The role of self-compassion in buffering symptoms of depression in the general population

Self-compassion, typically operationalized as the total score of the Self-Compassion Scale (SCS; Neff, 2003b), has been shown to be related to increased psychological well-being and lower depression in students of the social sciences, users of psychology websites and psychotherapy patients. The current study builds on the existing literature by examining the link between self-compassion and depressive symptomatology in a sample representative of the German general population (n = 2,404). The SCS subscales of self-judgment, isolation, and over-identification, and the “self-coldness”, composite score, which encompass these three negative subscales, consistently differed between subsamples of individuals without any depressive symptoms, with any depressive syndromes, and with major depressive disorder. The contribution of the positive SCS subscales of self-kindness, common humanity, and mindfulness to the variance in depressive symptomatology was almost negligible. However, when combined to a “self-compassion composite”, the positive SCS subscales significantly moderated the relationship between “self-coldness” and depressive symptoms in the general population. This speaks for self-compassion having the potential to buffer self-coldness related to depression—providing an argument for interventions that foster self-caring, kind, and forgiving attitudes towards oneself

Prototyping the implementation of a suicide prevention protocol in primary care settings using PDSA cycles: a mixed method study

IntroductionIn Canada, approximately 4,500 individuals die by suicide annually. Approximately 45% of suicide decedents had contact with their primary care provider within the month prior to their death. Current versus never smokers have an 81% increased risk of death by suicide. Those who smoke have additional risks for suicide such as depression, chronic pain, alcohol, and other substance use. They are more likely to experience adverse social determinants of health. Taken together, this suggests that smoking cessation programs in primary care could be facilitators of suicide prevention, but this has not been studied.Study objectivesThe objectives of the study are to understand barriers/facilitators to implementing a suicide prevention protocol within a smoking cessation program (STOP program), which is deployed by an academic mental health and addiction treatment hospital in primary care clinics and to develop and test implementation strategies to facilitate the uptake of suicide screening and assessment in primary care clinics across Ontario.MethodsThe study employed a three-phase sequential mixed-method design. Phase 1: Conducted interviews guided by the Consolidated Framework for Implementation Research exploring barriers to implementing a suicide prevention protocol. Phase 2: Performed consensus discussions to map barriers to implementation strategies using the Expert Recommendations for Implementing Change tool and rank barriers by relevance. Phase 3: Evaluated the feasibility and acceptability of implementation strategies using Plan Do Study Act cycles.ResultsEleven healthcare providers and four research assistants identified lack of training and the need of better educational materials as implementation barriers. Participants endorsed and tested the top three ranked implementation strategies, namely, a webinar, adding a preamble before depression survey questions, and an infographic. After participating in the webinar and reviewing the educational materials, all participants endorsed the three strategies as acceptable/very acceptable and feasible/very feasible.ConclusionAlthough there are barriers to implementing a suicide prevention protocol within primary care, it is possible to overcome them with strategies deemed both acceptable and feasible. These results offer promising practice solutions to implement a suicide prevention protocol in smoking cessation programs delivered in primary care settings. Future efforts should track implementation of these strategies and measure outcomes, including provider confidence, self-efficacy, and knowledge, and patient outcomes

Secondary prevention of melanoma via skin self-examination among at-risk individuals: An investigation of primary and secondary sources of evidence

