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High-risk pregnancies elevate maternal stress, impacting offspring neurodevelopment and behavior. This study, involving 112 participants, aimed to compare perceived stress, neurodevelopment, and behavior in high-risk and low-risk pregnancies. Two groups, high-risk and low-risk, were assessed during pregnancy for stress using hair cortisol and psychological analysis. At 24 months post-birth, their children’s neurodevelopment and behavior were evaluated. Results revealed higher perceived stress and pregnancy-related concerns in high-risk pregnancies, contrasting with low-risk pregnancies. Offspring from high-risk pregnancies displayed elevated internalizing behavior scores, while low-risk pregnancies showed higher externalizing behavior scores. Additionally, women in low-risk pregnancies exhibited increased cortisol concentrations 24 months post-delivery. These findings underscore the necessity for early stress detection and prevention programs during pregnancy, particularly in high-risk cases, to enhance maternal and infant health.
To analyze the effects of Dignity Therapy (DT) on the physical, existential, and psychosocial symptoms of individuals with amyotrophic lateral sclerosis (ALS).
Methods
This is a mixed-methods case study research that used the concurrent triangulation strategy to analyze the effects of DT on 3 individuals with ALS. Data collection included 3 instances of administering validated scales to assess multiple physical symptoms, anxiety, depression, spiritual well-being, and the Patient Dignity Inventory (PDI), followed by the implementation of DT and a semi-structured interview.
Results
The scale results indicate that DT led to an improvement in the assessment of physical, social, emotional, spiritual, and existential symptoms according to the score results. It is worth noting that the patient with a recent diagnosis showed higher scores for anxiety and depression after DT. Regarding the PDI, the scores indicate improvements in the sense of dignity in all 3 cases, which aligns with the positive verbal reports after the implementation of DT.
Significance of results
This study allowed us to analyze the effects of DT on the physical, existential, and psychosocial symptoms of individuals with ALS, suggesting the potential benefits of this approach for this group of patients. Participants reported positive effects regarding pain and fatigue, could reflect on their life trajectories, and regained their value and meaning.
Chronic stress responses can lead to physical and behavioural health problems, often experienced and observed in the care of people with intellectual disabilities or people with dementia. Electrodermal activity (EDA) is a bio-signal for stress, which can be measured by wearables and thereby support stress management. However, the how, when and to what extent patients and healthcare providers can benefit is unclear. This study aims to create an overview of available wearables enabling the detection of perceived stress by using EDA.
Methods:
Following the PRISMA-SCR protocol for scoping reviews, four databases were included in the search of peer-reviewed studies published between 2012 and 2022, reporting detection of EDA in relation to self-reported stress or stress-related behaviours. Type of wearable, bodily location, research population, context, stressor type and the reported relationship between EDA and perceived stress were extracted.
Results:
Of the 74 included studies, the majority included healthy subjects in laboratory situations. Field studies and studies using machine learning (ML) to predict stress have increased in the last years. EDA is most often measured on the wrist, with offline data processing. Studies predicting perceived stress or stress-related behaviour using EDA features, reported accuracies between 42% and 100% with an average of 82.6%. Of these studies, the majority used ML.
Conclusion:
Wearable EDA sensors are promising in detecting perceived stress. Field studies with relevant populations in a health or care context are lacking. Future studies should focus on the application of EDA-measuring wearables in real-life situations to support stress management.
Increased reactivity to minor stressors is considered a risk factor for psychosis, especially in vulnerable individuals. In the present study, we investigated affective and psychotic stress reactivity as well as its link with psychotic symptoms and psychopathology in youths with 22q11.2 deletion syndrome (22q11DS), a neurogenetic condition associated with a high risk for psychosis.
Methods
A 6-day ecological momentary assessment protocol was used to assess perceived daily-life stress as well as affective and psychotic reactivity to stress in participants with 22q11DS (n = 38, age = 18.4) and healthy controls (HC; n = 53, age = 19.1). Psychotic symptoms, general psychopathology, and coping strategies were also assessed through clinical interviews and questionnaires.
