25,753 research outputs found

    O tsunami causado pela COVID-19 na saĂșde mental : Perturbação de Stress PĂłs-TraumĂĄtico (PTSD) : artigo de revisĂŁo

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    Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2022A Dezembro de 2019, em Wuhan na China, surge a COVID-19, uma doença respiratĂłria aguda grave causada pelo vĂ­rus SARS-CoV-2. Devido Ă  sua rĂĄpida transmissibilidade, a 11 de março de 2020, a World Health Organization (WHO) declarou a COVID-19 uma pandemia mundial. A proliferação de surtos infeciosos para os quais a ciĂȘncia nĂŁo tem respostas concretas, nem capacidade de resposta atravĂ©s de tratamentos mĂ©dicos e/ou vacinas eficazes, contribui para o aumento de sentimentos de medo e ansiedade, levando a impactos significativos quer na saĂșde fĂ­sica quer na saĂșde mental da população. ExperiĂȘncias traumĂĄticas, como uma pandemia mundial, podem desencadear perturbaçÔes de stress pĂłs-traumĂĄtico, que se caracterizam por um estado de desequilĂ­brio psicolĂłgico que afeta direta ou indiretamente o indivĂ­duo. Os objetivos desta revisĂŁo sĂŁo abordar os critĂ©rios da perturbação de stress pĂłs-traumĂĄtico, os principais fatores de stress associados Ă  atual pandemia COVID-19, fatores de risco e protetores para a PTSD, e por fim, estratĂ©gias desenvolvidas e a desenvolver para combater este problema de saĂșde mental.In December 2019, in Wuhan, COVID-19 appers, a severe acute respiratory disease, caused by SARS-CoV 2 virus. Due to its rapid transmissibility, on March 11, 2020, the WHO declared COVID-19 a worldwide pandemic. The proliferation of infectious outbreaks for which science has no concret answers, nor the ability to respond through medical treatments and/or effective vacines, contributes to the increase in feelings or fear and anxiety, leading to significant impacts on both physical and mental health. Traumatic experiences, such as a global pandemic, can trigger post-traumatic stress disorders, which are characterised by a state of psychological imbalance that directly or indirectly affects the individual. The objectives of this review are to address the criteria of post-traumatic stress disorder, the main stress factos associated with the current COVID-19 pandemic, risk and protective factos for PTSD, and finally, strategies developed and to be developed to combat this mental health problem

