Multicomponent Intervention on Improving the Cognitive Ability of Older Adults with Mild Cognitive Impairment: A Pilot Randomized Controlled Trial.

This pilot randomized controlled trial aimed to evaluate the feasibility and potential outcomes of an innovative 16-session multicomponent intervention model to improve cognitive abilities in older adults with mild cognitive impairment (MCI) by promoting healthy lifestyle, cognitive skills, tai chi and mindfulness practices. This study was a multicentre, randomized controlled, two-arm, parallel-group, unblinded trial in Hong Kong. 57 Chinese older adults with MCI recruited from three local elderly centers were randomly assigned to either the control or intervention group. The study results support the feasibility and efficacy of the multicomponent intervention, and recommend future larger-scale randomized control trials.

Guided Online Mindfulness-Based Intervention for Community Residents with Emotional Distress during the COVID-19 Pandemic.

This study aimed to assess the efficacy of a guided online mindfulness-based intervention (iMBI) for community residents experiencing emotional distress during the COVID-19 pandemic in Hong Kong. In a randomized controlled trial, 64 participants were recruited from collaborating community-based mental health service units in Hong Kong and assigned to either the treatment (n = 32) or control (n = 32) groups. The treatment group received a guided iMBI consisting of 16 online modules, weekly telephone counseling, and two half-day online workshops on mindfulness practice. In contrast, the waitlist control group did not receive any intervention during the initial stage. Using a 2 (two groups) × time (pre versus post) repeated measures linear mixed model and one-way analysis of variance, authors demonstrated that the treatment group experienced a significantly larger reduction in anxiety and depressive symptoms with a large effect size compared with the control group. Additionally, the treatment group showed a significantly greater improvement in mindfulness with a moderate effect size. The findings support the effectiveness of guided iMBI for community residents experiencing emotional distress during the COVID-19 pandemic in Hong Kong.

Feasibility trial of a technology-based intervention (TI) among men with alcohol dependence from rural settings in India.

This feasibility study utilized two-arm randomized controlled trial (RCT), conducted in a de-addiction unit of tertiary mental care setting, India, between August 2021 and January 2022. Sixty-one participants diagnosed with alcohol dependent syndrome was randomly assigned to receive TI (n = 31) or Treatment as usual (TAU) (n = 30). Participants of both groups were initially assessed for craving, quantity and frequency of alcohol consumption and severity of alcohol use. TI participants received 8 video enabled cue exposure group sessions and periodic mobile phone interventions along with text message reminders after discharge along with routine treatment at de-addiction wards. TAU group participants received only routine treatment. All the participants were followed up over 3 months post-discharge. Results showed that majority (77 %) participants attended all 8-video enabled cue exposure group sessions. Rural men were willing to engage in the program and participated in behavioral rehearsals. Mobile intervention and text messages were accepted. We observed that at 3 months follow-up TI group subjects reported lesser mean craving scores, fewer drinking days, lesser quantity of alcohol consumption and less AUDIT scores compared to TAU group participants. This study provides preliminary support for the hypotheses that it is feasible to implement technology-based alcohol intervention for men with alcohol dependence.

Low-intensity online mindfulness-based intervention for university students with anxiety during the COVID-19 pandemic-A randomized controlled trial with 3-month follow-up.

Objective: This study investigated the effectiveness of a low-intensity online mindfulness-based Intervention (iMBI) for alleviating anxiety in university students during the COVID-19 pandemic. Methods: In a randomized controlled trial involving 134 participants from a local university in Hong Kong, subjects were randomly assigned to either the intervention group (n = 67) or the inactive control group (n = 67). The intervention group participated in a low-intensity iMBI comprising 16 online modules and two half-day online mindfulness workshops over an eight-week period. Outcomes were measured via an online platform using standardized assessment scales, including the Beck Anxiety Inventory and the Chinese Five Facets Mindfulness Questionnaire, at three different time points: pre-intervention, post-intervention and at a three-month follow-up. Results: Intent-to-treat analysis using 2 (group) × 3 (time) repeated measures of covariance (ANCOVA) showed that the intervention group, compared to the control group, showed a significant reduction in anxiety symptoms with a medium effect size (Cohen's d = 0.5) and a significant improvement in mindfulness skills with a medium effect size (Cohen's d = 0.5) at post-intervention. The effects of the intervention in reducing anxiety and improving mindfulness persisted at the three-month follow-up. Conclusion: The results of this study demonstrate the effectiveness of the low-intensity iMBI in alleviating anxiety among university students.

