1,626 research outputs found

    Talking about personal recovery in bipolar disorder: Integrating health research, natural language processing, and corpus linguistics to analyse peer online support forum posts

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    Background: Personal recovery, ‘living a satisfying, hopeful and contributing lifeeven with the limitations caused by the illness’ (Anthony, 1993) is of particular value in bipolar disorder where symptoms often persist despite treatment. So far, personal recovery has only been studied in researcher-constructed environments (interviews, focus groups). Support forum posts can serve as a complementary naturalistic data source. Objective: The overarching aim of this thesis was to study personal recovery experiences that people living with bipolar disorder have shared in online support forums through integrating health research, NLP, and corpus linguistics in a mixed methods approach within a pragmatic research paradigm, while considering ethical issues and involving people with lived experience. Methods: This mixed-methods study analysed: 1) previous qualitative evidence on personal recovery in bipolar disorder from interviews and focus groups 2) who self-reports a bipolar disorder diagnosis on the online discussion platform Reddit 3) the relationship of mood and posting in mental health-specific Reddit forums (subreddits) 4) discussions of personal recovery in bipolar disorder subreddits. Results: A systematic review of qualitative evidence resulted in the first framework for personal recovery in bipolar disorder, POETIC (Purpose & meaning, Optimism & hope, Empowerment, Tensions, Identity, Connectedness). Mainly young or middle-aged US-based adults self-report a bipolar disorder diagnosis on Reddit. Of these, those experiencing more intense emotions appear to be more likely to post in mental health support subreddits. Their personal recovery-related discussions in bipolar disorder subreddits primarily focussed on three domains: Purpose & meaning (particularly reproductive decisions, work), Connectedness (romantic relationships, social support), Empowerment (self-management, personal responsibility). Support forum data highlighted personal recovery issues that exclusively or more frequently came up online compared to previous evidence from interviews and focus groups. Conclusion: This project is the first to analyse non-reactive data on personal recovery in bipolar disorder. Indicating the key areas that people focus on in personal recovery when posting freely and the language they use provides a helpful starting point for formal and informal carers to understand the concerns of people diagnosed with bipolar disorder and to consider how best to offer support

    30th European Congress on Obesity (ECO 2023)

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    This is the abstract book of 30th European Congress on Obesity (ECO 2023

    Job Stress, Anxiety, and Depression in Mental Health Professionals: An Examination of Experienced Vicarious Trauma and Gender Differences

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    AbstractMental health professionals are susceptible to an increased risk of job stress, anxiety, and depression based on the very nature of their work. The study was quantitative, focusing on profile analysis. A two-way MANOVA was performed utilizing the independent variables of gender and vicarious trauma, and three dependent variables of job stress, anxiety, and depression. The population size was 88 mental health professionals with a Bachelor’s degree or higher who work in the behavioral health field, directly servicing clients in the capacity of supervision, case management, social work, counseling, or therapy. Participants completed four self-reported questionnaires: General Work Stress Scale (GWS), Beck Anxiety Inventory (BAI), Beck Depression Inventory-II (BDI-II), and the Trauma and Attachment Belief Scale (TABS). The results of the study indicated that there was no statistical significance of the interaction term of gender and vicarious trauma with respect to the GWS (F = 0.572, p = .45), BAI (F = 0.268, p = 0.60), or BDI-II (F = 1.270, p = .26). The results indicated there was no statistical significance in gender with respect to the GWS scale, BAI, or the BDI-II (F = 0.895, p = .347) (F = 2.870, p = 0.094) (F = 0.134, p = 0.715). In addition, the results did indicate there was a statistical significance in vicarious trauma with respect to the GWS (F = 9.79, p = 0.002), BAI (F = 18.98, p = 0.000), and BDI-II score (F = 38.2, p \u3c .01). The study outcomes may contribute to positive social change, assisting in the development, promotion, and facilitation of awareness training, educational workshops, organizational support systems, and gender-sensitive interventions for mental health professionals

    Measuring abortion stigma in Australia and Aotearoa New Zealand: the development, adaptation, and validation of multiple individual-level instruments

