Patients' experiences of a suppoRted self-manAGeMent pAThway In breast Cancer (PRAGMATIC): quality of life and service use results.

PURPOSE: To describe trends and explore factors associated with quality of life (QoL) and psychological morbidity and assess breast cancer (BC) health service use over a 12-month period for patients joining the supported self-management (SSM)/patient-initiated follow-up (PIFU) pathway. METHODS: Participants completed questionnaires at baseline, 3, 6, 9 and 12 months that measured QoL (FACT-B, EQ 5D-5L), self-efficacy (GSE), psychological morbidity (GHQ-12), roles and responsibilities (PRRS) and service use (cost diary). RESULTS: 99/110 patients completed all timepoints; 32% (35/110) had received chemotherapy. The chemotherapy group had poorer QoL; FACT-B total score mean differences were 8.53 (95% CI: 3.42 to 13.64), 5.38 (95% CI: 0.17 to 10.58) and 8.00 (95% CI: 2.76 to 13.24) at 6, 9 and 12 months, respectively. The odds of psychological morbidity (GHQ12 >4) were 5.5-fold greater for those treated with chemotherapy. Financial and caring burdens (PRRS) were worse for this group (mean difference in change at 9 months 3.25 (95% CI: 0.42 to 6.07)). GSE and GHQ-12 scores impacted FACT-B total scores, indicating QoL decline for those with high baseline psychological morbidity. Chemotherapy patients or those with high psychological morbidity or were unable to carry out normal activities had the highest service costs. Over the 12 months, 68.2% participants phoned/emailed breast care nurses, and 53.3% visited a hospital breast clinician. CONCLUSION: The data suggest that chemotherapy patients and/or those with heightened psychological morbidity might benefit from closer monitoring and/or supportive interventions whilst on the SSM/PIFU pathway. Reduced access due to COVID-19 could have affected service use.

Impact of informal care on the mental health of caregivers during the COVID-19 pandemic.

BACKGROUND: Informal care can affect the mental health of caregivers. The COVID-19 pandemic precipitated many people into informal care. Little is known about the longitudinal effect of informal care throughout the pandemic. We investigate changes in mental health in relation to changes in informal care between July 2020 and September 2021. METHODS: Using data from Understanding Society, we applied fixed-effects modelling to assess mental health variations associated with changes in caregiving among 13 557 participants (50 430 observations). Hours of weekly care were categorized as 0, 1-19, ≥20. Mental health was measured using the General Health Questionnaire (GHQ-12) as a continuous score and a binary indicator. Main analyses were stratified by gender. RESULTS: Compared to when delivering 0 hours care/week, the GHQ-12 scores of women providing care for 1-19 hours/week were 0.46 points higher (95%CI: -0.11, 1.09), while their mental health scores were 0.99 higher (95%: 0.08, 1.90) when caring for ≥20 hours/week. Changes on the binary GHQ-12 measure were only evident for women when providing ≥20 hours of weekly care. These changes were not substantial among men. CONCLUSION: Informal care adversely impacted the mental health of women carers during the COVID-19 pandemic. Support programmes for informal carers should focus on alleviating caregiving loads in women.

Risk factors for psychological morbidity and the protective role of coping self-efficacy in young women with breast cancer early in diagnosis: a national multicentre cohort study.

