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Frontiers in Public Health 2024This paper presents perspectives on the stigma and shame around mental health in conservative communities, and some of the issues faced by health systems in those... (Review)
Review
This paper presents perspectives on the stigma and shame around mental health in conservative communities, and some of the issues faced by health systems in those communities. The various causes of stigma are explored, and how these are often more pronounced in culturally reserved, conservative communities. While health systems are supposed to provide support for mental health sufferers, this stigma sometimes even extends to healthcare workers, which can discourage patients from asking for assistance. Solutions and reforms are needed, for example education programs; addressing gender norms, and the consideration of culture and religion, to form effective solutions. It is also suggested that alternative therapies and support mechanisms, including digital solutions such as artificial intelligence chatbots, may be useful to provide much needed support to individuals with poor mental health. Along with integrating options such as CBT (cognitive behavioral therapy), it may be useful to draw on indigenous psychologies, such as Islamic psychology, as a way of decolonizing approaches. Therefore, when considering solutions, cultural and religious norms must be considered to ensure their efficacy and acceptance.
Topics: Humans; Social Stigma; Health Personnel; Mental Disorders; Mental Health; Culture
PubMed: 38813403
DOI: 10.3389/fpubh.2024.1384521 -
Scientific Reports May 2024Timing it right framework was used as a framework to explore the illness experiences of patients infected with COVID-19 and to analyze the patients' perceptions of the...
Timing it right framework was used as a framework to explore the illness experiences of patients infected with COVID-19 and to analyze the patients' perceptions of the disease and their true inner feelings to provide a reference for the control of infectious diseases. This research adopted a phenomenological research approach to develop a longitudinal qualitative study. A purposive sampling method was used to select participants and 37 patients were recruited. Depending on the principle that participants should have maximum variation and sampling should cease when interviews content saturation is achieved, 16 COVID-19 patients in an isolation ward in Ningbo City, Zhejiang Province were finally included. Data were collected using semi-structured interviews, and the content of the interviews was analyzed by Colaizzi's 7-step method. The themes of COVID-19 patients' experiences at various phase were presented as follows: multiple emotions intertwined at the time of diagnosis (anxiety, stressful panic, facing the diagnosis calmly), multiple pressures during the hospitalization period (concerns about the disease, unable to adapt to the ward environment, worrying about future hardship), growth of positive illness experience during the isolation and observation period (sublimated outlook on life, affirmation of the government's anti-epidemic policy, more concerned about their own health), adjustment after returning to society (stigma, loss of previous living environment, problems caused by nucleic acid testing), and adaptation to social life (return to normal life, avoidance of illness experience, post-covid-19 syndrome). The illness experience of COVID-19 patients changed dynamically with time, but a sense of shame and uncertainty about recovery was present throughout the process. Interventions should be developed according to the needs of the patients at different times to inform subsequent optimization of care and management of infectious diseases.
Topics: Humans; COVID-19; Female; Male; Longitudinal Studies; Middle Aged; Adult; Qualitative Research; SARS-CoV-2; Anxiety; Aged; China; Emotions; Stress, Psychological; Hospitalization; Adaptation, Psychological
PubMed: 38811669
DOI: 10.1038/s41598-024-63215-4 -
ENeuro May 2024Sleep's contribution to affective regulation is insufficiently understood. Previous human research has focused on memorizing or rating affective pictures and less on...
Sleep's contribution to affective regulation is insufficiently understood. Previous human research has focused on memorizing or rating affective pictures and less on physiological affective responsivity. This may result in overlapping definitions of affective and declarative memories, and inconsistent deductions for how rapid eye movement sleep (REMS) and slow-wave sleep (SWS) are involved. Literature associates REMS theta (4-8Hz) activity with emotional memory processing, but its contribution to social stress habituation is unknown.Applying selective sleep stage suppression and oscillatory analyses, we investigated how sleep modulated affective adaptation towards social stress and retention of neutral declarative memories. Native Finnish participants (N=29, age M=25.8y) were allocated to REMS or SWS suppression conditions. We measured physiological (skin conductance response, SCR) and subjective stress response and declarative memory retrieval three times: before laboratory night, the next morning, and after three days. Linear mixed models were applied to test the effects of condition and sleep parameters on emotional responsivity and memory retrieval.Greater overnight increase in SCR towards the social stressor emerged after suppressed SWS (intact REMS) relative to suppressed REMS (20.1% vs. 6.1%, p=.016). The overnight SCR increase was positively associated with accumulated REMS theta energy irrespective of the condition (r=.601, p=.002). Subjectively rated affective response and declarative memory recall were comparable between the conditions.The contributions of REMS and SWS to habituation of social stress are distinct. REMS theta activity proposedly facilitates the consolidation of autonomic affective responses. Declarative memory consolidation may not have greater dependence on intact SWS relative to intact REMS. Disrupted sleep is a common problem with negative effects on affective regulation. While research indicates that rapid eye movement sleep has a central role in off-line affective processing, the mechanisms are not well defined. We used selective sleep stage suppression to investigate how disrupted sleep and stage-specific neural activity modulated the affective responsivity towards a self-conscious stressor inducing shame. We show that theta band oscillatory activity during rapid eye movement sleep is especially important for preserving the physiological stress response overnight. Understanding sleep-driven affective regulation facilitates development of applications aiming at improving mental wellbeing.
