Coping Strategies of Patients With Advanced Lung or Colorectal Cancer Over Time: Insights From the International ACTION Study.

OBJECTIVE: A comprehensive understanding of coping strategies of patients with advanced diseases can contribute to providing supportive care that meets patients' needs. However, insight into how coping of this population develops over time is lacking. We examined coping strategies of patients with advanced cancer over time and identified distinct trajectories and their predictors. METHODS: Data from 675 patients of the control group from the ACTION cluster-randomized trial were analyzed. Patients with lung or colorectal cancer from six European countries (Belgium, Denmark, Italy, the Netherlands, Slovenia and the United Kingdom) completed questionnaires at baseline, 12 and 20 weeks. Measures included Denial, Acceptance, and Problem-focused coping (COPE, Brief COPE inventory; scores 4-16 per scale). We used linear mixed models to analyze the data and latent class mixed models to identify stable (within patient change < 2) coping strategies. RESULTS: At baseline, patients reported low use of Denial (6.6) and greater use of Acceptance (12.6) and Problem-Focused coping (12.2). These scores did not significantly change. We found four distinct trajectories for the use of Denial, three for Acceptance and five for Problem-Focused coping strategies. Stable trajectories were found in 513 (77%) patients for Denial, 645 (96%) for Acceptance and 602 (91%) for Problem-Focused coping. All coping strategies were stable in 447 (68%) patients and two were stable in 181 patients (28%). CONCLUSIONS: Overall, the use of coping strategies was rather stable in the majority of patients with advanced cancer. However, for each of the coping strategies subgroups of patients reported fluctuating coping trajectories.

Medical Error: Using Storytelling and Reflection to Impact Resident Error Response Factors.

Introduction: Medical error is common and has a significant impact on physicians, learners, and patients' perception of the medical system; however, residents receive little formal training on this topic. This curriculum aims to foster sharing of personal medical error stories, review and practice error management and coping strategies, and impact error response factors. Methods: Faculty identified factors related to effective physician error management and recovery in order to develop a targeted curriculum for family medicine residents. The curriculum consisted of three 1-hour didactic sessions in a medium-sized, urban program. Instructional methods included guided reflection after mentor storytelling, small-group discussion, role-play, and self-reflection. Results: Twenty-two out of 30 (73%) residents completed the premodule survey, and 15 out of 30 (50%) residents completed the post module survey. Fewer than half of residents reported they knew what to do when faced with medical error, but this increased to 93% after curriculum delivery, as did rates of reported error story sharing. Resident reported self-efficacy (I can be honest about the errors I make as a doctor.) and self-awareness (I acknowledge when I am at increased risk for making errors) also increased following the curriculum. Discussion: Family medicine residents are receptive to learning from peers and mentors about error management and recovery. A brief curriculum can impact the culture around disclosure and support. Future iterations should focus on the impact of targeted curricular interventions on patient-oriented outcomes related to medical error.

Influence of slow and rapid weight loss periods on physiological performance, mood state and sleep quality in male freestyle wrestlers: a study from Sichuan Province, China.

Objective: This study aims to investigate the changes in physiological performance, mental state and sleep quality during the weight reduction phase prior to competition in male freestyle wrestlers. Methods: This study included 16 male freestyle wrestlers from Sichuan Province, China. Participants were evaluated at three time points: the first day of slow weight reduction (T1, March 26), the first day of rapid weight reduction (T2, April 26) and the day before the competition (T3, May 3), and measurements were taken for physiological performance, mood state and sleep quality. Results: The most relevant findings indicated the following: Morning heart rate, creatine kinase and fatigue scores increased by 12.6, 64.6, and 19.0%, respectively, from T1 to T2 (p < 0.05), and decreased by 14.1, 36.6, and 16.8%, respectively, from T2 to T3 (p < 0.05). Hemoglobin and testosterone levels decreased by 3.0 and 16.8%, respectively, from T1 to T3 (p < 0.05), and by 2.9 and 18.2%, respectively, from T2 to T3 (p < 0.05); The secondary findings revealed the following: The total mood disturbance scores decreased by 3.8% from T2 to T3 (p = 0.072), positive mood scores decreased by 9.0% from T1 to T2 (p = 0.090), the Pittsburgh Sleep Quality Index total scores increased by 14.4% from T1 to T2 (p = 0.323) and total work output and average power output decreased by 7.3 and 7.8%, respectively, from T1 to T3 (p = 0.067, p = 0.052); Regression analyses predicted negative mood (Y 1 = 62.306-0.018 × maximum power output) and sleep quality (Y 2 = 2.527 + 0.278 × Immunoglobulin G) during the weight reduction period. Conclusion: The combined slow and rapid weight reduction approach effectively minimized body fat in athletes with limited effect on their physiological performance and sleep quality. However, the effects were adverse on certain health variables and anaerobic power in Chinese male freestyle wrestlers. The identified correlations between negative mood and maximum power, and between sleep quality and immunoglobulin G, shed new light on factors influencing athletes' well-being during weight reduction, and underscored the need for careful monitoring of physiological variables in future weight management strategies.