    Maternal, partner, and infant health outcomes following traumatic childbirth

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    Aims: This thesis aimed to address important gaps in the scientific literature regarding the aftermath of traumatic childbirth on maternal, partner, and infant health outcomes, by 1. testing the effects of an early maternal behavioural intervention (visuospatial task procedure) on family health outcomes, via a randomised controlled trial protocol (Study 1); 2. validating the Lausanne Infant Crying Stress Paradigm (LICSP) as a standardised stress paradigm within a maternity context and comparing psychophysiological stress responses of mothers at low vs. high risk of childbirth-related post-traumatic stress disorder (CB-PTSD), via an experimental cross-sectional study (Study 2); and 3. studying associations between maternal mental health symptoms (i.e., postpartum depression, anxiety, and CB-PTSD) and infant sleep (i.e., night waking and nocturnal sleep duration), via an online cross-sectional study (Study 3). Methods: For Study 1, the primary outcome (i.e., maternal CB-PTSD symptoms at 6 weeks postpartum) will be compared within experimental and attention-placebo control participants (n = 144) following an emergency caesarean section. Secondary and other outcomes consist of other maternal and partner psychological and physiological outcomes, parent-infant interaction, and infant developmental and physiological outcomes. For Study 2, we examined the time and group effects on psychophysiological stress reactivity (i.e., salivary cortisol, heart rate variability, and perceived stress) of mothers at low vs. high risk of CB-PTSD (n = 52) in response to the LICSP. The low-risk participants were not traumatised after birth whereas the high-risk mothers were traumatised after birth, based on two screening questions assessing the maternal perceived life threat for herself and/or the infant. Study 3 collected maternal mental health and infant sleep data in French-speaking mothers of 3-to-12-month-olds (n = 410), and mediation and moderation effects were tested. All study outcomes were measured via standardised self-report questionnaires, clinical interviews, physiological measures, or behavioural testing. Results: Data collection of Study 1 is still ongoing. Study 2 validated the LICSP (time effect) and mothers at CB-PTSD risk showed altered psychophysiological stress responses compared to low-risk mothers, when taking into account the infant perceived life threat during childbirth (group effect). Study 3 found negative associations between maternal mental health symptoms and infant nocturnal sleep duration. Only postpartum depression and anxiety symptoms were associated with infant night waking. Among the three data-driven extracted maternal mental health symptom profiles (i.e., the depressive, anxious, and birth trauma profiles), only the associations between the depressive or anxious profiles and infant sleep were mediated by maternal perception of infant temperament at some particular infant ages and maternal educational levels (moderator effects). The method to fall asleep did not mediate the maternal mental health symptom profiles to infant sleep associations. Clinical implications: If results of Study 1 are conclusive, current clinical guidelines for traumatised mothers will change. Results of Study 2 form the first steps in identifying mothers susceptible to develop CB-PTSD with their early stress responses, leading to important clinical implications for early screening of mothers who need professional support. Study 3‘s findings show the relevance of considering maternal symptomatology and infant perception when infant sleep problems are reported. This thesis therefore supports the importance of considering mothers, partners, and their infants as interconnected components of a system. Future research should extend the focus of maternal mental health to the family context (i.e., both parents and their infant). ---- Objectifs: Cette thĂšse visait Ă  combler certaines lacunes de la littĂ©rature concernant les consĂ©quences de l’accouchement traumatique sur la santĂ© des mĂšres, des partenaires, et des bĂ©bĂ©s, 1. en testant les effets d'une intervention comportementale prĂ©coce (procĂ©dure de tĂąche visuospatiale) destinĂ©e aux mĂšres, sur la santĂ© de la famille par le biais d’un protocole d’essai randomisĂ© contrĂŽlĂ© (Ă©tude 1) ; 2. en validant le Lausanne Infant Crying Stress Paradigm (LICSP) comme paradigme de stress standardisĂ© pour le postpartum prĂ©coce, et en comparant la rĂ©activitĂ© psychophysiologique au stress des mĂšres Ă  faible vs. haut risque de trouble du stress post-traumatique liĂ© Ă  l’accouchement (TSPT-A) par le biais d'une Ă©tude transversale expĂ©rimentale (Ă©tude 2) ; et 3. en Ă©tudiant les relations entre les symptĂŽmes maternels de santĂ© mentale (dĂ©pression du postpartum, anxiĂ©tĂ© et TSPT-A) et le sommeil du bĂ©bĂ© (rĂ©veils nocturnes et durĂ©e du sommeil nocturne) par le biais d'une Ă©tude transversale en ligne (Ă©tude 3). MĂ©thodes: Pour l'Ă©tude 1, les symptĂŽmes du TSPT-A (rĂ©sultat principal) du groupe expĂ©rimental seront comparĂ©s Ă  ceux du groupe contrĂŽle six semaines aprĂšs une cĂ©sarienne en urgence (n = 144). Les rĂ©sultats secondaires incluent d’autres indicateurs parentaux psychologiques et physiologiques, l’interaction parent-bĂ©bĂ©, le dĂ©veloppement de l’enfant ainsi que certains de ses indicateurs physiologiques. L’étude 2 a examinĂ© les effets du temps et du groupe sur la rĂ©activitĂ© psychophysiologique de mĂšres Ă  faible vs. haut risque de TSPT-A (n = 52) en rĂ©ponse au LICSP. Les mĂšres Ă  faible risque n’étaient pas traumatisĂ©es par leur accouchement tandis que les mĂšres Ă  haut risque l’étaient, le risque ayant Ă©tĂ© calculĂ© selon leur rĂ©ponse Ă  deux questions de dĂ©pistage Ă©valuant la menace de mort perçue par la mĂšre pour elle-mĂȘme et/ou le bĂ©bĂ© durant l’accouchement. L’étude 3 a recueilli des informations sur la santĂ© mentale de 410 mĂšres et le sommeil de leur bĂ©bĂ©, Ăągé·e de 3 Ă  12 mois, et a testĂ© des effets modĂ©rateurs et mĂ©diateurs. RĂ©sultats: L'Ă©tude 1 est toujours en cours. L'Ă©tude 2 a validĂ© le LICSP (effet du temps) et a montrĂ© que les rĂ©ponses de stress psychophysiologiques des mĂšres Ă  risque de TSPT-A Ă©taient altĂ©rĂ©es comparĂ©es aux mĂšres Ă  faible risque, lorsque la menace de mort perçue pour le bĂ©bĂ© pendant l'accouchement Ă©tait contrĂŽlĂ©e (effet du groupe). L'Ă©tude 3 a observĂ© des associations entre les symptĂŽmes de santĂ© mentale maternelle et le sommeil du bĂ©bĂ©, sauf pour le TSPT-A et la durĂ©e du sommeil nocturne. Trois profils de symptĂŽmes de santĂ© mentale de la mĂšre ont Ă©mergĂ© des donnĂ©es (les profils dĂ©pressif, anxieux et liĂ© aux traumatismes de la naissance). La perception maternelle du tempĂ©rament du bĂ©bĂ© a seulement agi comme mĂ©diateur de la relation du profil dĂ©pressif ou anxieux sur le sommeil du bĂ©bĂ©, dĂ©pendamment de l'Ăąge du bĂ©bĂ© ou de l'Ă©ducation de la mĂšre (effets modĂ©rateurs). La mĂ©thode d'endormissement n'a pas mĂ©diĂ© la relation entre les profils de symptĂŽmes maternels et le sommeil du bĂ©bĂ©. Implications cliniques : Si les rĂ©sultats de l'Ă©tude 1 sont concluants, les directives cliniques pour la prise en charge des mĂšres traumatisĂ©es changeront. L’étude 2 fournit des premiers Ă©lĂ©ments de rĂ©ponse pour identifier, Ă  terme, les mĂšres Ă  risque de dĂ©velopper un TSPT-A grĂące Ă  leur rĂ©activitĂ© physiologique afin de leur proposer prĂ©cocement un soutien professionnel adĂ©quat. L’étude 3 souligne l'importance de considĂ©rer la symptomatologie maternelle et la perception maternelle du bĂ©bĂ© lorsque des problĂšmes de sommeil du bĂ©bĂ© sont rapportĂ©s. Les mĂšres, les partenaires, et leur enfant sont des composants interconnectĂ©s d'un systĂšme familial, et les recherches futures devraient Ă©tendre l’intĂ©rĂȘt portĂ© Ă  la santĂ© mentale maternelle au contexte familial (c.-Ă -d. les deux parents et leur enfant)

