The effectiveness of mindfulness-based cognitive therapy during poststroke rehabilitation: a randomized controlled trial.

Stroke can have a range of physical, psychological, cognitive, and social impacts that are challenging for survivors. This study aimed to evaluate the efficacy of a group-based mindfulness intervention integrated into an inpatient rehabilitation program compared to standard care. A single-center, randomized, controlled trial was conducted in 93 poststroke patients. The intervention group received 6-weeks of mindfulness-based cognitive therapy (MBCT) and standard care; the control group received standard care. Primary outcomes were depression and trait anxiety; secondary outcomes were trait mindfulness and attention. Participants completed questionnaires at baseline, and postintervention (6 weeks). Mixed-effect model repeated measures analysis of variance was conducted between groups and across time. A total of 80 participants (intervention n  = 43; standard care n  = 37) were included in the postintervention analysis. There were no statistically significant differences in the primary outcomes between the groups over time. An improvement was found, however, on the trait mindfulness observing subscale in favor of the intervention group. Eight sessions of MBCT integrated into an inpatient stroke rehabilitation program over 6 weeks was not effective in improving depression and anxiety compared to standard care. Lack of follow-up and low to moderate pathological symptoms at baseline may have limited the effectiveness of this intervention.

[Effects of gender on pulmonary rehabilitation outcomes in patients with COPD]. / Impact du genre sur les effets de la réadaptation respiratoire chez les patients atteints de BPCO.

INTRODUCTION: COPD has become more prevalent among women, revealing a specific feminine phenotype. Women experience greater dyspnea and a more impaired quality of life. The main objective of this study was to assess the effect of gender on dyspnea during a pulmonary rehabilitation program (PRP). METHODS: Retrospective study including COPD patients having participated in PRPs. The following data were analyzed according to gender before and after a PRP: dyspnea, quality of life, anxiety and depression, exercise capacity, muscle function (quadriceps and inspiratory muscles). RESULTS: More than 500 patients (252 men and 252 women) were included. We did not find a significant effect of gender on the evolution of dyspnea, anxiety or depressive disorders, exercise capacity, inspiratory muscle strength, or overall quality of life score. That said, we found a possible effect on the sub-scores of the quality of life questionnaire, and regarding quadriceps strength. All criteria improved during the program in both groups. CONCLUSIONS: During a PRP, gender does not impact the evolution of dyspnea. While women may nonetheless benefit to a greater extent in terms of quality of life sub-scores (impact, activities, symptoms) and quadriceps strength, these results still require confirmation.

[Rehabilitation for patients with chronic pruritus]. / Rehabilitation bei Patienten mit chronischem Pruritus.

BACKGROUND: For a long time, chronic pruritus was considered difficult to treat. Modern therapy options and detailed guidelines have created new opportunities for patients to improve their quality of life. However, due to the complexity of the disease, the need for multimodal treatment remains. OBJECTIVES: This article aims to investigate whether dermatological rehabilitation offers additional benefits to those affected and whether it should therefore be part of the treatment concept for chronic pruritus. METHODS: After introduction of the pruritus program of a rehabilitation clinic, a prospective study is presented that focuses on the patient-relevant benefits of therapy. It used standardized questionnaires to record pruritus intensity, the presence of depression, anxiety, itch-related limitations, and quality of life in patients with chronic pruritus before and after rehabilitation. RESULTS: Of the patients surveyed, 91.7% achieved a patient-relevant benefit through rehabilitation. Pruritus intensity, depression, anxiety, itch-related limitations, and restrictions on quality of life decreased significantly. Almost half of all participating patients had been initially diagnosed more than 10 years ago. CONCLUSIONS: Dermatological rehabilitation with a multimodal concept for the treatment of chronic pruritus can help affected patients and should be part of the therapy concept. This should be done as early as possible before the disease progresses over a long period of time and makes treatment more difficult.

Improved quality of life and psychological symptoms following mindfulness and cognitive rehabilitation in multiple sclerosis and their mediating role for cognition: a randomized controlled trial.