Childhood emotional abuse and alcohol use disorders in a national Nepali women sample: The mediating role of borderline personality traits.

While many studies have found an association between childhood emotional abuse and alcohol use disorders (AUD) during adulthood, underlying psychological mechanisms linking the two remain inadequately understood. Drawing on the developmental psychopathology perspective, this study examined the relationship between childhood emotional abuse and AUD during adulthood with a national sample of women in Nepal (N = 1,100, M age = 37.73), focusing on the mediating role of borderline personality traits. Mediation analyses were performed using the Karlson-Holm-Breen (KHB) method and bootstrapping confidence intervals. Results indicated that Nepali women's borderline personality traits significantly mediated the relationship between childhood emotional abuse and AUD. Hence, emotional abuse in childhood increases the risk for AUD during adulthood for Nepali women by increasing the risk of borderline personality traits. Findings underscore the necessity of continued emphasis on developing and implementing early interventions for childhood emotional abuse and therapeutic interventions for borderline personality traits in reducing AUD among vulnerable women in Nepal.

The mechanism and effectiveness of mindfulness-based intervention for reducing the psychological distress of parents of children with autism spectrum disorder: A protocol of randomized control trial of ecological momentary intervention and assessment.

BACKGROUND: Existing studies have unequivocally demonstrated that parents of children with autism spectrum disorder (ASD) experience various stressful daily life events and suffer from psychological distress. Mindfulness level is found to be an effective buffer between parents' appraisal of stress life events and psychological distress. However, the mechanism behind the function of mindfulness is unclear, and traditional mindfulness-based intervention (MBI) in experimental settings is not tailored to personal real-life needs. This study proposes to conduct a randomized controlled trial (RCT) to examine the effectiveness of MBI delivered by ecological momentary intervention (EMI) and assessed by ecological momentary assessment (EMA) in changing participants' cognitive appraisal of stressful life events and thus reducing the psychological distress of parents of children with ASD. METHOD: The proposed study will recruit 670 parents of children with ASD and randomly assign them to the intervention and control groups (335 in each group). Participants in the intervention group will install the EMI/A app on their smartphones. In the app, participants can receive practice prompts daily, browse and practice different mindfulness exercises in the intervention library at any time, talk to a virtual counselor (chatbot) when feeling stressed, complete EMA on the cognitive appraisal of life events, and receive the log of change of psychological status daily. Participants in the control group will only receive audio-based standardized mindfulness practice instructions three times per week. The effects of MBI will be assessed based on the EMA data, right after the intervention and at the 2-month follow-up. The primary outcome will be participants' psychological distress measured by the depression anxiety stress scale. The secondary outcomes will include participants' subjective well-being, measured by the satisfaction with life scale, and level of resilience, measured by the psychological empowerment scale. Multilevel structural equational modelling will be applied to examine the pathways of the relationship between daily life events, cognitive appraisal, and psychological distress. DISCUSSION: The potential benefit of the proposed study is to increase the psychological well-being of parents of children with ASD, and the method may extend to participants suffering from other psychological issues in the future. Trial registration: This trial has been registered on clinicaltrials.gov with the ID of NCT05746468.

Validation of the Chinese version stage of recovery instrument-30 (STORI-30) for adults with severe mental illness.