Results
Participants with 22q11DS reported higher levels of perceived social stress (b = 0.21, p = 0.036) but lower levels of activity-related stress (b = −0.31, p = 0.003) in their daily lives compared to HC. The groups did not differ in affective or psychotic reactivity to stress, but individuals with 22q11DS who reported increased affective reactivity to social stressors showed more severe positive psychotic symptoms (rs = 0.505, p = 0.008). Finally, avoidance coping strategies moderated the association between stress and negative affects.
Conclusions
Our results suggest an increased vulnerability for daily social stress in youths with 22q11DS, and link elevated social stress reactivity to heightened psychotic symptom severity. Given the high risk for psychosis in 22q11DS, interventions should focus on reducing social stress and developing adaptive coping strategies.
Negative experiences during feather growth can result in fault bar formation. Fault bars are malformations perpendicular to the rachis of the feather caused by stressful experiences during feather growth. However, there are little data on the causal effect of psychological stress on the formation of fault bars in chickens. The objective of this study was to examine the effect of acute stress in domestic chickens (Gallus gallus domesticus) on fault bar formation to validate this measure as a welfare indicator. Thirty broiler breeder pullets were housed in six cages at 21 days of age. Three cages were exposed to an acute stress protocol while the other three were the unstressed control. Feathers were marked as close as possible to the growing follicle at 21 (wing feathers) and 60 (all feathers) days of age. Acute stress came in the form of three procedures (unpredictable feed delivery, induction of tonic immobility, and crowding) repeated twice, 3-8 days apart and randomly, from 28 to 60 days of age. Wing, tail, and cover feathers were removed and measured at 60 days of age for weight, length, and number of fault bars. Exposure to acute, unpredictable stress increased the number of fault bars in wing feathers of chicks with a high number of initial fault bars. Feather growth decreased for the stressed group compared to the control. These results suggest that feather traits, including fault bars and feather growth, can be used as indicators of negative welfare in chickens.
Symptoms related to chronic stress are prevalent and entail high societal costs, yet there is a lack of international consensus regarding diagnostics and treatment. A new stress-related diagnosis, exhaustion disorder, was introduced into the Swedish version of ICD-10 in 2005. Since then, use of the diagnosis has increased rapidly.
Aims
To create the first comprehensive synthesis of research on exhaustion disorder to report on the current state of knowledge. Preregistration: Open Science Framework (osf.io), doi 10.17605/OSF.IO/VFDKW.
Method
A PRISMA-guided scoping review of all empirical studies of exhaustion disorder was conducted. Searches were run in the MEDLINE, PsycInfo and Web of Science databases. Data were systematically charted and thematically categorised based on primary area of investigation.
Results
Eighty-nine included studies were sorted into six themes relating to lived experience of exhaustion disorder (n = 9), symptom presentation and course (n = 13), cognitive functioning (n = 10), biological measures (n = 24), symptom measurement scales (n = 4) and treatment (n = 29). Several studies indicated that individuals with exhaustion disorder experience a range of psychiatric and somatic symptoms beyond fatigue, but robust findings within most thematic categories were scarce. The limited number of studies, lack of replication of findings and methodological limitations (e.g. small samples and scarcity of specified primary outcomes) preclude firm conclusions about the diagnostic construct.
Conclusions
More research is needed to build a solid knowledge base for exhaustion disorder. International collaboration regarding the conceptualisation of chronic stress and fatigue is warranted to accelerate the growth of evidence.
Women carrying a fetus diagnosed with congenital heart disease often experience significant distress because of their medical diagnosis. Given the well-documented impact associated with elevated prenatal stress and critical importance of developing targeted interventions, this study aims to examine stressors, coping and resilience resources, and mental health treatment preferences in pregnant women receiving a congenital heart disease diagnosis to inform the development of a psychological intervention to reduce maternal distress prenatally.
Methods:
Three groups of participants were included consisting of two pregnant women carrying a fetus with congenital heart disease, five women of children (4−16 months) with congenital heart disease, and five paediatric cardiology medical providers. Responses were gathered via semi-structured interviews and analysed using qualitative thematic analysis.