PubMed: 38802242
DOI: 10.1523/ENEURO.0453-23.2024 -
Frontiers in Psychiatry 2024The aim of the study was twofolded: to identify the early maladaptive schemas characteristic of obsessive-compulsive disorder in a Hungarian sample and, to examine the...
INTRODUCTION
The aim of the study was twofolded: to identify the early maladaptive schemas characteristic of obsessive-compulsive disorder in a Hungarian sample and, to examine the presence and severity of comorbid anxiety and depressive symptoms in the light of early maladaptive schemas.
METHODS
112 participants (58 men and 54 women) diagnosed with OCD were involved in the study. The questionnaire package consisted of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the State-Trait Anxiety Inventory (STAI), the Beck Depression Inventory (BDI), the Penn State Worry Questionnaire (PSWQ) and the Schema Questionnaire (SQ).
RESULTS
We identified five early maladaptive schemas with a direct effect on the manifestation of obsessive-compulsive symptoms: Mistrust-Abuse, Inferiority/Shame, Dependence/Incompetence, Insufficient Self-Control/Self-Discipline and Entitlement/Grandiosity (reversed effect). Based on the severity of the early maladaptive schemas, three significantly different groups could be identified in our sample: patients with mild, moderate and high schema-values. Among the groups significant differences can be found in the appearance and severity of compulsive symptoms, as well as in the presence of anxiety and depressive symptoms. But contrary to our expectations, not the severity, but the of the early maladaptive schemas showed a stronger correlation with the symptom variables. An additional result of our study derives from canonical correlation, addressing the relationship among early maladaptive schemas, OCD symptoms, anxiety and depressive symptoms from a new perspective. The results highlight that OCD is only one and not the most serious consequence of personality damage, indicated by early maladaptive schemas.
DISCUSSION
The results of our study suggest that obsessive-compulsive disorder can be divided into several subgroups, which can be separated in terms of symptom severity, comorbid psychiatric symptoms and personality impairment patterns. The relationship between OCD symptom severity and personality impairment seems to be not directly proportional. Our results strengthen the new dimensional view of OCD, which can determine the selection of the appropriate therapeutic treatment method beyond the diagnostic process.
PubMed: 38800063
DOI: 10.3389/fpsyt.2024.1360127 -
Alpha Psychiatry Jan 2024Several theoretical and clinical observations lead to the hypothesis that pathological narcissism could be associated with suicide ideation due to the difficulty in...
OBJECTIVE
Several theoretical and clinical observations lead to the hypothesis that pathological narcissism could be associated with suicide ideation due to the difficulty in regulating shame in a functional way. The present study investigated the roles of guilt, shame and rivalry in the relationship between pathological narcissism and suicidal ideation.
METHODS
A set of self-report questionnaires was completed by a sample of 936 Italian adults. These included the Italian version of the Guilt and Shame Proneness (GASP) scale, the Pathological Narcissism Inventory, the Beck Scale for Suicidal Ideation, and the Narcissism Admiration and Rivalry Questionnaire.
RESULTS
A structural equation model that tested the factorial structure of the GASP and its invariance produced satisfactory results. Moreover, shame was a significant factor in the relationship between narcissism grandiosity and suicidal ideation. However, beta regression coefficients were low.
CONCLUSION
These findings suggest that despite clinicians should consider the presence of suicidal ideation in patients with pathological narcissism and their maladaptive regulation of shame, the relationship between these variables is complex and deserve further investigation.
PubMed: 38799498
DOI: 10.5152/alphapsychiatry.2024.231282 -
Frontiers in Immunology 2024Lanadelumab is a first-line long-term prophylaxis (LTP) in hereditary angioedema (HAE). Real-life data on its long-term efficacy and safety are limited. It is unknown...
