scholarly journals Depression, Anxiety and Quality of Life in Greek Hospital Staff: A Study in the Aftermath of the Debt Crisis Era

2021 ◽  
Vol 28 (2) ◽  
pp. 3
Author(s):  
Despoina Melemeni ◽  
Konstantinos Mantzouranis ◽  
Vasiliki Epameinondas Georgakopoulou ◽  
Kyriakos Tarantinos ◽  
Nikolaos Garmpis ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Rating Scale ◽  
Debt Crisis ◽  
Hospital Staff ◽  
Mean Difference ◽  
Depression And Anxiety ◽  
Significant Depression ◽  
Clinically Significant

Background: Several studies investigated the mental health needs of hospital staff in Greece during the debt crisis era. Yet, no relevant data are available regarding the mental health of hospital staff after this period. The aims of this study are: 1) To investigate the prevalence of clinically significant depression and anxiety in healthcare workers in a general hospital in Athens, Greece; 2) to search for the association of quality of life with anxiety and depression in those workers; 3) to investigate the association of sociodemographic characteristics with those parameters.Methods: The Zung Depression Rating Scale, the Zung Anxiety Rating Scale, the Short-Form Survey-12, assessing quality of life, and sociodemographic assessments were administrated in 110 workers of a public hospital in Athens, Greece. The assessments were completed during January, 2020.Results: Of the study participants, 38.2% had clinically significant anxiety and 6.4% had clinically significant depression. Males had lower scores of depression compared to females (p=0.003). As for the effects of educational level, differences were noted in psychological quality of life between secondary education participants when compared to tertiary education (Mean Difference -3.527, p=0.021), post-graduate (Mean Difference -3.937, p=0.012) and PhD participants (Mean Difference -5.100, p=0.007). Quality of life and its psychological and physical health subscales had strong inverse associations with depression and anxiety (p=0.000).Conclusions: Relevant interventions are necessary to decrease anxiety in hospital staff, which is elevated in the aftermath of the debt crisis period. In addition, health policy makers have to reduce the gender gap in mental health between male and female workers, since the latter had higher levels of depression.

Coping and quality of life in one hundred and thirty five subjects with multiple sclerosis

2007 ◽  
Vol 13 (3) ◽  
pp. 393-401 ◽  
Author(s):  
S.R. Montel ◽  
C. Bungener
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Multiple Sclerosis ◽  
Coping Strategies ◽  
Rating Scale ◽  
Well Being ◽  
Self Report ◽  
Disease Course ◽  
Depression And Anxiety

Introduction and objective The aim of this study was to compare coping strategies and quality of life (QoL) in multiple sclerosis (MS), as they relate to the course of the disease (relapsing-remitting (RR), secondary progressive (SP), primary progressive (PP)), while taking depression and anxiety into account. Methods A total of 135 MS subjects were seen for a semi-structured interview in order to collect socio-demographic and clinical information, after which there was an assessment of their mental and cognitive states (Mini International Neuropsychiatric Interview (MINI), Montgomery and Asberg Depression Rating Scale (MADRS), Depressive Mood Scale (EHD), Hamilton Anxiety (HAMA), Frontal Assessment Battery (FAB)). All subjects then completed three self-report questionnaires; two about coping strategies (Ways of Coping Checklist (WCC), Coping with Health, Injuries and Problems Scale (CHIP)) and one about QoL (SEP59). Results The mental health (depression and anxiety) and the psychological and social dimensions of QoL were relatively unaffected. However, after controlling for age and disability, the disease course had a strong effect on both mental health and QoL, with the poorest condition for SPMS and the best condition for PPMS. The SPMS patients tend to use emotional coping strategies extensively, while the PPMS patients use more instrumental strategies. Discussion Our study clearly demonstrated that psychological and social well-being were substantially affected by the disease course. These results encourage us to develop interventions focused on coping strategies and which are better adapted to individual patients. Multiple Sclerosis 2007; 13: 393- 401. http://msj.sagepub.com

scholarly journals Quality of Life and Psychological Distress in Patients with Acute Myeloid Leukemia (AML)