PURPOSE: Young women with breast cancer (YWBC) are an understudied population and there are limited data on risk factors for psychological morbidity early in diagnosis. We examined psychological morbidity (anxiety, depression, stress symptoms), well-being and associated risk factors. METHODS: A total of 845 women from a pan-Canadian, multicentre inception cohort study of YWBC (age ≤ 40) who completed Patient Reported Outcome Measures (PROMs) after their initial surgical consultation and prior to surgical or other treatments were included. Multivariate regression analyses identified risk factors (i.e. parenting young children) associated with psychological morbidity and whether coping self-efficacy was protective. RESULTS: Rates of clinically significant anxiety (n = 683, 69.1%) and depression (n = 422, 42.7%) were high but lower for stress symptoms (n = 67, 6.8%). Probability of anxiety was high for women with a previous history of depression (OR 2.02, P = 0.03, CI 1.09-3.74) and working full-time (OR 1.76, P = 0.05 CI 1.02-2.77). Whereas, pre-existing depression (OR 2.91, P = 0.01, CI 1.36-6.01), younger children (age ≤ 10) (OR 1.69, P = 0.05, CI 1.01-2.93), and income > $100,000 (OR 2.06, P = 0.02, CI 1.18-3.64) were risk factors for depression. Coping self-efficacy was protective with a decreased risk of anxiety (OR 0.11, P ≤ 0.01 CI 0.04-0.28), depression (OR 0.03, P ≤ .01, CI 0.01-0.16), stress symptoms (OR 0.17, P ≤ .01, CI 0.04-0.65) and higher psychosocial well-being with a gain of 19.68 points (P < 0.01) for high levels of CSE (> mean plus 1 SD). Those with lower levels of neurosis had less negative outcomes. CONCLUSION: Young women with breast cancer are vulnerable to psychological morbidity early in diagnosis, particularly those with low coping self-efficacy and may benefit from earlier supportive care.

Women with gynaecological cancer awaiting radiotherapy: Self-reported wellbeing, general psychological distress, symptom distress, sexual function, and supportive care needs.

OBJECTIVE: To better serve women with gynaecological cancers, we need a sound understanding of their health, wellbeing and needs. This study sought to explore these issues in a sample of Australian women before commencing curative radiotherapy. METHODS: We undertook a secondary analysis of baseline data from a supportive care trial (n = 311). Descriptive statistics were used to summarise responses to measures of wellbeing, general psychological distress, symptom distress, sexual function and vaginal changes, and supportive care needs. Pre-specified regression models were used to examine sources of variation in wellbeing and sexual function. RESULTS: Women reported lower emotional, functional and physical wellbeing than population norms (all p < 0.001). The prevalence of general psychological distress was 31% (95% CI 26-36%). Distress caused by physical symptoms was typically low. Health system and information needs comprised eight of the top ten moderate-to-high supportive care needs. Most women reported no change in interest for physical contact or sex compared to pre-diagnosis, but some sexually active women (16-24%) reported smaller vaginal size, increased dryness, and more pain on intercourse. General psychological distress was a robust marker of poorer wellbeing and sexual function. CONCLUSIONS: Before radiotherapy, a substantial minority of women with gynaecological cancers experience general psychological distress, reduced wellbeing and moderate-to-high health system and information needs. A model of comprehensive care incorporating assessment of unmet needs, general psychological distress, and sexual issues is recommended. Healthcare providers may require training to elicit and respond to a constellation of interrelated issues and access relevant services for women requiring additional support.

Quality of surgical management of placenta accreta spectrum in a tertiary center in Sri Lanka: baseline study for quality improvement project: problems and solutions.