    Tejiendo el trauma: su genealogĂ­a en el contexto de la guerra y el sufrimiento humano

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    Se considera que los "objetos tĂ©cnicos", incluidas las neurosis de guerra (conmociĂłn, histeria y neurastenia) y el trastorno de estrĂ©s postraumĂĄtico, surgen de prĂĄcticas histĂłricas y culturales dentro del campo de la medicina, en lugar de representar avances epistemolĂłgicos. Estos objetos se han entrelazado con disciplinas como la cirugĂ­a, la neurologĂ­a, el psicoanĂĄlisis y la psiquiatrĂ­a, constituyendo una compleja telaraña de traumas y guerras en los siglos XIX y XX. AdemĂĄs, estos objetos surgieron de experiencias clĂ­nicas y experimentales orientadas a la comprensiĂłn del dolor humano y el sufrimiento social derivado de la guerra. Los investigadores a menudo no han podido ir mĂĄs allĂĄ de la postura mĂ©dica y sus limitaciones en tĂ©rminos de comprensiĂłn del dolor humano y el sufrimiento colectivo. Curiosamente, el descubrimiento de la memoria y sus relaciones con el miedo, la vergĂŒenza, la culpa y el trauma se convirtieron en hilos adicionales de la telaraña, con el trauma ocupando una posiciĂłn central. El trauma abarca mĂșltiples significados, conexiones y desacuerdos, constituyendo un significante Ășnico para una pluralidad de tipos de sufrimiento y enfermedad. Su objetivo es trazar la trayectoria y problematizar la nociĂłn de trauma y la relaciĂłn con el sufrimiento humano derivado de la guerra a travĂ©s de construcciones histĂłricas en el campo de la disciplina y la prĂĄctica mĂ©dica. El enfoque adoptado en este trabajo sigue el surgimiento de una serie de objetos tĂ©cnicos: histeria y neurastenia. En segundo lugar, se incluye una revisiĂłn de otras nociones relacionadas con la experiencia del sufrimiento humano. La tercera secciĂłn analiza algunos de los efectos del shock, la histeria y la neurastenia. Finalmente, los pĂĄrrafos finales presentan reflexiones relevantes para la medicina y la salud pĂșblica relacionadas con los efectos a menudo incuestionables de los usos actuales del PTSD.‘Technical objects,’ including war neuroses (shell shock, hysteria and neurasthenia) and post-traumatic stress disorder, are considered to emerge from historical and cultural practices within the field of medicine, rather than representing epistemological developments. These objects have been intertwined with disciplines such as surgery, neurology, psychoanalysis, and psychiatry, constituting a complex cobweb of trauma and warfare in the nineteenth and twentieth centuries. In addition, these objects emerged from clinical and experimental experiences oriented towards the understanding of human pain and social suffering derived from warfare. Researchers have often been unable to go beyond a medical stance and its limitations in terms of understanding human pain and collective suffering. Interestingly, the discovery of memory and its relationships with fear, shame, guilt, and trauma, became additional threads of the cobweb, with trauma occupying a central position. Trauma encompasses multiple meanings, connections, and disagreements, constituting a unique signifier for a plurality of types of suffering and illness. Its objective is to trace the trajectory and problematize the notion of trauma and the relationship with human suffering derived from war through historical constructions in the field of medical discipline and practice. The approach adopted in this work follows the emergence of a range of technical objects: shell shock, hysteria and neurasthenia. Secondly, a review of other notions related to the experience of human suffering is included. The third section discusses some of the effects of shell shock, hysteria and neurasthenia. Finally, the concluding paragraphs present relevant reflections for medicine and public health related to the often-unquestioned effects of current uses of PTSD