Resilience experienced by university students during the COVID-19 pandemic: A qualitative exploration based on focus-group interviews.

Purpose: University students have been one of the most affected groups worldwide during the COVID-19 pandemic, having experienced increased stress, anxiety, and depression. Resilience is reported as the most predictive factor in decreasing the impact of the threats of the COVID-19 pandemic. However, university students' resilience during the COVID-19 pandemic has not received much attention; this is a research gap that this study aimed to address. Methods: Seventeen 2nd- and 4th-year South Korean students who had experienced at least one year of university life during the COVID-19 pandemic participated in this study between June and July 2021.This study involved three focus-group interviews that were recorded and transcribed verbatim, and data were analyzed using qualitative content analysis. Results: Eight conceptual categories emerged from the three main themes distilled from participants' responses: 1) factors impeding resilience: experience of loss, experience of a dangerous situation, expansion of uncertainty, and accumulated stress; 2) strategies to strengthen resilience: change and innovation, loss and confrontation, and transcendence; and 3) outcomes from strengthening resilience: adapting to the changing world ("the new normal"). Conclusion: s: This study found several factors that impede resilience and strategies to further support resilience. Universities and relevant community organizations can use these findings to develop educational programs and interventions to strengthen resilience in university students, helping them to better cope with future challenges and overcome adversity.

A Role-Needs Framework: Rethinking Support for Informal Caregivers for Alzheimer's Across the Global South and Global North.

OBJECTIVE: Caregivers play an essential role in supporting people with Alzheimer's disease globally. User-informed research is vital to developing trans-cultural guidelines for dementia support organisations. While coping strategies of caregivers are well researched, the 'coping-effectiveness' framework falls short of representing all caregiver needs. Our aim was to develop a robust and inclusive, globally applicable framework of caregiver-informed support needs. METHODS: In partnership with Alzheimer's Disease International and Roche, we conducted qualitative online semi-structured interviews with 34 family caregivers from the Global North (UK, US) and Global South (Brazil, South Africa) in the COVID-19 context. Participant-generated photographs helped encourage discussions of hidden contextual issues. Iterative inductive narrative analysis of interviews and photographs was carried out with input from global and national charity and industry sectors. RESULTS: We identified a framework of four cross-cultural caring approaches with implications for support: (1) Empathising, using emotion-focused strategies to develop strong expertise and coping skills, with time specific information, psychosocial and peer support needs. (2) Organising, using problem-focused strategies, with strong narratives of expertise and advocacy which benefited from early structured information and professional confirmation. (3) Non-identifying caregiving, where daily aspects of caring occurred without specialist knowledge and expertise, and caregivers sought assistance in managing disease-related support. (4) Reluctance, where struggling with unwanted caring responsibilities meant caregivers looked to professionals to carry out daily care. CONCLUSION: Our findings move beyond the 'coping-effectiveness' framework of support to suggest a novel 'role-needs' framework. Our approach supports inclusive ways of tailoring support to fit individual caregiver circumstances globally.

Resiliency amid the COVID-19 pandemic: engagement in meaningful activities as a mediator between coping ability and depressive symptoms among older adults.

