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AIM: We wanted to examine the impact of the Covid-19 pandemic on mental health in Danish school children in 5th to 7th grade (11 to 15 years), and whether the impact differed across age and sex. METHODS: We included 793 and 391 school children from winter 2020 and winter 2021, respectively. Mental health was measured using the Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS), Strengths and Difficulties Questionnaire (SDQ), and Brief Resilience Scale (BRS). Data were analyzed by sex using linear regression models adjusting for grade (age), cohabitation, geographical region, employment status of parents, and schools as clusters. RESULTS: Girls in 5th grade and boys in 6th grade during Covid-19 had statistically significant lower well-being (SWEMWBS) compared with before Covid-19. Girls in 5th and 6th grade during Covid-19 had non-statistically significant lower scores on all subscales of SDQ compared with girls before Covid-19. Girls in 7th grade during Covid-19 had statistically significant lower total difficulty score (SDQ) and fewer conduct problems (SDQ) compared with girls before Covid-19. Boys in 5th grade during Covid-19 had statistically significant fewer conduct problems (SDQ) compared with boys before Covid-19. CONCLUSIONS: This study indicates that the Covid-19 pandemic impacted Danish school children differently across sex and grade (age). During Covid-19, mental health tended to be better among the oldest girls and worse among the youngest girls compared with girls before Covid-19. Boys in 6th grade had poorer mental well-being, and boys in 5th grade had fewer conduct problems during Covid-19 compared with before Covid-19.
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COVID-19 , Saúde Mental , Humanos , COVID-19/epidemiologia , Dinamarca/epidemiologia , Masculino , Feminino , Criança , Adolescente , Instituições Acadêmicas , Estudantes/psicologia , Estudantes/estatística & dados numéricos , Inquéritos e Questionários , Pandemias , Fatores SexuaisRESUMO
BACKGROUND: Mental health challenges are on the rise worldwide. In Iceland, little is known about the sociodemographic factors associated with poor mental health. This study aimed to investigate symptoms of depression, anxiety, stress, and psychiatric medication for mental disorders in a nationally representative sample in Iceland and to explore its associations with sociodemographic factors. METHODS: This Icelandic cross-sectional study 'Health and Wellbeing of Icelanders' was conducted in 2017 and included 9,887 randomly chosen adults. Participants' depression, anxiety, and stress levels were measured with the Depression Anxiety and Stress scale-21(DASS-21) and the association with sociodemographic factors and prescribed psychiatric medication was assessed in a multinominal logistic regression analysis. RESULTS: The youngest age group (18 to 29 years old) had the poorest mental health. Males had a higher risk of medium and high depression scores than females, RRR 1.23 (95% CI 1.06-1.44) and RRR 1.71 (95% CI 1.25-2.33) when adjusted for sociodemographic factors (age, sex, education, marital status, financial status, living area, employment) and use of psychiatric medication. Participants with the most considerable financial difficulties had the highest risk of high scores on depression RRR 11.19 (95% CI 5.8-21.57), anxiety RRR 12.35 (95% CI 5.62-27.14) and stress RRR 11.55 (95% CI 4.75-28.04) when compared to those that do not. CONCLUSIONS: The youngest participants and those with the most extensive financial difficulties had the highest depression, anxiety, and stress scores. Males scored higher than females on depression. There was a trend towards worse mental health with lower sociodemographic status. Higher education, living with someone, and financial security were associated with better mental health. These results implicate the importance of government actions to counteract social inequalities in the Icelandic nation.
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Depressão , Saúde Mental , Masculino , Adulto , Feminino , Humanos , Adolescente , Adulto Jovem , Islândia/epidemiologia , Depressão/diagnóstico , Estudos Transversais , Ansiedade/diagnósticoRESUMO
AIM: The aims of this this study was to examine the psychometric properties, including internal consistency and construct validity, of the Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS) in a sample of Danish schoolchildren aged 10-16 years. METHOD: A total of 1155 schoolchildren (54% girls) aged 10-16 years (Mage=12 years, SD=1.3) responded to an electronic questionnaire as part of the Danish SELFCARE study. To examine the internal consistency and construct validity of the SWEMWBS, we performed descriptive statistics, reliability and correlation analyses in Stata as well as confirmatory factor analysis (CFA) in Mplus. Correlations between scores on the SWEMWBS and scores on scales from the Strengths and Difficulties Questionnaire (SDQ) were calculated using Spearman's rank correlation coefficients. The analysis was conducted on the general study population and in subgroups divided by sex and class (age groups). RESULTS: CFA confirmed SWEMWBS one-dimensional factor structure, and the model fit the data well (CFI=0.984, TLI=0.97, RMSEA=0.062 and SRMR=0.021). The scale showed satisfactory internal consistency (É=0.78) and composite reliability (ω=0.82). In addition, the scale was shown to have acceptable construct validity. Thus, correlations between scores on the SWEMWBS and SDQ subscales were in line with expectations. Corresponding results were found for subgroups divided by sex and class (age groups). CONCLUSIONS: Our study indicates that the Danish translation of the SWEMWBS is valid for measuring well-being among Danish schoolchildren aged 10-16 years. This construct validation study is among the first to validate the SWEMWBS in younger populations.
