeling overwhelmed and unsure of their role. As caregivers are increasingly looking to medical websites for guidance, this study aimed to review reputable web-resources available to inform family caregivers on how to be involved in medical consultations and decisions.MethodsGoogle searches were performed using lay search strings, to imitate how a cancer caregiver may locate information. Relevant webpages were included if they were directed at caregivers and from a reputable health organisation. Qualitative content analyses were performed on the included webpages.Results22 webpages were included and 8 were directed at caregivers of cancer patients. Six key categories of information were identified: preparing for consultations, helping during consultations, advocating for the patient, decision-making, communicating in hospital settings, and communicating with family and friends.ConclusionA range of online resources were found to guide family caregivers, particularly cancer caregivers, on involvement in consultations. However, few provided information to caregivers on complex situations such as treatment decision-making, advocating for patient’s needs, and communicating in a hospital setting.Practice implicationsClinicians can actively refer family caregivers to online resources that support caregiver communication in medical settings.     

Effects of general change mechanisms on outcome in telephone-based cognitive-behavioral therapy for distressed family caregivers

Background

The study investigated the influence of general change mechanisms (GCMs) on outcome in telephone-based cognitive-behavioral therapy (CBT) for family caregivers.

Methods

In a stepped-care intervention approach, highly distressed family caregivers received telephone-based CBT after completing a care counseling intervention. Sixty-six therapist-caregiver dyads rated emotional bond, agreement on collaboration, problem actuation, resource activation, clarification of meaning, and mastery after each of 12 therapy sessions. Outcomes were caregiver burden (SCQ-AV) and depression (CES-D) after therapy. Associations of GCMs with outcome were examined in multilevel regression models.

Results

Caregiver burden was significantly predicted by caregiver-rated emotional bond (β = −0.18) as well as therapist-rated resource activation (β = −0.26), problem actuation (β = −0.22), clarification of meaning (β = −0.18), and mastery (β = −0.18). None of the GCMs predicted depression from any perspective.

Conclusion

The findings suggest that GCMs are relevant for reducing caregiver burden in CBT for family caregivers and should be fostered in treatment manuals, in particular therapist-rated GCMs. Since therapist and caregiver perspectives differed in predicting caregiver burden, future research should investigate perspective congruence and its effect on therapy outcome.     

Translational Applications of Personality Science for the Conceptualization and Treatment of Psychopathology

Utilizing personality science within clinical assessment and intervention can aid in treatment planning. General personality constructs also are related to clinically relevant areas of dysfunction. However, personality continues to be underutilized in clinical settings. This article reviews current literature pertaining to the clinical applications of personality with a focus on dimensional models such as the Five‐Factor Model. With the advent of a dimensional personality model in DSM‐5, the clinical use of traits is an important topic of exploration. This review discusses the clinical significance of personality and personality pathology in various aspects of living (i.e., functioning, physical health, mental health), clinical applications and utility within clinical and treatment settings, and future research directions, as well as suggestions for further utilization of personality traits.