Medizinisch-psychiatrische Rehabilitation in Österreich – Ein Vergleich der Symptombelastung bei Reha-Beginn vor und während der COVID-19-Pandemie, sowie des Rehabilitationserfolgs

Zusammenfassung Ziele In der internationalen Literatur werden Steigerungen der Inzidenzraten psychischer Erkrankungen durch die COVID-19-Pandemie berichtet. Junge Menschen und Menschen mit psychischen Vorerkrankungen sind besonders durch die Pandemie belastet. Gegenstand dieser Studie sind das Ausmaß psychischer Symptombelastung, die Funktionsfähigkeit und der Behandlungserfolg bei Rehabilitanden der medizinisch-psychiatrischen Rehabilitation im Jahr vor Beginn der COVID-19-Pandemie und während der COVID-19-Phase. Methodik Die Daten von N=1715 Rehabilitanden mit Reha-Abschluss vor dem ersten Lockdown und von N=707 Rehabilitanden mit Reha-Beginn nach der Corona-bedingten Schließung der Klinik von März bis Mai 2020 aus den Jahren 2019 und 2020 werden hinsichtlich der Stichprobencharakteristik sowie der Ergebnisse in den Patient-reported Outcomes (Beginn und Ende der Rehabilitation) verglichen. Ergebnisse Zwischen den beiden Beobachtungszeiträumen zeigen sich keine bedeutsamen Unterschiede in der soziodemografischen Charakteristik der Rehabilitanden. Bei Reha-Beginn zeigt sich in der Skala Somatisierung kein signifikanter Unterschied, in den Skalen Ängstlichkeit und Depressivität zeigt sich während der COVID-19-Phase ein signifikant höherer Wert, allerdings im Ausmaß eines sehr kleinen Effekts. In den Skalen zu Aktivitäten und Teilhabe (ICF 3 F AT) sowie bei der Funktionsfähigkeit (WHODAS 2.0) unterscheiden sich die Werte der Vergleichszeiträume bei Reha-Beginn nicht. Rehabilitanden mit niedrigerem sozioökonomischem Status (Reha-Geld oder Invaliditäts-/Berufsunfähigkeitspension) weisen hingegen in einigen Skalen kritischere Werte auf. Der Reha-Erfolg ist vergleichbar mit dem Zeitraum vor der COVID-19-Pandemie und liegt im Bereich von mittleren bis hohen Effektgrößen. Schlussfolgerung Die Studie zeigt – unter Berücksichtigung der Limitationen – geringe oder gar keine signifikanten Unterschiede in den soziodemografischen Daten und in der Symptombelastung bei Reha-Beginn und die Effektgrößen sind vergleichbar mit dem Zeitraum vor der COVID-19-Pandemie. Die Ergebnisse internationaler Studien, dass es zu einem deutlichen Anstieg psychischer Belastungen während der COVID-19-Pandemie in der Bevölkerung gekommen ist, können nicht direkt auf die österreichische Reha-Klientel übertragen werden.

Perfil das manifestações crônicas em profissionais de saúde acometidos pela SARS-CoV-2 do hospital regional de Mato Grosso do Sul

Objetivo: Identificar complicações crônicas associadas à SARS-CoV-2 em casos leves a graves em acometidos em profissionais de saúde do Hospital Regional do Mato Grosso do Sul (HRMS). Metodologia: Estudo de concepção metodológica transversal por incidência, quantitativo e de caráter descritivo. Aplicou-se um formulário de pesquisa e a Escala de Avaliação de Incapacidades da Organização Mundial da Saúde (WHODAS 2.0). Resultados: A população de estudo foi composta predominantemente por mulheres (75%) com a idade média de 38±9,7 anos, atuando na linha de frente do Hospital Regional de Mato Grosso do Sul, com características clínicas de hipertensão arterial e obesidade como as principais comorbidades relatadas. Durante a infecção, os indivíduos relataram a fadiga e dor de garganta como os principais sintomas respiratórios. Quanto aos sintomas do Sistema Nervoso Central e Sistema Nervoso Periférico, a cefaleia (38,63%) e a anosmia (27,27%), respectivamente, foram os mais mencionados. Além disso, apresentaram dor muscular relacionado ao Sistema Músculo Esquelético e alteração do sono, observando assim alguns acometimentos neurofuncionais e neuropsicológicos associados à infecção. Através da avaliação da WHODAS 2.0 foi observada a repercussão na funcionalidade desses indivíduos. Conclusão: Nesta pesquisa, concluiu-se que os domínios de mobilidade, atividades do cotidiano e a pontuação total das incapacidades avaliadas pela WHODAS 2.0 tiveram correlação negativa significativa, evidenciando piora na funcionalidade da população em estudo. Observa-se a necessidade de mais estudos direcionados a população adulto-jovem, reforçando a importância de uma avaliação biopsicossocial.

