Ensaios clínicos de intervenções baseadas em mindfulness (IBM) para promoção da saúde em populações vulneráveis : policiais e imigrantes

As Intervenções Baseadas em Mindfulness (IBMs) são uma estratégia importante para promoção da saúde, no entanto, a escassez de dados de efetividade entre algumas populações representam uma limitação deste campo de pesquisa. Policiais e imigrantes são duas populações vulneráveis que sofrem de disparidades significativas em saúde e uma variedade de fatores de estresse, apresentando alto risco para transtornos de saúde mental, como depressão e ansiedade, bem como para comportamentos nocivos em saúde e pior qualidade de vida. Esta tese tem como objetivo geral avaliar a efetividade das IBMs para promoção da saúde nas duas populações supracitadas e é composta por dois estudos (#Artigo 1 e #Artigo 2). No primeiro, foi conduzido um ensaio clínico randomizado (ECR) e multicêntrico com três pontos de avaliação (pré-intervenção, pós-intervenção e seguimento de seis meses) em que policiais brasileiros de Porto Alegre e São Paulo foram randomizados para o Programa Mindfulness-Based Health Promotion (MBHP) (n=88) ou para Lista de Espera (n=82) e os desfechos de sintomas de depressão e ansiedade, qualidade de vida (QV) e religiosidade foram avaliados, bem como a viabilidade do MBHP e os mecanismos de mudança. O segundo estudo avaliou a viabilidade, aceitabilidade, aspectos culturais e a efetividade preliminar do Programa Mindfulness Training for Primary Care (MTPC)-Português em desfechos de saúde mental (sintomas de depressão e ansiedade), autorregulação (regulação emocional, mindfulness, autocompaixão, consciência interoceptiva) e para início de mudança de comportamentos em saúde entre imigrantes de Língua Portuguesa na área de Boston (n = 30), através de um ensaio clínico aberto não-controlado com avaliações pré- e pós- intervenção. O Estudo #1 demonstrou que, ao ser comparado com o grupo da Lista de Espera, o grupo MBHP exibiu melhora na QV e em sintomas de depressão e ansiedade tanto na avaliação de pós-intervenção (QV d=0,69 a 1,01; depressão d=0,97; ansiedade d=0,73) quanto no seguimento de seis meses (QV d=0,41 a 0,74; depressão; d=0,60; ansiedade d=0,51), além de aumentar a religiosidade não organizacional na pós-intervenção (d=0,3; tamanho do efeito pequeno). O tamanho do efeito considerando pós-intervenção e seguimento de 6 meses variou entre médio e grande para sintomas de depressão e ansiedade e entre pequeno e grande para qualidade de vida. Mudanças na autocompaixão mediaram a relação entre o grupo e as diferenças pré e pós-intervenção para todos os domínios e facetas de QV. Além disso, mindfulness e espiritualidade moderaram o efeito do grupo na faceta de saúde geral da QV na pós-intervenção. Os resultados do #Estudo 2 demonstraram que os pacientes exibiram reduções nos sintomas de depressão (d=0,67; p <0,001; tamanho do efeito médio a grande) e ansiedade (d=0,48; p=0,011; tamanho do efeito médio), bem como melhora da regulação emocional (d =0,45; p=0,009; tamanho do efeito pequeno a médio) e, entre aqueles que responderam os questionários, 50% começaram uma mudança de comportamento em saúde por meio do início do plano de ação. Todos os participantes que responderam aos questionários recomendariam o MTPC-Português a um amigo, acharam o Programa útil e classificaram o Programa como “muito bom” ou “excelente”. Além disso, 93% dos pacientes participariam novamente. Os participantes e facilitadores forneceram “feedback” para refinar a responsividade cultural do MTPC-português em relação a linguagem dos materiais, local, tempo, comida e aspectos comunitários. demonstrando, dentro do nosso conhecimento, a primeira evidência empírica baseada em um ECR que, entre policiais, uma IBM de 8 semanas: (1) reduz sintomas de depressão, (2) diminui sintomas de ansiedade, (3) melhora todos os domínios e facetas de QV, (4) mantém os benefícios em depressão, ansiedade e QV após seis meses, (5) aumenta a religiosidade não-organizacional, (6) apresenta autocompaixão como uma variável mediadora para a melhoria em todos domínios e facetas da QV, (7) exibe mindfulness e espiritualidade como variáveis moderadoras para o incremento na faceta de saúde geral da QV na pós-intervenção, (8) é viável no ambiente policial brasileiro (Estudo #1); e também apresenta a primeira evidência de que um IBM de 8 semanas é (9) viável, (10) aceitável, (11) culturalmente apropriada, e pode diminuir (12) sintomas de depressão, (13) sintomas de ansiedade, (14) facilitar a mudança de comportamentos em saúde e (15) melhorar a regulação emocional entre imigrantes de Língua Portuguesa (Estudo #2). Os resultados desta tese são valiosos, expandindo