Results:
Information regarding four broad areas were analysed of emotional distress during pregnancy; experience of initial diagnosis; coping and resilience; and perspectives on a mental health intervention in pregnancy. Anxiety regarding baby’s future, guilt following diagnosis, and various coping strategies emerged as primary themes among the participant sample. Medical staff corroborated mothers’ heightened anxiety and viewed a psychotherapeutic intervention during the prenatal period as essential and complimentary to standard of care.
Conclusion:
We identified salient themes and preferred components for a future psychological intervention delivered prenatally.
Practice Implications:
Patients’ and providers’ perspectives regarding the nature of maternal distress, resilience and treatment preferences can inform the development of interventions to support the emotional well-being of pregnant women carrying a fetus with congenital heart disease to optimise care and potentially improve outcomes for fetal brain development.
Documenting Tunisian’ stress responses to an unprecedented pandemic is essential for mental health interventions and policy-making.
Objectives
To describe the perceived stress generated by the Covid-19 epidemic and confinement among the Tunisian people.
Methods
Participants had to fill out a questionnaire including epidemiological data and the Perceived Stress Scale 10 (PSS10), which is the most widely used psychological instrument for measuring the stress perception. Individual scores can range from 0 to 40 with higher scores indicating higher perceived stress.
Results
Our study included 121 subjects, of which 70.6% were women.They had an average age of 36.52 years and a history of psychiatric disorders in 13.1% of cases, such as anxiety disorders (10.4%), depressive disorders (5.9%) and obsessive compulsive disorders (2.3%). More than one in two participants (61.4%) reported the presence of sleep disorders. Regarding medical history, participants declared having asthma (5%), diabetes (1.8%), high blood pressure (3.6%), and a chronic disease with corticosteroid treatment (5%). The mean PSS score was 16.96. This last was correlated to age (p<0.001), female gender (p<0.001), primary or secondary school level (p=0.03), a history of anxiety (p<0.001) and depressive disorders (p<0.001), and to sleep disorders (p<0.001).
Conclusions
The stress level among the Tunisian people during the Covid-19 pandemic was very close to that observed in other countries, deserving special attention especially among vulnerable populations.
The ongoing COVID-19 pandemic is inducing fear, and a timely understanding of mental health status is urgently needed for society. Previous research has revealed a profound and wide range of psychosocial impacts on people at the individual, community, and international levels. On an individual level, people are likely to experience fear of falling sick or dying themselves, feelings of helplessness, and stigma. Currently, there is little understanding of mental well-being assessment under scenarios of pandemics that oblige to social isolation and quarantine.
Objectives
This study aims to: a) establish the prevalence of psychiatric symptoms; b) identify risk and protective factors contributing to psychological stress; and c) identify coping strategies to promote better adjustment during and after the pandemic crisis.
Methods
We will adopt a mixed-method approach, firstly with a cross-sectional survey design (in both Portugal and Swiss context) to assess the higher education student’s psychosocial response during and after the pandemic, by using an anonymous online questionnaire. In a 2nd phase, and in order to gain more insight into the psychological stress faced by the students as a result of pandemic, a qualitative approach was chosen, focusing on the experiences of the participants.
Results
This study has received ethical approval from both international and local institutional review boards. Data collection will start in November 2020 and will be completed at February 2021.
Conclusions
The findings of this study will provide important data to assist government agencies and healthcare professionals in safeguarding the psychosocial wellbeing of the community in the face of COVID-19 outbreak expansion.
COVID-19 lockdown measures imposed extensive restrictions to public life. Previous studies suggest significant negative psychological consequences, but lack longitudinal data on population-based samples.
Aims
We aimed to prospectively identify increased psychological stress and associated risk factors in parent–child dyads.
Method
We conducted a prospective, observational online study on a representative German sample of 1221 adolescents aged 10–17 years and their parents. Psychological stress and psychosocial variables were assessed before the pandemic (baseline) and 1 month after the start of lockdown (follow-up), using standardised measures. We used multilevel modelling to estimate changes in psychological stress, and logistic regression to determine demographic and psychosocial risk factors for increased psychological stress.