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    The stigmatisation of abortion is a pervasive influence on the prohibiting, threatening, and undermining of quality abortion care. In Australia and Aotearoa New Zealand (ANZ) abortion stigma impacts abortion care quality, including the experiences of accessing, providing, and supporting abortion. Although there are qualitative reports of how abortion stigma is experienced in ANZ, quantitative details are scant. This thesis aimed to address gaps in quantifying abortion stigma in ANZ. To understand how to best measure abortion stigma in ANZ, we conducted a systematic review of approaches quantifying abortion stigma globally. No instrument measuring abortion stigma in ANZ was found. The Individual Level Abortion Stigma scale (ILAS) and Abortion Providers Stigma Scale – Revised (APSS-R) have the most robust psychometric properties according to rigorous guidelines for evaluating measurement properties. The ILAS and APSS-R measure individual level abortion stigma. Through qualitative inquiry, the ILAS and APSS-R were reviewed for use in ANZ and their appropriateness for measuring stigmatisation of people, groups, and organisations supporting abortion care in ANZ. Four instruments measuring individual-level abortion stigma in ANZ were generated for: A) people who have had an abortion; B) people who provide abortion related care; C) people who publicly support abortion; and, D) groups/organisations supporting and/or providing abortion care. The four ANZ instruments were revised by representatives of the relevant end-user groups. Through an online survey, the instruments have been psychometrically tested for Australia demonstrating validity and reliability. These instruments can improve our understanding of abortion stigma and the evaluation of interventions addressing abortion stigma. Future co-designed research should explore the role of research in stigmatising abortion, revise the instruments for specific subgroups, and explore short form versions of the instruments

    Readiness for the end of Life: Importance of Death Anxiety, Assessment and Interventions in Cancer Care