BACKGROUND: Multiple sclerosis (MS) frequently gives rise to depressive and anxiety symptoms, but these are often undertreated. This study investigated the effect of mindfulness-based cognitive therapy (MBCT) and cognitive rehabilitation therapy (CRT) on psychological outcomes and quality of life (QoL), and whether they mediate treatment effects on MS-related cognitive problems. METHODS: This randomized controlled trial included MS patients with cognitive complaints (n = 99) and compared MBCT (n = 32) and CRT (n = 32) to enhanced treatment as usual (n = 35). Baseline, post-treatment and 6-months follow-up assessments included patient-reported outcome measures (PROMS) and cognitive outcomes (self-reported and neuropsychological assessment). PROMS concerned psychological symptoms, well-being, QoL, and daily life function. Linear mixed models indicated intervention effects on PROMS and mediation effects of PROMS on cognitive outcomes. RESULTS: MBCT positively affected depressive symptoms (Cohen's d (d) = -0.46), fatigue (d = -0.39), brooding (d = -0.34), mindfulness skills (d = 0.49), and mental QoL (d = -0.73) at post-treatment. Effects on mindfulness skills remained significant 6 months later (d = 0.42). CRT positively affected depressive symptoms (d = -0.46), mindfulness skills (d = 0.37), and mental QoL (d = -0.45) at post-treatment, but not at 6-month follow-up. No effects on anxiety, well-being, self-compassion, physical QoL, and daily life function were found. Treatment effects on self-reported, but not objective, cognition were mediated by psychological symptoms and mindfulness skills. CONCLUSIONS: MBCT and CRT reduced a wide array of psychological symptoms and improved mental QoL. These improvements seemed to impact self-reported cognitive problems after both treatments, whereas objective cognitive improvements after MBCT seemed independent of improvement in psychological symptoms. Future studies should investigate long-term sustainability of these beneficial effects. TRIAL REGISTRATION: The trial was prospectively registered in the Dutch Trial registry on 31 May 2017 (NL6285; https://trialsearch.who.int/Trial2.aspx?TrialID=NTR6459 ).

[Psychosomatic Rehabilitation for Post-COVID]. / Psychosomatische Rehabilitation bei Post-COVID.

Aim of the study Post-COVID is characterized by a large number of different symptoms. The indication for medical rehabilitation is based on the main symptom. Insured individuals who suffer from fatigue and have no relevant organic disorder are often rehabilitated in psychosomatic clinics. In the present study, the effectiveness of psychosomatic rehabilitation in patients with post-COVID will be investigated. Methods 91 patients with post-COVID are compared to 124 patients with mental disorders and 68 patients with cancer regarding the improvement of fatigue and depressiveness as well as satisfaction and socio-medical parameters. Results At admission, the level of fatigue did not differ in the three groups and was equally reduced. Patients with post-COVID and high depression scores at admission had clinically significant levels of fatigue at discharge. The proportion of patients with mental disorders who were discharged with a negative prognosis for employment was significantly increased. Discussion Although psychosomatic rehabilitation can reduce fatigue, the proportion of patients suffering from fatigue with post-COVID at discharge is still high. Conclusion The treatment concept for the rehabilitation of patients with post-COVID must take into account the often individual course of the disease. Psychosomatic rehabilitation can make an important contribution here.

Efficacy of remote exercise and physiotherapy programs on depressive symptoms in people with multiple sclerosis - A systematic review and meta-analysis.

BACKGROUND: The prevalence of depression in Multiple Sclerosis (MS) is common and negatively affects the quality of life of patients. The studies of the effect of remote forms of treatment conclude that it is a fairly easy process to carry out and with very good results for patients. Thus, the purpose of this systematic review and meta-analysis is to investigate randomized controlled trials on the effectiveness of remote forms of exercise and physiotherapy on the depressive symptoms of people with MS. METHODS: A literature search was conducted in PubMed, Scopus, PsychInfo, SportDiscus, Web of Science and ResearchGate databases. The keywords for the search were: telerehabilitation, telecounseling, tele, telephone, physiotherapy, physical therapy, rehabilitation, therapeutic exercise, exercise, depression, depressive disorders, multiple sclerosis and MS. In addition, some inclusion and exclusion criteria were defined for the selection of the final studies, which were also evaluated with the PEDro scale for their quality. RESULTS: Among the initial 176 studies found, 6 were included in the systematic review. The development of a remote individualized exercise program based on assessment, personal goals and daily life of the patient, as well as a program based on motor imagery training, showed beneficial effects on depression in people with MS, which are considered possibly equivalent to those of in-person intervention. Μeta-analysis revealed that remote exercise and physiotherapy programs are significantly more effective than control group interventions for the management of depression in people with MS (random effects model, Hedges' g = -0.41, 95%CI = -0.74,-0.09, SE = 0.17, p = 0.01). The sub-group analysis showed that studies that had chosen not to have their control group carry out any form of intervention had more significant outcomes than the others. CONCLUSION: Through telephone communication or other electronic monitoring systems, can be achieved an effective treatment of people with depression and MS, based on exercise and physiotherapy. However, more studies are deemed necessary to find the most appropriately designed and therapeutic forms of remote intervention.

