Impact of alternative terminology for depression on help-seeking intention: A randomized online trial.

OBJECTIVE: People with depression experience barriers to seeking professional help. Different diagnostic terminology can influence people's treatment/management preferences. The aim of this study was to investigate how alternative depression diagnostic labels and recommendations impact help-seeking intentions and psychosocial outcomes. METHODS: Participants (18-70 years) were recruited using an online panel (Australia) to complete a randomized controlled trial. They read a hypothetical scenario where they discussed experiencing depressive symptoms with their GP and were randomized to receive one of four diagnoses ("depression," "burnout," "functional impairment syndrome" [fictitious label], no label [control]), and one of two follow-up recommendations ("clinical psychologist," "mind coach"). PRIMARY OUTCOME: help-seeking intention (5-point scale, higher = greater intention); secondary outcomes: intention to speak to boss, self-stigma, worry, perceived severity, illness perceptions, and personal stigma. RESULTS: A total of 676 participants completed the survey. There was no main effect of diagnostic label on help-seeking intention or stigma outcomes. Intention to speak to a boss was higher with the depression compared to burnout label (MD = 0.40, 95% CI: 0.14-0.66) and perceived severity was higher with the depression label compared to control (MD = 0.48, 95% CI: 0.22-0.74) and all other labels. Those who received the "clinical psychologist" recommendation reported higher help-seeking intention (MD = 0.43, 95% CI: 0.25-0.60) and treatment control (MD = 0.69, 95% CI: 0.29-1.10) compared to the "mind coach" recommendation. CONCLUSION: Findings highlight the success of efforts to promote help-seeking from clinical psychologists for depression. If burnout is considered a separate diagnostic entity to depression, greater awareness around what such a diagnosis means may be needed. Future research should examine how different terminologies surrounding other mental health conditions impact help-seeking and stigma.

Time interval to delivery in asymptomatic twin pregnancies with a short cervix at 23-28 weeks' gestation.

OBJECTIVES: To evaluate the risk and timing of spontaneous preterm birth (PTB) in asymptomatic twin pregnancies with a short cervical length (CL≤25 mm) at 23-28 weeks of gestation. METHODS: Multicenter retrospective cohort study of asymptomatic twin pregnancies with a short CL between 23 and 28 weeks' gestation within a university health system from 1/2012 to 12/2019. Cases were divided into 4 groups based on CL measurement (≤10 mm, 11-15 mm, 16-20 mm, and 21-25 mm). The primary outcome was time interval from presentation to delivery. Secondary outcomes included delivery within one and two weeks of presentation, and delivery prior to 32, 34, and 37 weeks, respectively. RESULTS: 104 patients were included. The time interval from presentation to delivery was significantly different among the four groups (p<0.001), with the CL≤10 mm group having the shortest time interval to delivery. Regardless of the CL measurement, spontaneous PTB within one and two weeks was extremely uncommon and occurred in only one patient within the study cohort (1/104, 1.0%). The risk of spontaneous PTB was highest in the shortest CL group (CL ≤ 10 mm; 53.8% PTB<32 weeks, 61.5% PTB<34 weeks, 92.3% PTB<37 weeks). CONCLUSIONS: Asymptomatic twin pregnancies with a CL ≤ 10 mm had the shortest time interval to delivery and thus represent a specifically high risk group for sPTB. Although all patients were at high risk of sPTB, only one delivered within 1 or 2 weeks of presentation.

Mental health and mindfulness amongst Australian fire fighters.

BACKGROUND: While extensive research has highlighted the positive mental health outcomes associated with mindfulness, little work has examined how mindfulness may protect the mental health of first responders exposed to trauma. This is important as there is increasing evidence that mindfulness skills, if protective, can be taught to groups of at-risk workers. The purpose of the current research was to examine the potential role mindfulness may have in supporting the mental health of Australian fire fighters. METHODS: The sample consisted of 114 professional fire fighters who completed demographic and job-related questions followed by measures of mindfulness (FMI-14), well-being (WHO-5), depression (HADS-D) and anxiety (HADS-A). Hierarchical multiple linear regressions were performed to determine whether levels of mindfulness were associated with anxiety, depression and wellbeing after accounting for age and number of years of fire service. RESULTS: High levels of mindfulness were associated with decreased depression (p ≤ .001) and anxiety (p ≤ .001) as well as increased psychological well-being (p ≤ .001). Measures of mindfulness were able to explain a substantial amount of the variability in well-being (26.8%), anxiety (23.6%) and depression (22.4%), regardless of age and years of fire service. CONCLUSIONS: The present study provides evidence for robust associations between dispositional mindfulness and mental health markers of depression, anxiety and well-being in Australian fire fighters recently exposed to trauma. Mindfulness is a psychological characteristic that may be able to be modified, although further research is required to substantiate these findings and to formally test mindfulness interventions. Such studies would allow greater insight into the underlying mechanisms through which mindfulness may exert its beneficial effects.

