The Association between Deliberate Self-Harm and School Bullying Victimization and the Mediating Effect of Depressive Symptoms and Self-Stigma: A Systematic Review

Background. Identifying deliberate self-harm in the young and its relationship with bullying victimization is an important public health issue. Methods. A systematic review was performed to explore evidence of the association between deliberate self-harm and school bullying victimization in young people, as well as the mediating effect of depressive symptoms and self-stigma on this association. An advanced search in the following electronic databases was conducted in January 2018: PubMed/Medline; CINAHL; PsycINFO; PsycARTICLES; Science Direct; Scopus, and Cochrane Library. Studies that fulfilled the inclusion criteria were further assessed for their methodological integrity. The Norwegian Knowledge Centre for Health Services tool was applied for cross-sectional studies and the Critical Appraisal Skills Programme instrument for the cohort studies. Only empirical quantitative studies published in the English language in peer reviewed journals during the last decade (2007-2018) aimed at exploring the association between deliberate self-harm and school bullying victimization in community-based schoolchildren with a mean age of under 20 years were included. Results. The reviewed cross-sectional and cohort studies (22) revealed a positive association between school bullying victimization and deliberate self-harm, including nonsuicidal self-injury, which remained statistically significant when controlled for the main confounders. The mediating role of depressive symptoms in the association between deliberate self-harm and school bullying victimization was confirmed. A dose-response effect was shown in the association between nonsuicidal self-injury and school bullying victimization, whilst the mediating effect of depressive symptoms needs to be further explored. No studies were found directly exploring the mediating effect of self-stigma in the association between deliberate self-harm and bullying victimization. Conclusion. Targeted interventions aimed at eliminating victimization behaviours within the school context are therefore proposed, as well as interventions to promote healthy parenting styles for the parents of schoolchildren. Moreover, school healthcare professionals should screen students involved in bullying for self-injury, and vice versa

The Role of Perceived Organizational Support in Mental Health of Healthcare Workers During the COVID-19 Pandemic: A Cross-Sectional Study

Background: Data support the link between the coronavirus disease 2019 (COVID-19) pandemic and mental distress in healthcare workers (HCWs). Although previous studies have documented the association between organizational policies and employees' psychological and mental status, there is still scant evidence regarding the effect of perceived organizational support (POS) on mental distress in HCWs during the pandemic. Aims: The present study aimed to assess the association between POS and mental distress in HCWs during the COVID-19 pandemic. The role of POS in stress, depressive and trauma symptoms in HCWs was investigated. Methods: This was an online cross-sectional study in 424 HCWs. Data were collected during the first wave of the pandemic, and included demographics, a 7-item questionnaire assessing POS, the “Patient Health Questionnaire” assessing depressive symptoms, the “Impact of Events Scale Revised,” measuring post-traumatic stress disorder (PTSD) symptoms and the “Perceived Stress Scale” assessing perceived stress. Results: The mean POS score was 3.33 [standard deviation:1.85; range 0–7]. Younger (p < 0.001), less experienced (p < 0.001), female (p = 0.002), and non-physician HCWs (p = 0.031) were more likely to report lower self-perceived organizational support than older, male, more experienced physicians. Self-perceived organizational support was significantly and negatively associated with and self-assessed intensity of stress, depressive and traumatic symptoms, after adjusting for putative confounders (p < 0.001). Discussion: Self-perceived organizational support was significantly associated with HCWs' self-assessed mental status during the pandemic. Organizational support and mental distress should be addressed simultaneously in HCWs during the COVID-19 pandemic to increase resilience among them