Integrating vocational rehabilitation and mental healthcare to improve the return-to-work process for people on sick leave with depression or anxiety: results from a three-arm, parallel randomised trial.

OBJECTIVE: The aim of this study was to investigate an integrated mental healthcare and vocational rehabilitation intervention to improve and hasten the process of return-to-work of people on sick leave with anxiety and depression. METHODS: In this three-arm, randomised trial, participants were assigned to (1) integrated intervention (INT), (2) improved mental healthcare (MHC) or (3) service as usual (SAU). The primary outcome was time to return-to-work measured at 12-month follow-up. The secondary outcomes were time to return-to-work measured at 6-month follow-up; levels of anxiety, depression, stress symptoms, and social and occupational functioning at 6 months; and return-to-work measured as proportion in work at 12 months. RESULTS: 631 individuals were randomised. INT yielded a higher proportion in work compared with both MHC (56.2% vs 43.7%, p=0.012) and SAU (56.2% vs 45%, p=0.029) at 12-month follow-up. We found no differences in return-to-work in terms of sick leave duration at either 6-month or 12-month follow-up, with the latter being the primary outcome. No differences in anxiety, depression or functioning between INT, MHC and SAU were identified, but INT and MHC showed lower scores on Cohen's Perceived Stress Scale compared with SAU at 12-month follow-up. CONCLUSIONS: Although INT did not hasten the process of return-to-work, it yielded better outcome with regard to proportion in work compared with MHC and SAU. The findings suggest that INT compared with SAU is associated with a few, minor health benefits. Overall, INT yielded slightly better vocational and health outcomes, but the clinical significance of the health advantage is questionable. TRIAL REGISTRATION NUMBER: NCT02872051.

Investigations on the Respiratory Function in COVID-19 Patients: A Prospective Cohort Study.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) is a global public health crisis. However, whether it can cause respiratory dysfunction or physical and psychological disorders in patients remains unknown. Thus, this study was conducted to investigate the respiratory function, activities of daily living, quality of life, and mental status of patients with COVID-19. Participants and outcomes. Data was collected from the follow-up of eligible patients who attended the fever clinic of three hospitals in Jiangxi Province, from March to May 2020. The outcomes included respiratory muscle function, degree of dyspnea, aerobic capacity, activities of daily living, quality of life, and mental status. RESULTS: A total of 139 patients (72 men and 67 women) were included in this study. The proportions of mild, moderate, severe, and critical cases of COVID-19 were 7.1% (10 cases), 68.3% (95 cases), 20.1% (28 cases), and 4.2% (6 cases), respectively. The rates of abnormal maximal inspiratory pressure were 10.0%, 25.2%, 25.0%, and 16.7%, respectively. There were 50%, 65.3%, 50%, and 66.7% of the patients with abnormal dyspnea in the four clinical classifications, respectively. Patients generally show a decline in quality of life, anxiety, and depression symptoms. CONCLUSIONS: Respiratory dysfunction, decreased quality of life, and psychological disorders were present in each clinical classification of COVID-19. Therefore, it is necessary to carry out respiratory rehabilitation and psychological intervention for COVID-19 patients.

Effectiveness of a nurse-led hospital-to-home transitional care intervention for older adults with multimorbidity and depressive symptoms: A pragmatic randomized controlled trial.