OBJECTIVES: This study investigated the longitudinal association between coping ability and depressive symptoms from before to during and after the COVID-19 pandemic and whether engagement in meaningful activities plays a mediating role in this association. METHOD: Individuals aged 75, 80, and 85 years (n = 1021) were interviewed in 2017-2018 (T1, pre-pandemic). Of these persons, 608 were interviewed in 2020 (T2, first wave) and 2021-2022 (T3, partly post-pandemic). Coping ability, depressive symptoms, and engagement in meaningful activities were assessed using the 10-item Connor-Davidson Resilience Scale, 10-item Center for Epidemiologic Studies Depression Scale, and 17-item activity subscore of the University of Jyväskylä Active Aging Scale, respectively. Structural equation modeling was used for the mediation analyses. RESULTS: Higher coping ability was associated with decreased depressive symptoms, partly mediated by higher activity scores between T1 and T2. From T2 to T3, higher coping ability reduced the depressive symptoms, but the activity scores did not mediate the changes during this period. CONCLUSION: Good coping ability may help older people sustain good mental well-being. With good coping ability, active engagement in meaningful activities contributed to the low level of depressiveness during the early phases of the pandemic, when many social activities were restricted.

"We just ignored them." Adaptation strategies used by emergency department personnel in the face of workplace violence: A qualitative study.

BACKGROUND: Workplace violence (WPV) can have adverse psychological, physical, and emotional effects on emergency department (ED) personnel. Adaptive strategies can help them better adapt to WPV. The study aimed to explore ED personnel's experiences with adaptive strategies used in the face of WPV. METHODS: In this qualitative study, 22 ED personnel (nurses, doctors, services patient care assistants, and security guards) were selected using purposive sampling from Urmia city hospitals. Deep semi-structured individual face-to-face interviews were used to collect data. After recording and implementing interviews, conventional content analysis was used to extract concepts. RESULTS: Data analysis led to extracting an overarching theme of "mastering the situation and avoiding harm." Two categories that supported the main theme were: "effort to avoid violence" and "effort to escape suffering." The seven subcategories supported main categories included "managing patients and companions, "self-control," "seeking support, "emotional discharge," "thought diversion, "tendency to spirituality," and "seeking medical assistance." CONCLUSION: Given the experiences of ED personnel regarding strategies used, health managers and policymakers are recommended to develop and implement comprehensive programs to reduce violence and empower nurses before and after dealing with violence. The following programs will help: developing and implementing guidelines such as zero-tolerance WPV policy, criminalizing violence against personnel and punishing perpetrators; holding classes related to communication skills, self-control skills, and deviant thinking skills for ED personnel; raising public awareness of the prevailing conditions in the emergency through mass media, and counseling and treating violent ED personnel.

The Perceptions and Experiences of Older People Living in the Aftermath of Lombok Earthquakes, Indonesia: A Qualitative Study.

INTRODUCTION: Despite the growing knowledge of people's vulnerability following natural disasters, the perspective of older people has received limited attention. This study aimed to explore the perceptions and experiences of older people encountering the 2018 Lombok earthquakes. METHODS: This exploratory qualitative study involved 16 older people living in one of the villages most affected by the 2018 earthquakes in Lombok Island, Nusa Tenggara Barat, Indonesia. The data were collected in June 2019 using semi-structured interviews. Participants' responses were digitally recorded and transcribed verbatim for analysis. The data were analysed using qualitative content analysis managed in NVivo. RESULTS: From older people's perspectives, three themes were generated: surviving the disaster, dealing with life changes and navigating through challenges and hope. Each theme comprised two categories, which reflected the journey of older people from the early to the later phase of the disaster. CONCLUSIONS: Older people experienced critical conditions and difficulties both physically and mentally. They also experienced various emotional responses before accepting living situations following a disaster. Nurses should play a role in fulfilling the physical and mental health needs of older people in post-disaster conditions. IMPLICATIONS FOR PRACTICE: This study can inform nurses and other key stakeholders about the needs of older people during and after natural disasters. Nurses need to be equipped with the skills and abilities to identify and meet the needs of older people in difficult situations and with limited resources.