INTRODUCTION: Placenta accreta spectrum (PAS) is associated with a multitude of maternal and fetal complications. Events related to its management have resulted in significant psychological morbidity, with lifelong consequences which warrant continuous support to cope with their lives. The objective of the study is to highlight the importance of multidisciplinary holistic care and explore room for improvement in the provision of care for women with PAS. METHODS: Our study was conducted on deliveries complicated with PAS from January 2019 to June 2021. 27 women were diagnosed with PAS during this period and received treatment. Impact of life event scale- revised (IES-R) and short form health survey-36(SF-36) questionnaires were administered to assess the impact of PAS on their lives. In depth interviews were conducted with the women. A multidisciplinary team meeting was later conducted to formulate a comprehensive care plan for women with PAS. RESULTS: The response rate was 96.2%. Mean age of the sample is 34.1 years (SD 4.3). Interval to current pregnancy varies from 0.6 years to 10 years with mean of 4.6 years. Mean gestational age of diagnosis of PAS was 25.4(SD 6.7) weeks. The care bundle provided for women with PAS was evaluated in all cases. Surgery was conducted electively in 82% of patients. Blood transfusions were noted in 85%. Mean pre-operative stay was 9.5 days (SD 8.3) and mean post-operative stay was 8.8 days (SD 8). Total hospital stay ranged from 6 to 48 days (mean 19.5 days, SD 11.4). IES-R scores were significant in 4/26 patients. There was no correlation with the interval from the surgery with any of the subscales or with the total scores. The lapsed time after the surgery had a significant correlation with physical functioning and pain domains of the SF-36 questionnaire. Description of the experience, loss of femininity with loss of the uterus, concerns and fears about the future and measures to improve the quality of care were the themes identified and described. A multidisciplinary team meeting, consisting of consultant obstetricians performing surgery for PAS, anesthetists, hematologist, transfusion medicine specialist, urologist, physiotherapist, nutritionist and nursing officers from ICU and wards, was held and their contributions helped to map out a definitive care plan. CONCLUSIONS: PAS is associated with long term physical and psychological morbidity. Continuous support through quarterly clinic visits and telephone conversations may alleviate the psychological trauma. However, some physical disabilities may be lifelong and life changing. Importance of reducing primary caesarean section and promoting trial of labour after caesarean delivery should be promoted among patients and caregivers.

Quality of life in Female Users of Antiageing Cosmetic Products/Aesthetic Treatments.

BACKGROUND: Ageing is accompanied by physical changes, both at the physiological and appearance levels. The way people perceive these changes have important consequences on general health and quality of life (QoL). This study analysed the relationship between sociodemographic variables, psychological variables, use of antiageing cosmetic products/aesthetic treatments, and QoL. METHODS: This cross-sectional study included a sample of 271 women, aged between 25 and 70 years, users of antiageing cosmetic products and/or aesthetic services. Participants were assessed on psychological morbidity (Hospital Anxiety and Depression Scale), appearance schemes (Appearance Schemas Inventory - Revised), self-esteem (Rosenberg Self-Esteem Scale), perfectionism (Frost Multidimensional Perfectionism Scale), self-perceptions of ageing (Brief Aging Perceptions Questionnaire), and QoL (SF-12v2). RESULTS: Being older and having a higher household income was associated with better QoL. The use of facial firming products, hair colouring products, and sunscreen was also associated with better QoL. Psychological morbidity and perfectionism contributed negatively to QoL, while household income contributed positively. Ageing perceptions moderated the relationship between self-esteem and QoL. CONCLUSION: According to the findings, intervention programs to reduce psychological morbidity, increase self-esteem, promote more adaptive patterns of perfectionism, and recognize the role of age perception are needed to improve women's QoL. The perceived influence of the usage of cosmetic products to prevent/minimize aging signs should be further explored.

CONTEXTE: Le vieillissement s'accompagne de changements physiques, tant au niveau physiologique qu'au niveau de l'apparence. La façon dont les gens perçoivent ces changements a des conséquences importantes sur la santé générale et la qualité de vie (QdV). Cette étude a analysé la relation entre les variables sociodémographiques, les variables psychologiques, l'utilisation de produits cosmétiques anti-âge/soins esthétiques et la QdV. MÉTHODES: Cette étude transversale a inclus un échantillon de 271 femmes, âgées de 25 à 70 ans, utilisatrices de produits cosmétiques anti-âge et/ou de soins esthétiques. Les participants ont été évalués sur la morbidité psychologique (Hospit Anxiety and Depression Scale), les schémas d'apparence (Appearance Schemas Inventory - Revised), l'estime de soi (Roenberg Self-Esteem Scale), le perfectionnisme (Frost Multidimensional Perfectionism Scale), l'auto-perception du vieillissement (Brief Questionnaire sur les perceptions du vieillissement) et QdV (SF-12v2). RÉSULTATS: Être plus âgé et avoir un revenu du ménage plus élevé était associé à une meilleure qualité de vie. L'utilisation de produits raffermissants pour le visage, de produits de coloration capillaire et de soins solaires était également associée à une meilleure qualité de vie. La morbidité psychologique et le perfectionnisme ont contribué négativement à la qualité de vie, tandis que le revenu du ménage a contribué positivement. Les perceptions du vieillissement ont modéré la relation entre l'estime de soi et la qualité de vie. CONCLUSION: Selon les résultats, des programmes d'intervention visant à réduire la morbidité psychologique, à augmenter l'estime de soi, à promouvoir des schémas de perfectionnisme plus adaptatifs et à reconnaître le rôle de la perception de l'âge sont nécessaires pour améliorer la qualité de vie des femmes. L'influence de l'utilisation de produits cosmétiques pour prévenir/minimiser les signes du vieillissement doit être davantage perçue.