OBJECTIVE: To evaluate the effectiveness of a nurse-led hospital-to-home transitional care intervention versus usual care on mental functioning (primary outcome), physical functioning, depressive symptoms, anxiety, perceived social support, patient experience, and health service use costs in older adults with multimorbidity (≥ 2 comorbidities) and depressive symptoms. DESIGN AND SETTING: Pragmatic multi-site randomized controlled trial conducted in three communities in Ontario, Canada. Participants were allocated into two groups of intervention and usual care (control). PARTICIPANTS: 127 older adults (≥ 65 years) discharged from hospital to the community with multimorbidity and depressive symptoms. INTERVENTION: This evidence-based, patient-centred intervention consisted of individually tailored care delivery by a Registered Nurse comprising in-home visits, telephone follow-up and system navigation support over 6-months. OUTCOME MEASURES: The primary outcome was the change in mental functioning, from baseline to 6-months. Secondary outcomes were the change in physical functioning, depressive symptoms, anxiety, perceived social support, patient experience, and health service use cost, from baseline to 6-months. Intention-to-treat analysis was performed using ANCOVA modeling. RESULTS: Of 127 enrolled participants (63-intervention, 64-control), 85% had six or more chronic conditions. 28 participants were lost to follow-up, leaving 99 (47 -intervention, 52-control) participants for the complete case analysis. No significant group differences were seen for the baseline to six-month change in mental functioning or other secondary outcomes. Older adults in the intervention group reported receiving more information about health and social services (p = 0.03) compared with the usual care group. CONCLUSIONS: Although no significant group differences were seen for the primary or secondary outcomes, the intervention resulted in improvements in one aspect of patient experience (information about health and social services). The study sample fell below the target sample (enrolled 127, targeted 216), which can account for the non-significant findings. Further research on the impact of the intervention and factors that contribute to the results is recommended. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT03157999.

Effectiveness and safety of music-supported therapy on mood in post-stroke rehabilitation patients: A protocol for systematic review and meta-analysis.

BACKGROUND: Music-supported therapy has been widely used clinically to relieve post-stroke rehabilitation. However, the efficacy of Music-supported therapy in the treatment of Mood in post-stroke rehabilitation Patients is uncertain. The purpose of this study is to determine the effectiveness and safety of Music-supported therapy in the treatment of Mood in post-stroke rehabilitation Patients. METHODS: Search PubMed, Cochrane Library, Embase, China National Knowledge Infrastructure Database, Wanfang Database, China Science and Technology Journal Database, China Biomedical Literature Database, and search related randomized controlled trials. Two reviewers will independently select studies, collect data, and evaluate methodological quality through the Cochrane Deviation Risk Tool. Revman V.5.3 will be used for meta-analysis. RESULTS: This study will evaluate the current status of Music-supported therapy treatment for mood in post-stroke rehabilitation Patients, aiming to illustrate the effectiveness and safety of Music-supported therapy treatment. CONCLUSION: This study will provide a basis for judging whether Music-supported therapy is effective in treating mood in post-stroke rehabilitation Patients. INPLASY REGISTRATION NUMBER: INPLASY202120011.

Can Yoga or Physical Therapy for Chronic Low Back Pain Improve Depression and Anxiety Among Adults From a Racially Diverse, Low-Income Community? A Secondary Analysis of a Randomized Controlled Trial.

OBJECTIVE: To determine and compare the effect of yoga, physical therapy (PT), and education on depressive and anxious symptoms in patients with chronic low back pain (CLBP). DESIGN: Secondary analysis of a randomized controlled trial. SETTING: Academic safety net hospital and 7 community health centers. PARTICIPANTS: A total of 320 adults with CLBP. INTERVENTION: Yoga classes, PT sessions, or an educational book. OUTCOME MEASURE: Depression and anxiety were measured using the Patient Health Questionnaire and Generalized Anxiety Disorder 7-item Scale, respectively, at baseline, 12, and 52 weeks. We identified baseline and midtreatment (6-wk) factors associated with clinically meaningful improvements in depressive (≥3 points) or anxious (≥2 points) symptoms at 12 weeks. RESULTS: Participants (female=64%; mean age, 46.0±10.7 years) were predominantly non-White (82%), low-income (<$30,000/year, 59%), and had not received a college degree (71%). Most participants had mild or worse depressive (60%) and anxious (50%) symptoms. At 12 weeks, yoga and PT participants experienced modest within-group improvements in depressive symptoms (mean difference [MD]=-1.23 [95% CI, -2.18 to -0.28]; MD=-1.01 [95% CI, -2.05 to -0.03], respectively). Compared with the education group, 12-week differences were not statistically significant, although trends favored yoga (MD=-0.71 [95% CI, -2.22 to 0.81]) and PT (MD= -0.32 [95% CI, -1.82 to 1.18]). At 12 weeks, improvements in anxious symptoms were only found in participants who had mild or moderate anxiety at baseline. Independent of treatment arm, participants who had 30% or greater improvement in pain or function midtreatment were more likely to have a clinically meaningful improvement in depressive symptoms (odds ratio [OR], 1.82 [95% CI, 1.03-3.22]; OR, 1.79 [95% CI, 1.06-3.04], respectively). CONCLUSIONS: In our secondary analysis we found that depression and anxiety, common in this sample of underserved adults with CLBP, may improve modestly with PT and yoga. However, effects were not superior to education. Improvements in pain and function are associated with a decrease in depressive symptoms. More research is needed to optimize the integration of physical and psychological well-being in PT and yoga.