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 2291-2291
Author(s):  
Areej El-Jawahri ◽  
Lauren Waldman ◽  
Joseph Greer ◽  
Gregory A. Abel ◽  
David P. Steensma ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Psychological Distress ◽  
Older Patients ◽  
Research Funding ◽  
Tertiary Care ◽  
Intensive Chemotherapy ◽  
Significant Depression ◽  
Linear Effects ◽  
Clinically Significant

Abstract Background: Older patients with AML face difficult treatment decisions as they can be treated either with multi-drug 'intensive' chemotherapy requiring a prolonged hospitalization, or 'non-intensive' chemotherapy. Although intensive chemotherapy is often perceived by clinicians as more burdensome, studies comparing patients' quality of life (QOL) and psychological distress while receiving these treatments are lacking. Methods: We conducted a longitudinal study of older patients (≥ 60 years) newly diagnosed with AML receiving intensive (i.e. 7+3: cytarabine/anthracycline combination) or non-intensive (i.e. hypomethylating agents) chemotherapy at two tertiary care hospitals. We assessed patient's QOL [Functional Assessment of Cancer Therapy-Leukemia], and psychological distress [Hospital Anxiety and Depression Scale [HADS]] at baseline and 2, 4, 8, 12, and 24 weeks after diagnosis. We compared the proportion of patients in each group reporting clinically significant depression or anxiety (HADS subscale cut off ≥ 7) and used mixed linear effects models to compare QOL and psychological distress longitudinally between groups. Results: We enrolled consecutive patients within 72 hours of initiating intensive (n=50) or non-intensive (n=50) chemotherapy. There were no differences in baseline QOL, depression, or anxiety symptoms between the groups. At baseline, 33.33% (33/100) and 30% (30/100) of the overall cohort reported clinically significant depression and anxiety, respectively, with no differences between groups. At 4 weeks, 41.98% (34/81) of patients in the overall cohort reported clinically significant depression, with no differences between groups. In mixed linear effects models, there were no differences in QOL (β=-0.71, SE=1.12, P=0.527), depression (β=0.24, SE=0.20, P=0.226), or anxiety (β=-0.16, SE=0.19, P=0.386) symptoms between groups over time. Conclusion: Older patients with AML receiving intensive and non-intensive chemotherapy experience similar QOL impairments and high rates of psychological distress. These findings underscore the need to develop supportive care interventions for older patients with AML, regardless of their initial treatment strategy. Disclosures Brunner: Takeda: Research Funding; Novartis: Research Funding; Celgene: Consultancy, Research Funding. Fathi:Celgene: Consultancy, Honoraria, Research Funding; Jazz: Honoraria; Boston Biomedical: Consultancy, Honoraria; Astellas: Honoraria; Agios: Honoraria, Research Funding; Seattle Genetics: Consultancy, Honoraria; Takeda: Consultancy, Honoraria. DeAngelo:ARIAD: Consultancy, Research Funding; Takeda: Honoraria; Amgen: Consultancy; Shire: Honoraria; Blueprint Medicines: Honoraria, Research Funding; Pfizer Inc: Consultancy, Honoraria; Novartis Pharmaceuticals Corporation: Consultancy, Honoraria; BMS: Consultancy; Glycomimetics: Research Funding; Incyte: Consultancy, Honoraria. Amrein:Takeda: Research Funding.

scholarly journals Psychological Distress and Quality of Life among Hospital Staff in India during COVID-19 Pandemic

2021 ◽  
Vol 8 (3) ◽  
pp. 55-60
Author(s):  
Lokesh Kumar Ranjan ◽  
Pramod R Gupta ◽  
Nilesh Maruti Gujar ◽  
Shefali Baraik
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Psychological Health ◽  
Hospital Staff ◽  
Healthcare Services ◽  
Online Study ◽  
Treatment Services ◽  
Physical And Psychological Health ◽  
Quality In Healthcare