Medical Error: Using Storytelling and Reflection to Impact Error Response Factors in Family Medicine Residents.

I am a healer, yet sometimes I do more harm than good…David Hilfiker, 1984. Objectives: Medical error is common and significantly impacts patients, physicians, learners, and public perception of the medical system; however, residents receive little formal training on this topic. Research on error response in practicing physicians is limited, and even more so on medical education interventions to improve this. This study evaluates a curriculum developed to foster the sharing of faculty medical error stories, practice of constructive coping strategies, and growth in resident confidence in managing error. Methods: Researchers identified factors related to effective physician error management and recovery to develop a targeted intervention for family medicine residents. The intervention consisted of three one hour didactic sessions in a medium-sized midwestern, urban family medicine residency program over the course of 6 months. Instructional methods included guided reflection after mentor storytelling, small group discussion, role play, and self-reflection. Results: Of the 30 residents, 22 (73%) completed the preintervention survey, and 15 (50%) completed the postintervention survey. While most residents reported having experienced error (55%), fewer than half of the residents reported they knew what to do when faced with medical errors (46%). This increased to 93% after intervention. Personal error stories from mentors were the most desired type of training reported by residents preintervention, but this was surpassed by legal and malpractice concerns in the postintervention survey. Rates of reported error story sharing increased after the intervention. Residents reported self-efficacy (I can be honest about errors) and self-awareness (I acknowledge when I am at increased risk for error) also increased with intervention. However, these changes did not reach statistical significance. Conclusions: Family medicine residents are receptive to learning from peers and mentors about error management and recovery. A brief intervention can impact the culture around disclosure and support. Future research should focus on the impact of targeted interventions on patient-oriented outcomes related to medical error.

Role of Sports Motivation and Basic Psychological Needs in the Relationship Between Child Maltreatment and Psychological Adaptation in Adolescents.

Child maltreatment poses serious consequences, while sports participation among adolescents offers a potential avenue for mitigating such consequences. This study, based on self-determination theory (SDT), examines the associations among child maltreatment, sports motivation (intrinsic and extrinsic), and satisfaction or frustration of basic psychological needs (BPNs). This study also investigated the mediating role of sports motivation in the relationship between child maltreatment and psychological adaptation. Adolescents engaged in sports were derived from the first wave of a large two-wave study (wave 1: n = 1403; wave 2: n = 618) using data on child maltreatment, intrinsic and extrinsic motivation, and satisfaction and frustration of within the sports context. Subsequently, data on psychological adaptation, including self-esteem and satisfaction with life, were collected during the second wave. Path analyses revealed satisfaction and frustration of BPNs as significant mediators in the relationship between child maltreatment and sports motivation. In addition, intrinsic motivation mediated the relationship between child maltreatment and psychological adaptation after 18 months. Specifically, the results indicated that enhancing intrinsic motivation in adolescents with a history of child maltreatment by improving satisfaction of BPNs could be an innovative intervention target.

Does self-care improve coping or does coping improve self-care? A structural equation modeling study.

BACKGROUND: Support interventions often address both self-care and coping. Different approaches are used to promote self-care and coping so clarifying the intervention effect can guide clinicians and researchers to provide interventions that achieve benefit. PURPOSE: To compare two models to determine whether self-care improves coping or coping improves self-care. METHODS: We used cross-sectional data from 248 caregivers obtained at enrollment into a randomized controlled trial testing the efficacy of a support intervention. Factor scores for scales measuring caregiver demand, self-care, coping, stress appraisal, and mental health were derived from exploratory factor analysis. Structural equation models were analyzed using the factor scores as estimates of each construct. To control possible spurious effects caregiver age, gender, relationship with the patient, and income adequacy were included. RESULTS: Both models were compatible with the data, but the self-care model was stronger than the coping model. That model had a non-significant chi square and an excellent fit to the data, χ2(4, N = 248) = 2.64, p = .62. The percentage of variance explained by the self-care model was 54 % for mental health, 42 % for stress appraisal, 10 % for avoidance coping, and 6 % for active coping. In the coping model the explained variance of stress appraisal dropped to 33 %, avoidance coping dropped to 0 %, and active coping dropped to 3 %. CONCLUSIONS: The self-care model was strongest, illustrating that self-care decreases stress, promotes coping, and improves mental health. These results suggest that promoting self-care may be more effective in improving mental health than interventions aimed at improving coping.