BACKGROUND: Stage of Recovery Instrument-30 (STORI-30) is grounded in a five-stage model of psychological recovery, and serves as measuring recovery stage of people with mental illness. AIMS: To develop and validate the Chinese version STORI-30 on adults with severe mental illness. METHODS: STORI-30 was translated to traditional Chinese through forward-backward method. An expert panel and potential users evaluated face validity and content validity. The Chinese version STORI-30 plus other convergent and divergent scales were then administered to 113 participants for field test. RESULTS: Face and content validity were confirmed with acceptable Content Validity Index and high inter-rater agreement. Exploratory factor analysis revealed a three-factor structure. An ordinal sequence was presented among the five subscales, similar to the original version. Construct validity was supported by positive correlations with recovery and mental well-being scales, and negative correlation with self-stigma scale. Good internal consistency (Cronbach's α = 0.78-0.86) and high level of test-retest reliability (Intraclass correlation coefficient = 0.96) were obtained. CONCLUSIONS: Chinese STORI-30 presents satisfactory psychometric properties in internal consistency, construct convergent and divergent validity, and test-retest reliability. The three-factor structure revealed does not echo the original five-stage recovery model. Further studies exploring the underlying structure are warranted.

What Could Highly Engaged Workers Gain From Mental Health Promotion Programs?: An Exploratory Analysis of Secondary Outcomes of Brief Daily Workplace Well-being Programs.

OBJECTIVE: The current study aims to examine the effects of mental health programs on well-being among highly engaged workers. METHODS: Participants were randomly allocated to body-mind-spiritual or peer support program. Of the whole sample, we examined participants' work engagement and positive affect from the highest quarter and the lowest quarter of work engagement at baseline. Measures were taken at baseline and 1-month intervals during 3-month programs and 3-month follow-up. RESULTS: The programs had decreasing effects on work engagement in the HWE subgroup. There is an increasing trend of positive affect on the HWE group only in the body-mind-spiritual program. The trajectories of work engagement in the HWE group moved toward a moderate level. CONCLUSION: Our results suggest that the work engagement's decrease in the HWE group could be a sign of recovery and relaxation.

Enhancing intergroup relationship between local and mainland college students in Hong Kong - an intensive contact-based intervention.

This study examined the efficacy of an intensive one-day intergroup contact intervention for two groups under tension: local and mainland Chinese college students in Hong Kong. The differential effects of contact intimacy at cognitive, interpersonal, and emotional levels in fostering changes in knowledge, attitude, and behavior were evaluated. Adopting a two-arm Randomized Controlled Trial (RCT) design, participants (N = 72) were randomly assigned to the intervention group that facilitated progressively higher levels of contact intimacy, or the control group that had limited level of contact intimacy. The results support the short-term intervention efficacy in enhancing outgroup knowledge, attitude, and behavior, with Cohen's d of 0.97, 0.60 and 0.30, respectively. Specifically, cognitive-level intergroup contact enhanced outgroup knowledge only. Adding interpersonal-level intergroup contact further enhanced outgroup attitude. Notably, adding emotional-level intergroup contact enhanced changes in all three domains: knowledge, attitude, and behavior. One-month maintenance effect was found in outgroup knowledge, with Cohen's d increased to 1.33.

A self-administered moxibustion-cum-massage intervention for older adults with chronic pain in the community: A randomized controlled trial.

OBJECTIVES: To determine the effectiveness of a simple, self-administrable moxibustion-cum-massage intervention for relieving chronic pain and improving psychological well-being for older adults in the community. DESIGN: A randomized controlled trial. SETTING: Seventy-eight participants with chronic pain were randomly assigned to the intervention and waitlist control groups. INTERVENTIONS: Participants received two moxa sticks a day to use the moxibustion-cum-massage procedure with the help of trained volunteers or caregivers for five consecutive days. MAIN OUTCOME MEASURES: Participates' pain level, sleep quality, depression and subjective well-being were measured before the intervention (T0), immediately after the intervention (T1), and one week after the intervention (T2). RESULTS: Repeated measures ANOVA revealed a significant group × time interaction effect in subjective well-being with a medium effect size. Regarding within-group effects in the intervention group at post-intervention (T1), the subjective pain level was significantly reduced with a small effect size, while sleep quality and depression significantly improved with large effect sizes. The control group showed no significant within-group effects in these variables. Maintenance effects at follow-up (T2) were not significant. CONCLUSION: Despite the short intervention timeframe of five days, the study revealed preliminary evidence that the moxibustion-cum-massage intervention can be an effective, self-administrable pain relief regime for older adults. A longer period of intervention time is suggested for future studies.