Eating disorder severity and psychological morbidity in adolescents with anorexia nervosa or atypical anorexia nervosa and premorbid overweight/obesity.

PURPOSE: A significant proportion of adolescents with anorexia nervosa (AN) or atypical anorexia nervosa (AAN) experience premorbid overweight/obesity, yet distinct characteristics among this subset of patients remain unclear. This study examined eating disorder (ED) symptom severity, psychological morbidity, and weight stigma in patients with premorbid overweight/obesity as compared to patients with premorbid normal weights. METHODS: Participants included adolescents with AN or AAN (aged 12-18) who received multidisciplinary treatment at a pediatric medical center in the United States. ED symptoms, anxiety, and depression were compared among patients with premorbid overweight/obesity (n = 43) and premorbid normal weights (n = 63). Associations between weight stigma, ED severity, and psychological morbidity were also examined. RESULTS: Patients with premorbid overweight/obesity reported greater ED severity (p = 0.04), anxiety (p < 0.003), depression (p = 0.02), and a higher frequency of weight-based teasing by peers (p = 0.003) and parent weight talk about their own weights (p < 0.001). Weight-based teasing was positively associated with ED symptoms, anxiety, and depression for all patients, regardless of premorbid weight status. CONCLUSIONS: Adolescents with AN or AAN and a history of overweight/obesity may present with greater ED symptom severity and psychological morbidity than patients with normal weight histories. Distinct prevention and treatment interventions for adolescents with AN or AAN and premorbid overweight/obesity may be warranted. LEVEL OF EVIDENCE: Level III, case-control analytic study.

Implantation of a Coronary Sinus Reducer to Treat Refractory Angina in a 38-Year-Old with an Anomalous Left Coronary Artery and No Revascularization Options.

A 38-year-old female with anomalous left coronary artery from the pulmonary artery presented with refractory angina (Canadian Cardiovascular Society [CCS] class 4). Having failed two previous internal mammary artery grafts to the left anterior descending artery and with no percutaneous revascularization options, she underwent coronary sinus reducer implantation, which improved her symptoms (CCS 0), quality of life, and corresponded to an improvement in ischemia on myocardial perfusion scanning. This case report describes an unusual case of refractory angina in the context of congenital heart disease, illustrates the benefit of this novel hourglass-shaped stent in improving ischemia, quality of life, depression and anxiety, and highlights the importance of managing these patients in multidisciplinary teams.

The mediator role of unmet needs on quality of life in myeloma patients.