Group problem management plus (PM+) to decrease psychological distress among Syrian refugees in Turkey: a pilot randomised controlled trial

Background Syrian refugees resettled in Turkey show a high prevalence of symptoms of mental disorders. Problem Management Plus (PM+) is an effective psychological intervention delivered by non-specialist health care providers which has shown to decrease psychological distress among people exposed to adversity. In this single-blind pilot randomised controlled trial, we examined the methodological trial procedures of Group PM+ (gPM+) among Syrian refugees with psychological distress in Istanbul, Turkey, and assessed feasibility, acceptability, perceived impact and the potential cost-effectiveness of the intervention. Methods Refugees with psychological distress (Kessler Psychological Distress Scale, K10 > 15) and impaired psychosocial functioning (World Health Organization Disability Assessment Schedule, WHODAS 2.0 > 16) were recruited from the community and randomised to either gPM+ and enhanced care as usual (E-CAU) (n = 24) or E-CAU only (n = 22). gPM+ comprised of five weekly group sessions with eight to ten participants per group. Acceptability and feasibility of the intervention were assessed through semi-structured interviews. The primary outcome at 3-month follow-up was symptoms of depression and anxiety (Hopkins Symptoms Checklist-25). Psychosocial functioning (WHODAS 2.0), symptoms of posttraumatic stress disorder and self-identified problems (Psychological Outcomes Profiles, PSYCHLOPS) were included as secondary outcomes. A modified version of the Client Service Receipt Inventory was used to document changes in the costs of health service utilisation as well as productivity losses. Results There were no barriers experienced in recruiting study participants and in randomising them into the respective study arms. Retention in gPM+ was high (75%). Qualitative analyses of the interviews with the participants showed that Syrian refugees had a positive view on the content, implementation and format of gPM+. No adverse events were reported during the implementation. The study was not powered to detect an effect. No significant difference between gPM+ and E-CAU group on primary and secondary outcome measures, or in economic impacts were found. Conclusions gPM+ delivered by non-specialist peer providers seemed to be an acceptable, feasible and safe intervention for Syrian refugees in Turkey with elevated levels of psychological distress. This pilot RCT sets the stage for a fully powered RCT. Trial registration ClinicalTrials.gov Identifier NCT03567083; date: 25/06/2018.

PERAN RASA SYUKUR DAN DUKUNGAN SOSIAL TERHADAP KESEPIAN PADA LANJUT USIA DI PANTI WREDA

Lansia (lanjut usia) merupakan periode perkembangan dewasa akhir. Pada masa dewasa akhir terjadi tahap perkembangan integrity versus despair. Seringkali lansia mengalami ketidakberdayaan dikarenakan menurunnya fungsi fisik dan terbatasnya mobilitas. Lansia yang tinggal di panti wreda cenderung lebih rentan mengalami kesepian karena jauh dari keluarga. Penelitian ini bertujuan untuk melihat gambaran rasa syukur dan dukungan sosial guna mengurangi kesepian pada lansia di panti wreda. Penelitian ini menggunakan single case experiment design A-B dengan satu orang partisipan. Penelitian ini menggunakan WHODAS 2.0 dan UCLA Loneliness. Hasil yang diperoleh adalah partisipan sudah tidak bisa berfungsi secara baik dan tidak bisa melakukan kegiatan secara mandiri. Tingkat kesepian berada pada kategori sedang dan aspek paling tinggi berada pada aspek social desirability. Berdasarkan hasil maka penelitan memberikan 3 sesi terkait rasa syukur dan 1 sesi terkait dukungan sosial. Setelah intervensi, diperoleh hasil bahwa rasa syukur dan dukungan sosial berpengaruh mengurangi kesepian pada lansia di Panti Wreda.