Trajectories of psychological adaptation to Chinese older internal migrants: a latent transition model.

OBJECTIVES: Little is known about the heterogeneity and transitions between psychological adaptation patterns in Chinese older internal migrants. This study addressed two questions: (a) Do distinct patterns of psychological adaptation exist among Chinese older internal migrants? (b) If so, what factors predict different trajectories? METHOD: The study drew on two waves of data and involved 405 older internal migrants into Nanjing, China. First, a latent transition analysis was performed to visualize the different patterns of psychological adaptation. Second, an ecological model of resilience was used to identify the factors explaining the differences between adaptation patterns. RESULTS: Three main trajectories of psychological adaptation among Chinese older internal migrants over time were: recovery, stability and deterioration. Adaptation trajectories were associated with age, gender, length of stay, psychological resilience, self-esteem, family support, social participation, and living with a spouse. CONCLUSION: Chinese older internal migrants undertake heterogeneous psychological adaptation trajectories, and their positive adaptation is closely associated with coping resources. Our data may provide references for the identification of vulnerable older internal migrants, as well as the making of targeted interventions.

Perception of aesthetic impairment in patients with systemic sclerosis determined using a semi-quantitative scale and its association with disease characteristics.

Background: Systemic sclerosis is a fibrotic disease. Body image assessments could be key in optimizing care; however, data are scarce. The main objective was to assess the perception of aesthetic impairment using a visual aesthetic evaluation scale in patients with systemic sclerosis compared with healthy subjects. The secondary objectives were to assess associations between the perception of aesthetic impairment and scores on standardized questionnaires for aesthetic impairment as well as clinical, psychological/quality of life, and functional parameters of patients with systemic sclerosis. Methods: This study evaluated and compared the perception of aesthetic impairment in two populations: patients with systemic sclerosis from a referral center at Lille Hospital, France, and healthy controls. Results: This study included 88 patients (69 (78.4%) women) with a median age of 52 years and 88 controls (49 (55.7%) women) with a median age of 45 years. The perception of aesthetic impairment assessed using the aesthetic evaluation scale was poorer in systemic sclerosis patients than in controls (3.7 ± 0.3 vs 2.8 ± 0.3, p = 0.028) and was statistically correlated with assessments using the adapted satisfaction with appearance, a specific aesthetic impact assessment questionnaire for patients with systemic sclerosis. Patients with anxiety or depressive symptoms had significantly higher aesthetic evaluation scale scores. Systemic sclerosis patients with facial involvement and pitting scars had a worse perception of aesthetic impairment. Compared with healthy controls, systemic sclerosis patients had a worse perception of aesthetic impairment, especially systemic sclerosis patients with anxiety or depression and those with facial and hand involvement. Conclusion: The aesthetic evaluation scale appears to be an easy-to-use tool to evaluate body image. Correlations of the aesthetic evaluation scale score with psychological and quality of life parameters reflect the importance of these parameters for body image evaluation and its complex assessment. Trial registration: Clinical Trial NCT03271320 (Registered 9 January 2017, https://www.clinicaltrials.gov/ct2/show/NCT03271320?term=NCT03271320&cntry=FR&draw=2&rank=1).

Discrepancies in perceived family resilience between adolescents with chronic illness and parents: using response surface analysis to examine the relationship with adolescents' psychological adjustment.