PURPOSE: The diagnosis of multiple myeloma (MM) has a significant impact on patients. This study analyzed the mediating role of patients' unmet needs in the relationship between psychological morbidity/social support and quality of life (QoL). METHODS: This study included 213 patients with MM recruited from the outpatient medical oncology and clinical hematology services from five hospitals. Patients who meet the study criteria were referred by physicians and invited to participate in the study by the researcher. All participants answered the following questionnaires: Hospital Anxiety and Depression Scale, Satisfaction with Social Support Scale, Short-Form Survivor Unmet Needs Survey, and The European Organization for Research and Treatment of Cancer's Multiple Myeloma Module. Descriptive statistics, bivariate correlations, and structural equation modeling were performed to analyze the data. RESULTS: The indirect effect of psychological morbidity on patients' future perspectives (MYFP) was partially mediated by information unmet needs (INF), while the indirect effect of psychological morbidity on treatment side effects (MYSE) was partially mediated by relationship and emotional unmet needs (REH). In turn, the indirect effect of psychological morbidity on disease symptoms (MYDS) was fully mediated by REH. Social support had an indirect effect on MYDS and MYSE fully mediated by REH. CONCLUSION: Intervention programs tailored to promote MM patients' QoL should specifically address information and emotional needs, raising awareness and training health professionals, caregivers, and family members to attend  MM patients' unmet needs.

The English National Cohort Study of Flooding & Health: psychological morbidity at three years of follow up.

BACKGROUND: Flooding is expected to increase due to climate change, population growth and urban development. The longer-term mental health impacts of flooding are not well understood. In 2015, the English National Study of Flooding and Health was established to improve understanding of the impact of flooding on health and inform future public health action. METHODS: We used 3 years of data from the English National Study of Flooding and Health. Participants who had consented to follow up were sent a questionnaire. Participants were classified into either "unaffected", "disrupted" or "flooded" according to their exposure. Logistic regression models were used to calculate adjusted odds ratios for probable depression, anxiety and post-traumatic stress disorder (PTSD) in each exposure group. The Wald test was used to assess the difference in probable mental health outcomes for those who did and did not experience "persistent damage" to their home. Conditional logistic regression was conducted to assess change in prevalence over the 3 years and to identify possible determinants of recovery. RESULTS: Eight hundred nineteen individuals were included in the final analysis - 119 were classified as unaffected, 421 disrupted and 279 flooded. Overall, 5.7% had probable depression, 8.1% had probable anxiety and 11.8% had probable PTSD, with higher prevalence in the flooded group compared with the unaffected group. After adjustment for potential confounders, probable mental health outcomes were higher in the flooded group compared to the unaffected group, significantly for probable depression (aOR 8.48, 95% CI 1.04-68.97) and PTSD (aOR 7.74, 95% CI 2.24-26.79). Seventy-seven (9.4%) participants reported experiencing persistent damage to their home, most commonly damp (n = 40) and visible mould (n = 26) in liveable rooms. Of the 569 participants who responded at all 3 years, a significant reduction in prevalence for all probable mental health outcomes was observed in the flooded group. CONCLUSIONS: Flooding can have severe long-lasting consequences on mental health in affected populations. If these problems are not identified and treated early, they may persist for years. Further research is necessary to develop and evaluate interventions to increase resilience in at risk populations and to ensure timely access to support services following flooding.

Quality of life in patients with systemic lupus erythematosus: the mediator role of psychological morbidity and disease activity.

Patients with systemic lupus erythematosus (SLE) experience chronic symptoms that negatively impact their quality of life (QoL). This study analyzed the variables that contributed to QoL in patients with SLE, including the mediating role of psychological morbidity and disease activity. This study used a transversal design and included 104 women with SLE. Participants answered several instruments assessing fatigue, psychological morbidity (depression and anxiety), body image, disease activity, and quality of life. The results showed that disease activity, fatigue severity, psychological morbidity and body image were associated with all domains of QoL. Additionally, psychological morbidity and disease activity mediated the relationship between body image and psychological morbidity. Also, disease activity mediated the relationship between body image and fatigue severity. According to the results, intervention in patients with SLE should focus on patients' psychological morbidity, particularly in the active phase of the disease. Body image, fatigue severity and psychological morbidity should be monitored in patients with SLE in order to promote QoL.

The contribution of purpose in life to psychological morbidity and quality of life in chronic pain patients.