Background: Hospital staff has been constant and at the forefront to provide treatment services to the patient with risk of COVID-19 infection. The fear and uncertainty forced by the COVID-19 pandemic have become a risk for physical and psychological health among health care professionals.Aim: To explore the stress, anxiety, depression, and quality of life among hospital staff working in general and mental health hospitals during the outbreak of the COVID-19 pandemic.Methods: The present survey was an online study among hospital staff in India. We received a total of 373 responses by the stipulated time from hospital staff - participants with written consent diverted for further study. Socio-demographic datasheet, quality of life (QOL- BREF), depression, anxiety, and stress scale (DASS-21) were included in the Google form.Results: The results showed 2.4% of depression, 6.3% of anxiety, and 5.9% of stress among hospital staff. Nursing staff, physicians, and lab technicians had higher stress, anxiety, and depression. The result also revealed 4.3% physical, 16.6% psychological, 65.4% social, and 21.7% environmental health had a poor level of QOL in hospital staff.Conclusion: Healthcare workers are stressed, anxious, and depressive while working in the COVID-19 pandemic situation. To sustain and develop quality in healthcare services, physical and psychological wellness programs can enhance mental health and quality of life among hospital staff.

Sleep disorder prevalence in at-risk adolescents and potential effects of nightmare triad syndrome

2018 ◽  
Vol 0 (0) ◽  
Author(s):  
Natalia D. McIver ◽  
Barry Krakow ◽  
Jessica Krakow ◽  
Michael R. Nadorff ◽  
Victor A. Ulibarri ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
At Risk ◽  
High School Students ◽  
Sleep Disorders ◽  
Anxiety Symptoms ◽  
Depression And Anxiety ◽  
School Students ◽  
At Risk Adolescents

Abstract Objective At-risk high school students, those considered to have a higher probability for academic failure or dropping out, were assessed for various sleep disorders. Effects were compared between students with and without the nightmare triad syndrome (NTS+), the sleep disorders’ cluster of frequent nightmares, insomnia disorder and suspected sleep-disordered breathing (SDB). Methods Data were gathered at a charter school for at-risk youth using: computer based surveys, physical airway exams, and mental health interviews by school social worker. Ninety-two students were enrolled, and 70 completed all study components. Results Students were teenaged [17.10 (1.50) years], male (52.2%) slightly overweight [BMI 25.50 (6.41)] Hispanics (87.0%); two-thirds (65 of 92) subjectively reported a sleep problem. Frequent nightmares (39.1%), insomnia (ISI ≥ 12, 41.3%), and SDB risk (79.3%) were common. Several presumptive sleep disorders (insomnia, SDB risk, parasomnia, or nightmares) were associated with worse sleep quality and lower quality of life. Nineteen students met criteria for NTS. Compared to NTS−, NTS+ showed significantly lower quality of life (p < 0.003, g = 0.84). Regression analyses revealed higher levels of depression and anxiety symptoms in NTS+ students. NTS was associated with reduced quality of life independent of anxiety symptoms. Conclusion Prevalence of presumptive sleep disorders was high with a tendency for clusters of sleep disorders in the same individual. Students with NTS+ showed worse outcomes and reduced quality of life, mediated partially by depression and anxiety. To examine relationships between sleep disorders and mental health in at-risk adolescents, research investigations must include both subjective and objective measurements of sleep.

scholarly journals The effect of self-care counseling on depression and anxiety in women with Endometriosis: a randomized controlled trial.

2020 ◽  
Author(s):  
Nooshin Farshi ◽  
Shirin Hasanpour ◽  
Mojgan Mirghafourvand ◽  
Khalil Esmaeilpour
Keyword(s):  
Quality Of Life ◽  
Confidence Interval ◽  
Self Care ◽  
Mean Difference ◽  
Control Group ◽  
Depression And Anxiety ◽  
Control Groups ◽  
Randomized Controlled ◽  
And Control

