Beyond HIV shame: the role of self-forgiveness and acceptance in living with HIV.

Research is developing regarding the beneficial association of spirituality with numerous health outcomes in people living with HIV (PLWH); however, little attention has been paid to the association of these variables with forgiveness and acceptance of HIV status. This cross-sectional study used a sample of 648 PLWH from the United States aged 18-61 to test the mediating effects of forgiveness and acceptance of HIV status on the relationship of spirituality and life satisfaction. As expected, self-forgiveness and acceptance straightforwardly and serially explained the links between spirituality and life satisfaction, while forgiveness of others was not a significant mediator for this relationship. The data obtained suggest that spirituality and self-forgiveness are two important targets for future experimental research, and therapeutic interventions on these variables may have a synergistic effect of increasing acceptance and improving well-being in PLWH.

The mediating effects of anxiety on the relationships between persistent thinking and life satisfaction: A two-wave longitudinal study in patients with anxiety disorders.

OBJECTIVE: According to cognitive theories, anxiety disorders may result from distorted beliefs, sensations, feelings, and decisions, leading to an overestimation of the danger presented by various stimuli. METHODS: In this two-wave longitudinal study of 435 German patients with anxiety disorders, we assessed the association of negative persistent thinking, anxiety, and life satisfaction. RESULTS & CONCLUSION: Structural equation modeling results suggest that persistent thinking may initiate the occurrence of anxiety, which in turn influences a decrease in life satisfaction. The convergence of the evidence from this longitudinal study with earlier results of evidence-based trials fortifies the case supporting the need to identify and reduce cognitive distortions in therapeutic interventions to improve health in people with anxiety disorders.

Beyond HIV Shame: Effects of Self-Forgiveness in Improving Mental Health in HIV-Positive Individuals in Poland.

Guided by the bio-psycho-socio-spiritual approach, this randomized controlled trial assessed the efficacy of a self-forgiveness intervention among 60 HIV-positive individuals in Poland. Participants underwent a 90-min "Restore: The Journey Toward Self-Forgiveness" session, in contrast to a wait-list control group. The intervention significantly enhanced self-forgiveness, spirituality, mental well-being, and heart rate variability in response to a cognitive stressor (i.e., a mental arithmetic challenge). Significant effects were observed in both between-group and within-subject comparisons. These results support the incorporation of self-forgiveness into psychological rehabilitation programs for HIV to improve quality of life and health outcomes.

The Relationship Between Forgiveness and Health Outcomes Among People Living with HIV: A Cross-Sectional Study in France.

Research to date has shown that HIV infection is a highly stressful experience for individuals, and one of the key adaptive resources after such painful experiences may be forgiveness. The aim of the present study was to examine the associations between dispositional forgiveness (assessed using Mullet's Forgivingness Questionnaire and Toussaint's Forgiveness Scale), perceived stress (single-item measure of stress symptoms), health perception (EuroQol visual analogue version of the scale) and life satisfaction (Satisfaction With Life Scale) in people living with HIV (PLWH) in France. Paper surveys were completed by 222 PLWH aged 18-78 (57% male). Multiple regression analysis revealed that sensitivity to circumstances, unconditional forgiveness, self-forgiveness, and forgiveness of others were significant predictors of health and happiness. Mediation analysis showed that these relationships are completely mediated by perceived stress. The present findings suggest that forgiveness and perceived stress may be important variables for healing in PLWH. Interventions designed to improve forgiveness and self-forgiveness may result in improved health and life satisfaction in PLWH.

Forgiveness, rumination, and depression in the United States and Korea: A cross-cultural mediation study.

OBJECTIVE: Although substantial research has separately investigated forgiveness, rumination, and depression in the United States, few studies have investigated all three constructs in the same sample and we know of no studies that have examined how forgiveness, rumination, and depression are interrelated across cultures. METHOD: To address this issue, we conducted a cross-cultural study wherein 204 and 297 healthy young adults from Korea and the United States, respectively, completed the Heartland Forgiveness Scale, Ruminative Response Scale, and Beck Depression Inventory-II. RESULTS: Compared to US participants, Korean participants exhibited more forgiveness, similar levels of rumination, and slightly more depression. Two-group structural equation models revealed that forgiveness was directly related to depressive symptoms, and that forgiveness was indirectly related to depressive symptoms through rumination, in both the United States (proportion mediated = 0.363) and Korea (proportion mediated = 0.394). This indirect association did not differ across cultures. CONCLUSION: Considered together, these results suggest that forgiveness appears to have beneficial effects on depression that are mediated through forgiveness-related reductions in rumination, and, importantly, that these effects are similar across cultures.