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    In bisherigen Studien wird der zugrunde liegende Einfluss von Angst vor Tod und Sterben (engl. death anxiety, DA) auf psychologisches Wohlbefinden diskutiert. In der onkologischen Praxis berichten auch Krebspatient:innen zu verschiedenen Zeitpunkten im Verlaufe der Erkrankung von entsprechenden BeeintrĂ€chtigungen. ZusĂ€tzlich wurde in verschiedenen Bereichen der Einfluss von DA auf gesundheitsbezogenes Verhalten festgestellt. Neben Motivation kann DA dementsprechend auch zu Vermeidung von Verhalten fĂŒhren, welches das Erleben von DA in den Vordergrund rĂŒcken und in emotionaler Belastung resultieren könnte. So zĂ€hlen auch GesprĂ€che ĂŒber das Lebensende zu langfristig vorteilhaftem Gesundheitsverhalten, welches durch Vermeidung betroffen ist. Die vorliegende Dissertation untersucht die Relevanz von DA fĂŒr Krebspatient:innen, entwickelt Instrumente zur Erfassung von Bedarf und Bereitschaft fĂŒr GesprĂ€che ĂŒber das Lebensende und berichtet erste Ergebnisse zweier Interventionen auf die Bereitschaft, ĂŒber das Lebensende ins GesprĂ€ch zu kommen. Außerdem werden erstmals Erkenntnisse zu VerĂ€nderungen von DA, Angst, dass der Krebs wiederkommen oder sich die Prognose verschlechtern könnte (engl. fear of cancer recurrence or progression, FCR) und Dankbarkeit durch die Teilnahme an den Interventionen erfasst. Die strukturelle Beziehung zwischen DA und FCR wurde in einer ersten Studie (Study I) fĂŒr eine Stichprobe von mehrheitlich an Krebs erkrankten Frauen (N = 121) untersucht. Die ĂŒberwiegende VarianzaufklĂ€rung durch einen allgemeinen Faktor DA bestĂ€tigt die Relevanz fĂŒr Krebspatient:innen. Durch die Ergebnisse der ersten Studie verdeutlicht sich der Einfluss von DA auf Krebspatient:innen und legt einen starken Einfluss auf gesundheitsbezogenes Verhalten nahe. Die Vermeidung von GesprĂ€chen ĂŒber das Lebensende kann langfristig zu lĂ€ngerer und intensiverer medizinischer Versorgung fĂŒhren als sich das Patient:innen gewĂŒnscht hĂ€tten. Neben dem psychologischen Wohlbefinden der Patient:innen kann dies auch die Angehörigen nachhaltig beeintrĂ€chtigen. Aus diesem Grund erscheint es notwendig, entsprechend belastete Patient:innen frĂŒhzeitig zu identifizieren und GesprĂ€chsangebote zu bereiten. Eine bewĂ€hrte Möglichkeit, belastete und bedĂŒrftige Patient:innen zu erkennen, findet sich in Screening Instrumenten. Diese erleichtern es, krankenhausinterne, sowie persönliche Barrieren zu umgehen und GesprĂ€che zu initiieren. Dementsprechend wurde das erste Screening Instrument zur Erfassung von Bedarf an GesprĂ€chen ĂŒber das Lebensende mit der Möglichkeit, eine Patient:innenverfĂŒgung im GesprĂ€ch (engl. advance care planning) zu erstellen, entwickelt (Study II). Die Evaluierung resultierte in ersten VorschlĂ€gen fĂŒr Initiierungs-Kriterien. ZusĂ€tzlich wurde deutlich, dass eine Kombination von Bedarf und Bereitschaft in der Erfassung notwendig ist, da diese zeitweise unabhĂ€ngig voneinander bestehen können. WĂ€hrend ein Screening Instrument ausschließlich der Erfassung und Vermittlung dient, können Fragebögen sowohl fĂŒr die Erfassung des Status-Quo, als auch fĂŒr die Messung von VerĂ€nderungen genutzt werden. Folglich wurde ein Fragebogen entwickelt (Studie III), der die Bereitschaft fĂŒr GesprĂ€che ĂŒber das Lebensende in der Allgemeinbevölkerung (N = 349) erfassen sollte. Erste ÜbertrĂ€ge in einer Stichprobe von Krebspatient:innen (N = 84) konnten in einer weiteren Studie (N = 295) psychometrisch bestĂ€tigt werden (Study IV). Der entwickelte Fragebogen konnte daraufhin in einer vergleichenden Interventionsstudie (Study V) eingesetzt werden. Zwei Interventionen wurden fĂŒr ein online-Setting adaptiert und die Effekte in einem randomisiert-kontrolliertem Design untersucht (N = 118). Beide Interventionen waren erfolgreich in der Steigerung der Bereitschaft, an GesprĂ€chen ĂŒber das Lebensende teilzunehmen. Des Weiteren zeigten sich in SekundĂ€ranalysen erste Befunde zu Langzeit-Auswirkungen beider Interventionen auf das Erleben von DA, FCR und Dankbarkeit bei Krebspatient:innen. Insgesamt lĂ€sst sich durch die Ergebnisse dieser Dissertation a) die Relevanz von DA fĂŒr Krebspatient:innen bestĂ€tigen, b) ein erstes Screening-Instrument zur Erfassung von Bedarf und subjektiver Bereitschaft fĂŒr GesprĂ€che ĂŒber das Lebensende mit Erstellen einer Patient:innenverfĂŒgung im Krankenhaus bereitstellen, c) ein Fragebogen zur Erfassung der Bereitschaft fĂŒr GesprĂ€che am Lebensende zuverlĂ€ssig in der Allgemeinbevölkerung und fĂŒr Krebspatient:innen einsetzen und d) zwei online Interventionen zur Steigerung der Bereitschaft, ĂŒber das Lebensende zu reden nutzen, welche ebenfalls DA, FCR und Dankbarkeitserleben beeinflussen. Diese Doktorarbeit verdeutlicht nicht nur den Einfluss von DA auf verschiedene Aspekte in der Gesundheitsversorgung Krebsbetroffener. ZusĂ€tzlich wird die Bereitschaft fĂŒr Gesundheitsverhalten hervorgehoben und entsprechende Methoden sowie Interventionen zur VerĂ€nderung und Motivation von langfristig hilfreichem Verhalten bereitgestellt