BACKGROUND: This study aimed to explore discrepancies in adolescents with chronic illness and their parents' perceptions of family resilience, as well as the relationship between these differences and the psychological adjustment of adolescents with chronic illness. METHODS: A cross-sectional study was conducted. A total of 264 dyads of parents (77.7% mothers, mean age 41.60 years, SD = 6.17) and adolescents (48.5% girls, mean age 12.68 years, SD = 2.11) with chronic illness were recruited through convenience sampling from three children's hospitals in Wenzhou, Hangzhou, and Shanghai, China between June 2022 and May 2023. The Chinese version of the Family Resilience Scale and the Psychological Adjustment Scale, which are commonly used measures with good reliability and validity, were employed to assess family resilience and psychological adaption, respectively. The data were analyzed using polynomial regression and response surface analysis. RESULTS: Adolescents with chronic illness reported higher family resilience than their parents (t=-2.80, p < 0.05). The correlations between family resilience and adolescents' psychological adjustment reported by the adolescents (r = 0.45-0.48) were higher than parents (r = 0.18-0.23). In the line of congruence, there were positive linear (a1 = 1.09-1.60, p < 0.001) and curvilinear (a2=-1.38∼-0.72, p < 0.05) associations between convergent family resilience and adolescents' psychological adjustment. In the line of incongruence, when adolescents reported lower family resilience than parents, adolescents had a lower level of psychological adjustment (a3=-1.02∼-0.45, p < 0.05). Adolescents' sociability decreased when the perceived family resilience of parent-adolescent dyads converged (a4 = 1.36, p < 0.01). CONCLUSION: The findings highlighted the importance of considering the discrepancies and congruence of family resilience in the parent-child dyads when developing interventions to improve the psychological adjustment of adolescents with chronic illness. Interventions aimed at strengthening family communication to foster the convergence of perceptions of family resilience in parent-adolescent dyads were warranted.

Stay strong, stay healthy: exploring a predictive model of psychological adaptation among Macau students studying in Mainland China within the postcolonial context.

The prevailing research on adaptation primarily centers around the settlement of international students and immigrants in different cultural environments. However, there is a notable gap in understanding the intra-cultural adaptation process for individuals from postcolonial areas when relocating to their home country. The primary focus of the current study lies in constructing a predictive model that delineates the psychological adaptation experienced by Macau students studying in Mainland China. In total, two hundred and fifty-five Macau students completed a questionnaire which assessed variables falling into two categories: identity-related variables, such as language proficiency and identity, and intergroup-related variables, including intergroup contact and the quality of contact, and psychological adaptation. The findings from the present study revealed that identity and quality of contact continued to make significant contributions to psychological adaptation in intra-cultural environments as in inter-cultural environments, whereas language proficiency and intergroup contact were unrelated to psychological adaptation in intra-cultural adaptation. The present study extended the adaptation research by transporting hypotheses and findings from inter-cultural adaptation and testing their validity and applicability in postcolonial contexts. The findings also provided practical implications for Chinese education institutions and policy-makers.

Difficulties in emotion regulation and well-being in breast cancer.

Objective: Breast cancer is responsible for disruptive changes in women's lives, causing them to experience diverse and intense negative emotions that can affect their perception of well-being. The present study aimed to characterize difficulties in emotion regulation (ER), according to Gratz and Roemer's multidimensional assessment, in women with breast cancer and to relate them with General Well-Being and its different domains: Physical, Social/Familial, Emotional, and Functional. Method: Ninety-five Portuguese women with breast cancer aged between 32 and 75 years answered a sociodemographic and clinical questionnaire and the Portuguese versions of the Difficulties in Emotion Regulation Scale and the Functional Assessment of Cancer Therapy - General. Data were collected in an oncology public hospital. Results: In general, difficulties in ER presented negative correlations with General Well-Being and its domains. The multiple regression analysis findings indicated that two specific types of difficulties, Limited Access to ER Strategies and Lack of Emotional Clarity, play a significant role in predicting well-being, especially in the Emotional domain, which was most compromised in these patients. Conclusions: These difficulties should be approached within psycho-oncological interventions as they are essential contributors to improving emotional and general well-being and fostering psychological adaptation to breast cancer.

The effect of a couple-based posttraumatic growth intervention in supporting couples coping with colorectal cancer: A randomized controlled study.