Results
The time of measurement explained 43% of the psychological stress variance. Of 731 dyads with complete data, 252 adolescents (34.5%, 95% CI 31.0–37.9) and 217 parents (29.7%, 95% CI 26.4–33.0) reported a significant increase in psychological stress. Baseline levels were lower than in dyads without increased psychological stress. Risk factors for increased psychological stress included sociodemographic (e.g. female parents, severe financial worries) and emotion regulation aspects (e.g. non-acceptance of emotional responses in parents, limited access to emotion regulation strategies in adolescents), explaining 31% of the adolescent (Nagelkerke R2 = 0.31) and 29% of the parental (Nagelkerke R2 = 0.29) model variance.
Conclusions
This study is the first to prospectively show an increase in psychological stress during COVID-19 lockdown in a representative family sample. Identified demographic and psychosocial risk factors lead to relevant implications for prevention measures regarding this important public health issue.
This study investigates burnout and sources of stress related to the coronavirus disease 2019 (COVID-19) pandemic among a group of health care risk managers/patient safety practitioners.
Methods:
An online survey was used, including the Oldenburg Burnout Inventory (OLBI) and 1 open-ended question: Since the start of the COVID-19 pandemic, what work or non-work-related issues have been causing you the most stress?
Results:
A total of 31 participants completed the OLBI; 27 answered the open-ended question. Over 70% of participants qualified as burned out. A thematic analysis was used to analyze stressors. Key themes included impacts of social distancing, changing duties and workload, real and potential impacts of the virus (eg, fear of infection for self or others), and financial concerns (personal and organizational). Less common themes included untrustworthy and constantly changing guidance, feeling abused by persons in power, and positive comments about the experience of working during the pandemic.
Conclusion:
Burnout and pandemic-related stress may be very common in the health care risk management and patient safety workforce. Additional research is required to more robustly estimate the prevalence of burnout in this population. Meanwhile, the sources of stress identified here may aid health care organizations in taking immediate action to protect this vital workforce.
The current study aimed to analyse the prospective association between perceived work demand and changes in eating behaviours in schoolteachers.
Design:
This was a prospective cohort study with self-reported information obtained on the Demand Control Support Questionnaire and eating behaviours at baseline and after a 2-year follow-up. The analyses were performed using mixed-effects models adjusted for the main confounders.
Setting:
The setting consisted of elementary and secondary schools located in a large city in southern Brazil.
Participants:
The participants were 502 schoolteachers (65·9 % females, median age of 42·7 years [interquartile range 34·2, 49·4]).
Results:
A total of 39·2 % of the schoolteachers were classified at baseline with job strain, 28·9 % with passive job, 12·2 % with active job and 19·7 % with low-strain job. In the fully adjusted models, compared with teachers who reported low-strain job, those with higher levels of job strain were more likely to reduce (coefficient = 0·064; 95 % CI 0·018, 0·109) and less likely to increase (coefficient = −0·066; 95 % CI −0·115, −0·016) their frequency of fruit consumption regardless of sociodemographic, lifestyle, health conditions and social support at work.
Conclusion:
Job strain plays a relevant role in the frequency of fruit consumption over time in schoolteachers. The balance between demand and control at work must be considered in strategies for promoting healthy eating despite perceived social support.
Stress is a risk factor for numerous negative health outcomes, including cognitive impairment in late-life. The negative association between stress and cognition may be mediated by depressive symptoms, which separate studies have identified as both a consequence of perceived stress and a risk factor for cognitive decline. Pathways linking perceived stress, depressive symptoms, and cognition may be moderated by sociodemographics and psychosocial resources. The goal of this cross-sectional study was to identify modifying factors and enhance understanding of the mechanisms underlying the stress–cognition association in a racially and ethnically diverse sample of older adults.
Method:
A linear regression estimated the association between perceived stress and episodic memory in 578 older adults (Mage = 74.58) in the Washington Heights-Inwood Columbia Aging Project. Subsequent models tested whether depressive symptoms mediated the stress–memory relationship and whether sociodemographics (gender, race, and ethnicity) or perceived control moderated these pathways.