PROFESSIONAL AUTONOMY, COLLABORATION WITH PHYSICIANS, AND MORAL DISTRESS AMONG EUROPEAN INTENSIVE CARE NURSES

Background Discretionary autonomy is a key factor in enhanced patient outcomes and nurses’ work satisfaction. Among nurses, insufficient autonomy can result in moral distress. Objectives To explore levels of autonomy among European critical care nurses and potential associations of autonomy with nurse-physician collaboration, moral distress, and nurses’ characteristics. Methods Descriptive correlational study of a convenience sample of 255 delegates attending a major European critical care conference in 2009. Respondents completed a self-administered questionnaire with validated scales for nurses’ autonomy, nurse-physician collaboration, and moral distress. Results The mean autonomy score (84.26; SD, 11.7; range, 18-108) and the mean composite (frequency and intensity) moral distress score (73.67; SD, 39.19; range, 0-336) were both moderate. The mean collaboration score was 47.85 (SD, 11.63; range, 7-70). Italian and Greek nurses reported significantly lower nurse-physician collaboration than did other nurses (P&lt;.001). Greek and German nurses reported significantly higher moral distress (P&lt;.001). Autonomy scores were associated with nurse-physician collaboration scores (P&lt;.001) and with a higher frequency of moral distress (P=.04). Associations were noted between autonomy and work satisfaction (P=.001). Frequency of moral distress was associated inversely with collaboration (rho=-0.339; P&lt;.001) and autonomy (rho=-0.210; P=.01) and positively with intention to quit (rho=0.257; P=.004). Conclusions In this sample of European intensive care nurses, lower autonomy was associated with increased frequency and intensity of moral distress and lower levels of nurse-physician collaboration. (American Journal of Critical Care. 2012; 21(2): e41-e52

May BDNF be implicated in the exercise-mediated regulation of inflammation? critical review and synthesis of evidence

Introduction: Exercise attenuates inflammation and enhances levels of brain-derived neurotrophic factor (BDNF). Exercise also enhances parasympathetic tone, although its role in activating the cholinergic anti-inflammatory pathway is unclear. The physiological pathways of exercise’s effect on inflammation are obscure. Aims: To critically review the evidence on the role of BDNF in the anti-inflammatory effects of exercise and its potential involvement in the cholinergic anti-inflammatory pathway. Methods: Critical literature review of studies published in MEDLINE, PubMed, CINAHL, Embase, and Cochrane databases. Results: BDNF is critically involved in the bidirectional signaling between immune and neurosensory cells and in the regulation of parasympathetic system responses. BDNF is also intricately involved in the inflammatory response: inflammation induces BDNF production, and, in turn, BDNF exerts pro- and/or anti-inflammatory effects. Although exercise modulates BDNF and its receptors in lymphocytes, data on BDNF’s immunoregulatory/anti-inflammatory effects in relation to exercise are scarce. Moreover, BDNF increases cholinergic activity and is modulated by parasympathetic system activation. However, its involvement in the cholinergic antiinflammatory pathway has not been investigated. Conclusion: Converging lines of evidence implicate BDNF in exercisemediated regulation of inflammation; however, data are insufficient to draw concrete conclusions. We suggest that there is a need to investigate BDNF as a potential modulator/mediator of the anti-inflammatory effects of exercise and of the cholinergic antiinflammatory pathway during exercise. Such research would have implications for a wide range of inflammatory diseases and for planning targeted exercise protocols

Anxiety symptoms and quality of interaction among oncology nurses: a correlational, cross-sectional study

To explore the severity of Anxiety Symptoms (AS) among Greek oncology nursing personnel, the degree of satisfaction from professional relationships, and potential association between them. Method: A descriptive cross-sectional correlational study was performed in 2 Greek Oncology Hospitals, in 72 members of nursing personnel. Hamilton Anxiety Scale was used for the assessment of AS severity and the Index of Work Satisfaction subscale "Satisfaction from Interaction" for the degree of satisfaction from professional relationships among nursing personnel (NN) and between nursing personnel and physicians (NP). Results: 11% of the sample reported clinical AS [>= 26, scale range (SR): 0-52]. Satisfaction from NN [5.10 (SD: 1.04), SR: 1-7], and NP [4.21 (SD: 0.77), SR: 1-7] professional interaction were both moderate. Statistically significantly associations were observed between clinical AS and satisfaction from NN (p= 0.014) and NP (p= 0.013) professional interaction. Conclusions: Anxiety reduction interventions and improvement of professional relationships are essentials in order to reduce oncology nurses' psychological distress