Comparison of cardiac rehabilitation (exercise + education), exercise only, and usual care for patients with coronary artery disease: A non-randomized retrospective analysis.

Cardiac rehabilitation program is well-established but the Rehabilitation After Myocardial Infarction Trial (RAMIT) is reported that it does not affect mortality and morbidity of patients after myocardial infarction during follow-up period. The objectives of the study were to compare functional walking capacity, risk factor control, and morbidities in follow-up for cardiac rehabilitation (exercise + education), exercise only, and usual care among patients with coronary artery disease. A total of 492 male and female patients (age range: 45-73 years) with coronary artery disease after myocardial infarction or underwent percutaneous coronary intervention or coronary artery bypass grafting surgeries referred to cardiac rehabilitation were included in the study. Patients were participating in a cardiac rehabilitation program (exercise + education, CRP cohort, n = 125), exercise only (USC cohort, n = 182), or usual care (NCR cohort, n = 185). Data regarding incremental shuttle walk test, lipid profile, the Patient Health Questionnaire 9, and morbidities in follow-up of patients were retrospectively collected and analyzed. After completion of 1 year, cardiac rehabilitation program (p < 0.0001, q = 20.939) and exercise (p < 0.0001, q = 6.059) were successfully increased incremental shuttle walk test. After completion of 1 year, cardiac rehabilitation program reduced low-density lipoprotein (p = 0.007, q = 3.349) and depressive symptoms (p < 0.0001, q = 5.649). Morbidities were reported fewer in the patients of CRP cohort than those of USC (p = 0.003, q = 3.427) and NCR (p = 0.003, q = 4.822) cohorts after completion of 1 year of program. Cardiac rehabilitation program (exercise +education) improved functional walking capacity, controlled risk factors, and reduced morbidities of patients with coronary artery disease than exercise only and usual care (Level of evidence: III).

Cognitive Stimulation Therapy for Older Adults With Mild-to-Moderate Dementia in Italy: Effects on Cognitive Functioning, and on Emotional and Neuropsychiatric Symptoms.

OBJECTIVES: Cognitive Stimulation Therapy (CST) is one of the most popular evidence-based interventions for people with dementia. The aim of the present study was to assess the effectiveness in the short- and long-term (on completing the treatment and 3 months later) of an Italian adaptation of the CST protocol (CST-IT). METHOD: Older adults with mild-to-moderate dementia at 16 residential care homes were randomly assigned to a CST-IT group (N = 123) or an active control group (N = 102). The following domains were examined for potential benefits: general cognitive functioning (Mini-Mental State Examination [MMSE] and the Alzheimer's Disease Assessment Scale-Cognitive subscale [ADAS-Cog]), language (Narrative Language Test), mood and behavior (Cornell scale and Neuropsychiatric Inventory), everyday life functioning (Disability Assessment for Dementia), and quality of life (Quality of Life-Alzheimer's Disease scale). RESULTS: At both the short- and long-term assessments, the CST-IT group's MMSE scores remained stable, while the control group's scores decreased slightly from pretest to posttest and at follow-up. The CST-IT group also had short-term benefits in other cognitive measures (ADAS-Cog and Narrative Language Test) and mood and behavior measures, which were generally maintained at follow-up. No other differences were observed. DISCUSSION: The effectiveness of CST in sustaining cognitive and emotional functioning, and counteracting the progression of behavioral/neuropsychiatric symptoms in people with dementia was confirmed, and a long-term benefit was demonstrated. CST is a promising option for the treatment of people with dementia in clinical practice.

Perspectives of people with late age-related macular degeneration on mental health and mental wellbeing programmes: a qualitative study.