The effects of an integrated mindfulness-based tai chi chuan programme on sleep disturbance among community-dwelling elderly people: protocol for a randomized controlled trial.

BACKGROUND: Many elderly individuals who experience sleep disturbances would consider complementary and alternative medicine as an alternative therapeutic option in light of the limitations of traditional treatments. Mindfulness-based interventions (MBIs) and Tai Chi Chuan (TCC) are two alternative forms of complementary and alternative medicine. They both share the common feature of a focus on breathing but represent distinct approaches with different mechanisms and philosophical orientations. The trial described in this protocol aims to evaluate the effects of an integrated form of mindfulness-based Tai Chi Chuan (MBTCC) programme and the underlying mechanisms of the beneficial effects over a 12-month follow-up. METHODS: The planned study is a four-armed randomized controlled trial with repeated measures. A total of 256 community-dwelling older adults with sleep problems will be recruited and randomized into four groups: (1) an MBTCC group, (2) an MBI group, (3) a TCC group, and (4) a sleep hygiene education (SHE) control group. The outcome measures in terms of insomnia severity, interoception, sleep-wake pattern, health status, rumination, and hyperarousal level will be collected at four time points: at baseline (T1), after the 8-week intervention (T2), 6 months after the intervention (T3), and 1 year after the intervention (T4). In addition, qualitative evaluation through focus group interviews will be conducted at the end of the 12-month assessment period (T4). DISCUSSION: This trial will illuminate the synergetic effect of combining both MBIs and TCC on optimizing improvements in sleep disturbance. The findings from this study can provide empirical support for this integrated treatment, which provides an alternative for healthcare professionals in elderly service to select appropriate practices to treat elderly people with sleep disturbance. It can further help to lessen the growing public health burden of sleep disturbances among the elderly living in the community. TRIAL REGISTRATION: ClinicalTrials.gov . NCT05396092 . Published on 24 May 2022.

Survey of High Expressed Emotions Experienced By Community Mental Health Service Users in Hong Kong During the COVID-19 Pandemic.

Background: High expressed emotion (EE) experienced by people with mental illness is a known risk factor of relapse. With drastically increased time spent at home and limited health and social service provision during the COVID-19 pandemic, patients' experience of high EE warranted attention. Aims and Methods: The study aimed to investigate the experience of high EE among people with mental illness during the COVID-19 pandemic. We surveyed the service users of 2 community mental health centers, including participants with psychotic and nonpsychotic disorders. Results: Valid responses from 303 participants indicated an overall high EE prevalence of 71.62%, much higher than previous findings, which range between 30% and 40%. People with other psychotic and nonpsychotic disorders showed a higher probability of experiencing high EE than people with schizophrenia. Participants reported a higher probability of experiencing high EE as a result of caregiving by other family relatives and friends than by parents. Conclusion: Findings suggest a significantly elevated high EE prevalence among people suffering from mental illness in the community during the COVID-19 pandemic. It is worth further evaluating the long-term effects of high EE beyond the pandemic.

Study protocol of guided mobile-based perinatal mindfulness intervention (GMBPMI) - a randomized controlled trial.