o corpo de evidência dos benefícios das IBM ao incluir duas populações vulneráveis e oferecendo “insights” sobre como as IBM funcionam, possíveis adaptações e na sua disseminação para o mundo real de policiais e imigrantes.Mindfulness-Based Interventions (MBIs) represent an important strategy in health promotion, nonetheless, the paucity of effectiveness data among some populations is a limitation in the research field. Police officers and immigrants are two vulnerable populations which experience significant health disparities and a variety of stressors, being at high-risk for mental health disorders such as depression and anxiety, poor health behaviors and quality of life impairment. The general objective of this thesis is to evaluate MBIs effectiveness regarding health promotion among above-mentioned population and it is composed by two studies (#Article 1 and #Article 2). In the first one, a multicenter randomized controlled trial (RCT) with three assessment points was conducted (baseline, post-intervention and six-month follow-up). Brazilian police officers from Porto Alegre and São Paulo were randomized to Mindfulness-Based Health Promotion (MBHP) (n=88) or a Waiting List group (n=82). Depression and anxiety symptoms, quality of life (QOL) and religiosity outcomes were evaluated, as well as MBHP feasibility and mechanisms of change. The second study assessed the feasibility, acceptability, cultural aspects, and the preliminary effectiveness of Mindfulness Training for Primary Care (MTPC)-Portuguese on mental health outcomes (depression and anxiety symptoms), self-regulation (emotional regulation, mindfulness, self-compassion, interoceptive awareness) and initiation of health behavior change among Portuguese-speaking immigrants in the Boston area (n=30) using a pre-post single-group open trial design. Study #1 showed that, when compared to the Waiting List group, MBHP group exhibited greater improvements in QOL, depression and anxiety symptoms at both post-intervention (QOL d=.69 36 to 1.01; depression d=.97; anxiety d=.73) and six-month follow-up (QOL d=.41 to .74; depression; d=.60; anxiety d=.51); in addition to increasing non-organizational religiosity at post-intervention 38 (d=.31; small effect size). Effect sizes considering post-intervention and six-month follow-up ranged from medium to large for depression and anxiety symptoms and from small to large for quality of life. Changes on self-compassion mediated the relationship between group and pre-to-post changes for all QOL domains and facets. Group effect on QOL overall health facet at post-intervention was moderated by mindfulness trait and spirituality changes. Results from Study #2 demonstrated that patients exhibited reductions in depression (d=0.67; p<0.001; medium-to-large effect size) and anxiety (d=0.48; p=0.011; medium effect size) symptoms, as well as enhanced emotional regulation (d=0.45; p=0.009; small-to-medium effect size) and among survey finishers, 50% started health behavior change through action plan initiation. All survey finishers would recommend MTPC-Portuguese to a friend, found the program helpful, and rated the overall program as “very good” or “excellent”. In addition, 93% of the participants would participate again. Participants and facilitators provided feedback to refine MTPC-Portuguese culturally-responsiveness regarding materials language, settings, time, food, and community-building. This thesis offers relevant contributions to the literature showing, to the extent of our knowledge, the first empirical evidence grounded on a RCT that among police officers an 8-week MBI: (1) reduces depression symptoms, (2) decreases anxiety symptoms, (3) enhances all QOL domains and facets, (4) maintains depression, anxiety and QOL benefits after six months, (5) increases non-organizational religiosity, (6) has self-compassion as a mediating variable for improvement in all QOL domains and facets, (7) shows that mindfulness and spirituality are moderating variables for general health QOL facet improvement at post-intervention; (8) is feasible in the Brazilian police environment (Study #1); and also the first evidence that an 8-week MBI is (9) feasible, (10), acceptable, (11) culturally appropriate, and might decrease (12) depression and (13) anxiety symptoms, (14) facilitate health behavior change, and (15) improve emotional regulation among Portuguese-speaking immigrants (Study #2). Findings from this thesis are valuable in the sense that they expand the body of research of MBIs benefits to include two vulnerable populations, and offer insights on how MBIs work, are suited and can be disseminated in real word settings among police officers and immigrants