PURPOSE: People with age-related macular degeneration (AMD) experience high rates of depression, but rarely engage in or have access to tailored mental wellbeing programmes. This qualitative study investigated the perspectives of those primarily with late AMD on mental health and mental wellbeing programmes. METHODS: Twenty-eight people with late AMD in at least one eye, and one person with early AMD in both eyes, aged 56-87 years (mean age 78 years) attending a private eye clinic between December 2019 and January 2020 in Sydney, New South Wales, Australia, participated. Individual semi-structured interviews were conducted and analysed deductively using content analysis, following the individual level factors for health promotion interventions in the behaviour change wheel: Capability (Physical & Psychological), Opportunity (Physical & Social), and Motivation (Reflective & Automatic). RESULTS: Six major themes were identified: Capability: (1) Impact of vision loss on mobility and leisure pursuits; (2) Adjustment to living with vision loss; Opportunity: (3) Program considerations for those with AMD; (4) Stigma and self-perception of vision loss and mental health; Motivation: (5) Accumulation of vision-related issues as a barrier to participation; (6) Examples of others living with vision loss. General personal factors relevant to delivery of a programme in this age group were also identified: Comorbidities; Limitations using technology; Isolation; Financial concerns and Beliefs that undesired effects of aging are inevitable. CONCLUSIONS: Complex individual, environmental and social factors influence the perspectives of people with late AMD on mental health, and potential participation in mental wellbeing programmes. These factors should be considered when developing and implementing mental wellbeing programmes to improve the emotional and functional rehabilitation outcomes for people with AMD.

Psychological complexities of visual restoration.

In this paper, we report the psychological and emotional experience of a patient who regained vision after over a decade of vision loss. The negative psychological implications of blindness are well recognised and there is a robust link between visual impairment and low mood and depressive symptoms. Although uncommon, low mood and depressive symptoms have been reported in patients whose sight has been restored, and lack of research gives rise to the possibility their prevalence may be grossly under-recognised in such patient groups. The effects can be so severe that patients may revert to living in darkness in mimicry of their previous lifestyle, effectively obviating the sight-restoring surgery. Healthcare professionals have a responsibility to address this traditionally neglected need by facilitating social, psychological and medical interventions that may ease the return to vision.

Mediating role of post-traumatic growth in the relationship between inadequate disaster recovery and mental health outcomes: long-term evidence from the Wenchuan earthquake.

Background: The mental health outcomes from disasters have aroused great concern worldwide, yet few studies incorporate a long-term disaster recovery perspective. Evidence has also emerged about the importance of the social determinants of mental health, but aspects of recovery including disruptions to livelihoods and social networks remain relatively understudied. Objective: This study utilizes cognitive adaptation theory to examine the long-term relationship between inadequate disaster recovery and mental health outcomes while considering domains of post-traumatic growth (PTG) as mediators. Methods: A cross-sectional study was conducted among 1369 adult survivors of the 2008 Wenchuan earthquake. Correlation analyses and multivariable regression analyses examined the association between inadequate disaster recovery and mental health outcomes, while parallel multiple mediator models and structural equation model explored the mediating role of PTG among these relationships. Results: 52.2% and 8.1% of the respondents reported inadequate recovery on livelihood and social ties, respectively. Inadequate disaster recovery was associated with higher levels of PTSD and depressive symptoms, and this association was partially mediated by PTG. Lower reported PTG on the interpersonal relationship and new possibilities domains mediated the association between inadequate livelihood recovery on PTSD and depressive symptom severity, and enhanced personal strength mediated the association between inadequate social ties recovery on these symptoms. Conclusion: Enhancing disaster recovery is essential for mental health protection, and PTG may be a valuable starting point in cognitive therapy to protect against stress responses after trauma.