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Saúde Mental , Feminino , Humanos , Criança , Masculino , Psicometria/métodos , Reprodutibilidade dos Testes , Inquéritos e Questionários , DinamarcaRESUMO
Aims: We aimed to investigate associations between mental health and sociodemographic characteristics among schoolchildren in Denmark. Methods: We performed a cross-sectional survey from January to October 2019 among 4th to 9th graders (N=1247) based on pilot data from a nationwide research project Stress-free Everyday LiFe for Children and Adolescents REsearch (SELFCARE). We assessed mental health using the five-item World Health Organization Well-Being Index and the self-report version of the Strengths and Difficulties Questionnaire. We investigated associations between mental health and sex, age in terms of grade, type of school, family setting and geographic region using regression analysis. Results: Mental health was poorer among girls in the older classes compared to girls in 4th grade, and better among boys in the older classes compared to boys in 4th grade. We found no difference in mental health among schoolchildren in municipal and private schools. Mental health was poorer among both girls and boys living alternately with their parents compared to residing with both of them. Mental health varied across geographic regions. Conclusions: We found associations between mental health and sex, age in terms of grade, family setting and geographic region.
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Saúde Mental , Instituições Acadêmicas , Adolescente , Criança , Estudos Transversais , Dinamarca/epidemiologia , Feminino , Humanos , Masculino , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Exploring mediators of preventive intervention effects has important implications for the planning of complex interventions. Our aim was to assess the extent to which knowledge, skills and confidence to manage health, here measured as "patient activation", was a mediator of the effect of the intervention "Live your life without diabetes" on weight, waist circumference and systolic blood pressure at 12 months follow-up in adults at high risk of type 2 diabetes. METHODS: Autoregressive path models with three time points of measurement, and contemporaneous and constant b paths were used in a randomised controlled trial (RCT). The RCT took place in a Danish municipal healthcare center and included 127 individuals aged 28 to 70 years with fasting plasma glucose: 6.1-6.9 mmol/l and/or glycated haemoglobin (HbA1c): 42.0-47.9 mmol/mol. Participants were randomised to routine care (n = 64), or intervention (n = 63). The intervention group received an empirical and theory-based intervention delivered over four two-h group sessions during five weeks, and two further sessions after one and six months. The outcomes were weight, waist circumference and systolic blood pressure, and the mediator was patient activation, measured by the self-reported Patient Activation Measure (PAM). Data for the present study was derived from questionnaires and clinical measures from baseline, three- and 12-months follow-up. RESULTS: Mediated effects via PAM on: weight: - 0.09 kg (95% CI - 0.38 to 0.20) out of the total effect - 1.09 kg (95% CI - 3.05 to 0.87); waist circumference: - 0.04 cm (95% CI - 0.36 to 0.28) out of the total effect - 1.86 cm (95% CI - 4.10 to 0.39); and systolic blood pressure: - 0.31 mmHg (- 1.10 to 0.49) out of the total effect - 2.73 mmHg (95% CI - 6.34 to 0.87). CONCLUSION: We found no mediating effects of patient activation as a single variable of the intervention "Live your life without diabetes" on weight, waist circumference and systolic blood pressure at 12 months follow-up in adults at high risk of type 2 diabetes. Our study demonstrates an analytic approach for estimating mediating effects in complex interventions that comply with the criteria on temporal ordered data. Future studies should include possible interacting variables.
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Diabetes Mellitus Tipo 2 , Participação do Paciente , Adulto , Diabetes Mellitus Tipo 2/prevenção & controle , Hemoglobinas Glicadas , Promoção da Saúde , Humanos , Circunferência da CinturaRESUMO
BACKGROUND: Teaching has been found to be one of the most stressful occupations. Hence, current interest in reducing stress and enhancing the well-being of teachers is strong. Mindfulness-based stress reduction (MBSR) is documented to be effective in reducing stress and increasing well-being. This study investigated the effectiveness of delivering MBSR to lower secondary school teachers as a part of a teacher-training programme. METHODS: This study was a nested trial within the parallel cluster-randomized controlled trial, Stress-free Everyday LiFe for Children and Adolescents REsearch (SELFCARE). Schools were recruited from all five geographical regions in Denmark between May 2018 and May 2019. One to three teachers from each school were allowed to participate. At baseline, 110 schools, representing 191 lower secondary school teachers, were cluster-randomized to intervention or a wait-list control group. The intervention group received MBSR during 2019 and the wait-list control group during 2020. Data were collected at baseline and after 3 and 6 months. The primary outcome was measured by Cohen's Perceived Stress Scale (PSS). Data were analyzed using a mixed-effect linear regression model and bootstrapped for cluster effects. RESULTS: At 3 months, the intervention group statistically significantly reduced their PSS score 1.7 [95% confidence interval (CI) 0.04-3.3] points more than did the wait-list control group. At 6 months, the intervention group had statistically significantly reduced their mean PSS score 2.1 (95% CI: 0.5-3.8) points more than the wait-list control group. CONCLUSION: It is possible to reduce perceived stress among lower secondary school teachers by delivering MBSR as part of a teacher-training programme.