Obesity, putative biological mediators, and cognitive function in a national sample of children and adolescents.

Childhood obesity has reached epidemic rates nationwide and may be associated with impaired cognitive function. A growing body of evidence suggests that poorer academic performance for children with obesity and overweight is related to declines in executive function skills. This study aimed to identify biological mediators between obesity and overweight and cognitive function among children and adolescents. A total of 3323 children aged 6-16 years from the Third National Health and Nutrition Examination Survey between 1988 and 1994 (NHANES III) was used to measure associations between measures of obesity and overweight, cognitive function (IQ test batteries), iron deficiency, inflammation (c-reactive protein), and glucose metabolism (glycosylated hemoglobin) using multiple mediation models. Approximately 15% of the children were overweight and 11% were obese. Results showed lower scores for children who were obese or overweight than children of normal weight on several IQ subtest batteries. Obesity and overweight were also associated with biological mediators such as iron deficiency, elevated c-reactive protein and glycosylated hemoglobin. Several biomarkers of iron status were also related to measures of cognitive function. Early declines in cognitive function are associated with biomarkers of iron deficiency and inflammation in children and adolescents, and while some biological linkages between obesity and overweight and cognitive function are identified herein, further study is needed to identify additional biological mediators between obesity and overweight and cognitive function in pediatric populations.

Clinical impact of confinement due to the COVID-19 pandemic on patients with fibromyalgia: a cohort study.

OBJECTIVES: To our knowledge, the impact of the COVID-19 pandemic on fibromyalgia (FM) patients has not been studied before. FM patients often experience clinical impairment with stress. The aim of this study was to determine whether severity of FM increases because of confinement by the COVID-19 pandemic. METHODS: This prospective study includes patients from the Combined Index of Severity of Fibromyalgia (ICAF) cohort who met the 2010 ACR FM criteria. In this cohort, all patients have a periodical evaluation of their quality of life through two questionnaires, the ICAF, which assesses the ability to perform daily living activities, anxiety and depression, and through the Patient Global Impression of Change (PGIC), which assesses overall change after a therapeutical intervention. Pre- and post-confinement measurements were analysed. Inferential statistical analysis and ANOVA for repeated measurements were used. RESULTS: A total of 93 patients received a phone consultation, (95.5% females), mean (SD) age of 48.23 (8.38) years. Four patients were excluded as presenting COVID-19 and 51 (57%) completed the post-confinement ICAF. Following confinement, 25 (49%) patients got worse (group-worse) and 26 (51%) patients experienced no change or improved (group-stable). Comparisons between pre- and post-confinement ICAF did not show significant differences in both groups. Passive coping was significantly different in group-worse in pre-confinement evaluation. In the 80% of patients with passive coping predominance there were no changes in coping strategy. CONCLUSIONS: No clinical impairment due to COVID-19 confinement occurred. The perceived worsening among FM patients relies primarily on how patients cope with their disease, without a real impact on clinical manifestations.

Pain is not the major determinant of quality of life in fibromyalgia: results from a retrospective "real world" data analysis of fibromyalgia patients.

OBJECTIVE: To identify correlates of quality of life (QoL) measured with the Quality of Life Scale (QOLS) in participants of a multidisciplinary day hospital treatment program for fibromyalgia (FM). METHODS: In this cross-sectional, observational study, "real world" data from 480 FM patients including socio-demographics, pain variables and questionnaires such as the SF-36, Beck Depression Inventory (BDI), Multiphasic Pain Inventory (MPI), SCL-90-R and others were categorized according to the components (body structure and function, activities and participation, personal factors, environmental factors) of the International Classification of Functioning (ICF). For every ICF component, a linear regression analysis with QOLS as the dependent variable was computed. A final comprehensive model was calculated on the basis of the results of the five independent analyses. RESULTS: The following variables could be identified as main correlates for QoL in FM, explaining 56% of the variance of the QOLS (subscale/questionnaire and standardized beta in parenthesis): depression (- 0.22), pain-related interference with everyday life (- 0.19), general activity (0.13), general health perception (0.11), punishing response from others (- 0.11), work status (- 0.10), vitality (- 0.11) and cognitive difficulties (- 0.12). Pain intensity or frequency was not an independent correlate. CONCLUSIONS: More than 50% of QoL variance could be explained by distinct self-reported variables with neither pain intensity nor pain frequency playing a major role. Therefore, FM treatment should not primarily concentrate on pain but should address multiple factors within multidisciplinary therapy.

Fibromyalgia Pain and Fatigue Symptoms in Spanish and U.S. Men.

