Actigraphic and Self-reported Sleep in Traffic Accident Victims

Background: Some accident victims report poorer sleep during the months after the trauma, which may double the risk for and is a mediator of the development of a PTSD. Furthermore, subjective and objective sleep measures are often discrepant in PTSD-patients, which is why a ‘sleep state misperception’ of PTSD patients is often hypothesized. Objective: The goal of this study is to assess differences in sleep quality in victims of a traffic accident compared to healthy participants without an accident history as well as differences between objective and subjective sleep quality measures. Methods: We recruited 25 hospitalized accident victims within ten days of an accident and 31 age and sex-matched controls without an accident history. Three months later, participants were given a structured clinical interview (SCID), they completed the Pittsburg Sleep Quality Index (PSQI) for the previous two weeks, wore a wrist actigraph, and kept a sleep log for two consecutive nights. Results: At the three-month follow-up, none of the victims met the criteria for any kind of mental disorder, but scored higher on the Posttraumatic Diagnostic Scale. On the PSQI they reported slightly worse sleep than controls for the previous two weeks, although sleep log and actigraphy measures on the two recording nights showed no group differences. Actigraphy measures showed shorter sleep onset latencies compared to log measures. Conclusions: The accident victims suffered only minimal sleep disturbances three months later. The assumption of a ‘sleep state misperception’ in traffic accident victims is questioned by these results.

An Investigation into the Impact of COVID-19 on the Relationships Between Parents of Children Diagnosed with Cystic Fibrosis and the Cystic Fibrosis Multi-Disciplinary Team

Background: The COVID-19 pandemic has seen working practice in Cystic Fibrosis (CF) move to more remote clinical models. This study assesses the impact of shifting working models on the relationships between families of young people with CF and CF Multi-disciplinary Teams (MDT) as well as parents perceptions of working remotely. Methods: Six semi-structured interviews with parents of young people under the care of a regional UK CF specialist centre were analysed using Inductive content analysis. Results: Three domains emerged: Interpersonal Relationships, Remote Clinics and CF in the Context of COVID-19. The enduring and close relationships between the MDT and families were discussed as well as the acceptability of remote clinics moving forwards. Conclusions: The importance of the quality in the relationship between families and CF MDTs is vital to enhance ongoing care. Remote working was acceptable in the context of COVID-19 and with some considerations could be useful moving forwards.

A Comparison of Depressive Symptoms in Medical and Psychology Students in Germany – Associations with Potential Risk and Resilience Factors

Background: Previous studies have shown that medical students are more prone to suffer from symptoms related to depression than other students. Even though there is some evidence that psychology students also experience such symptoms, research concerning the mental health of future psychologists is scarce. Objective: The aims of this study were threefold: (a) to determine the prevalence of symptoms related to depression among medical and psychology students (b) to investigate risk factors, which may have a potential influence on the development of depressive symptoms and (c) to examine resilience factors in order to indicate possible approaches to improve the mental health of the students. Methods: A total of 673 medical and psychology students completed the Beck Depression Inventory-II (BDI-II) to assess depressive symptoms, a neuroticism scale, and a standardized questionnaire for 13 risk and eight resilience factors derived from the literature. Results: While the results of previous research concerning the prevalence of depressive symptoms could be replicated for medical students (22% exceeding the cut-off in the BDI-II), psychology students demonstrated an even higher prevalence (28%). Ten potential risk factors and five potential resilience factors could be identified, which also showed a cumulative effect: The more risk factors students reported, the more depressive symptoms they experienced; the inverse effect was observed for resilience factors. Conclusions: Not only medical but also psychology students show elevated depressive symptomatology. In the university context, notably, the pressure to perform represents a potential risk factor, whereas the presence of just two resilience factors such as emotional support and study satisfaction contribute to a decrease of symptoms.

Mammography Adherence among High-Risk Women with Breast Cancer and Either a Non-Pathogenic Mutation Identified or Untested BRCA1/2 Genetic Status

Background: Little is known about the illness perceptions of women with a previous breast cancer diagnosis and either no access to a personal BRCA1/2 test or tested and a no pathogenic mutation identified result and how this might impact their mammography adherence. Objective: The aim of this study was to assess the impact of illness beliefs, specifically those relating to emotional representations and cure and control beliefs about breast cancer, and socio-economic status (SES) on mammography adherence of these women. The traditional health belief model (HBM) was compared to a modified model which allowed for the contribution of emotions in health surveillance decision-making. Method: Mailed self-report questionnaires were completed by 193 women recruited from an Australian Familial Cancer Centre. Step-wise logistic regression analyses were conducted on n=150 [aged 27-89 years (M=56.9)] for whom complete data were available. Results: The questionnaire response rate was 36%. Higher levels of emotional representations of breast cancer were associated with greater mammography adherence (OR = 1.18, 95% CI = 1.03-1.36, p =.019). Middle income was six times more likely to predict mammography adherence than lower income (OR = 6.39, 95% CI = 1.03 – 39.63, p =.047). The modified HBM was superior to the traditional HBM in predicting mammography adherence (X2 [15, N = 118] = 26.03, p =.038). Conclusions: Despite a modest response rate, our data show that emotional illness representations about breast cancer and middle income status were found to significantly predict mammography adherence. Therefore, providing surveillance services and delivering information considerate of financial status and constructed around emotional motivators may facilitate mammography adherence among women like those described in this study.

Studying and More: Part-Time Employment as an Educational Challenge?