Abstract Background: Considering the prevalence of endometriosis and depression and anxiety caused by this disease and its effect on the body, mind and quality of life of patients, this study was performed to determine the effect of self-care counseling on depression and anxiety (primary outcome), and quality of life of women with endometriosis (secondary outcome). Method: This randomized controlled clinical trial was conducted on 76 women with endometriosis who were treated in Al-Zahra Teaching and Treatment Center of Tabriz between2017-2019. The patients were divided into intervention (counselling) and control groups using random blocking method. For the intervention group, self-care group counseling was held weekly for 7 sessions. The control group received routine care. The Socio-demographic Questionnaire, Beck Depression Inventory, Spline Berger Anxiety Inventory and SF36 Quality of Life Questionnaire were completed by the researcher through an interview before and four weeks after the intervention. Results: No statistically significant difference was found between the intervention and control groups in terms of socio-demographic characteristics (p>0.05). After intervention mean scores of state anxiety (mean difference: -0.12, 95% confidence interval: -9.6 to -14.4, p<0.001) and trait anxiety (mean difference: -10.9: 95% confidence interval: -9.1 to -12.7, p=0.001) were significantly lower than control group and mean score of depression in counseling group was less than control group but it was not significant (p=0/565). Mean score of quality of life in terms of physical health (mean difference= 17.2, 95% confidence interval: 13.8 to 20.5, p<0.001) and in terms of mental health mean difference = 12.0, 95% confidence interval: 9.0 to 14.9, p<0.001) were significantly upper in counselling group. Conclusion: Self-care counselling is effective on anxiety and quality of life of women with endometriosis. So in addition to other therapies, this method is recommended to improve the mental health of patients with this disease. Trial Registration: IRCT Registration Number: IRCT 20111219008459N13, registered 10 February 2019, https://irct.ir/user/trial/35915

scholarly journals A mixed methods exploration of the role of multi-family groups in community treatment of patients with depression and anxiety in Pakistan

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Saniya Saleem ◽  
Anayat Baig ◽  
Sana Sajun ◽  
Victoria Bird ◽  
Stefan Priebe ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Community Treatment ◽  
Depression And Anxiety ◽  
Social Outcome ◽  
Subjective Quality Of Life ◽  
Symptoms Of Depression ◽  
Outcome Index ◽  
Family Groups

Abstract Background An open, non-controlled trial was conducted to explore the feasibility, experiences and outcomes of multi-family groups in community mental health care of patients with depression and anxiety. Methods The study was conducted in community settings within the catchment area of a free of cost primary care center in Karachi, Pakistan. 30 patients with symptoms of depression and anxiety, their caregivers and 3 lay counsellors were recruited enrolled in the study between May–September 2019. Patients were enrolled for monthly multi-family group meetings conducted over 6 months in groups of 5–6 patients and 1–2 nominated caregivers each. Meetings were facilitated by the non-specialist trained counsellors. The primary outcome was quality of life (assessed using Manchester Short Assessment of Quality of Life) and secondary outcomes were symptoms of depression and anxiety (assessed on Aga Khan University Depression and Anxiety Scale), social outcomes (Social Outcome Index), and caregiver burden (Burden Assessment Scale). Change in all measures was assessed pre and 6-month post intervention using t-test. In-depth interviews were conducted with 7 patients, 7 caregivers and the 3 lay counsellors. Results A total of 36 family intervention meetings were conducted with six groups with a total of 30 patients, 34 caregivers and 3 counsellors. Between baseline and the end of the intervention, subjective quality of life increased significantly from 3.34 to 4.58 (p < 0.001, 95% CI 0.93–1.54). Self-reported depression and anxiety scores reduced from 34.7 to 19.5 (p < 0.001, 95% CI 10.8–19.8) and the Social Outcome Index improved from 3.63 to 4.52 (p < 0.001, 95% CI 0.39–1.39). There was no change in family burden. Participants reported that the group meetings were seen as a safe space for shared learning, and that the experience helped improve self-regulation of emotions and behaviors and instilled a sense of belonging. Conclusion Multi-family groups in community treatment of common mental health disorders facilitated by non-specialist mental health service providers is feasible, experienced positively and has the potential for large and positive effects on subjective quality of life, self-reported depression and anxiety, and objective social outcomes. Trial Registration: ISRCTN, ISRCTN12299326. Registered 05 June 2019. Retrospectively registered, https://doi.org/10.1186/ISRCTN12299326.

scholarly journals Recovery Education for Adults Transitioning From Homelessness: A Longitudinal Outcome Evaluation