Chronic pain is a cause of morbidity, interference with daily functioning, decreased health and quality of life. Purpose in life acts as a protective factor and mitigates these consequences. This cross-sectional study aimed to determine whether purpose in life contributed to psychological morbidity and quality of life in patients with chronic pain by controlling psychological variables related to health (pain severity and interference, pain perceptions, pain catastrophizing and coping). The sample included 103 patients diagnosed with chronic pain. Results showed that purpose in life independently contributed to psychological morbidity and to mental quality of life, but not to physical quality of life, after controlling for pain-related variables. Results showed the relevance of purpose in life to identify patients at risk of developing psychological morbidity and decreased quality of life, suggestting the need to intervene in chronic pain, specifically on purpose in life, to prevent psychological morbidity and promote quality of life, in this population.

Validation of the caregiver oncology quality of life questionnaire in Portuguese caregivers of myeloma patients.

OBJECTIVE: Cancer diagnosis affects patients, their families, and their caregivers in particular. This study focused on the validation of the CareGiver Oncology Quality of Life (CarGOQoL) questionnaire in Portuguese caregivers of patients with multiple myeloma, from the caregiver's point of view. METHOD: This was a cross-sectional study with 146 caregivers of patients with multiple myeloma from outpatient medical oncology and clinical hematology consultations from five hospitals in north and central Portugal. Participants were assessed on quality of life (QoL), psychological morbidity and social support. RESULT: The Portuguese version maintains 17 of the original 29 items version, maintaining general coherence and a dimensional structure that is clinically interpretable. Reliability findings indicated good internal consistency for the total scale (0.86) and respective subscales (0.75 to 0.88), which is in agreement with the alpha values from the previous CarGOQoL validation study for the corresponding subscales (0.74 to 0.89) and total scale (0.90). SIGNIFICANCE OF RESULTS: The CarGOQoL is a reliable and valid tool for clinical trials and intervention programs to assess QoL in caregivers of myeloma patients. Future studies should validate the adapted version in caregivers of other types of cancer patients including other chronic diseases.

PTSD, psychological morbidity and marital dissatisfaction in colonial war veterans.

Background: Forty years after Colonial War, veterans still show psychological disturbances affecting their marital and sexual satisfaction.Aims: This study analyzed the relationships between Post-Traumatic Stress Disorder (PTSD), number of PTSD symptoms and symptom clusters, psychological morbidity, marital dissatisfaction and sexual dissatisfaction; the variables that contributed to marital dissatisfaction and the mediator role of marital dissatisfaction and sexual dissatisfaction, in a sample of colonial War Veterans.Method: The sample included 138 Portuguese war veterans who answered Index of Marital Satisfaction; Index of Sexual Satisfaction; Beck Depression Inventory; State Trait Anxiety Inventory; Post-Traumatic Stress Disorder Scale.Results: PTSD, number of PTSD symptoms and symptom clusters were associated with psychological morbidity, marital and sexual dissatisfaction. Age, depression symptoms and sexual dissatisfaction contributed to marital dissatisfaction and the model explained 55% of the variance. Marital dissatisfaction mediated the relationship between depression symptoms and sexual dissatisfaction, as well as between number of PTSD symptoms and sexual dissatisfaction.Conclusions: Health professionals need to take into consideration the veteran's marital and sexual relationship in clinical routine consultations. As such, treating the veteran in the couple' context seems warranted.

Quality of life in early-stage Alzheimer's disease: the moderator role of family variables and coping strategies from the patients' perspective.