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Atenção Plena , Professores Escolares , Adolescente , Criança , Humanos , Instituições Acadêmicas , Estresse Psicológico/prevenção & controle , Listas de EsperaRESUMO
BACKGROUND: The purpose of the present study was to conduct a pilot randomised controlled trial (RCT) to lend support to a larger effectiveness RCT comparing Mindfulness-Based Stress Reduction (MBSR), a locally-developed stress reduction intervention (LSR) and a waiting list control group in a Danish municipal health care center setting. METHODS: A three-armed parallel pilot RCT was conducted among 71 adults who contacted a Danish municipal health care center due to stress-related problems. Recruitment was made between January and April 2018 and followed usual procedures. EXCLUSION CRITERIA: 1) acute treatment-demanding clinical depression or diagnosis of psychosis or schizophrenia, 2) abuse of alcohol, drugs, medicine, 3) pregnancy. Randomisation was performed by an independent data manager using the REDCap electronic data capture tool. The primary outcome was a description of RCT feasibility (recruitment and retention rates regarding intervention participation and 12-week follow-up). Secondary outcomes were completion rates regarding questionnaire data and proposed effect-estimates of outcome measures considered to be used in the following real RCT. Type of intervention and outcome assessment were not blinded. RESULTS: We recruited 71 of 129 eligible individuals from the target population (55, 95%CI: 46-64). Forty-two (59%) were females. Median age: 44 years (1-quartile:34, 3-quartile:50). Twenty-nine (41%) had < 16 years of education. Forty-eight (68%) were employed; 30 of these 48 (63%) were on sick leave. Mean scores for perceived stress (PSS): 25.4 ± 5.3; symptoms of anxiety and depression (SCL-5): 2.9 ± 0.6, and well-being (WHO-5): 31.7 ± 8.5 indicated a need for intervention. 16/24 (67, 95%CI: 45 to 84) who were allocated to MBSR and 17/23 (74, 95%CI: 52 to 90) who were allocated to LSR participated in ≥5 sessions. The loss to follow-up at 12 weeks: MBSR: 5 (21% (95% CI: 7 to 42), LSR: 5 (22% (95% CI: 7 to 44) and waiting list: 4 (17% (95% CI: 5 to 37). This was acceptable and evenly distributed. The results indicated MBSR to be superior. CONCLUSIONS: An RCT assessing the effectiveness of stress reduction interventions in a real-life municipal health care setting is feasible among adults with a clear need for stress reduction interventions based on scores on mental health. TRIAL REGISTRATION: ClinicalTrials.gov. Identifier: NCT03663244. Registered September 10, 2018.
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Serviços Comunitários de Saúde Mental/métodos , Atenção Plena/métodos , Estresse Psicológico/terapia , Adulto , Ansiedade/psicologia , Ansiedade/terapia , Dinamarca , Depressão/psicologia , Depressão/terapia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Projetos Piloto , Estresse Psicológico/psicologia , Inquéritos e Questionários , Listas de Espera , Adulto JovemRESUMO
BACKGROUND: Risk factors for chronic disease, including low cardiorespiratory fitness levels (VO2max), are often present in middle-aged populations. We aimed to evaluate the efficacy of a motivational, individual, and locally anchored physical activity intervention on increasing VO2max in 30-49 year-olds with low VO2max. METHODS: 232 adult volunteers with low VO2max were randomised to intervention (n = 115) or routine care (n = 117). The intervention included four motivational interviews; six months' free membership to a local sports club; and a GPS-watch/activity monitor for uploading training data to an online platform/community. Routine care was one or two motivational interviews. Inclusion criteria were low VO2max based on the cut off levels: ≤ 39 and ≤ 35 ml O2/kg/min. For 30-39 and 40-49 year-old men respectively and ≤ 33 and ≤ 31 ml O2/kg/min for 30-39 and 40-49 year-old women, respectively. The primary outcome was change in VO2max from baseline to twelve months estimated with a maximal ergometer bicycle test. Secondary outcomes included physical activity, biochemical and anthropometric measures, and health-related quality of life. The primary analyses were based on all available data and sensitivity- and predefined sex analyses were performed. The between-group differences were estimated using independent t-tests and presented with 95% confidence intervals. RESULTS: No significant between-group differences in primary or secondary outcomes were found at twelve months' follow-up. The mean VO2max change from baseline in the intervention- and routine care (ml/kg/min) was 3.8 (95% CI: 2.6; 5.0) and 3.4 (95% CI: 1.7; 5.2), respectively. No changes in physical activity were observed. The mean VO2max (ml/kg/min) changes from baseline in the intervention- and routine care group in men were: 5.0 (95% CI: 3.5; 6.4) and 3.5 (95% CI: 1.5; 5.4); and in women: 1.5 (95% CI: -0.1; 3.1) and 3.4 (95% CI: -0.1; 7.8), respectively. Significant differences in VO2max between non-completers (44.2%) and completers were observed, 26.3 (95% CI: 25.1; 27.5) vs 28.2 ml/kg/min (95% CI: 27.1; 29.0; p = 0.02). Sensitivity analyses did not change the main result. CONCLUSION: Offering a multi-component physical activity intervention to 30-49 year-olds with low levels of VO2max had no effect on the change in VO2max from baseline to twelve months compared with routine care. TRIAL REGISTRATION: ClinicalTrials.gov (no. NCT01801956 ). Registered 1 March 2013.