BACKGROUND: Psychological distress is a common occurrence among women during the perinatal period. Maternal psychological distress (MPS) can also have a negative influence on neonatal outcomes such as infant health, child development or mother-child interaction. Hence, interventions to improve mental wellbeing during this period are vital. Mindfulness based intervention (MBI) has been found to be effective in reducing psychological distress. Delivery of MBI via the internet, making it accessible and inexpensive, is showing a promising positive effect in reducing psychological distress. A randomized control trial with sufficient power is required to confirm its positive effect among pregnant women. The positive effects of MBI have been found to be associated with heart rate variability (HRV) biofeedback; however, the efficacy of MBI on HRV has been rarely studied among pregnant women. Also, the potential association of HRV with MBI and psychological wellbeing needs further examination. This research aims to test the effectiveness of guided mobile-based perinatal mindfulness intervention (GMBPMI) among pregnant women experiencing psychological distress during the pre- and post-natal period, as well as examining the efficacy of GMBPMI on HRV. METHOD: This study is a randomized controlled trial that follows a parallel design. Consenting pregnant women in their second trimester (between 12th and 20th week gestation) will be randomly assigned to an intervention group (GMBPMI) or a control group (psychoeducation). The intended sample size is 198, with 99 participants in each group. Three levels of outcomes will be measured at baseline, post intervention in both the intervention and control groups, and at 36-week gestation and five-week postpartum. The primary outcomes include maternal psychological stress, mindfulness and positive appraisal HRV. Secondary outcomes are psychological and physical wellbeing. Tertiary outcomes include obstetric and neonatal outcomes, and social support. Analyses will follow an intention-to-treat method and repeated measures MANOVA will be conducted to compare changes in primary and secondary outcomes. A series of mixed-effects models will be fitted to assess the mediation effects. DISCUSSION: This trial expects to increase understanding of GMBPMI on HRV and psychological wellbeing for pregnant women, with extended support in both pre-and post-natal periods. The study could also potentially provide evidence for delivery of cost-effective and accessible services to pregnant women. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04876014, registered on 30 March 2021. Protocol Version 1.0., 10 May 2021.

Hypnotherapy for persons with Irritable Bowel Syndrome: A three-arm randomized controlled trial.

The current study sought to (1) compare the efficacies of Ericksonian hypnotherapy, traditional hypnotherapy, and educational talk in treating irritable bowel syndrome (IBS), and to (2) evaluate the impacts of hypnotic susceptibility on participants' responses to hypnotherapy. The study adopted a three-arm randomized controlled trial design and achieved an effective sample size of 144. Self-reported psychological questionnaires were used to assess participants' IBS symptom severity, health-related quality of life, and coping patterns at baseline, immediately post-intervention, and 3 months after intervention. The evaluation focused primarily on IBS symptom severity and health-related quality of life, as well as on the illness coping patterns of symptom catastrophizing and symptoms-related social hypervigilance.The findings showed that significant improvements in IBS symptom severity occurred in all three types of study groups immediately after completion of the intervention (p < .05, ηρ2 = .20). However, only the traditional hypnotherapy groups and the Ericksonian hypnotherapy groups still had a notably significant decrease in symptoms 3 months after the intervention, whereas the educational talk groups had dropped back to pre-treatment symptom levels at the 3-month follow-up. The amplitude of change of symptom catastrophizing in the traditional hypnotherapy groups was stronger than that in the Ericksonian hypnotherapy groups after completion of the intervention, and the two types of hypnotherapy groups were significantly lower in symptom catastrophizing both immediately after the intervention and also 3 months post-intervention (p < .001, ηρ2 = .17). The other coping mechanism studied, symptoms-related social hypervigilance, showed a significant decline only in the Ericksonian hypnotherapy groups (ps < .001, ηρ2 = .45). Interestingly, in the traditional hypnotherapy groups, persons with higher hypnotic susceptibility showed significant improvement in symptom severity, health-related quality of life, and coping patterns following treatment. Notably, the effects from Ericksonian hypnotherapy for IBS diverged from the effects from traditional hypnotherapy. Finally, both Ericksonian hypnotherapy and traditional hypnotherapy appeared to have greater positive effects than educational talk did, but at different levels.

Effect of holistic relapse prevention intervention among individuals with alcohol dependence: a prospective study at a mental health care setting in India.

Present study examined effectiveness of Integrative Body Mind Spirit (I-BMS) intervention among individuals with alcohol dependence. A 2-group single blind RCT design was used, comparing I-BMS to treatment as usual (TAU) on drinking and psychological outcomes. One hundred participants diagnosed with alcohol dependent syndrome were randomly assigned to receive 7 sessions of I-BMS or TAU. Measurements done by a registered nurse who was blinded to the experimental design used standardized questionnaire on wellbeing, readiness to change, craving, quantity and frequency of drinking before and up to 6 months after the intervention. With respect to the within group effects, the I-BMS group demonstrated significant improvement in all outcome measures with large effect size. Compared to TAU, I-BMS participants showed lesser relapse rates and quantity of drinking at 3-month follow-up, reduction in craving and drinking days at 2-month follow-up. At 6 months follow-up, participants in I-BMS group reported significant improvement in wellbeing and motivation compared to TAU. Results of binary logistic regression showed that number of previous attempts and living in urban area positively predicted participant's relapse possibility at 6-month follow-up. Results suggest that I-BMS is worthy of further efficacy testing. In conclusion, it is feasible to implement I-BMS intervention for individuals with alcohol dependence.