Manuscripts 1 and 2 pertain to a systematic review of 12 randomized controlled trials (RCT) of behavioural interventions with individuals at increased risk for melanoma. Eligible behavioural interventions were those that included materials or teaching sessions on how individuals can check their skin for problematic lesions and how /when to ask for medical evaluation of lesions. Manuscript 1 aimed to summarize the various conceptualizations (definitions and operationalizations) of skin self-examination behaviour (or SSE) , as it was used in the identified RCTs. The study found that SSE behaviour was assessed primarily via single items and there were variations across trials in how the items were phrased, scored, and used in analyses. We also found that there is only minimal evidence supporting the validity and reliability of the items used to assess SSE behaviour. Manuscript 2 aimed to evaluate the effect of behavioural interventions on three outcomes, melanoma-related mortality, melanoma early detection, and preventive health behaviours, including skin self-examination (SSE), partner-assisted skin examination (PASE), and clinician-administered skin examination (CSE). Early detection of melanoma was conceptualized as thin (early stage, 0-II) versus thick (advanced stage; III-IV) lesions at diagnosis. This study found that currently there are no behavioural trials that evaluate melanoma-related mortality or early detection of melanoma. The 12 eligible trials evaluated the effect of interventions on preventive behaviours: SSE, PASE, and CSE. The study found some methodological heterogeneity between the trials and the risk of bias was unclear for most trials, due to incomplete reporting. Meta-analysis including studies with comparable intervention components (i.e., provision of tailored information on personal risk and recommendations on how to perform SSE) and similar methods of assessing SSE (i.e., percentage of individuals who performed SSE in the 4-6 months post the intervention) found a small significant effect on SSE; the effect on PASE and CSE was not significant. Manuscript 3, which was an observational study with longitudinal follow-up, investigated the short- and long-term predictors of SSE in a sample of melanoma survivors, who are at increased risk for subsequent melanomas. All of the participants recruited in the study were administered a brief educational session on SSE, i.e., how to check their skin for problematic, potentially cancerous lesions. Predictors of SSE were assessed at 3, 12, and 24 months post the educational session. The study found that SSE behaviour decreased over time, from 3 month to 24 months after the educational session. Intentions to perform SSE predicted the comprehensiveness of the skin exam (i.e., checking the entire body, comprised of 5 body parts) at both short- and long-term follow-ups. Self-efficacy for SSE predicted optimal SSE (i.e., checking of the entire body on a monthly basis, as recommended during the educational session and as per current guidelines of care for melanoma survivors) at both short- and long-term follow-ups.Les manuscrits 1 et 2 portent sur une revue systématique d'essais contrôlés randomisés (ECR) d'interventions comportementales auprès d'individus présentant un risque accru de mélanome. Les interventions comportementales éligibles devaient inclure des matériaux ou des séances d'enseignement pour montrer aux individus comment vérifier leur peau pour des lésions problématiques et comment/quand demander un avis médical pour les lésions. Le manuscrit 1 avait pour but de synthétiser les différentes conceptualisations (définitions opérationnelles) des comportements d'auto-examen de la peau utilisées dans les ECR identifiés. L'étude a révélé que les comportements d'auto-examen de la peau était évaluée principalement avec des items singuliers et qu'il y avait des différences dans la façon dont ces items étaient formulés, scorer et utilisés dans les analyses. Nous avons également trouvé peu de preuves pour appuyer la validité et de la fidélité des items utilisés pour évaluer les comportements d'auto-examen de la peau. Le manuscrit 2 visait a évalué l'effet des interventions comportementales sur trois résultats : la mortalité liée au mélanome, la détection précoce du mélanome, et les comportements préventifs pour la santé, incluant l'auto-examen de la peau, l'examen de la peau assisté par un partenaire, et l'examen de la peau effectué par un médecin. La détection précoce du mélanome a été conceptualisée comme étant des lésions mince (stade précoce, 0-II) versus épais (stade avancé, II-IV) lors du diagnostic. Cette étude a révélé qu'il n'existe présentement aucun essai comportemental évaluant la mortalité liée au mélanome ou la détection précoce du mélanome. Les 12 ECR éligibles ont évalués l'effet des interventions sur les comportements de prévention : l'auto-examen de la peau, l'examen de la peau assisté par un partenaire, et l'examen de la peau effectué par un médecin. L'étude a identifié de l'hétérogénéité méthodologique entre les ECR et le risque de biais était vague dû au reportage incomplet. Une méta-analyse incluant des études avec des interventions comparables (c.-à-d. la provision d'information personnalisé sur le risque et de recommandations sur comment effectué l'auto-examen de la peau) et des méthodes similaires pour évaluer l'auto-examen de la peau (c.-à-d. le pourcentage d'individus qui ont effectué des auto-examens de la peau dans les 4 à 6 mois suivant l'intervention) a trouvé petit effet significatif sur l'auto-examen de la peau. L'effet sur l'examen de la peau assisté par un partenaire et l'examen de la peau effectué par un médecin n'était pas significatif. Le manuscrit 3, une étude observationnelle avec suivi longitudinal, a examiné les facteurs prédictifs à court et à long terme de l'auto-examen dans un échantillon de patients atteints de mélanome ayant un risque plus élevé pour des mélanomes futurs. Tous les participants recrutés pour l'étude ont reçu une brève séance éducative sur l'auto-examen de la peau, c.-à-d. les méthodes pour identifier des lésions problématiques et potentiellement cancéreuses sur la peau. Les indicateurs d'auto-examen de la peau ont été évalués a 3, 12, et 24 mois suivant la séance éducative. L'étude a révélé que les comportements d'auto-examen diminuent avec le temps, de 3 à 24 mois après la session éducative. L'intention de procéder à l'auto-examen de la peau prédit l'exhaustivité de l'examen cutané (c.-à-d. la vérification des 5 parties du corps composant l'ensemble du corps) lors de suivis à court et à long terme. L'auto-efficacité pour l'auto-examen de la peau prédit une fréquence d'auto-examen optimal (c.-à-d. une vérification mensuelle de l'ensemble du corps, comme recommandé par la séance éducative et par les guides pratiques pour le soin des survivant du mélanome) lors d'un suivi à court et à long terme