    Machine Learning Applications in Studying Mental Health Among Immigrants and Racial and Ethnic Minorities: A Systematic Review

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    Background: The use of machine learning (ML) in mental health (MH) research is increasing, especially as new, more complex data types become available to analyze. By systematically examining the published literature, this review aims to uncover potential gaps in the current use of ML to study MH in vulnerable populations of immigrants, refugees, migrants, and racial and ethnic minorities. Methods: In this systematic review, we queried Google Scholar for ML-related terms, MH-related terms, and a population of a focus search term strung together with Boolean operators. Backward reference searching was also conducted. Included peer-reviewed studies reported using a method or application of ML in an MH context and focused on the populations of interest. We did not have date cutoffs. Publications were excluded if they were narrative or did not exclusively focus on a minority population from the respective country. Data including study context, the focus of mental healthcare, sample, data type, type of ML algorithm used, and algorithm performance was extracted from each. Results: Our search strategies resulted in 67,410 listed articles from Google Scholar. Ultimately, 12 were included. All the articles were published within the last 6 years, and half of them studied populations within the US. Most reviewed studies used supervised learning to explain or predict MH outcomes. Some publications used up to 16 models to determine the best predictive power. Almost half of the included publications did not discuss their cross-validation method. Conclusions: The included studies provide proof-of-concept for the potential use of ML algorithms to address MH concerns in these special populations, few as they may be. Our systematic review finds that the clinical application of these models for classifying and predicting MH disorders is still under development

    „Ich war mutig“: Eine qualitative Studie zur Rekonstruktion kindlicher Perspektiven auf Erfahrungen im pferdegestĂŒtzten Setting

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    Das vorliegende kumulative Dissertationsprojekt besteht aus fĂŒnf FachbeitrĂ€gen und befasst sich mit pferdegestĂŒtzten Interventionen aus der Perspektive von Kindern. ZunĂ€chst wird eine kritische Auseinandersetzung mit dem Forschungsfeld tiergestĂŒtzter Interventionen vorgenommen, da hier hĂ€ufig ErklĂ€rungsansĂ€tze herangezogen werden, die wissenschaftlich nicht abgesichert sind. Diese AnsĂ€tze sollen in der eigenen Arbeit nicht reproduziert werden. FĂŒr die Erhebung des Forschungsstandes werden Studien herangezogen, welche sich mit der psychischen, sozialen und emotionalen Wirkung pferdegestĂŒtzter Interventionen bei Kindern befassen. Das bearbeitete Forschungsdesiderat ergab sich aus der Betrachtung bestehender Studien, da die Kinderperspektive in diesem Zusammenhang bisher kaum wissenschaftlich betrachtet wurde. Um zu verstehen, was fĂŒr Kinder an pferdegestĂŒtzten Interventionen relevant ist, wird ein Forschungsdesign verwendet, welches die Kinder in den Forschungsprozess einbezieht, sodass sie ihre eigenen Relevanzen explizieren können. Somit wird eine neue Perspektive auf bestehende Forschungsergebnisse eröffnet, welche ein tieferes VerstĂ€ndnis fĂŒr die Wirkweisen pferdegestĂŒtzter Interventionen bietet und die Möglichkeit zur Evaluation der praktischen DurchfĂŒhrung beinhaltet. Die Ergebnisse beruhen auf der Befragung von 23 Kindern die wöchentlich an einer pferdegestĂŒtzten Intervention teilnahmen. Die meisten der Kinder lebten zum Zeitpunkt des Interviews in Einrichtungen der Kinder- und Jugendhilfe und nicht bei ihren Familien und standen somit unter erhöhter psychosozialer Belastung. Wie Kinder pferdegestĂŒtzte Förderung wahrnehmen, wird mit Hilfe von offenen Leitfadeninterviews und der Grounded Theory herausgearbeitet. Als zusĂ€tzliche Ausdrucksmöglichkeit der Kinder wurden Bilder, die sie vom pferdegestĂŒtzten Setting malten, als ergĂ€nzendes Material genutzt und mittels Segmentanalyse ausgewertet. Am Ende der Arbeit ist festzuhalten, dass in pferdegestĂŒtzten Interventionen, mit dem Ziel der Förderung von mentaler Gesundheit, reitpĂ€dagogische FachkrĂ€fte Situationen mit Pferden konstruieren, die das interpersonale Vertrauen und das Selbstvertrauen von Kindern stĂ€rken, indem gezielt die BewĂ€ltigung von Herausforderungen mit dem Pferd unterstĂŒtzend angeleitet wird. Insbesondere die zentrale Rolle der reitpĂ€dagogischen Fachkraft sowie relevante Wirkfaktoren werden vertieft betrachtet