Mindfulness training improves quality of life and reduces depression and anxiety symptoms among police officers : results from the POLICE study : a multicenter randomized controlled trial

Background: Police officers’ high-stress levels and its deleterious consequences are raising awareness to an epidemic of mental health problems and quality of life (QoL) impairment. There is a growing evidence that mindfulness-based interventions are efficacious to promote mental health and well-being among high-stress occupations. Methods: The POLICE study is amulticenter randomized controlled trial (RCT) with three assessment points (baseline, post-intervention, and 6-month follow-up) where police officers were randomized to mindfulness-based health promotion (MBHP) (n = 88) or a waiting list (n = 82). This article focuses on QoL, depression and anxiety symptoms, and religiosity outcomes. Mechanisms of change and MBHP feasibility were evaluated. Results: Significant group × time interaction was found for QoL, depression and anxiety symptoms, and non-organizational religiosity. Between-group analysis showed that MBHP group exhibited greater improvements in QoL, and depression and anxiety symptoms at both post-intervention (QoL d = 0.69 to 1.01; depression d = 0.97; anxiety d = 0.73) and 6-month follow-up (QoL d = 0.41 to 0.74; depression d = 0.60; anxiety d = 0.51), in addition to increasing non-organizational religiosity at post-intervention (d = 0.31). Changes on self-compassion mediated the relationship between group and pre-to-post changes for all QoL domains and facets. Group effect on QoL overall health facet at post-intervention was moderated by mindfulness trait and spirituality changes. Conclusion: MBHP is feasible and efficacious to improve QoL, and depression and anxiety symptoms among Brazilian officers. Results were maintained after 6 months. MBHP increased non-organizational religiosity, although the effect was not sustained 6 months later. To our knowledge, this is the first mindfulness-based intervention RCT to empirically demonstrate these effects among police officers. Self-compassion, mindfulness trait, and spirituality mechanisms of change are examined

Mindfulness and Behavior Change

Initiating and maintaining behavior change is key to the prevention and treatment of most preventable chronic medical and psychiatric illnesses. The cultivation of mindfulness, involving acceptance and nonjudgment of present-moment experience, often results in transformative health behavior change. Neural systems involved in motivation and learning have an important role to play. A theoretical model of mindfulness that integrates these mechanisms with the cognitive, emotional, and self-related processes commonly described, while applying an integrated model to health behavior change, is needed. This integrative review (1) defines mindfulness and describes the mindfulness-based intervention movement, (2) synthesizes the neuroscience of mindfulness and integrates motivation and learning mechanisms within a mindful self-regulation model for understanding the complex effects of mindfulness on behavior change, and (3) synthesizes current clinical research evaluating the effects of mindfulness-based interventions targeting health behaviors relevant to psychiatric care. The review provides insight into the limitations of current research and proposes potential mechanisms to be tested in future research and targeted in clinical practice to enhance the impact of mindfulness on behavior change

Mindfulness training for primary care for portuguese-speaking immigrants : a pilot study