Results:
Independent of sociodemographics and chronic diseases, greater perceived stress was associated with worse episodic memory. This relationship was mediated by more depressive symptoms. Higher perceived control buffered the association between stress and depressive symptoms. There was no significant moderation by gender, race, or ethnicity.
Conclusion:
Depressive symptoms may play a role in the negative association between perceived stress and cognition among older adults; however, longitudinal analyses and studies using experimental designs are needed. Perceived control is a modifiable psychological resource that may offset the negative impact of stress.
The aim of this study was to investigate risk factors and psychological stress of health-care workers (HCWs) with coronavirus disease 2019 (COVID-19) in a nonfrontline clinical department.
Methods:
Data of 2 source patients and all HCWs with infection risk were obtained in a department in Wuhan from January to February 2020. A questionnaire was designed to evaluate psychological stress of COVID-19 on HCWs.
Results:
The overall infection rate was 4.8% in HCWs. Ten of 25 HCWs who contacted with 2 source patients were diagnosed with confirmed COVID-19 (8/10) and suspected COVID-19 (2/10). Other 2 HCWs were transmitted by other patients or colleagues. Close care behaviors included physical examination (6/12), life nursing (4/12), ward rounds (4/12), endoscopic examination (2/12). Contacts fluctuated from 1 to 24 times and each contact was short (8.1 min ± 5.6 min). HCWs wore surgical masks (11/12), gloves (7/12), and isolation clothing (3/12) when providing medical care. Most HCWs experienced a mild course with 2 asymptomatic infections, taking 9.8 d and 20.9 d to obtain viral shedding and clinical cure, respectively. Psychological stress included worry (58.3%), anxiety (83.3%), depression (58.3%), and insomnia (58.3%).
Conclusions:
Close contact with COVID-19 patients and insufficient protection were key risk factors. Precaution measures and psychological support on COVID-19 is urgently required for HCWs.
The coronavirus disease (COVID-19) pandemic continues to be a devastating chapter in history. The consequences of the pandemic unfold daily and they extend beyond physical health. Current research suggests that it is a public mental health crisis. With regard to the physical effects of COVID-19, policy-makers have drawn from past experiences, such as the severe acute respiratory syndrome (SARS) outbreak of 2003, to craft unique responses. A similar approach must be taken to address the mental health effects of the pandemic. Because COVID-19 can fit the definitions of a mental health disaster, it can be addressed using the principles of disaster mental health management. This letter to the editor presents arguments for defining COVID-19 as a mental health disaster, the challenges facing policy-makers in addressing it as such, and calls upon researchers to fill this gap in the literature.
Some recent researches have shown the important role of hair cortisol as a retrospective biomarker of chronic stress. The aim of this research was to investigate the relationship between hair cortisol levels and sociodemographic and psychological variables, such as perceived stress levels and psychopathological symptoms on a Spanish population. The sample consisted of 347 healthy people, 230 women and 117 men, with an average age of 33.39 years (SD = 12.63). Hair cortisol levels were measured by obtaining a hair sample. In addition, a psychological assessment composed by: Analogic-Visual Stress Scale, Perceived Stress Scale (PSS), Symptom Checklist 90 Revised (SCL–90–R) and the assessment of vital stressful events suffered, was carried out. The mean cortisol level was 108.93 pg/mg (SD = 66.43) in men, and 120.38 pg/mg (SD = 87.26) in women. The linear hierarchical regression showed that Analogic-Visual Stress Scale and perceived stress levels were related with higher hair cortisol levels (R2 = .032; t = 2.21; p = .029). Due to the relationship between daily stress levels, Analogic-Visual Stress Scale, anxiety sub-scale of SCL 90–R and perceived stress levels with hair cortisol levels, we conclude that there is a relation between perceived yourself stressed and the physiological levels.
We investigated plasma cortisol in a psychological stress paradigm in seven weaned anhedonic alcoholics in comparison with seven age-matched healthy controls. Alcoholics had significantly higher mean plasma cortisol at baseline and no increase following a psychological stress paradigm. Anhedonic alcoholics judged the experimental situation less agreeable than controls. Anhedonic alcoholics may have blunted cortisol response to psychological stress.