BACKGROUND AND AIMS: Fibromyalgia Syndrome (FMS) is a chronic centralized pain disorder characterized by widespread pain and fatigue. Of those affected by FMS, the majority are women, and minimal research exists involving men. The purpose of this paper is to describe the pain and fatigue experiences of men with FMS from two Western countries, Spain and the United States, in order to support more accurate and earlier recognition and diagnosis in men. DESIGN AND METHODS: We used individual and focus group interviews with qualitative and quantitative assessments. SETTINGS AND PARTICIPANTS/SUBJECTS: Ten men in Spain and seven men in the United States provided information about their symptoms, psychosocial and health-seeking behaviors, and gender experiences with FMS. RESULTS: Men articulated types, trends, and triggers of pain and fatigue that enrich an understanding of their symptoms. For example, men report more localized pain than generalized pain. Employment status and activities, among other contextual factors, impacted men's pain and fatigue experiences. CONCLUSIONS: Men experience distinct facets of pain and fatigue compared with women, with notable similarities and differences across the Spanish and U.S. SAMPLES: Cross-cultural comparisons highlight contextual factors that may inspire future inquiries about determinants of men's experiences with FMS. CLINICAL IMPLICATIONS: The present study could be useful for anyone treating men suffering from FMS, especially care providers in nursing, medical, and psychology fields. These initial findings may prompt a closer examination of recommendations for assessment and diagnostic criteria used internationally for patients with FMS with better recognition of men's experience.

Risk factors for teen suicide and bullying: An international integrative review.

AIM: This study aimed to analyse risk and protective factors for teen suicide and bullying. BACKGROUND: Research shows that high percentages of bully-victims report suicidal thinking or suicide attempts. DESIGN: This was an international integrative review. DATA SOURCES: Five databases including CINAHL, Scopus, PubMed, Google Scholar and Cuiden were searched between January 2010 and December 2020. REVIEW METHODS: Review methods included problem identification; search, evaluation and analysis of literature; and presentation of results. RESULTS: Eighteen studies were included. We grouped the selected articles into seven thematic categories. The most significant risk factors were being male, having a previous personal and/or family suicide attempt, mental health problems, substance abuse, previous physical and/or sexual abuse, low socio-economic level, belonging to a single-parent family, underachievement, family dysfunction and violent environment. The most common protective factors for both suicide and bullying were being female, having good mental health, belonging to a two-parent family, safe school environment, good family relationships and having an involved teacher. CONCLUSION: Suicide resulting from bullying is a social and public health problem, so nurse practitioners and paediatric primary care nurses have a responsibility to educate teachers and parents in order to promote early detection and the development of more effective prevention and action plans.

Holistic Medicine Must Mean Whole: How to Deal with Spirituality.

Holistic medicine is the art and science of healing that addresses the whole person-body, mind and spirit. It is a broad discipline comprising a wide range of practices aimed at the overall health of the patient. More often than not, holistic medicine takes spirituality into account and incorporates practices like group therapy led by trained therapists. One problem, however, is that the words 'holistic' and 'medicine' are not specific, adding to the general confusion on what holistic medicine is. The aim of this review is to describe holistic medicine as a form of integrative medicine, combining both conventional and alternative medical practices. Furthermore, in light of the heterogeneous definitions and practices found in existing literature, we present arguments on the need for a proper terminology in order to create a system for fully evaluating the patient as a whole, which we call 'holology'.

Clean and Contain: Initial Development of a Measure of Infection Prevention Behaviors During the COVID-19 Pandemic.

BACKGROUND: The Centers for Disease Control and Prevention (CDC) offer behavioral guidance to prevent the spread of infectious diseases like COVID-19. Cleaning (e.g., cleaning surfaces, washing and sanitizing hands) and containing (e.g., covering coughs, keeping distance from others, especially sick people) behaviors are recommended. PURPOSE: To develop the Clean and Contain Measure, a brief measure of compliance with CDC recommendations for prevention of infectious disease, and validate the measure in individuals experiencing the COVID-19 pandemic. METHODS: Participants were recruited from Amazon Mechanical Turk and social media. RESULTS: In Study 1 (N = 97), exploratory factor analysis revealed two scales: (a) five items assessing cleaning behaviors and (b) four items assessing containing behaviors. Simple structure was obtained and alpha coefficients for both scales were >.83. In Studies 2 (N = 204) and 3 (N = 527), confirmatory factor analysis verified the identical factor structure found in Study 1. All loadings were statistically significant at p < .001. Alpha coefficients for both scales were >.84 for Studies 2 and 3. CONCLUSIONS: Our measure is a reliable and valid indicator of compliance with cleaning and containing health behaviors that help to prevent the spread of diseases like COVID-19. Future research should replicate construct validity in more diverse samples and continue to refine items, examine construct validity, including predictive and discriminant validity, and improve the measure for future use. With continued use and refinement, this measure could allow health officials and researchers to accurately assess compliance with important infection prevention behavior guidelines.