Antecedentes: Los resultados de salud mental de los desastres han despertado una gran preocupación en todo el mundo, sin embargo, pocos estudios incorporan una perspectiva de recuperación de desastres a largo plazo. También ha surgido evidencia sobre la importancia de los determinantes sociales de la salud mental, pero los aspectos de la recuperación, incluidas las alteraciones de los medios de subsistencia y las redes sociales, siguen siendo relativamente poco estudiados.Objetivo: Este estudio utiliza la teoría de la adaptación cognitiva para examinar la relación a largo plazo entre la recuperación inadecuada ante desastres y los resultados de salud mental, al tiempo que considera los dominios del crecimiento postraumático (DCP) como mediadores.Métodos: Se realizó un estudio transversal entre 1369 adultos sobrevivientes del terremoto de Wenchuan del 2008. Los análisis de correlación y los análisis de regresión multivariado examinaron la asociación entre la recuperación inadecuada a desastres y los resultados en salud mental, mientras que los modelos paralelos de múltiples mediadores y los modelos de ecuaciones estructurales exploraron el papel mediador de la DCP entre estas relaciones.Resultados: El 52,2% y el 8,1% de los encuestados informaron una recuperación inadecuada de los medios de subsistencia y los lazos sociales, respectivamente. La recuperación de desastres inadecuada se asoció con niveles más altos de TEPT y síntomas depresivos, y esta asociación fue parcialmente mediada por DCP. Un menor DCP reportado sobre la relación interpersonal y los nuevos dominios de posibilidades mediaron la asociación entre la recuperación inadecuada de los medios de subsistencia en el TEPT y la gravedad de los síntomas depresivos, y el aumento de la fuerza personal medió la asociación entre la recuperación inadecuada de los lazos sociales en estos síntomas.Conclusión: Mejorar la recuperación ante desastres es esencial para la protección de la salud mental, y la DCP puede ser un punto de partida valioso en la terapia cognitiva para proteger contra las respuestas al estrés después de un trauma.

Social housing promotes recovery of wheel running depressed by inflammatory pain and morphine withdrawal in male rats.

The increased use of opioids to treat pain has led to a dramatic increase in opioid abuse. Our previous data indicate that pain may facilitate the development of opioid abuse by increasing the magnitude and duration of opioid withdrawal. The present study tested the hypothesis that social housing would facilitate recovery of activity depressed by pain and opioid withdrawal. Male Sprague Dawley rats were housed either in pairs or alone and then moved to a cage with a running wheel for 6 h daily to assess pain- and opioid withdrawal-induced depression of wheel running. Rats were implanted with two morphine (75 mg each) or placebo pellets to induce opioid dependence and were simultaneously injected with Complete Freund's Adjuvant or saline into the right hind paw to induce persistent inflammatory pain. Hind paw inflammation depressed wheel running whether rats were implanted with a morphine or placebo pellet. Pair-housed rats showed greater recovery of wheel running than individually housed rats. Spontaneous morphine withdrawal precipitated by removal of the morphine pellets caused a reduction in wheel running that was greater in rats with hind paw inflammation compared to pain free rats. Social housing facilitated recovery from withdrawal in rats with hind paw inflammation, but slowed recovery in pain free rats. These data suggest that social housing facilitates recovery by reducing pain both before and during opioid withdrawal. Our findings are consistent with previous studies showing that social buffering reduces pain-evoked responses.

Effectiveness of an ACT-based rehabilitation program for the treatment of chronic fatigue: Results from a 12-months longitudinal study.

Acceptance and Commitment Therapy (ACT) is potentially effective for treating chronic fatigue. Given the paucity of studies on this topic, we aimed to assess long-term trajectories of primary (fatigue, quality of life and functional abilities) and secondary outcomes (anxious and depressive symptoms) of an ACT-based rehabilitation program for patients with chronic fatigue. Further, we examined if changes in potential process variables (psychological inflexibility, metacognitive beliefs, and cognitive and behavioral responses to symptoms) during ACT predicted change in all outcomes across follow-up. One-hundred ninety-five workers on sick leave (mean age: 43.61 ± 9.33 years; 80.5% females) with a diagnosis of chronic fatigue were enrolled in a manualized, 3.5-week intensive return-to-work rehabilitation program based on ACT. All completed a battery of questionnaires at pre-, post-treatment, 6 and 12 months follow-up. We found significant longitudinal changes in most primary and secondary outcomes from pre- up to 12 months follow-up. All process variables significantly decreased from pre- up to 12 months follow-up, and pre-to-post changes in fear avoidance beliefs were most often associated with a greater change in outcomes across follow-up. Depressive symptomatology showed a similar trajectory of change to fatigue, meaning that scores were correlated at each time point and tended to converge over time. This suggests that both symptoms influence each other substantially over a year following the treatment. Concluding, results lend support to the effectiveness of an ACT-based rehabilitation program for patients with chronic fatigue and provide preliminary evidence for the role of process variables and depressive symptomatology on subsequent change in outcomes.