Resilience@Work Mindfulness Program: Results From a Cluster Randomized Controlled Trial With First Responders.

BACKGROUND: A growing body of research suggests that resilience training can play a pivotal role in creating mentally healthy workplaces, particularly with regard to protecting the long-term well-being of workers. Emerging research describes positive outcomes from various types of resilience training programs (RTPs) among different occupational groups. One specific group of workers that may benefit from this form of proactive resilience training is first responders. Given the nature of their work, first responders are frequently exposed to stressful circumstances and potentially traumatic events, which may impact their overall resilience and well-being over time. OBJECTIVE: This study aimed to examine whether a mindfulness-based RTP (the Resilience@Work [RAW] Mindfulness Program) delivered via the internet can effectively enhance resilience among a group of high-risk workers. METHODS: We conducted a cluster randomized controlled trial (RCT) comprising 24 Primary Fire and Rescue and Hazmat stations within New South Wales. Overall, 12 stations were assigned to the 6-session RAW Mindfulness Program and 12 stations were assigned to the control condition. A total of 143 active full-time firefighters enrolled in the study. Questionnaires were administered at baseline, immediately post training, and at 6-month follow-up. Measurements examined change in both adaptive and bounce-back resilience as well as several secondary outcomes examining resilience resources and acceptance and mindfulness skills. RESULTS: Mixed-model repeated measures analysis found that the overall test of group-by-time interaction was significant (P=.008), with the intervention group increasing in adaptive resilience over time. However, no significant differences were found between the intervention group and the control group in terms of change in bounce-back resilience (P=.09). At 6-month follow-up, the group receiving the RAW intervention had an average increase in their resilience score of 1.3, equating to a moderate-to-large effect size compared with the control group of 0.73 (95% CI 0.38-1.06). Per-protocol analysis found that compared with the control group, the greatest improvements in adaptive resilience were observed among those who completed most of the RAW program, that is, 5 to 6 sessions (P=.002). CONCLUSIONS: The results of this RCT suggest that mindfulness-based resilience training delivered in an internet format can create improvements in adaptive resilience and related resources among high-risk workers, such as first responders. Despite a number of limitations, the results of this study suggest that the RAW Mindfulness Program is an effective, scalable, and practical means of delivering online resilience training in high-risk workplace settings. To the best of our knowledge, this is the first time a mindfulness-based RTP delivered entirely via the internet has been tested in the workplace. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry ACTRN12615000574549; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368296 (Archived by WebCite at http://www.webcitation.org/75w4xtrpw).

Mindfulness-Based Resilience Training in the Workplace: Pilot Study of the Internet-Based Resilience@Work (RAW) Mindfulness Program.

BACKGROUND: The impact of mental illness on society is far reaching and has been identified as the leading cause of sickness absence and work disability in most developed countries. By developing evidence-based solutions that are practical, affordable, and accessible, there is potential to deliver substantial economic benefits while improving the lives of individual workers. Academic and industry groups are now responding to this public health issue. A key focus is on developing practical solutions that enhance the mental health and psychological resilience of workers. A growing body of research suggests resilience training may play a pivotal role in the realm of public health and prevention, particularly with regards to protecting the long-term well-being of workers. OBJECTIVE: Our aim is to examine whether a mindfulness-based resilience-training program delivered via the internet is feasible and engaging to a group of high-risk workers. Additionally, we aim to measure the effect of the Resilience@Work Resilience@Work Mindfulness program on measures of resilience and related skills. METHODS: The current pilot study recruited 29 full-time firefighters. Participants were enrolled in the 6-session internet-based resilience-training program and were administered questionnaires prior to training and directly after the program ended. Measurements examined program feasibility, psychological resilience, experiential avoidance, and thought entanglement. RESULTS: Participants reported greater levels of resilience after Resilience@Work training compared to baseline, with a mean increase in their overall resilience score of 1.5 (95% CI -0.25 to 3.18, t14=1.84, P=.09). Compared to baseline, participants also reported lower levels of psychological inflexibility and experiential avoidance following training, with a mean decrease of -1.8 (95% CI -3.78 to 0.20, t13=-1.94, P=.07). With regards to cognitive fusion (thought entanglement), paired-samples t tests revealed a trend towards reduction in mean scores post training (P=.12). CONCLUSIONS: This pilot study of the Resilience@Work program suggests that a mindfulness-based resilience program delivered via the Internet is feasible in a high-risk workplace setting. In addition, the firefighters using the program showed a trend toward increased resilience and psychological flexibility. Despite a number of limitations, the results of this pilot study provide some valuable insights into what form of resilience training may be viable in occupational settings particularly among those considered high risk, such as emergency workers. To the best of our knowledge, this is the first time a mindfulness-based resilience-training program delivered wholly via the internet has been tested in the workplace.