Impact of mind-body intervention on proinflammatory cytokines interleukin 6 and 1ß: A three-arm randomized controlled trial for persons with sleep disturbance and depression.

Depressed people are prone to sleep disturbance, which may in return perpetuate the depression. Both depression and sleep disturbance influence proinflammatory cytokines interleukin (IL) 6 and 1ß. Thus interventions for depression should consider the effect on sleep disturbance, and vice versa. Integrative Body-Mind-Spirit (IBMS) and Qigong interventions have been applied in a wide range of health and mental health conditions, including depression and sleep disturbance. This study aimed to evaluate the effect of these two mind-body therapies for persons with both depressive symptoms and sleep disturbance. A three-arm randomized controlled trial was conducted among 281 participants, who were randomly assigned to either IBMS, Qigong or wait list control group. Participants in IBMS and Qigong groups received eight weekly sessions of intervention. Outcome measures were plasma concentrations of IL-6 and IL-1ß, and a questionnaire containing Pittsburgh Sleep Quality Index, Center for Epidemiologic Studies Depression Scale, Somatic Symptom Inventory, Perceived Stress Scale and Body-Mind-Spirit Holistic Well-being Scale. Outcomes were assessed at baseline (T0), immediate post-intervention (T1) and at three-months post-intervention (T2). Besides intervention efficacy analysis, path analysis was performed to explore the relations among perceived stress, depression, sleep disturbance, and IL-6 and IL-1ß values. The study found both IBMS and Qigong reduced depression, sleep disturbance, painful and painless somatic symptoms, IL-6 and IL-1ß levels, and increased holistic well-being. The effect sizes of IBMS and Qigong, mostly in the medium magnitude range, were approximatively equivalent. Path analysis models revealed a predictive role of perceived stress in depression and sleep disturbance, a bidirectional relationship between depression and sleep disturbance, and significant influence of depression and sleep disturbance on IL-6 and IL-1ß. Compared with control, the findings support the efficacy of IBMS and Qigong interventions in relieving depression and sleep disturbance, and in reducing IL-6 and IL-1ß levels.

Knowledge, contact and stigma of mental illness: Comparing three stakeholder groups in Hong Kong.

BACKGROUND: It remains unknown what the impacts of multiple dimensions of contact (e.g. level, quantity and quality) are on the stigma of mental illness. AIMS: To explore the relationship between the multiple dimensions of contact and stigma of mental illness among family members (FM), mental health workers (MHW) and community residents (CR) in Hong Kong. METHODS: The stigma, contact and knowledge were measured in FM, MHW and CR in Hong Kong. Multiple regression analyses were used. RESULTS: MHW (n = 141) had higher knowledge, more contact and lower stigma of mental illness than CR (n = 95) or FM (n = 62). Knowledge and contact quality were significantly associated with lower stigma of mental illness in the three groups. However, contact level and contact quantity were not significantly associated with most stigma components. The contact level was positively associated with stigma of mental illness among FM and CR. CONCLUSIONS: The results of this study highlight the differences in knowledge, contact and stigma of mental illness among different stakeholder groups. This study suggests that positive contact (e.g. equal, supportive, voluntary and pleasant contact) reduces stigma of mental illness, while negative contact (e.g. unfriendly, unsupportive, unpleasant contact) may increase stigma. The Enhancing Contact Model (ECM) should be tested in future anti-stigma interventions.

Physical activity, confidence and quality of life among cancer patient-carer dyads.