OBJECTIVES: To promote posttraumatic growth (PTG) in colorectal cancer (CRC) couples, a couple-based PTG intervention was conducted, and the intervention had previously proved be feasible in CRC couples. The current study was conducted to validate the effects of intervention in CRC couples. METHOD: This is a randomized controlled study that included 174 CRC couples. All participants were randomized to either the intervention (usual care plus 5-week PTG intervention, n = 87) or the control group (usual care, n = 87). Data were collected from CRC couple dyads at baseline and immediately post-intervention periods. Primary outcome refers to positive changes, and secondary outcomes include marital satisfaction, quality of life (QOL), and anxiety and depression. Multilevel modeling was applied to analyze the intervention effects. RESULTS: Participants in the program showed increased PTG, marital satisfaction, and QOL both physically and mentally, and decreased levels of anxiety and depression over time. And spousal caregivers showed greater improvement in marital satisfaction and physical QOL compared with patients. In addition, significant intervention effects were shown in the participants' benefit finding, physical health and depressive symptoms. CONCLUSION: The study confirmed the effect of the PTG intervention on CRC couples' benefit finding, physical health and depressive symptoms. However, this study only measured outcome variables at two time-points. Future studies should add follow-up assessments to evaluate long-term effects of the intervention in CRC couples. REGISTRATION NUMBER: ChiCTR2300067809.

Resilience, coping and Personal Factors of medical students at a Public University; Karachi, Pakistan.

OBJECTIVE: To assess resilience levels of medical students, identify factors associated with it, and explore association between coping styles and resilience level among medical students. METHODS: The analytical, cross-sectional study was conducted at the Dow Medical College, Dow University of Health Sciences, Karachi, from February to June 2022, and comprised medical students regardless of gender and the academic year. Data was collected using self-administered socio-demographic form, Brief Resilience Scale and Brief Cope. Data was analysed using SPSS 28. RESULTS: Out the 301 participants, 197(65.4%) were females and 104(34.6%) were males. The overall mean age was 20.7±1.849 years. Of the total, 132(43.9%) students had low resilience, with males having better resilience compared to females (p<0.001). Higher resilience was seen in year 1 students compared to those of clinical years (p=0.029). There was a significant positive correlation between high resilience and problem-focussed coping, while a significant negative correlation was found between resilience and avoidant and emotionally focussed strategies (p<0.05). There was a significant negative correlation between resilience levels and age (p<0.025). There was a significant difference in resilience scores with respect to the last grade point average, sleep hours, and hours spent studying (p<0.05). CONCLUSIONS: More than one-third medical students demonstrated low resilience, and the majority reported adopting emotion-focussed coping style.

Practitioner perspectives on the use of acceptance and commitment therapy for bereavement support: a qualitative study.

BACKGROUND: There is currently a high demand for bereavement support coupled with inconclusive findings as to the efficacy of existing approaches. Acceptance and Commitment Therapy (ACT) aims to improve human functioning and has shown efficacy across a wide range of conditions. ACT may be a promising means of supporting bereaved people, yet evidence on the use of ACT for bereavement support is lacking. The aim of this study is to explore how ACT is currently used for bereavement support and practitioner perspectives of how it helps following bereavement. METHODS: Semi-structured interviews were conducted online via MS Teams with practitioners experienced in using ACT for bereavement support. Data were analysed thematically guided by a framework approach. RESULTS: Nine participants were recruited. Three themes were identified: (i) creating psychological space around grief; (ii) using psychological space for value-directed action in the midst of grieving, and (iii) adapting ACT for bereavement support. Practitioners indicated that ACT improves clients' relationship with distressing internal experiences. Metaphors and mindfulness techniques were used to encourage acceptance of grief responses, taking perspective on distressing thoughts and images, and contact with the present moment. Better relationships with distressing experiences were regarded as less psychologically taxing, improving coping and well-being, while providing the psychological space to engage in value-directed action. Values exploration, sometimes using metaphors and exercises, was seen as supporting the bereaved person to rediscover a sense of purpose and engage in meaningful activities alongside their grief. Practitioners used ACT flexibly, integrating other interventions, and adapted ACT to the perceived sensitivities of bereaved people, and age-related and developmental factors. CONCLUSION: ACT is used to support people who have been bereaved to live effectively with the difficult thoughts and feelings associated with grieving and to enable them to gradually identify, reconnect with, and act in line with their values after loss.