2021 ◽  
Vol 12 ◽  
Author(s):  
Anna Durbin ◽  
Rosane Nisenbaum ◽  
Ri Wang ◽  
Stephen W. Hwang ◽  
Nicole Kozloff ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Mean Difference ◽  
Control Group ◽  
Quasi Experimental ◽  
Program Enrollment ◽  
Mental Health Challenges ◽  
Post Hoc ◽  
Recovery Education

Objective: Grounded in principles of adult education, Recovery Education Centres (RECs) hold promise in promoting recovery for adults with mental health challenges, but research on recovery outcomes for hard-to-reach populations participating in RECs is scant. This quasi-experimental study compares 12-month recovery outcomes of adults with histories of homelessness and mental health challenges enrolled in a REC, to those of participants of other community services for this population.Methods: This pre-post quasi-experimental study compared participants enrolled in a REC for people with histories of homelessness and mental health challenges (n = 92) to an age-and-gender frequency matched control group participating in usual services (n = 92) for this population in Toronto, Ontario. Changes from program enrollment to 12 months in personal empowerment (primary outcome), disease specific quality of life, recovery, health status, health related quality of life, and mastery were assessed. Post-hoc analyses compared subgroups with 1–13 h (n = 37) and 14+ h (n = 37) of REC participation during the study period to the control group. Linear mixed models estimated mean changes and differences in mean changes and 95% confidence intervals.Results: Mean change in perceived empowerment from program enrollment to 12 months in the intervention group [0.10 (95% CI: 0.04, 0.15)] was not significantly different from the control group [0.05 (−0.01, 0.11)], mean difference, 0.05 [(−0.03, 0.13), P = 0.25]. In the post-hoc analysis, the mean change in perceived empowerment for the intervention subgroup with 14+ h of REC participation [0.18 (0.10, 0.26)] was significantly different than in the control group [0.05 (−0.01, 0.11)] mean difference, 0.13 [(0.03, 0.23), P &lt; 0.01]. Mean change in mastery was also significantly different for the intervention subgroup with 14+ h of REC participation [2.03 (1.04, 3.02)] vs. controls [0.60 (−0.15, 1.35)], mean difference, 1.43 [(0.19, 2.66), P = 0.02]. There were no significant differences in other outcomes.Conclusion: With sufficient hours of participation, recovery education may be a helpful adjunct to health and social services for adults with mental health challenges transitioning from homelessness.

scholarly journals Effectiveness and cost-effectiveness of community singing on mental health-related quality of life of older people: Randomised controlled trial

2015 ◽  
Vol 207 (3) ◽  
pp. 250-255 ◽  
Author(s):  
Simon Coulton ◽  
Stephen Clift ◽  
Ann Skingley ◽  
John Rodriguez
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Older People ◽  
Controlled Trial ◽  
Mean Difference ◽  
Health Related Quality ◽  
Community Group ◽  
Related Quality ◽  
Health Related

BackgroundAs the population ages, older people account for a greater proportion of the health and social care budget. Whereas some research has been conducted on the use of music therapy for specific clinical populations, little rigorous research has been conducted looking at the value of community singing on the mental health-related quality of life of older people.AimsTo evaluate the effectiveness and cost-effectiveness of community group singing for a population of older people in England.MethodA pilot pragmatic individual randomised controlled trial comparing group singing with usual activities in those aged 60 years or more.ResultsA total of 258 participants were recruited across five centres in East Kent. At 6 months post-randomisation, significant differences were observed in terms of mental health-related quality of life measured using the SF12 (mean difference = 2.35; 95% CI = 0.06–4.76) in favour of group singing. In addition, the intervention was found to be marginally more cost-effective than usual activities. At 3 months, significant differences were observed for the mental health components of quality of life (mean difference = 4.77; 2.53–7.01), anxiety (mean difference =–1.78; –2.5 to –1.06) and depression (mean difference =–1.52; –2.13 to –0.92).ConclusionsCommunity group singing appears to have a significant effect on mental health-related quality of life, anxiety and depression, and it may be a useful intervention to maintain and enhance the mental health of older people.

Quality of life and psychological distress in patients with acute myeloid leukemia (AML).