Barriers and facilitators of adherence to social distancing recommendations during COVID-19 among a large international sample of adults.

BackgroundSocial distancing measures (e.g., avoiding travel, limiting physical contact with people outside of one's household, and maintaining a 1 or 2-metre distance between self and others when in public, depending on the country) are the primary strategies used to prevent transmission of the SARS-Cov-2 virus that causes COVID-19. Given that there is no effective treatment or vaccine for COVID-19, it is important to identify barriers and facilitators to adherence to social distancing to inform ongoing and future public health campaigns.MethodThis cross-sectional study was conducted online with a convenience sample of English-speaking adults. The survey was administered over the course of three weeks (March 30 -April 16, 2020) when social distancing measures were well-enforced in North America and Europe. Participants were asked to complete measures assessing socio-demographic characteristics, psychological constructs, including motivations to engage in social distancing, prosocial attitudes, distress, and social distancing behaviors. Descriptive (mean, standard deviation, percentage) and inferential statistics (logistic regression) were used to describes endorsement rates for various motivations, rates of adherence to social distancing recommendations, and predictors of adherence.ResultsData were collected from 2013 adults living primarily in North America and Europe. Most frequently endorsed motivations to engage in social distancing (or facilitators) included "I want to protect others" (86%), "I want to protect myself" (84%), and I feel a sense of responsibility to protect our community" (84%). Most frequently endorsed motivations against social distancing (or barriers) included "There are many people walking on the streets in my area" (31%), "I have friends or family who need me to run errands for them" (25%), "I don't trust the messages my government provides about the pandemic" (13%), and "I feel stressed when I am alone or in isolation" (13%). Adherence to social distancing recommendations ranged from 45% for "working from home or remotely" to 90% for "avoiding crowded places/non-essential travel", with men and younger individuals (18-24 years) showing lower adherence compared to women and older individuals.ConclusionThis study found that adherence to social distancing recommendations vary depending on the behaviour, with none of the surveyed behaviours showing perfect adherence. Strongest facilitators included wanting to protect the self, feeling a responsibility to protect the community, and being able to work/study remotely; strongest barriers included having friends or family who needed help with running errands and socializing in order to avoid feeling lonely. Future interventions to improve adherence to social distancing measures should couple individual-level strategies targeting key barriers to social distancing identified herein, with effective institutional measures and public health interventions. Public health campaigns should continue to highlight compassionate attitudes towards social distancing