Self-forgiveness in fibromyalgia patients and its relationship with acceptance, catastrophising and coping.

OBJECTIVES: Forgiveness influences health through numerous mechanisms, but commonly it is thought to reduce stress, increase healthy behaviour, and promote social support, thereby positively impacting health and wellbeing. Self-forgiveness has been given considerable attention in relation to health and wellbeing. Fibromyalgia (FM) patients had lower forgiveness of others and self-forgiveness as compared to controls. The aim of this study is to explore the relationship of self-forgiveness (FS) with the impact and severity of FM, acceptance, catastrophising, and coping. METHODS: We evaluated 228 FM female patients who completed the Mauger Forgiveness Scale, the Combined Index of Severity in Fibromyalgia (ICAF) survey, the Chronic Pain Acceptance Questionnaire (CPAQ), and the Pain Catastrophising Scale (PCS). RESULTS: High self-forgiveness is related to high levels of active coping (r=.41) and acceptation (r=.38), and low self-forgiveness is related to emotional negative factors and catastrophising (r=-.56). Two factors (physical and emotional) were obtained. Lower FS is an emotional factor with negative emotion, catastrophising and a deficit in active coping. A decision-tree analysis showed a first node with ICAF Emotional scores and a second level with CPAQ and PCS scores as predictors. CONCLUSIONS: A notable lack of FS indicates a problem (distress and catastrophising) with the health aspects related to this syndrome. Acceptance could require a low negative emotional status. People with high FS were likely to increase acceptation as the positive component of acceptance in FS. This finding does not indicate an interest in maintaining problematic behaviours.

Fibromyalgia impact and depressive symptoms: Can perceiving a silver lining make a difference?

Individuals with fibromyalgia are at greater risk for depressive symptoms than the general population, and this may be partially attributable to physical symptoms that impair day-to-day functioning. However, individual-level protective characteristics may buffer risk for psychopathology. For instance, the ability to perceive a "silver lining" in one's illness may be related to better mental and physical health. We examined perceived silver lining as a potential moderator of the relation between fibromyalgia impact and depressive symptoms. Our sample of persons with fibromyalgia (N = 401) completed self-report measures including the Fibromyalgia Impact Questionnaire-Revised, Depression Anxiety Stress Scales, and the Silver Lining Questionnaire. Moderation analyses covaried age, sex, and ethnicity. Supporting hypotheses, increasing impact of disease was related to greater depressive symptoms, and perceptions of a silver lining attenuated that association. Despite the linkage between impairment and depressive symptoms, identifying positive aspects or outcomes of illness may reduce risk for psychopathology. Therapeutically promoting perception of a silver lining, perhaps via signature strengths exercises or a blessings journal, and encouraging cognitive reframing of the illness experience, perhaps via Motivational Interviewing or Cognitive Behavioral Therapy, may reduce depressive symptoms in persons with fibromyalgia.

Alleviating Social Pain: A Double-Blind, Randomized, Placebo-Controlled Trial of Forgiveness and Acetaminophen.

BACKGROUND: Research has suggested that physical pain (e.g., caused by injury) and social pain (e.g., caused by social rejection) are modulated by some of the same biological systems. Consequently, it is possible that acetaminophen, which is commonly used to alleviate physical pain through neurochemical pathways, may have social pain-relieving effects that interact with forgiveness, which reduces social pain through psychological pathways. To date, however, only a few studies have examined how experiences of social pain change over time, and none have examined how acetaminophen and forgiveness interact to influence these effects. PURPOSE: We addressed these issues by investigating how acetaminophen administration and daily forgiveness are associated with experiences of social pain over 21 days. We hypothesized that acetaminophen-related reductions in social pain across the 21-day study period would be greatest on days following high levels of forgiveness. METHOD: To test this hypothesis, we conducted a double-blind, randomized, placebo-controlled trial in which we randomly assigned 42 healthy young adults to an acetaminophen condition (1,000 mg of acetaminophen daily), placebo-control condition (400 mg of potassium daily), or empty-control (no pill) condition. We then assessed their levels of forgiveness and social pain for 20 consecutive days. RESULTS: As hypothesized, acetaminophen reduced participants' social pain levels over time but only for those exhibiting high levels of forgiveness (i.e., 18.5% reduction in social pain over 20 days). CONCLUSIONS: These data are the first to show that forgiveness and acetaminophen have interactive effects on experiences of social pain, which is one of the most common and impactful of all human experiences.