AIM: This study assessed the effects of sociodemographic and psychological variables on quality of life (QOL), as well as the moderator role of family variables and coping strategies in the relationship between psychological morbidity and QOL, based on patients' perspective. METHODS: This study used a cross-sectional design. A total of 158 patients with early Alzheimer's disease completed the Mini-Mental State Examination, the Montreal Cognitive Assessment, the Hospital Anxiety and Depression Scale, the Ways of Coping Questionnaire, the Spiritual and Religious Attitudes in Dealing with Illness, the Family Adaptability and Cohesion Evaluation Scales, the Family Satisfaction Scale, the Family Communication Scale, the Barthel Index, and the Quality of Life in Alzheimer's Disease Scale. RESULTS: Being a man, having a higher education, and engaging in more exercise activity were associated with better QOL. Lower levels of cognitive impairment, psychological morbidity, and spirituality predicted better QOL. Also, lower levels of functionality, family communication, family satisfaction, and family functioning contributed to worse QOL. Gender, psychological morbidity, and functionality contributed significantly to QOL. Family satisfaction, family communication, and coping strategies moderated the relationship between psychological morbidity and QOL. CONCLUSION: Intervention in early-stage Alzheimer's disease should focus on patients' coping strategies and family context, particularly family satisfaction and communication, to foster QOL.

Unconfirmed death as a predictor of psychological morbidity in family members of disappeared persons.

BACKGROUND: The 2004 tsunami, the civil conflict until 2009 and the youth insurrection in the late 1980s in Sri Lanka resulted in many persons being classified as 'missing' as they disappeared and were unaccounted for. Our aim was to compare the prevalence of major depressive disorder (MDD) and prolonged grief disorder (PGD) in families of disappeared individuals, who eventually received the mortal remains and those who did not. METHOD: An ethically approved cross sectional study was conducted in a purposively selected sample after informed consent. Information on the circumstances of the family member going missing was gathered. Culturally adapted versions of the General Health Questionnaire and the Beck Depression Scale were administered. Those who screened positive were assessed by a psychiatrist on Diagnostic and Statistical Manual of Mental Disorders-5 criteria to arrive at a diagnosis. RESULTS: Of 391 cases of disappearances studied, MDD (17.5% v. 6%) and PGD (22% v. 7%) were significantly higher in those who did not eventually receive the mortal remains of the disappeared person. Among those who did not receive the mortal remains, being unsure whether the disappeared person was dead or alive was highly predictive of MDD and PGD. Mothers and wives, older family members and those with a family history of mental illness were more vulnerable. CONCLUSIONS: Family members of missing individuals unsure whether their loved one was alive or dead have higher psychological morbidity in the form of MDD and PGD.

Psychological morbidity in Nepali cross-border migrants in India: a community based cross-sectional study.

BACKGROUND: Since Nepali cross-border migrants can freely enter, work and stay in India, they are largely undocumented. The majority is involved in semi-skilled or unskilled jobs with limited labour rights and social security, a fact which predisposes them to psychological distress. We aimed to assess the prevalence of and factors associated with psychological morbidity among Nepali migrants upon their return from India. METHODS: A community based cross-sectional study was conducted in six districts of Nepal between September 2017 and February 2018. A total of 751 participants who had worked at least six months in India and returned to Nepal were interviewed from 24 randomly selected clusters. The General Health Questionnaire (GHQ)-12 was used to measure the psychological morbidity. Data were analysed using Poisson regression analysis. RESULTS: The majority was younger than 35 years (64.1%), male (96.7%), married (81.8%), had at least a primary education (66.6%), and belonged to Dalit, Janajati and religious minorities (53.7%). The prevalence of psychological morbidity was 13.5% (CI: 11.2-16.1%). Participants aged 45 years and above (adjusted prevalence ratio (aPR) = 2.74), from the Terai (aPR = 3.29), a religious minority (aPR = 3.64), who received no sick leave (aPR = 2.4), with existing health problems (aPR = 2.0) and having difficulty in accessing health care (aPR = 1.88) were more likely than others to exhibit a psychological morbidity. CONCLUSION: This study demonstrated that psychological morbidity was prevalent in the study participants and varied significantly with individual characteristics, work conditions and health. Multifaceted approaches including psychological counselling for returnees and protection of labour and health rights in the workplace are recommended to help reduce psychological morbidity.

Validation of the Quality of Life Multiple Myeloma Module Questionnaire (QLQ-MY20) in Portuguese myeloma patients.