Background: Future health-care professionals face stress both during education and in later professional life. Next to educational trainings, many students are forced to assume part-time employment. Objective: Applying the Job Demands-Resources Model to the educational context, we investigate which role part-time employment plays next to health-care professional students’ education-specific demands and resources in the prediction of perceived stress. Method: In this cross-sectional study, data from N = 161 health-care students were analysed, testing moderation models. Results: Education-specific demands were associated with higher and education-specific resources with lower amounts of perceived stress. Part-time employment functioned as moderator, i.e. demands were less associated with stress experiences in students who were employed part-time. Conclusion: Identifying part-time employment as a resource rather than a demand illustrates the need to understand students’ individual influences on stress. Both educators and students will benefit from reflecting these resources to support students’ stress management.

Generalized Anxiety Disorder Symptom Improvement Following Mindfulness-Based Stress Reduction in a General Hospital Setting

Background: GAD symptom complaints are common in general medical settings, yet psychosocial intervention options provided within such settings are limited. Randomized controlled trials have found that MBSR is effective for symptom reduction, but such research typically delivered MBSR to small diagnostically homogeneous patient groups rather than to larger heterogeneous groups as provided in medical settings. Objective: The current research examined what proportion of patients already enrolled in a general hospital MBSR program presented with symptoms of GAD and whether such symptoms reduced after delivering MBSR in large diagnostically heterogeneous groups. Methods: Twenty-six (40%) of 65 participants enrolled in a large hospital MBSR program indicated moderate to severe GAD symptom severity at the first MBSR session. Of these, 19 voluntarily completed brief self-report measures at the beginning and end of their MBSR course. Results: Statistically significant reductions pre to post-MBSR were found on the GAD-7 (Cohen’s d = 1.95), Penn State Worry Questionnaire (Cohen’s d = 0.76) and the DASS21 Anxiety (Cohen’s d = 0.71) and Stress (Cohen’s d = 1.31) scales. Fifteen (79%) GAD participants scored below the GAD-7 screening measure cutoff at the final MBSR session. Forty-seven percent showed clinically significant improvement on PSWQ scores. Conclusions: MBSR, as typically delivered in general hospital settings, may provide an acceptable and effective treatment option for GAD patients seeking care in medical settings.

Prefrontal BOLD Responses Coupled to Changing Emotional Faces in Adolescents with and without a History of Suicide Attempt

Background: Functional abnormalities in emotion processing neural circuitry in adolescents with a history of suicide attempt relative to depressed adolescents with no history of suicide and healthy controls have been identified, typically utilizing static face presentations. Objective: The objective of the present work was to characterize functional activations associated with emotional face processing in adolescents with and without a history of suicide attempt. Methods: 64 adolescents including 19 with a history of depression and suicide attempt (ATT), 22 with a history of depression but no suicide attempt (NAT) and 23 healthy controls (HC) performed an implicit emotional-faces task during functional neuroimaging, in which they identified a color label superimposed on neutral faces that dynamically morphed into one of four emotional faces (angry, fearful, sad, and happy). Results: HC showed greater Blood Oxygenation Level Dependent (BOLD) responses compared with ATT in the Right Dorsolateral Prefrontal Cortex (rDLPFC) to all emotional faces compared to shapes. A similar pattern of group differences was seen when both ATT and NAT groups were compared with HC. Across all participants, an association between child trauma and rDLPFC activation was seen, although this was not corrected for multiple comparisons. Conclusions: Together, the findings are consistent with prior observations of emotion-related alterations in neural function in suicide attempters. However, they also suggest that adequate control groups are necessary to dissociate specific correlates of suicide risk from depression or trauma severity, which may contribute to prefrontal alterations in emotion processing.

Bedside Treatment Decisions: An Evaluation of the Factors Physicians Take into Consideration When Making Complex Rationing Decisions

Background: The budget limitations that are imposed on health care providers often force caregivers to become rationers, and physicians are required to select which patients receive treatments and which go without on a daily basis. This involves making highly complex decisions, and physicians are required to evaluate both relevant and irrelevant parameters to ensure the final decision is sound. Objective: This research examined which of seven parameters physicians used to make rational decisions as to which of a group of five patients in need received treatment. Method: An experiment was conducted in which the decision relevance of objective parameters and additional information about the needy, such as gender or smoking habits, were investigated. Results and conclusion: The findings indicated that physicians focus on central disease-related criteria very well and, thus, arrive at a comprehensive rationing decision, even in complex situations.

Early Amygdala Activation and Later Ventromedial Prefrontal Cortex Activation During Anger Induction and Imagery

Background: Neurobiological studies implicate the amygdala and related limbic/paralimbic structures, such as the ventromedial prefrontal cortex (VMPFC), in anger and aggression. Previous studies of self-generated anger using Positron Emission Tomography (PET) have consistently documented a lack of amygdala activation during anger. Objective: We investigated the hypothesis that a lack of amygdala activation during anger is due to differences in the time course of amygdala and VMPFC activation. Specifically, we explored whether the amygdala is involved in the early phases of anger experience which is later followed by increased VMPFC activation. Methods: Eighteen healthy control participants underwent fMRI. We adapted an anger induction paradigm previously used in our PET study, in which neutral and angry states were induced using autobiographical scripts. The hypothesized time course of amygdala and VMPFC activation during acute anger induction and imagery were modeled. Region of interest (ROI) analyses were used to identify significant a priori region activation, and correlations were run between signal values and VAS anger ratings. Results: Amygdala activation increased during the acute phase of anger induction and decreased during the later phase of anger imagery, whereas VMPFC activation decreased during anger induction and increased during anger imagery, compared to the neutral conditions. In addition, negative correlations were found between self-ratings of anger and bilateral VMPFC activation. Conclusions: Overall, our results suggest that the amygdala may be active at the initial onset of anger while the VMPFC is activated over time as the individual sustains and perhaps regulates that emotional state.