Forgiveness and late life functioning: the mediating role of finding ego-integrity.

OBJECTIVES: This study seeks (1) to replicate previous findings on the mediating effect of integrity/despair in the relation between forgiveness and depression in an elderly population and (2) to extend these findings to other aspects of functioning, namely life satisfaction and subjective health. Both aims were studied in a sample of residential elderly. METHODS: Residential elderly (n = 329, M = 87 years) filled out questionnaires on forgivingness, depressive symptoms, life satisfaction, subjective health and the developmental task of integrity/despair. Structural equation modeling was used to test the mediational role of integrity-despair in the relation between forgivingness and the aspects of functioning. Direct and indirect effects are tested. RESULTS: The results confirmed earlier findings stating that forgivingness and depression are negatively associated in residential elderly and that the developmental task of finding integrity and avoiding despair is significant mediator in this relationship. A similar pattern of mediational associations was found for life satisfaction. However, for subjective health only a direct effect between forgiveness and subjective health was found, whereas the developmental task of integrity and despair did not function as an underlying mechanism. DISCUSSION: Framed within a life span perspective, we showed that the developmental task of finding a balance between integrity and despair is an important intrapersonal mechanism through which forgivingness is related with depressed feelings and life satisfaction for residential elderly. A different mechanism might explain the direct effect between forgiveness and subjective health.

Health beliefs, attitudes, and health-related quality of life in persons with fibromyalgia: mediating role of treatment adherence.

Fibromyalgia is a chronic illness characterized by pain and fatigue. Persons with fibromyalgia experience increased the risk for poor mental and physical health-related quality of life, which may be dependent on multiple factors, including health beliefs, such as confidence in physicians and the health-care system, and health behaviors, such as treatment adherence. Respondents with fibromyalgia (n = 409) were recruited nationally, via support organizations, and completed self-report measures: Multidimensional Health Profile - Health Functioning Index (MHP-H), Short-Form-36 Health Survey (SF-36v2), and Medical Outcomes Study (MOS) Measure of Patient Adherence - General Adherence Items. In mediation models, belief in the healthcare system and health-care personnel, and health efficacy exerted an indirect effect through treatment adherence on mental and physical quality of life. Adaptive health beliefs and attitudes were related to greater treatment adherence and, in turn, to a better quality of life. Maladaptive health beliefs and mistrusting attitudes about physician-level and systemic-level healthcare provision are negatively related to both treatment adherence and consequent physical and mental health-related quality of life in persons with fibromyalgia. Future randomized controlled trials are needed to determine if therapeutic strategies to alter health values might improve adherence and self-rated health.

[Current Research Activities on Person-Centered Medicine in Academic Institutes of General Practice in Germany and Austria]. / Aktuelle Forschungsaktivitäten zur personenzentrierten Medizin in akademischen Instituten für Allgemeinmedizin in Deutschland und Österreich.

AIM OF STUDY: Person-centered medicine (PCM) with its focus on humanistic-biographical-oriented medicine and integrated, positive-salutogenic health is a central aspect in the patient-physician relationship in general practice. The objective of this analysis is to assess the prevalence and type of research project in academic institutions of general practice in Germany (Ger) and Austria (At) and the thematic priorities of the projects in the areas PCM, health promotion (HP), prevention (PRE) and conventional medicine (CM). METHODS: A search was conducted (September-December 2015) on the websites of 30 institutes and divisions of general medicine for their current research projects. The retrieved projects were assigned to five categories: PCM, HP, PRE, CM and others. Subsequently, we identified the targeted patient groups of the projects as well as the thematic focus in the categories PCM, HP, PRE and CM with focus on PCM and HP. RESULTS: 541 research projects were identified, 452 in Germany and 89 in Austria. Research projects were only included if they were explicitly indicated as research-oriented. Seventy projects addressed PCM aspects, 15 projects HP aspects, 32 projects PRE aspects and 396 projects CM aspects. The most frequently target groups in the categories PCM (24 of 70) and HP (7 of 15) were chronically ill patients. The most common thematic focus in PCM was communication (13 of 70) and in HP, physical activity (6 of 15). CONCLUSION: The vast majority of research projects investigated conventional medical topics. The percentage of research activities in the field of PCM (13%) or PCM including HP (16%) in Ger and At is below the European average of 20%. From our point of view, PCM and HP need to be implemented to a greater extent in general practice.