2018 ◽  
Vol 36 (34_suppl) ◽  
pp. 154-154 ◽  
Author(s):  
Netana Markovitz ◽  
Lauren Waldman ◽  
Julia Carp ◽  
Lara Traeger ◽  
Gregory A. Abel ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Psychological Distress ◽  
Older Patients ◽  
Tertiary Care ◽  
Depression Scale ◽  
Intensive Chemotherapy ◽  
Significant Depression ◽  
Linear Effects ◽  
Clinically Significant

154 Background: Older patients with AML face difficult treatment decisions as they can be treated either with multi-drug ‘intensive’ chemotherapy requiring a prolonged hospitalization, or ‘non-intensive’ chemotherapy. Although clinicians often perceive intensive chemotherapy as more burdensome, studies comparing older patients’ quality of life (QOL) and psychological distress while receiving these treatments are lacking. Methods: We conducted a longitudinal study of older patients (≥ 60 years) newly diagnosed with AML receiving intensive (i.e. 7+3: cytarabine/anthracycline combination) or non-intensive (i.e., hypomethylating agents) chemotherapy at two tertiary care hospitals. We assessed patient’s QOL [Functional Assessment of Cancer Therapy-Leukemia], and psychological distress [Hospital Anxiety and Depression Scale [HADS]] at baseline and 2, 4, 8, 12, and 24 weeks after diagnosis. We compared the proportion of patients in each group reporting clinically significant depression or anxiety (HADS subscale cut off ≥ 7) and used mixed linear effects models to compare QOL and psychological distress longitudinally between groups. Results: We enrolled 75.2% (100/133) of eligible patients within 72 hours of initiating intensive (n = 50) or non-intensive (n = 50) chemotherapy. Baseline QOL, depression, or anxiety symptoms did not differ between the groups. At baseline, 33.33% (33/100) and 30% (30/100) of the overall cohort reported clinically significant depression and anxiety, respectively, with no differences between groups. At 4 weeks, 41.98% (34/81) of patients in the overall cohort reported clinically significant depression, with no differences between groups. In mixed linear effects models, there were no differences in QOL (β = -0.71, SE = 1.12, p = 0.527), depression (β = 0.24, SE = 0.20, p = 0.226), or anxiety (β = -0.16, SE = 0.19, p = 0.386) symptoms over all time points. Conclusions: Older patients with AML receiving intensive and non-intensive chemotherapy experience similar QOL and high rates of psychological distress. These findings underscore the need to develop supportive care interventions for older patients with AML, regardless of their initial treatment strategy.

scholarly journals Health-Related Quality of Life and Mental Health of Adolescents Involved in School Bullying and Homophobic Verbal Content Bullying

2019 ◽  
Vol 16 (14) ◽  
pp. 2622 ◽  
Author(s):  
Natalia Albaladejo-Blázquez ◽  
Rosario Ferrer-Cascales ◽  
Nicolás Ruiz-Robledillo ◽  
Miriam Sánchez-SanSegundo ◽  
Manuel Fernández-Alcántara ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Well Being ◽  
School Bullying ◽  
Depression And Anxiety ◽  
Health Related Quality ◽  
Homophobic Bullying ◽  
Related Quality ◽  
Health Related

Bullying has been traditionally related to a significant reduction in well-being and Health-Related Quality of Life (HRQoL) of adolescents. This negative impact on HRQoL seems to be modulated by the developed role in bullying (uninvolved, bully, victim or bully-victim). However, no studies have identified if these negative results are the same when other types of bullying, such as homophobic bullying, are evaluated. The main aim of the present study was to analyze the prevalence of different roles of bullying and homophobic bullying and the relationship between these roles in both types of bullying with HRQoL, depression and anxiety levels in a sample of 1723 Spanish adolescents. Although results exhibited lower prevalence of homophobic bullying roles when compared to traditionally bullying in general, in the case of victims, the prevalence was high in the case of homophobic bullying. When differences between roles in HRQoL, depression and anxiety were evaluated, in both types of bullying, uninvolved adolescents showed the best results and bully-victim adolescents the worst. The obtained results suppose an improvement in the understanding of the negative effects of different types of bullying on HRQoL and mental health in adolescents. Future research could advance in this comprehension, analyzing possible differences with other types of bullying, such as cyberbullying.

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