INTRODUCTION
Lanadelumab is a first-line long-term prophylaxis (LTP) in hereditary angioedema (HAE). Real-life data on its long-term efficacy and safety are limited. It is unknown whether patients using lanadelumab need short-term prophylaxis (STP).
OBJECTIVES
To provide 4-year follow-up data for our first 34 patients treating with lanadelumab.
METHODS
Patients were assessed for their current injection interval, attacks, treatment satisfaction, disease control (AECT), quality of life impairment (AE-QoL), events that can induce attacks, and the use of STP since the start of their treatment with lanadelumab.
RESULTS
Of 34 patients who started lanadelumab treatment, 32 were still using it after 4 years, with a median injection interval of 33 (range 14-90) days. HAE patients (n=28) reported longer intervals, i.e. 35 (14-90) days, than patients with angioedema due to acquired C1 inhibitor deficiency (n=4, 23 (14-31) days). With their current injection intervals, used for a mean duration of 29 ± 17 months, patients reported a yearly attack rate of 0.3 ± 0.1. More than 70% of patients were attack-free since starting their current injection interval. All patients reported well-controlled disease, i.e. ≥10 points in the AECT; 21 patients had complete control (16 points). AE-QoL scores improved further compared to our initial report, most prominently in the fears/shame domain (-6 points). Treatment satisfaction was very high. No angioedema occurred after 146 of 147 potentially attack-inducing medical procedures without STP.
CONCLUSIONS
Our results demonstrate the long-term efficacy and safety of lanadelumab in real-life and question the need for STP in patients who use effective LTP.
Topics: Humans; Male; Female; Adult; Middle Aged; Angioedemas, Hereditary; Antibodies, Monoclonal, Humanized; Quality of Life; Treatment Outcome; Aged; Follow-Up Studies; Young Adult; Cohort Studies
PubMed: 38799421
DOI: 10.3389/fimmu.2024.1405317 -
BMC Psychology May 2024This cross -sectional research evaluated the psychometric properties of the Self-Stigma of Depression Scale (SSDS) among Iranian people.
INTRODUCTION
This cross -sectional research evaluated the psychometric properties of the Self-Stigma of Depression Scale (SSDS) among Iranian people.
METHODS
This methodological study was conducted among 881 people in 2023, Iran. The method of proportional stratified sampling was used to select participants. To evaluate the validity, face, content, construct, convergent, and discriminant were evaluated. The reliability of SSDS was assessed with the McDonald's omega coefficient, Cronbach α coefficient, and test- retest (Intraclass Correlation Coefficient).
RESULTS
In confirmatory factor analysis, the factor loading of all items of SSDS was more than 0.5, and two items had low factor loading. After deleted these items, goodness of fit indexes (such as GFI = 0.945, RMSEA = 0.067, AGFI = 0.917, CFI = 0.941, RFI = 0.905) confirmed the final model with 14 items and four factors of social inadequacy (3 items), help-seeking inhibition (4 questions), self-blame (3 questions), and shame (4 questions). In the reliability phase, for all items of SSDS, Cronbach α coefficient was 0.850, the McDonald omega coefficient was 0.853, and the intraclass correlation coefficient was 0.903.
CONCLUSION
The Persian form of SSDS was approved with 14 items and four factors: social inadequacy, help-seeking inhibition, self-blame, and shame. This tool can be used to check the status of self-stigmatization of depression in different groups.
Topics: Humans; Iran; Male; Female; Adult; Social Stigma; Psychometrics; Cross-Sectional Studies; Reproducibility of Results; Depression; Middle Aged; Self Concept; Psychiatric Status Rating Scales; Young Adult; Factor Analysis, Statistical; Adolescent; Surveys and Questionnaires
PubMed: 38797822
DOI: 10.1186/s40359-024-01802-w -
The Lancet. Global Health May 2024Timely and safe elective health care facilitates return to normal activities for patients and prevents emergency admissions. Surgery is a cornerstone of elective care...
BACKGROUND
Timely and safe elective health care facilitates return to normal activities for patients and prevents emergency admissions. Surgery is a cornerstone of elective care and relies on complex pathways. This study aimed to take a whole-system approach to evaluating access to and quality of elective health care globally, using inguinal hernia as a tracer condition.
METHODS
This was a prospective, international, cohort study conducted between Jan 30 and May 21, 2023, in which any hospital performing inguinal hernia repairs was eligible to take part. Consecutive patients of any age undergoing primary inguinal hernia repair were included. A measurement set mapped to the attributes of WHO's Health System Building Blocks was defined to evaluate access (emergency surgery rates, bowel resection rates, and waiting times) and quality (mesh use, day-case rates, and postoperative complications). These were compared across World Bank income groups (high-income, upper-middle-income, lower-middle-income, and low-income countries), adjusted for hospital and country. Factors associated with postoperative complications were explored with a three-level multilevel logistic regression model.
