Lifestyle and biological factors influence the relationship between mental health and low-grade inflammation

Mental health modulates the risk of common chronic conditions. Although inflammation is thought to partly explain this link, its relation with mental health is still unclear and largely unexplored.We investigated three scales assessing psychological resilience (CD-RISC), depression symptoms (PHQ9-6) and mental wellbeing (SF36-MCS) in an Italian adult population cohort (N_max = 16,952). This showed a slightly higher frequency of men, more educated and younger participants, compared to samples with incomplete questionnaires. We performed stepwise generalized linear models to test the association between each scale and INFLA-score, a composite blood-based inflammation index. At each step, a class of potential mediators was included in the model, namely health conditions, lifestyle factors, or both (full model). Full model analysis was also conducted on single blood markers involved in the inflammatory process.In the baseline model, we observed significant associations of PHQ9-6 (standardized β(SE) = 0.024(0.009), p = 8.9 × 10⁻³) and SF36-MCS (β(SE) = −0.021(0.008), p = 7 × 10⁻³) with INFLA-score. These associations survived adjustment for health conditions but not for lifestyle factors, which explained 81% and 17% of the association with PHQ9-6 and SF36-MCS. Significant associations (p < 4.2 × 10⁻³) after mediator adjustment were observed for single low-grade inflammation markers, including platelet distribution width (with PHQ9-6 and CD-RISC), granulocyte- and neutrophil-to-lymphocyte ratios, monocyte and lymphocyte fractions (with SF36-MCS). After imputation of missing data, we observed substantially consistent associations.These findings suggest that the relationship between mental health and low-grade inflammation is largely influenced by lifestyle. However, the associations with specific biomarkers related to inflammation are partly independent and might be explained by biological factors.     

Experiences of delayed maturation in female vocational ballet students: An interpretative phenomenological analysis

IntroductionThere is a well-established bias toward late maturing females in the context of ballet, with up to 70% of professionals delayed in maturation. The timing of maturation has implications for physical and psychological outcomes which are likely to be amplified in dance. The aim of this research was to explore the role of maturity timing in adolescent dance students' experiences of vocational ballet training.MethodsSemi-structured interviews were carried out with 28 adolescent female dancers of differing maturity timing across three vocational ballet schools in the UK. Interpretative phenomenological analysis was employed in the analysis of data. This study comprises findings from the nine late maturing dancers within the sample.ResultsLate maturing dancers perceived a number of aesthetic and functional advantages. The aesthetic advantages noted by the dancers are congruent with the well-established bias toward a later maturing physique for ballet; being ‘small’ and not having ‘bits’ is advantageous for these dancers in terms of maintaining a more pre-pubescent look and thereby conforming more easily to the expectations of the ballet world. However, dancers in this study perceived some significant drawbacks. Despite aesthetic advantages, later maturing dancers were disadvantaged by the current training system which sees them undertaking the most crucial training period during their most rapid period of growth.ConclusionsGreater consideration of maturation is needed within training systems and further research is warranted to understand these experiences in more depth and their implications for the physical and psychological wellbeing of young people in dance.     

Towards integrated care for chronic conditions: Dutch policy developments to overcome the (financial) barriers

Chronic non-communicable diseases are a major threat to population health and have a major economic impact on health care systems. Worldwide, integrated chronic care delivery systems have been developed to tackle this challenge. In the Netherlands, the recently introduced integrated payment system - the chain-DTC - is seen as the cornerstone of a policy stimulating the development of a well-functioning integrated chronic care system.The purpose of this paper is to describe the recent attempts in the Netherlands to stimulate the delivery of integrated chronic care, focusing specifically on the new integrated payment scheme and the barriers to introducing this scheme. We also highlight possible threats and identify necessary conditions to the success of the system. This paper is based on a combination of methods and sources including literature, government documents, personal communications and site visits to disease management programs (DMPs).The most important conditions for the success of the new payment system are: complete care protocols describing both general (e.g. smoking cessation, physical activity) and disease-specific chronic care modules, coverage of all components of a DMP by basic health care insurance, adequate information systems that facilitate communication between caregivers, explicit links between the quality and the price of a DMP, expansion of the amount of specialized care included in the chain-DTC, inclusion of a multi-morbidity factor in the risk equalization formula of insurers, and thorough economic evaluation of DMPs.     

Discrimination and victimization as mediators between social support and psychological distress in autistic adults

BackgroundThe mental health of autistic adults is a critical concern. The aim of this study is to gain a better understanding of how access to professional and social support combines with the experience of discrimination and victimization to explain psychological distress in autistic adults.MethodA cross-sectional online survey was conducted to provide information on psychological distress (Kessler K6), characteristics of the personal social support network, utilization and access to social and professional support, diagnosis and health conditions, and socio-demographic characteristics of the respondents. Two-hundred and twenty-two (222) autistic adults from Quebec (Canada) completed the survey.ResultThe results indicate high rates of psychological distress (51%), significant unmet support needs and many barriers to accessing psychosocial and health services. Four independent serial multiple mediator models confirm that social support and experiences of discrimination and victimization statistically mediate the relationship between professional support and psychological distress.ConclusionsThis study contributes to the understanding of the role of social support in the development of mental health difficulties in autistic people. Several courses of action are proposed, such as the implementation of structural corrective measures for access to services (e.g., limiting waiting times), design of service settings to limit possible sources of hypersensitivity, diversification of appointment methods (telehealth), making general service providers aware of the specific realities and characteristics of autism, greater consideration of the social aspects that influence mental health, the development of peer support programs, and the adoption of a positive and non-ableist view of autism in training programs.     