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Aptidão Cardiorrespiratória/fisiologia , Aptidão Cardiorrespiratória/psicologia , Doença Crônica/terapia , Terapia por Exercício/psicologia , Exercício Físico/fisiologia , Exercício Físico/psicologia , Motivação , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida/psicologiaRESUMO
Sunbed use is associated with an increased risk for skin cancer and is particularly dangerous for younger persons. The objective of this study was to assess how demographic factors, health-related behaviours and appearance-related factors are associated with sunbed use. Cross-sectional data from the Danish National Youth Study collected by the National Institute of Public Health during 2014 was used. A total of 64,382 students aged 15-25years were included in the present study. Multilevel logistic regression analyses were used to determine associations. Sunbed use during the past 12months was reported by 22% of students, with a higher proportion among females (29%) than males (12%). Factors associated with sunbed use were older age, studying at a vocational college or a higher preparatory examination school compared to upper secondary school, and lower parental education. Furthermore, being a smoker, been binge-drinking, longer duration of exercise and been dieting were also associated with sunbed use. For females, poor dietary habits were also associated with sunbed use. Feeling overweight was associated with lower odds for sunbed use for males, but with higher odds for females. Lower body satisfaction was associated with higher odds of sunbed use, except for overweight males. Students who were underweight had lower odds for sunbed use, than normal weight students. Conclusively, we found evidence of associations between demographic factors, health-related behaviours and appearance-related factors and sunbed use. Understanding these relations could help to identify high-risk groups and guide preventive strategies for sunbed use and skin cancer prevention.
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Imagem Corporal/psicologia , Demografia/estatística & dados numéricos , Comportamentos de Risco à Saúde , Banho de Sol/estatística & dados numéricos , Adolescente , Estudos Transversais , Dinamarca , Feminino , Humanos , Masculino , Fatores de Risco , Neoplasias Cutâneas/prevenção & controle , Inquéritos e Questionários , Raios Ultravioleta/efeitos adversos , Adulto JovemRESUMO
BACKGROUND: Low levels of cardiorespiratory fitness are associated with high risk of non-communicable diseases and all-cause mortality. Physical activity level is the primary determinant of cardiorespiratory fitness in adults. However, knowledge on how to motivate people to engage in physical activity and maintain an active lifestyle is lacking. This study aims to investigate whether a motivational, individual, and locally anchored exercise intervention, in primary care, can improve cardiorespiratory fitness in 30 to 49 year olds with a low or very low cardiorespiratory fitness. METHODS/DESIGN: Two-armed randomised controlled trial with 6 and 12 months follow-up. The primary outcome is cardiorespiratory fitness estimated via a maximal incremental exercise test. Secondary outcomes include physical activity level and sedentary behavior (objectively measured), self-reported physical activity, biochemical parameters (HbA1C, HDL- and LDL-cholesterol, and triglyceride), anthropometric parameters and health-related quality of life. A total of 236 participants with low levels of cardiorespiratory fitness classified at a local health check programme will be randomised. The intervention consists of four motivational interviews, a six months membership to a sport club, and a global positioning watch to upload training activity to Endomondo.com. The comparison group will receive standard care: a one hour motivational interview followed by another interview if requested. Effects will be estimated by evaluating the differences in mean changes in cardiorespiratory fitness between the two groups. DISCUSSION: In new and innovative ways the focus of this study will be to improve cardiorespiratory fitness among a 30-49 year-old at-risk group using social media, Global Positioning System-technology, on-going personal support and individually tailored physical activity. TRIAL REGISTRATION: ClinicalTrials.gov (no.NCT01801956).