    Outcome Measurement in Functional Neurological Symptom Disorder

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    Outcome measurement in Functional Neurological Symptom Disorders (FNSDs) is particularly complex. Pressing questions include what kind of measure is more accurate or meaningful, or how to achieve standardisation in a clinically heterogenous group where subjective and objective observations of the same construct may deviate. This project aimed to build on the limited knowledge of measuring outcomes in FNSDs and attempts to address one of its inherent complexities; where clinical aspects of the disorder confound the usual prioritisation of "objective" over "subjective" (or patient-rated) measures. This PhD comprised a literature review and three research studies, each using different measures to assess the current status and (potential) outcomes in FNSD patients. A narrative description of systematically identified literature on stress, distress, and arousal measures in FNSD presents an overarching profile of the relationships between subjective and objective study measures. Eighteen studies (12 functional seizures, six other FNSD) capturing 396 FNSD patients were included. Eleven reported no correlation between subjective and objective measures. Only four studies reported significant correlations (r's=-0.74-0.59, p's <0.05). The small number of studies and diverse methodologies limit the conclusions of this review. However, the review's findings underscore the importance of validating outcome measures in patients with FNSD, carefully selecting the most appropriate measures for the research objectives, and possibly combining different measures optimally to triangulate a patient's current state, level of functioning or disability. Study One used factor analysis and Rasch modelling to investigate the psychometric properties of a novel FNSD-specific resource-based measure developed as an outcome measure for psychological therapies (The sElf-efficacy, assertiveness, Social support, self-awareness and helpful thinking (EASE) questionnaire). A 4-factor model identified self-efficacy (SE), self-awareness/assertiveness (SA), social support (SS) and interpersonal illness burden (IIB) as relevant domains. Each latent scale fits the Rasch model after refinement of the category responses and removing two items. With further improvement, the EASE-F has the potential to reliably measure self-reported SE, SA, SS, and IIB constructs which were found to be meaningful to patients with FNSD. This can identify patients with strengths and deficits in these constructs, allowing therapists to individualise interventions. Recommendations for refinement of future instrument versions, using the measure in clinical practice, and research in FNSDs are discussed. Study Two sought to understand the urgent and emergency care (UEC) service usage patterns among FNSD patients. Retrospective FNSD patient data from 2013 to 2016 UEC records (including NHS 111 calls, ambulance services, A&E visits, and acute admissions) were used to compare FNSD UEC usage rates with those of the general population and to model rates before and after psychotherapy. FNSD patients displayed 23 to 60 times higher UEC usage than the general population. Emergency service usage rates showed a significant reduction in level (rate level change = -0.90--0.70, p's <0.05) immediately after psychotherapy. While this study was uncontrolled, and a causal relationship between psychotherapy and reduced UEC service use cannot be proven by its design, the decrease in pre-treatment service usage among FNSD patients mirrors treatment-related improvements in health status and functioning previously documented using self-reported outcome measures. Further research is warranted to elucidate features of emergency care service use by patients with FNSD, assess interventions' cost-effectiveness, and help to optimise limited health care resource allocation. Study Three utilised a delay discounting and emotional bias task to assess if these measures could indicate the health state of FNSD patients and to compare findings in patients with those in healthy controls. This online-based study collected data on cognitive-affective functioning, decision-making and, indirectly, emotion regulation, alongside self-reported health data and indicators of mood while completing the tasks. Delay discounting (DD) was steeper in patients with FNSD, indicating a preference for less subjectively valuable immediate rewards. Patients displayed priming and interference effects for angry and happy facial expressions, which differed from the interference effects observed in healthy controls [F(1,76) = 3.5, p = 0.037, η2p = 0.084]. Modest associations (r's =0.26-0.33, p's <0.05) were found between the DD estimates and self-reported generalised anxiety, but not current feelings of anxiety in FNSD. There were no correlations with indices for negative affective priming or interference. These measures did not show predictive ability for self-reported difficulty regulating emotions, anxiety, depression or coping in FNSD. However, the fact that the DD task and self-reported constructs failed to correlate does not invalidate this objective test. The findings underscore the importance of using a combined approach to outcome measurement. This project highlights the importance of a more comprehensive understanding of outcomes and measures that capture clinically valid and meaningful health information. Given that subjective and objective measures capture different aspects of health state or function, a combination of measurement approaches will likely produce the most comprehensive understanding of patients' current state or treatment outcome. Because of the attentional, emotional, and perceptual alterations implicated in FNSD and the variable external representations of these, the difference between objective and subjective measures represents an interesting observation in its own right. The size of the discrepancy between subjective and objective measures may provide additional valuable insights into the underlying pathology. Nonetheless, there is still a need for standardisation and consistency in FNSD outcome measurement and reporting. Several important factors, such as the timeframe of measures, the influence of confounding factors, and the variety of presentation of any aspect of the disorder (e.g., physiological, cognitive, social, or behavioural presentations of arousal/stress), will need to be considered when designing and interpreting measurements for research or clinical analysis of the patient group