    Pediatric critical care–associated parental traumatic stress: Beyond the first year*

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    Objectives: Perform a longitudinal analysis of parental traumatic stress up to 30 months after PICU discharge. Design: Prospective observational cohort study. Setting: Two tertiary care children\u27s hospitals with mixed medical/surgical/cardiac PICUs. Subjects: Parents of patients unexpectedly admitted to the PICU. Interventions: None. Measurements and main results: Two hundred sixty-five parents of 188 children were enrolled. Of the 195 parents who completed the 3-9-month assessments, 29 (14.8%) met posttraumatic stress disorder (PTSD) qualification on the PTSD Symptom Scale Interview for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Multivariable analysis showed parents who met acute stress disorder (ASD) qualification (odds ratio [OR] 8.01; 95% CI 2.64-24.3), parents of children with Pediatric Overall Performance Category score of severe or coma at discharge (OR 5.21; 95% CI 1.65-16.4), parents who had concerns for their child\u27s permanent injury (OR 1.82; 95% CI 1.36-2.43), and parents who reported increased knowledge of child illness during admission (OR 1.82; 95% CI 1.13-2.93) had increased odds of developing parental PTSD. Of the 175 parents (66%) who completed the 18-30-month assessments, 22 (12.5%) met PTSD qualification. Multivariable analysis showed parents who met ASD qualification (OR 4.19; 95% CI 1.12-15.7), parents who had a history of a family member or themselves being admitted to ICU (OR 6.51; 95% CI 1.43-29.6), and parents who had concerns of child\u27s susceptibility to death post discharge (OR 1.58; 95% CI 1.19-2.09) had increased odds of developing parental PTSD. At 18-30 months post discharge, parents who met the PTSD qualification were more likely to report a decrease in household income following discharge (OR 9.23; 95% CI 1.71-49.9

    Efektivitas Positive Cognitive Behavioral Therapy terhadap Penurunan Depresi Pada Prajurit TNI-AD

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    Tujuan dari penelitian ini adalah untuk melihat pengaruh Positive Cognitive Behavioral Therapy terhadap penurunan depresi pada tentara Nasional Indonesia Angkatan Darat yang memiliki disabilitas tingkat II akibat kecelakaan dalam tugas. Metode penelitian yang digunakan yaitu metode eksperimen dengan disain penelitian the one group pretest-posttest design dengan jumlah subjek sebanyak tiga orang (n=3). Data dianalisis menggunakan uji Paired T-Test untuk menguji perbedaan skor depresi sebelum dan sesudah terapi. Hasil penelitian menunjukkan bahwa Positive Cognitive Behavioral Therapy (Positive-CBT) mampu menurunkan depresi pada Prajurit TNI yang mengalami disabilitas tingkat II akibat kecelakaan dalam tugas. Akan tetapi, penurunan ini secara statistik tidak signifikan apabila dilihat dari nilai Asymp.sig (Two-sided p) 0.118 dengan signifikansi 0.05%. Uji statistik tidak dapat terdeteksi secara jelas dan akurat untuk sampel sedikit (n=3)

    Role of the Psychiatric Nurse in Improving the Psychosocial Health of Families After Suicide

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    Suicide is defined as death that occurs as a result of deliberate self-harming behavior with the intention of ending one's life. Each suicide has many physical, economic and psychological short and long-term effects on the individual, family, friends and society. The death of an individual as a result of suicide creates a traumatic effect for family members and causes family members to experience various psychosocial problems. For this reason, it is very important to focus on the consequences of suicide in family members who have lost due to suicide, to evaluate the family's reactions to suicide, and to provide the needed psychosocial support. In this context, in this review, it is aimed to review the literature on the psychosocial problems experienced by families who have lost due to suicide and to present up-to-date information on the role of psychiatric nurse in improving the psychosocial health status of families
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