OBJECTIVE: The aim of this study was the validation of the European Organization for Research and Treatment of Cancer's Multiple Myeloma Module (QLQ-MY20) in Portuguese myeloma patients. METHODS: A total of 213 Portuguese patients diagnosed with multiple myeloma participated in this study and were assessed with the European Organization for Research and Treatment of Cancer's (EORTC) Questionnaire C30 (QLQ-C30), the EORTC Multiple Myeloma Module (QLQ-MY20), the Hospital Anxiety and Depression Scale (HADS) and the Satisfaction with Social Support Scale (SSSS). RESULTS: The validated version includes 17 items presenting good global adjustment and good internal consistency. Overall, the Portuguese validation maintains the original model with the exception of three items that were excluded. The instrument also showed good reliability and good convergent and divergent validity. CONCLUSION: The Portuguese version of the EORTC Multiple Myeloma Module questionnaire seems to be a valid instrument for myeloma patients to help monitor interventions in this population focused on the promotion of quality of life.

Psychological morbidity in family caregivers of people living with terminal cancer: Prevalence and predictors.

OBJECTIVE: The issues surrounding a patient's terminal phase of cancer and the imminent death of the individual represent a major family crisis affecting all its members. The goal of this study was to assess the prevalence of psychological morbidity in family caregivers of persons with terminal cancer in terms of psychological distress, depression, anxiety, somatization, and complicated anticipatory grief, and to determine which factors may influence these responses. METHOD: One hundred and twelve family caregivers of individuals with terminal cancer completed an assessment protocol comprising the Brief Symptom Inventory (depression, anxiety, somatization, and a computed score for global distress), the Marwit-Meuser Caregiver Grief Inventory - Short Form (anticipatory grief), the Family Inventory of Needs (importance and satisfaction of needs), and the Systemic Clinical Outcome Routine Evaluation -15 (family functioning). Prevalence of psychological morbidity was determined through descriptive and frequency statistics. Predictors of psychological morbidity were ascertained through structural equation modelling methods.ResultRegarding the prevalence of psychological morbidity in family caregivers, 66.1% reported high levels of distress, 68.8% showed high risk of depression, 72.3% showed high risk of anxiety, 50.9% reported high levels of somatization, and 25.9% showed high risk of complicated anticipatory grief. It was found that the predictors of age, gender, relationship to the family member with terminal cancer, the caregiving role played (i.e., primary vs. nonprimary), the satisfaction of needs by healthcare professionals, and family functioning play an important role in terms of one's risk of developing psychological morbidity.Significance of resultsThis study revealed an alarming prevalence of psychological morbidity in family caregivers of individuals living with terminal cancer, making it crucial to move forward from a patient-centered approach to a family-centrad approach to reduce the risk of family maladjustment when facing the imminent death of a family member and to prevent postdeath unadjusted responses.

Psychological Stress and Satisfaction with Life among Physical Therapy Students of Rawalpindi / Islamabad, Pakistan.

OBJECTIVE: To determine the occurrence of perceived stress and satisfaction with life as well as the association between the two among under graduate physical therapy students. METHODS: The cross-sectional study was conducted from January to July 2015 at Riphah International University, Isra University and Foundation University, Islamabad, Pakistan, and comprised Doctor of Physical Therapy students aged 17-23 years. Perceived Stress Scale and Satisfaction with Life Scale were used as tools to measure the outcomes. Data was analysed using S P SS 2 0.. RESULTS: Of the 306 students approached, 279(91%) responded. There were 39(14%) males and 240(86%) females with an overall mean age of 19.18±0.92 years. Mean stress and satisfaction with life scores were 21.35±5.76 and 24.49±5.77. Significant negative co-relation between the two scores was observed (p=0.001). There was no significant association of age with satisfaction with life (p=0.591) and perceived stress (p=0.283). A significant gender-based difference was observed in terms of perceived stress (p=0.037) and satisfaction with life ( (p=0.008), with females scoring higher. CONCLUSIONS: Male students were more satisfied with life compared to female students, and satisfaction with life decreased with an increase in stress.