FUNCIONALIDADE E CONDIÇÕES DE SAÚDE EM IDOSOS DE UMA CIDADE DO INTERIOR DA BAHIA

Objetivo: avaliar a capacidade funcional de idosos de acordo o WHODAS 2.0. Método: Trata-se de uma pesquisa descritiva, com abordagem quantitativa, de corte transversal e levantamento de campo, realizado na Estratégia de Saúde da Família, em janeiro de 2019, com 129 idosos de uma cidade do interior da Bahia, localizada na região centro-sul da Bahia. Foi utilizado um questionário com avaliação sócio demográfica, econômica e condições de saúde, o MEEM para avaliar a função cognitiva e WHODAS para avaliar o nível de funcionalidade dos idosos. A análise dos dados foi feito com auxílio do software Statistical Package for Social Sciences. Resultados: predomínio de idosos até 79 anos (80,6%), sexo feminino (75,5%), solteiras, divorciadas, viúvas, ou seja, a predominância de mulheres que vivem sem companheiro foi maior (57,4%), recebem 1 a 3 salários mínimos (58%). No estado geral de saúde, prevalência de idosos que a consideram boa (44,2%), nunca usam bebida alcoólica e cigarro, representam o mesmo percentual (85,3%). Em relação às doenças crônicas não transmissíveis, maior prevalência para hipertensão arterial sistêmica (37,2%), possuem a doença há mais de 10 anos (31%). Nos domínios do WHODAS as médias que de maior nível de incapacidade foram a participação na sociedade (12,66 ± 4,91), seguida de cognição (8,41 ± 2,92), e mobilidade (8,24 ± 4,88). E os menores índices de incapacidade foram em atividade da vida com (7,98 ± 7,70), autocuidado (5,00 ± 2,04) e relação interpessoal (4,90 ± 1,57). Já sobre a classificação geral composta por moderada, grave e completa, houve dificuldade moderada (69%) e dificuldade grave (27,9%). Houve correlação significativa entre os domínios Cognição e Autocuidado tanto para os homens (r 0,644) quanto para as mulheres (r 0,684). Na correlação geral os domínios Mobilidade (r 0,756), Participação na sociedade (r 0,774) tiveram correlação significativa e positiva com a Classificação geral no WHODAS. Considerações finais: este estudo reforça a importância de trabalhos voltados ao processo de envelhecimento e a sua relação com a funcionalidade, contemplando os indivíduos de maneira holística, contribuindo assim para a melhoria e desenvolvimento de cuidados na perspectiva da saúde dessa população.

Longitudinal clinical and functional outcome in distinct cognitive subgroups of first-episode psychosis: a cluster analysis

Background Cognitive deficits may be characteristic for only a subgroup of first-episode psychosis (FEP) and the link with clinical and functional outcomes is less profound than previously thought. This study aimed to identify cognitive subgroups in a large sample of FEP using a clustering approach with healthy controls as a reference group, subsequently linking cognitive subgroups to clinical and functional outcomes. Methods 204 FEP patients were included. Hierarchical cluster analysis was performed using baseline brief assessment of cognition in schizophrenia (BACS). Cognitive subgroups were compared to 40 controls and linked to longitudinal clinical and functional outcomes (PANSS, GAF, self-reported WHODAS 2.0) up to 12-month follow-up. Results Three distinct cognitive clusters emerged: relative to controls, we found one cluster with preserved cognition (n = 76), one moderately impaired cluster (n = 74) and one severely impaired cluster (n = 54). Patients with severely impaired cognition had more severe clinical symptoms at baseline, 6- and 12-month follow-up as compared to patients with preserved cognition. General functioning (GAF) in the severely impaired cluster was significantly lower than in those with preserved cognition at baseline and showed trend-level effects at 6- and 12-month follow-up. No significant differences in self-reported functional outcome (WHODAS 2.0) were present. Conclusions Current results demonstrate the existence of three distinct cognitive subgroups, corresponding with clinical outcome at baseline, 6- and 12-month follow-up. Importantly, the cognitively preserved subgroup was larger than the severely impaired group. Early identification of discrete cognitive profiles can offer valuable information about the clinical outcome but may not be relevant in predicting self-reported functional outcomes.

Exploratory and confirmatory factor analysis of the 12-item Arabic World Health Organization Disability Assessment Schedule (WHODAS 2.0) as a screening tool for Syrian refugees

Background The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a generic measure of functional impairment and disability but to date no studies have reported its applicability in a population of Syrian refugees. Aims The aim of this study was to explore the psychometric properties and factor structure of the Arabic version of the WHODAS 2.0 among a population of Syrian refugees in a Jordanian refugee camp setting. The tool was used as part of a screening procedure for a randomised controlled trial assessing the effectiveness of a low-intensity psychological intervention. Method A representative sample of Syrian refugees (n = 650) were screened to assess levels of functional impairment and psychological distress. The screening results were used to explore the internal consistency and dimensionality of the WHODAS 2.0. We assessed level of convergence with the validated Kessler 10-item Psychological Distress Scale (K10), which assesses psychological distress. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were conducted to explore the construct validity and factor structure of the WHODAS 2.0. Results The mean baseline WHODAS 2.0 score was 20.5 (s.d. = 7.6). The internal consistency was acceptable (Cronbach's alpha 0.74), with all 12-items appearing to be related to the same construct. The WHODAS 2.0 was positively correlated with the K10 (r = 0.57, P < 0.001). The results of the EFA identified a three-factor solution accounting for 51% of variation, corresponding with factors related to self-activities, external activities and self-care. CFA results indicated good fit of the three-factor solution. Conclusions The results indicated that the WHODAS 2.0 has a three-factor solution and is an acceptable screening tool for use among Syrian refugees.