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Fenômenos Fisiológicos Cardiovasculares , Terapia por Exercício/métodos , Aptidão Física , Atenção Primária à Saúde , Fenômenos Fisiológicos Respiratórios , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Entrevista Motivacional , Projetos de Pesquisa , Resultado do TratamentoRESUMO
Background: A large body of randomized controlled trials (RCTs) has shown that mindfulness-based interventions are effective for improving mental health, but research is lacking in regards to the mechanisms of change. We aimed to investigate the mediating effects of self-reported altered resting state of Mindfulness-Based Stress Reduction (MBSR) on mental health, when provided as a universal intervention in a real-life context. Methods: Autoregressive path models with three time points of measurement, and contemporaneous and constant b paths were used in an RCT. The RCT took place in all five geographical regions of Denmark and included 110 schools and 191 schoolteachers. The schools were randomized 1:1 in each geographical region to intervention or a wait-list control group. The intervention was the standardized MBSR. Data were collected at baseline and after 3 and 6 months. The outcomes were perceived stress, measured by Cohen's Perceived Stress Scale (PSS), symptoms of anxiety and depression, measured by Hopkins Symptom Check List-5 (SCL-5), and well-being measured by WHO-5 Well-being Index (WHO-5). The mediator was resting state measured by the Amsterdam Resting State Questionnaire (ARSQ). Results: Statistically significant mediated effects of altered ARSQ-subscales scores for Discontinuity of Mind, Planning, and Comfort were found for the MBSR effect on all outcomes; PSS, SCL-5 and WHO-5. Furthermore, statistically significant mediated effects of altered sleepiness subscale score of the effects on PSS and SCL-5 of MBSR were found. No statistically significant mediating effects of the subscales Theory of Mind, Self and Somatic Awareness for the MBSR intervention effect were found. Conclusion: The results support that the MBSR program can alter self-reported resting state, towards less mind wandering and more comfort, measured by the ARSQ, and that this may explain some of the mechanisms regarding the effectiveness of MBSR on mental health at 6 months, when provided as a universal intervention. The study provides insight into an active ingredient of how MBSR may improve mental health and well-being. It supports the suggestions that mindfulness meditation may be a sustainable way of training the mental health.Clinical trial registration:ClinicalTrials.gov, identifier NCT03886363.
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BACKGROUND: Mental health is decreasing among young people in Denmark. Our primary aim is to evaluate the effectiveness of a teacher training programme to teach mindfulness as part of regular classroom teaching in Danish upper secondary schools and schools of health and social care on students' self-reported mental well-being 6 months from baseline. Secondary aims are (1) to evaluate the effectiveness in a vulnerable subgroup as well as in the total population of students 3 and 6 months from baseline using other outcome measures on mental health and (2) to investigate the facilitators and barriers among teachers to implement mindfulness in schools. METHODS: This pragmatic cluster-randomised two-arm superiority trial includes 30 upper secondary schools, 13 schools of health and social care, 76 teachers, and approximately 1100 students aged 16 to 24 years. Our intervention is multi-level and consists of (a) a teacher training programme and (b) a mindfulness programme delivered to students. Students in control schools receive education as usual. Our primary study population is the total population of students. The primary outcome is changes in the short version of the Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS). We also evaluate the effectiveness in a vulnerable subgroup (the 15% with the lowest SWEMWBS score), as well as in the total population of students 3 and 6 months from baseline using other outcome measures on mental health. Data will be analysed using repeated measurement models taking clusters into account. Facilitators and barriers among teachers to implement mindfulness in schools will be investigated through qualitative focus group interviews. DISCUSSION: The trial will estimate the effectiveness of a population-based strategy on mental health in Danish young people enrolled in education. TRIAL REGISTRATION: ClinicalTrials.gov NCT04610333 . Registered on October 10 2020.
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Atenção Plena , Capacitação de Professores , Humanos , Adolescente , Instituições Acadêmicas , Estudantes/psicologia , Apoio Social , Dinamarca , Serviços de Saúde Escolar , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
Background: Through the past decades, the mental health of the European population has been continuously declining. Social relations in various spheres of life, including workplace settings, have been shown to impact mental health. Mindfulness-based stress reduction (MBSR) has been found effective in enhancing well-being, and reducing perceived stress, and symptoms of depression and anxiety. Research into mindfulness-based interventions (MBIs) in workplace settings has shown that these interventions may positively affect workplace outcomes, such as interpersonal relations. However, research regarding the organizational impacts of MBIs is still nascent. The objective of this study was to investigate how an organizational-level mindfulness-based intervention (MBI) including a workplace-adapted MBSR programme may impact workplace social capital and psychological safety. Methods: Four small and medium-sized private companies were included in this study, representing 368 employees and managers. The intervention consisted of three steps: 1. Mandatory participation in introductory sessions on mental health and mindfulness, 2. Voluntary participation in a 10-week workplace-adapted MBSR programme, and 3. A workshop for selected employee representatives and managers on further implementation of mindfulness. Data was collected using pre and post-intervention focus group interviews. In total, 27 interviews including 76 respondents were conducted. Verbatim transcription was performed. Data was analyzed using deductive content analysis with theoretical frameworks for social capital and psychological safety. Results: The analysis resulted in three main categories: 1. Social capital (1.1. bonding social capital, 1.2. bridging social capital, 1.3. linking social capital), 2. Psychological safety, and 3. Emergent theme: The role of lockdown on the perceived organizational impact of a workplace MBI. The greatest impact was found relating to the bridging social capital, i.e., social capital between departments, and psychological safety among colleagues at the same level of employment. Conclusion: The results indicate that company participation in this organizational-level MBI including a workplace-adapted MBSR programme may positively impact social relations at work, especially the bridging social capital and psychological safety between colleagues at the same level of employment. These results may have been influenced by lockdowns due to the COVID-19 pandemic.