Background: Portuguese-speaking immigrants are a growing underserved population in the Unites States who experience high levels of psychological distress and increased vulnerability to mental health disorders such as depression and anxiety. Current evidence shows that mindfulness-based interventions (MBIs) are effective to promote physical and mental health among educated English speakers; nonetheless, the lack of diversity in the mindfulness literature is a considerable limitation. To our knowledge, the feasibility and acceptability of MBIs among Portuguese-speaking immigrants have not yet been investigated. Methods: This single-arm pilot study (N = 30) explored the feasibility, acceptability, and cultural aspects of Mindfulness Training for Primary Care (MTPC)-Portuguese among Portuguese-speaking immigrants in the Boston area. MTPC is an 8-week, primary care-adapted, referral-based, insurance-reimbursable, trauma-informed MBI that is fully integrated into a healthcare system. The study also examined intervention preliminary effectiveness on mental health outcomes (depression and anxiety symptoms) and self-regulation (emotional regulation, mindfulness, self-compassion, interoceptive awareness), and initiation of health behavior was explored. Results: Primary care providers referred 129 patients from 2018 to 2020. Main DSM-5 primary diagnoses were depression (76.3%) and anxiety disorders (6.7%). Participants (N = 30) attended a mean of 6.1 (SD 1.92) sessions and reported a mean of 213.7 (SD = 124.3) min of practice per week. All survey finishers would recommend the program to a friend, found the program helpful, and rated the overall program as “very good” or “excellent,” and 93% would participate again, with satisfaction mean scores between 4.6 and 5 (Likert scale 0– 5). Participants and group leaders provided feedback to refine MTPC-Portuguese culturally responsiveness regarding materials language, settings, time, food, and community building. Patients exhibited reductions in depression (d = 0.67; p < 0.001) and anxiety (d = 0.48; p = 0.011) symptoms, as well as enhanced emotional regulation (d = 0.45; p = 0.009), and among survey finishers, 50% initiated health behavior change through action plan initiation. Conclusion: This pilot study suggests that MTPC-Portuguese is feasible, acceptable, and culturally appropriate among Portuguese-speaking patients in the Boston area. Furthermore, the intervention might potentially decrease depression and anxiety symptoms, facilitate health behavior change, and improve emotional regulation. MTPC-Portuguese investigation with larger samples in controlled studies is warranted to support its dissemination and implementation in the healthcare system

Rhipicephalus sanguineus (ACARI: IXODIDAE) BITING A HUMAN BEING IN PORTOALEGRE CITY, RIO GRANDE DO SUL, BRAZIL

We report the finding of a female brown dog tick, Rhipicephalus sanguineus (Acari: Ixodidae) on the scalp of a male patient inPorto Alegre, Rio Grande do Sul, Brazil. Human parasitism by this tick is rare and has seldomly been reported in the literature, despite its recognized importance since it can act as a vector of Rickettsia rickettsii, the agent of spotted fever

Study protocol of a multicenter randomized controlled trial of mindfulness training to reduce burnout and promote quality of life in police officers: the POLICE study

Abstract Background Police officers experience a high degree of chronic stress. Policing ranks among the highest professions in terms of disease and accident rates. Mental health is particularly impacted, evidenced by elevated rates of burnout, anxiety and depression, and poorer quality of life than the general public. Mindfulness training has been shown to reduce stress, anxiety, burnout and promote quality of life in a variety of settings, although its efficacy in this context has yet to be systematically evaluated. Therefore, this trial will investigate the efficacy of a mindfulness-based intervention versus a waitlist control in improving quality of life and reducing negative mental health symptoms in police officers. Methods This multicenter randomized controlled trial has three assessment points: baseline, post-intervention, and six-month follow-up. Active police officers (n = 160) will be randomized to Mindfulness-Based Health Promotion (MBHP) or waitlist control group at two Brazilian major cities: Porto Alegre and São Paulo. The primary outcomes are burnout symptoms and quality of life. Consistent with the MBHP conceptual model, assessed secondary outcomes include perceived stress, anxiety and depression symptoms, and the potential mechanisms of resilience, mindfulness, decentering, self-compassion, spirituality, and religiosity. Discussion Findings from this study will inform and guide future research, practice, and policy regarding police offer health and quality of life in Brazil and globally. Trial registration ClinicalTrials.gov NCT03114605. Retrospectively registered on March 21, 2017