A positive concept of health – Interviews with patients and practitioners in an integrative medicine clinic

Using the phenomenography method, interviews with patients and practitioners were undertaken to explore their understanding of ‘health that is more than the absence of disease’.The question was challenging and stimulating for all interviewees. A few were unable to conceptualise this positive definition of health, some perceived it as an optimum end-state, whereas others saw it as an ongoing process. Many positive attributes of health and its influencers were identified. The more advanced understandings of this concept were of a holistic, multidimensional, expansive state where the all dimensions of health are interdependent and positively reinforcing.The results affirmed that wellness is more than psychological wellbeing, ‘happiness’ and life satisfaction. Optimum physical and cognitive capacities along with spiritual, social and occupational wellness were equally as important. ‘Energy and vitality’ were sufficiently emphasised by patients and some practitioners to support the inclusion of the principles of vitalism in any discussion about health.     

幸福指数量表在我国内地城市居民中的初步试用研究

目的对幸福指数量表运用于我国内地城市居民的测量学特性进行考察,对该量表的跨文化适用性进行检验。方法在山东济南取样(n=739),采用α系数和题总相关系数对量表的内在一致性信度进行检验,采用探索性因素分析对量表的构想效度进行检验。结果幸福指数量表运用于我国内地城市居民时具有良好的信度,内在一致性系数分别为0. 77和0. 82。因素分析结果表明,其构想效度比较理想。结论幸福指数量表运用于我国内地城市居民取得了良好的测量学特性,所得出的结论可信,可以作为研究我国居民主观生活质量的工具。     

Managing,making sense of and finding meaning in advanced illness: a qualitative exploration of the coping and wellbeing experiences of patients with lung cancer

Coping plays an essential role in maintaining the wellbeing of patients with cancer. A number of different coping responses and strategies have been identified in the literature. The value and relevance of meaning based coping theory has also been emphasised, including Antonovosky's Sense of Coherence (SoC) theory. Ten patients with advanced lung cancer were interviewed up to three times. A total of twenty in depth interviews were carried out, fully transcribed and data were analysed following a methodology of Interpretative Phenomenological Analysis. Three broad domains were identified to categorise the core life concerns of participants; making sense of and managing one's illness; maintaining daily life and relationships and confronting the future. Within these domains multiple coping themes are identified, which to varying degrees help to maintain patient wellbeing and quality of life. This article considers the relevance of SoC theory for understanding the coping experiences of patients with advanced cancer, and identifies resources and factors likely to support patient coping, with implications for health and social care services.     

The independent effects of match location,match result and the quality of opposition on subjective wellbeing in under 23 soccer players: a case study

This study examined if subjective wellbeing in soccer players was affected by match location, match result and opposition quality before a match (PRE), 1 day after (POST-1), and 3 days after a match (POST-3). Eleven professional male soccer players from the under 23 squad playing in the Premier League 2 division completed a wellbeing questionnaire before and after 17 matches. Match training load (session-rating perceived exertion) was not different, regardless of the location, result, or quality of opposition faced (P > 0.05). Subjective wellbeing was not different at PRE (P > 0.05); however, at POST-1 and POST-3, stress and mood were ≥20% lower after playing away from home or losing (P < 0.05). Stress, mood and sleep were ≥12% worse after playing against a higher-level opposition at POST-1. Coaches need to be aware that match location, match result and the quality of the opposition can influence post-match wellbeing, irrespective of match load.     

The SARS (Severe Acute Respiratory Syndrome) pandemic in Hong Kong: Effects on the subjective wellbeing of elderly and younger people

Objectives: This study examined the impact of the Severe Acute Respiratory Syndrome (SARS) outbreak in Hong Kong in 2003, on the subjective wellbeing (SWB) of elderly people and a younger comparative sample. The Personal Wellbeing Index (PWI), a contemporary instrument employed to measure SWB, was also examined for its psychometric performance to substantiate its use.

Method: A total of 302 older adults (age 65 + years) and 158 younger adults (age 35–46 years) were recruited from different districts. Data were collected by individual face-to-face interviews.

Result: While elderly people living in severely infected districts showed significantly lower levels of SWB, these levels and those of the younger sample were found to remain within the normative range. A major mitigating factor was an increased sense of community-connectedness. Other characteristics linked to low wellbeing levels included chronic illness, female gender, low education and unemployment. The living districts, characterized by varying extents of infection, had stronger associations with SWB than participants’ age. The PWI demonstrated good psychometric performance and also more robustness with elderly people, including its sensitivity to the sense of population threat.

Conclusion: Psychological resilience was identified among both the elderly and younger age-groups in Hong Kong during the SARS pandemic. The PWI is verified as a suitable instrument for SWB measurements.     

地震后长期心理援助模式的探索:“壹基金-北大童心康复项目”一年回顾与思考

本文对北京大学心理学系震后干预项目"壹基金-北大童心康复项目"1年的工作内容、组织架构及主要成果等进行回顾,对地震后长期心理援助工作如何开展和坚持作出思考。