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Introduction: Informal caregivers of people with a mental illness are at increased risk of developing depression, anxiety, and stress, so preventive interventions are needed. Method: The review was reported in PROSPERO (ID: CRD42018094454). The PsycINFO, PubMed, and Scopus databases were searched in June 2019. The Cochrane Risk of Bias and Jadad scale scores were used to assess study quality. Inclusion criteria were: RCTs of informal caregiver interventions regardless of the care receiver's mental illness and intervention modality. Interventions should be compared to a waitlist, treatment as usual or active control, taught in real-time by a mental health professional, include an outcome measure on psychological distress, and published in a peer-reviewed journal article in English. RCTs were excluded if the intervention was given in dyads (caregiver + care receiver), limited to the provision of respite care where the patient sample included a mix of both physical and psychological illnesses, unpublished, not peer-reviewed, study protocols, or dissertations. Results: A total of 2,148 studies were identified; of these, 44 RCT studies met the inclusion criteria, and 31 had sufficient data to conduct a meta-analysis including subgroup analysis (N = 1,899). The systematic review showed that thirty-one out of the 44 RCTs had an effect of the intervention on decreasing psychological distress. The results of the meta-analysis, which included informal caregiver interventions, compared to waitlist, treatment as usual, or active control, regardless of care-receiver mental illness or intervention modality showed a small effect of -0.32 (95% CI -0.53 to -0.11). The heterogeneity of the included studies was high (I 2 = 78). The subgroup analysis included manualized interventions lasting at least 8 weeks and the subgroup analysis that included an active control showed a small effect and low heterogeneity. Lack of active control and long-term follow-up is a limitation of most of the studies. Conclusion: The evidence supports that several interventions improve the mental health of caregivers. Manualized interventions ≥ 8 weeks with active participation are most effective. Future RCTs should improve methodology, and research should investigate which intervention modality is most effective for what kind of caregiver. Future research should clearly specify what the included intervention components are, use longer follow-up times, and conduct mediational analyses to better understand what mechanisms create the effect of an intervention. Systematic review registration: Identifier: CRD42018094454.
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BACKGROUND: Treatment recommendations for prevention of type 2 diabetes complications often require radical and life-long health behaviour changes. Observational studies based on Self-determination theory (SDT) propose substantial factors for the maintenance of behaviour changes and concomitant well-being, but experimental research is needed to develop and evaluate SDT-based interventions. The aims of this paper were to describe 1) the design of a trial assessing the effectiveness of a training course for practice-nurses in autonomy support on patient-perceived motivation, HbA1, cholesterol, and well-being among a diabetes population, 2) the actual intervention to a level of detail that allows its replication, and 3) the connection between SDT recommendations for health care-provider behaviour and the content of the training course. METHODS/DESIGN: The study is a cluster-randomised pragmatic trial including 40 Danish general practices with nurse-led diabetes consultations, and the associated diabetes population. The diabetes population was identified by registers (n = 4034).The intervention was a 16-hour course with interactive training for practice nurses. The course was delivered over 4 afternoons at Aarhus University and one 1/2 hour visit to the practice by one of the course-teachers over a period of 10 months (0, 2, 5, 10 mths.). The intervention is depicted by a PaT Plot showing the timeline and the characteristics of the intervention components.Effectiveness of the intervention will be assessed on the diabetes populations with regard to well-being (PAID, SF-12), HbA1c- and cholesterol-levels, perceived autonomy support (HCCQ), type of motivation (TSRQ), and perceived competence for diabetes care (PCD) 15-21 months after the core course; the completion of the second course afternoon. Data will be retrieved from registers and by questionnaires. DISCUSSION: Challenges and advantages of the pragmatic design are discussed. In a real-world setting, this study will determine the impact on motivation, HbA1c, cholesterol, and well-being for people with diabetes by offering a training course in autonomy support to practice-nurses from general practices with nurse-led consultations. TRIAL REGISTRATION: ClinicalTrials.gov: NCT01187069.