The prevalence and socio-demographic correlates of depressive symptoms among Cypriot university students: a cross-sectional descriptive co-relational study

Background: Previous findings in the literature suggest that the occurrence of depressive symptoms among university students is associated with specific socio-demographic characteristics. No related research studies have been conducted among university students in Cyprus. The current study aims to add more evidence to the literature by estimating the prevalence of clinical depressive symptoms and their association with individual, parental, academic and health-related behavior characteristics. Methods: A descriptive cross sectional study with internal comparison was performed. The occurrence of depressive symptoms was assessed by the Center for Epidemiology Studies - Depression Scale (CES-D). Clinical depressive symptoms were reported as CES-D values ≥ 20. The socio-demographic and other characteristics of the participants were assessed using a questionnaire specifically designed for the present study. Both questionnaires were completed anonymously and voluntarily by 1,500 students (29.9% males and 70.1% females, response rate 85%). Results: The prevalence of clinical depressive symptoms [CES-D score ≥ 20] was 27.9%. Among other, strong positive associations with clinical depressive symptoms were observed with a) positive personal and family history of depression (OR 2.85, 95% CI: 1.77 – 4.60), b) self -assessed poor physical and mental health (OR 11.30, 95% CI: 7.05 – 18.08). Moreover, students with learning disabilities, as well as those who were dissatisfied with the major under study, the quality of the educational system, the living arrangement, their social life and the available university facilities (OR 2.73, 95% CI: 2.00 – 3.72) were more likely to report clinical depressive symptoms. Conclusions: The results of the present study highlight specific individual, parental, academic and health-related behavior characteristics of the students associated with the presence of depressive symptoms. Thus, targeted interventions considering the socio-demographic profile of vulnerable students for early recognition and manifestation of mental health disturbances may be designed. Moreover, the relatively high prevalence of clinical symptoms of depression within this particular cultural context may warrant further investigation in longitudinal studies

Investigation of stressful life events as significant predictors on depressive symptoms among Cypriot University students: a cross-sectional descriptive correlational study.

Background: Previous findings suggest that stressful life events have a causal relationship with depressive symptoms. However, to date little is known concerning the contribution of the number and severity of recent stressful life events on the prevalence of depressive symptoms among university students. The aim of this study was to investigate the prevalence of depressive symptoms and its association with the number and the severity of self-reported stressful life events among university students in Cyprus. Methods: A descriptive correlational design with cross sectional comparison was used. The CES-D scale was applied for the assessment of depressive symptoms and the LESS instrument for stressful life events. Both scales were completed anonymously and voluntarily by 1.500 students (response rate 85%). Results: The prevalence of mild to moderate depressive symptoms [CES-D score between 16 and 21] and of clinically significant depressive symptoms [CES-D score ≥ 22] were 18.8% and 25.3% respectively. There were statistically significant differences in clinically significant depressive symptoms by gender, with higher rates among women (x2 = 8.53, df = 1, p = 0.003). Higher scores on the LESS scale were associated with more frequent reports of clinical depressive symptoms (x2 = 70.63, df = 4, p < 0.001). Similarly, an association was found between the number of life events and clinical depressive symptoms (x2 = 40.06, df = 4, p < 0.001). Logistic regression analysis after adjusting for socio-demographic characteristics confirmed that the responders who reported a high number (n = 12–21) of stressful life events during the previous year (OR = 2.64 95% CI: 1.02, 6.83) and a severe degree of stress due to these events (total LESS score > 351, OR = 3.03 95% CI: 1.66, 5.39) were more likely to manifest clinical depressive symptoms. Conclusions: The high frequency of occurrence of depressive symptoms among Cypriot university students, as well as the strong association with stressful life events, highlights the need for psychological empowerment strategies towards students by institutional counseling services