FINDINGS
18 058 patients from 640 hospitals in 83 countries were included, of whom 1287 (7·1%) underwent emergency surgery. Emergency surgery rates increased from high-income to low-income countries (6·8%, 9·7%, 11·4%, 14·2%), accompanied by an increase in bowel resection rates (1·2%, 1·4%, 2·3%, 4·2%). Overall waiting times for elective surgery were similar around the world (median 8·0 months from symptoms to surgery), largely because of delays between symptom onset and diagnosis rather than waiting for treatment. In 14 768 elective operations in adults, mesh use decreased from high-income to low-income countries (97·6%, 94·3%, 80·6%, 61·0%). In patients eligible for day-case surgery (n=12 658), day-case rates were low and variable (50·0%, 38·0%, 42·1%, 44·5%). Complications occurred in 2415 (13·4%) of 18 018 patients and were more common after emergency surgery (adjusted odds ratio 2·06, 95% CI 1·72-2·46) and bowel resection (1·85, 1·31-2·63), and less common after day-case surgery (0·39, 0·34-0·44).
INTERPRETATION
This study demonstrates that elective health care is essential to preventing over-reliance on emergency systems. We identified actionable targets for system strengthening: clear referral pathways and increasing mesh repair in lower-income settings, and boosting day-case surgery in all income settings. These measures might strengthen non-surgical pathways too, reducing the burden on society and health services.
FUNDING
NIHR Global Health Research Unit on Global Surgery and Portuguese Hernia and Abdominal Wall Society (Sociedade Portuguesa de Hernia e Parede Abdominal).
PubMed: 38797188
DOI: 10.1016/S2214-109X(24)00142-6 -
Body Image May 2024Body Dysmorphic Disorder (BDD) is a distressing psychological condition where an individual is preoccupied by a perceived issue with their appearance. Qualitative... (Review)
Review
Body Dysmorphic Disorder (BDD) is a distressing psychological condition where an individual is preoccupied by a perceived issue with their appearance. Qualitative studies enable nuanced aspects of BDD phenomenology to be investigated. The current systematic review used thematic synthesis to integrate the findings from the extant qualitative studies. Searches were run on six databases to identify studies that had sought to describe the experience of individuals with BDD. PRISMA guidance was followed and ten articles were identified for inclusion. The quality of each article was appraised and thematic synthesis was conducted to generate novel and summative themes. Three superordinate themes were created: 'self-objectification and the view of self'; 'control and protecting the self'; and 'sociocultural influences and the impact of others in BDD'. Shame and self-disgust emerged as key experiential elements of BDD. The findings of the review suggest that self-objectification theory and possibly models of self-compassion are theoretically relevant to understanding the experience of individuals presenting with BDD. Current interventions may benefit from consideration of these theoretical models when seeking to improve efficacy.
PubMed: 38797069
DOI: 10.1016/j.bodyim.2024.101727 -
International Journal of Qualitative... Dec 2024This paper examines the subjective experience of medical interventions on intersex bodies to reduce cancer risk.
PURPOSE
This paper examines the subjective experience of medical interventions on intersex bodies to reduce cancer risk.
METHODS
Twenty-five individuals with intersex variations took part in semi-structured interviews, analysed through thematic discourse analysis.
RESULTS
Intersex bodies were positioned as inherently sick and in need of modification, with cancer risk legitimating surgical and hormonal intervention. This resulted in embodied shame, with negative impacts on fertility and sexual wellbeing. However, many participants resisted discourses of bio-pathologisation and embraced intersex status. Some medical interventions, such as HRT, were perceived to have increased the risk of cancer. Absence of informed consent, and lack of information about intersex status and the consequences of medical intervention, was positioned as a human rights violation. This was compounded by ongoing medical mismanagement, including health care professional lack of understanding of intersex variations, and the objectification or stigmatization of intersex people within healthcare. The consequence was non-disclosure of intersex status in health contexts and lack of trust in health care professionals.
CONCLUSIONS
The legitimacy of poorly-evidenced cancer risk discourses to justify medical intervention on intersex bodies needs to be challenged. Healthcare practitioners need to be provided with education and training about cultural safety practices for working with intersex people.
Topics: Humans; Male; Female; Neoplasms; Adult; Middle Aged; Disorders of Sex Development; Fear; Qualitative Research; Young Adult; Shame
PubMed: 38796859
DOI: 10.1080/17482631.2024.2356924