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Complicações do Diabetes/prevenção & controle , Diabetes Mellitus Tipo 2/complicações , Medicina Geral , Autonomia Pessoal , Adulto , Idoso , Humanos , Pessoa de Meia-IdadeRESUMO
Long-term stress can lead to long-term increased cortisol plasma levels, which increases the risk of numerous diseases. Dehydroepiandrosterone (DHEA) and its sulfated form dehydroepiandrosterone-sulfate (DHEAS), together DHEA(S), have shown to counteract some of the effects of cortisol and may be protective during stress. The program "Mindfulness-Based Stress Reduction" (MBSR) has shown to have positive effects on stress. The present study examined a possible effect of MBSR on DHEAS in plasma compared to a waiting list and a locally developed stress reduction program (LSR) in people with self-reported stress. The study was a three-armed randomized controlled trial conducted in a municipal health care center in Denmark. It included 71 participants with self-reported stress randomized to either MBSR (n = 24) or LSR (n = 23), or a waiting list (n = 24). Blood samples were collected at baseline and at 12 weeks follow-up to estimate effects of MBSR on DHEAS. The effect of MBSR on DHEAS was statistically significant compared to both the waiting list and LSR. We found a mean effect of 0.70 µmol/L (95% confidence interval [CI] = 0.18-1.22) higher DHEAS in the MBSR group compared with the waiting list group and a mean effect of 0.54 µmol/L (95% CI = 0.04-1.05) higher DHEAS in the MBSR group compared with the LSR group. Findings indicate an effect on DHEAS of the MBSR program compared to a waiting list and LSR program in people with self-reported stress. However, we consider our findings hypothesis-generating and validation by future studies is essential.
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Adjuvantes Imunológicos/uso terapêutico , Desidroepiandrosterona/uso terapêutico , Atenção Plena , Autorrelato , Estresse Psicológico/tratamento farmacológico , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
Background: There is a paucity of research on mediators of change, within compassion training programs. The aim was to investigate the mediators, of an 8-week compassion cultivation training (CCT) program, on the effect of psychological distress on caregivers of people with a mental illness. Method: Longitudinal path models in a randomized controlled trial (RCT). One hundred ninety-two participants were assessed for eligibility, and 161 participants were included into the trial and randomized. The main outcome was psychological distress measured by the Depression, Anxiety and Stress scale at 6 months. Mediators included self-compassion (SC), mindfulness (FM), emotion regulation (ER), emotion suppression (ES), and cognitive reappraisal (CR). Baseline, post, and 3- and 6-month follow-up measurements were collected. Results: The mediated effects for CCT are as follows: depression at 6 months: SC: -1.81 (95% CI: -3.31 to -0.31); FM: -1.98 (95% CI: -3.65 to -0.33); ER: -0.14 (95% CI: -1.31 to 1.02); anxiety at 6 months: SC: -0.71 (95% CI: -1.82 to 0.40); FM: -1.24 (95% CI: -2.39 to -0.09); ER: 0.18 (95% CI: -1.04 to 1.40); stress at 6 months: SC: -1.44 (95% CI: -2.84 to -0.05); FM: -2.17 (95% CI: -3.63 to -0.71); ER: -0.27 (95% CI: -1.51 to 0.98). Conclusion: Mindfulness and self-compassion are important components in reducing psychological distress experienced by informal caregivers of people with a mental illness. Results contribute to the knowledge about the underlying mechanisms of CCT.
RESUMO
Importance: Caregivers of people with mental illness are at increased risk of developing depression, anxiety, and stress. Objective: To investigate the effect of a compassion cultivation training (CCT) program on decreasing caregiver psychological distress. Design, Setting, and Participants: This waitlist-controlled randomized clinical trial was conducted in 2 different community settings in Denmark. Caregivers were excluded if they had a diagnosed and untreated mental illness, addiction, meditation practice, or current psychotherapeutic treatment. Enrollment occurred between May 2018 and March 2019. A repeated measurement model was used to examine the impact of the intervention. The primary analysis was based on the intention-to-treat principle. Data analysis was conducted from June 4 to July 7, 2020. Interventions: Participants were randomized 1-to-1 to an 8-week CCT course or waitlist control. Block randomization was used with 40 participants in each block. Main Outcomes and Measures: The main outcome was reduction in psychological distress, as measured by the Depression, Anxiety, Stress Scale (DASS). Baseline, postintervention, and 3- and 6-month follow-up measurements were collected. Results: Among 192 participants assessed for eligibility, 161 participants were included in the study (mean [SD] age, 52.6 [12.5] years; 142 [88.2%] women), with 79 participants randomized to the CCT intervention and 82 participants in the waitlist control group. At baseline, the mean (SD) DASS scores for the intervention vs control groups were 10.89 (8.66) vs 10.80 (8.38) for depression, 6.89 (6.48) vs 6.68 (5.33) for anxiety, and 14.96 (7.90) vs 15.77 (7.40) for stress. The CCT group experienced statistically significant improvement in the primary outcome in mean change from baseline vs the control group at postintervention (adjusted mean difference: depression, -4.16 [95% CI, -6.75 to -1.58]; P = .002; anxiety, -2.24 [95% CI, -3.99 to -0.48]; P = .01; stress, -4.20 [95% CI, -6.73 to -1.67]; P = .001), the 3-month follow-up (adjusted mean difference: depression, -3.78 [95% CI, -6.40 to -1.17]; P = .005; anxiety, -2.50 [95% CI, -4.27 to -0.73]; P = .006; stress, -3.76 [95% CI, -6.32 to -1.21]; P = .004), and the 6-month follow-up (adjusted mean difference: depression: -4.24 [95% CI, -6.97 to -1.52]; P = .002; anxiety, -2.12 [95% CI, -3.96 to -0.29]; P = .02; stress: -3.79 [95% CI, -6.44 to -1.13]; P = .005). Conclusions and Relevance: These findings suggest that CCT was superior to the waitlist control in supporting caregivers' mental health. Statistically and clinically significant reductions in psychological distress were found and sustained at the 6-month follow-up. The improvements noted in this randomized clinical trial could serve to encourage implementation of future evidence-based programs for caregivers. Trial Registration: ClinicalTrials.gov Identifier: NCT03730155.