    Healthy living with COPD: a telehealth self-management program for patients with chronic obstructive pulmonary disease (COPD)

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    Chronic obstructive pulmonary disease (COPD) is a common, preventable, and treatable respiratory disease that was the third leading cause of death in 2019, accounting for 3.2 million people globally. An exhaustive literature review indicates that treating COPD is a long, ongoing, multisystem process. Three central factors influencing COPD care and the resulting morbidity, including the heath care service model and access to care, professionals’ knowledge and behaviors, and each patient’s personal factors. Without proper care, shortness of breath and dyspnea progress leading to deterioration in activity tolerance and participation. The COVID-19 pandemic led to suspending or reducing outpatient and primary care services in Hong Kong and worldwide. The resulting restrictions in patient access to care lead to poor COPD management, including deterioration of quality of life, increased frequency of acute conditions, hospital readmission, and mortality. Healthy Living With COPD is a 6-month telehealth-based self-management program for people with COPD. The theoretical basis of Health Living With COPD draws from two main models: the social cognitive theory and the electronic health-enhanced chronic care model. It is designed to empower participants in managing their health and wellness by improving their access to, knowledge in, and self-efficacy for managing their health, wellness, and quality of life. The program has four essential components to generate clinical evidence: Self-management education, supervised health qigong (baduanjin), online health coaching, and virtual community. This doctoral project includes a plan for the target audience, dissemination activities, and budget to magnify the program's visibility and enhance the implementation scale

    Predicting and preventing relapse of depression in primary care: a mixed methods study

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    BackgroundMost people with depression are managed in primary care. Relapse (reemergence of depression symptoms after improvement) is common and contributes to the burden and morbidity associated with depression. There is a lack of evidence-based approaches for risk-stratifying people according to risk of relapse and for preventing relapse in primary care.MethodsIn this mixed methods study, I initially reviewed studies looking to predict relapse of depression across all settings. I then attempted to derive and validate a prognostic model to predict relapse within 6-8 months in a primary care setting, using multilevel logistic regression analysis on individual participant data from seven studies (n=1244). Concurrently, a qualitative workstream, using thematic analysis, explored the perspectives of general practitioners (GPs) and people with lived experience of depression around relapse risk and prevention in practice.ResultsThe systematic review identified eleven models; none could currently be implemented in a primary care setting. The prognostic model developed in this study had inadequate predictive performance on internal validation (Cstatistic 0.60; calibration slope 0.81). I carried out twenty-two semi-structured interviews with GPs and twenty-three with people with lived experience of depression. People with lived experience of depression and GPs reflected that a discussion around relapse would be useful but was not routinely offered. Both participant groups felt there would be benefits to relapse prevention for depression being embedded within primary care.ConclusionsWe are currently unable to accurately predict an individual’s risk ofdepression relapse. The longer-term care of people with depression ingeneral practice could be improved by enabling continuity of care, increased consistency and clarity around follow-up arrangements, and focussed discussions around relapse risk and prevention. Scalable, brief relapse prevention interventions are needed, which would require policy change and additional resource. We need to better understand existing interventions and barriers to implementation in practice
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