BACKGROUND: Physical activity (PA) has been positively associated with health-related quality of life (HRQoL) among cancer patients and family caregivers. However, there has been no relevant research for patient-caregiver dyads. METHODS: Path analysis, based on the actor-partner interdependence model (APIM), was used to examine the relationship between physical activity and health-related quality of life and explore the mediating role of emotional distress in 233 dyads. RESULTS: In both patients and caregivers, physical activity had a direct positive effect on physical quality of life (QoL) but not on mental. There was a significant indirect effect of physical activity on health-related quality of life via emotional distress for both dyad members. Patients' and caregivers' confidence in fighting cancer was negatively associated with their own emotional distress. Caregivers' confidence in fighting cancer was positively associated with their physical activity and also negatively associated with patients' emotional distress. CONCLUSIONS: Physical activity may be considered as a possible behavioral and rehabilitation strategy for improving health-related quality of life in patient-caregiver dyads and reducing negative symptoms. Future research and intervention may consider cancer patient-family caregiver dyad as a unit of care.

Application of Mobile Call-Based Integrative Body-Mind-Spirit (IBMS) Intervention to Deal With Psychological Issues of COVID-19 Patients: A Case Study in India.

Aim: The aim of this case study was to assess whether 8 sessions of mobile call based integrated Body-Mind-Spirit (IBMS) intervention could help COVID-19 patient to deal with psychological issues. Methods: This article is based on a practical example of working with COVID-19 patient using the IBMS model. It is a single subject study involving a 50 year old south Indian male living in a Covid Care Center (CCC). Mobile call interviews and brief symptom inventory were used for evaluation. Subject underwent 8 sessions of integrated body-mind-spirit Intervention through video/mobile calls of 45 minutes each time for 8 sessions offered on alternative days over a period of 15 days with pre-post assessments. Results: The results indicate that there was a reduction in somatic symptoms, anxiety and depression on 15th day. Conclusion: Illustrations of real life cases may help psychiatric nurses to gain insight into the application of psycho-social-spiritual interventions through mobile phone during isolation and lockdown.

Health and social care service utilisation and associated expenditure among community-dwelling older adults with depressive symptoms.

AIMS: Late-life depression has substantial impacts on individuals, families and society. Knowledge gaps remain in estimating the economic impacts associated with late-life depression by symptom severity, which has implications for resource prioritisation and research design (such as in modelling). This study examined the incremental health and social care expenditure of depressive symptoms by severity. METHODS: We analysed data collected from 2707 older adults aged 60 years and over in Hong Kong. The Patient Health Questionnaire-9 (PHQ-9) and the Client Service Receipt Inventory were used, respectively, to measure depressive symptoms and service utilisation as a basis for calculating care expenditure. Two-part models were used to estimate the incremental expenditure associated with symptom severity over 1 year. RESULTS: The average PHQ-9 score was 6.3 (standard deviation, s.d. = 4.0). The percentages of respondents with mild, moderate and moderately severe symptoms and non-depressed were 51.8%, 13.5%, 3.7% and 31.0%, respectively. Overall, the moderately severe group generated the largest average incremental expenditure (US$5886; 95% CI 1126-10 647 or a 272% increase), followed by the mild group (US$3849; 95% CI 2520-5177 or a 176% increase) and the moderate group (US$1843; 95% CI 854-2831, or 85% increase). Non-psychiatric healthcare was the main cost component in a mild symptom group, after controlling for other chronic conditions and covariates. The average incremental association between PHQ-9 score and overall care expenditure peaked at PHQ-9 score of 4 (US$691; 95% CI 444-939), then gradually fell to negative between scores of 12 (US$ - 35; 95% CI - 530 to 460) and 19 (US$ -171; 95% CI - 417 to 76) and soared to positive and rebounded at the score of 23 (US$601; 95% CI -1652 to 2854). CONCLUSIONS: The association between depressive symptoms and care expenditure is stronger among older adults with mild and moderately severe symptoms. Older adults with the same symptom severity have different care utilisation and expenditure patterns. Non-psychiatric healthcare is the major cost element. These findings inform ways to optimise policy efforts to improve the financial sustainability of health and long-term care systems, including the involvement of primary care physicians and other geriatric healthcare providers in preventing and treating depression among older adults and related budgeting and accounting issues across services.