Assuntos
Cuidadores/educação , Cuidadores/psicologia , Empatia , Transtornos Mentais , Angústia Psicológica , Estresse Psicológico/prevenção & controle , Adulto , Idoso , Dinamarca , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estresse Psicológico/etiologiaRESUMO
BACKGROUND: There is a call for sustainable, evidence-based interventions in schools to promote mental health in schoolchildren. Our primary aim of this trial is to evaluate the effectiveness in vulnerable pupils of a school teacher training programme to teach mindfulness (".b" programme) as a part of compulsory class room teaching in Danish schools on the pupils' self-reported mental health at 6-month follow-up. Our secondary aim is to evaluate the effectiveness of the school teacher training programme to teach the ".b"-programme as a part of compulsory class room teaching among the total pupil population on the pupils' self-reported mental health at 3 and 6 months after baseline. METHODS: The pragmatic cluster two-armed randomised controlled trial includes 110 municipal or private schools from all five regions in Denmark; 191 school teachers and approximately 2000 pupils at 11-15 years of age. Exclusion criteria; for schools: < 100 pupils; for pupils: parental opt out. Our intervention consists of (A) a school teacher training programme and (B) the ".b"-programme delivered as part of compulsory class room teaching in schools to pupils at the age of 11-15 years. The pupils in the control schools receive education as usual. Our primary study population is the vulnerable subgroup with a Strengths and Difficulties Questionnaire (SDQ) total difficulties score > 80% percentile at baseline (approximately 400 pupils). The primary outcome is change in the SDQ total score by the pupils. We also evaluate the effectiveness among the total pupil study population and in girls and boys, respectively and use other measures on mental health. Data will be analysed with repeated measurement models taken clusters into account. DISCUSSION: This large-scale trial will estimate the effectiveness of a population-based strategy on mental health in Danish schoolchildren. The trial evaluates the effect of a school teacher training programme, where teachers are trained in teaching the ".b" programme. The ".b" programme will be taught as a part of compulsory class room teaching. The intervention takes implementation issues into account. Effectiveness will be evaluated both in a vulnerable subgroup and among the total population. Trial registration number ClinicalTrials.gov Identifier: NCT04208113, registered December 23 2019, https://clinicaltrials.gov/ct2/show/NCT04208113 .
Assuntos
Atenção Plena , Professores Escolares , Adolescente , Criança , Feminino , Humanos , Masculino , Saúde Mental , Serviços de Saúde Escolar , Instituições AcadêmicasRESUMO
Background: In this study, we aimed to investigate the effects of a mindfulness program including Mindfulness-Based Stress Reduction (MBSR) on the mental health of student teachers when offered at their educational institution in a real-life context. Methods: A parallel randomized controlled trial (RCT) was conducted among self-selected student teachers at a Danish undergraduate program for teacher education in the autumns of 2019 and 2020. Participation was not recommended in case of (1) clinical depression or a diagnosis of psychosis or schizophrenia, (2) abuse of alcohol, drugs, and/or medicine. Randomization was performed by a Statistician who was blinded to the identity of the students. Data was collected using self-reported questionnaires. The primary outcome was a change in perceived stress 3 months from baseline. Secondary outcome measures were symptoms of anxiety and depression, well-being, resilience, mindfulness, and thoughts and feelings during rest. The effects were analyzed according to the intention-to-treat principle using mixed-effect linear regression models. Mediating effects of mindfulness skills on the mental health outcomes were explored using structural equation modeling. Results: The study group included 67 student teachers with 34 allocated to the intervention group (median age: 25 years; women: n = 24, 71%); and 33 students (median age: 25 years; women: n = 25, 76%) allocated to a waiting list control group. At baseline, mean Perceived Stress Scale (PSS) scores were 18.88 (SD: 5.75) in the intervention group and 17.91 (SD: 6.36) in the waiting list control group. A total of 56 students completed the questionnaire at a 3-month follow-up (28 in both the intervention- and the control group). Statistically significant effects of the intervention were found on perceived stress, symptoms of anxiety and depression, well-being, and on three of seven resting-state dimensions. No effects were found on resilience or mindfulness. Statistically significant mediated effects via resting-state dimensions were found. Conclusion The findings suggested that offering a mindfulness program at an undergraduate program for teacher education could significantly improve the mental health among self-selected students within 3 months. Results of mediation analysis supported the hypothesis that some of the effects might be explained by reduced distracting thoughts. Clinical Trial Registration: [www.ClinicalTrials.gov], identifier [NCT04558099].