Effect of Sleep Disturbance Symptoms on Treatment Outcome in Blended Cognitive Behavioral Therapy for Depression (E-COMPARED Study): Secondary Analysis.

BACKGROUND: Sleep disturbance symptoms are common in major depressive disorder (MDD) and have been found to hamper the treatment effect of conventional face-to-face psychological treatments such as cognitive behavioral therapy. To increase the dissemination of evidence-based treatment, blended cognitive behavioral therapy (bCBT) consisting of web-based and face-to-face treatment is on the rise for patients with MDD. To date, no study has examined whether sleep disturbance symptoms have an impact on bCBT treatment outcomes and whether it affects bCBT and treatment-as-usual (TAU) equally. OBJECTIVE: The objectives of this study are to investigate whether baseline sleep disturbance symptoms have an impact on treatment outcomes independent of treatment modality and whether sleep disturbance symptoms impact bCBT and TAU in routine care equally. METHODS: The study was based on data from the E-COMPARED (European Comparative Effectiveness Research on Blended Depression Treatment Versus Treatment-as-Usual) study, a 2-arm, multisite, parallel randomized controlled, noninferiority trial. A total of 943 outpatients with MDD were randomized to either bCBT (476/943, 50.5%) or TAU consisting of routine clinical MDD treatment (467/943, 49.5%). The primary outcome of this study was the change in depression symptom severity at the 12-month follow-up. The secondary outcomes were the change in depression symptom severity at the 3- and 6-month follow-up and MDD diagnoses at the 12-month follow-up, assessed using the Patient Health Questionnaire-9 and Mini-International Neuropsychiatric Interview, respectively. Mixed effects models were used to examine the association of sleep disturbance symptoms with treatment outcome and treatment modality over time. RESULTS: Of the 943 patients recruited for the study, 558 (59.2%) completed the 12-month follow-up assessment. In the total sample, baseline sleep disturbance symptoms did not significantly affect change in depressive symptom severity at the 12-month follow-up (ß=.16, 95% CI -0.04 to 0.36). However, baseline sleep disturbance symptoms were negatively associated with treatment outcome for bCBT (ß=.49, 95% CI 0.22-0.76) but not for TAU (ß=-.23, 95% CI -0.50 to 0.05) at the 12-month follow-up, even when adjusting for baseline depression symptom severity. The same result was seen for the effect of sleep disturbance symptoms on the presence of depression measured with Mini-International Neuropsychiatric Interview at the 12-month follow-up. However, for both treatment formats, baseline sleep disturbance symptoms were not associated with depression symptom severity at either the 3- (ß=.06, 95% CI -0.11 to 0.23) or 6-month (ß=.09, 95% CI -0.10 to 0.28) follow-up. CONCLUSIONS: Baseline sleep disturbance symptoms may have a negative impact on long-term treatment outcomes in bCBT for MDD. This effect was not observed for TAU. These findings suggest that special attention to sleep disturbance symptoms might be warranted when MDD is treated with bCBT. Future studies should investigate the effect of implementing modules specifically targeting sleep disturbance symptoms in bCBT for MDD to improve long-term prognosis.

Resource-Based Internet Intervention (Med-Stress) to Improve Well-Being Among Medical Professionals: Randomized Controlled Trial.

BACKGROUND: Medical professionals are exposed to multiple and often excessive demands in their work environment. Low-intensity internet interventions allow them to benefit from psychological support even when institutional help is not available. Focusing on enhancing psychological resources-self-efficacy and perceived social support-makes an intervention relevant for various occupations within the medical profession. Previously, these resources were found to operate both individually or sequentially with self-efficacy either preceding social support (cultivation process) or following it (enabling process). OBJECTIVE: The objective of this randomized controlled trial is to compare the efficacy of 4 variants of Med-Stress, a self-guided internet intervention that aims to improve the multifaceted well-being of medical professionals. METHODS: This study was conducted before the COVID-19 pandemic. Participants (N=1240) were recruited mainly via media campaigns and social media targeted ads. They were assigned to 1 of the following 4 groups: experimental condition reflecting the cultivation process, experimental condition reflecting the enabling process, active comparator enhancing only self-efficacy, and active comparator enhancing only perceived social support. Outcomes included 5 facets of well-being: job stress, job burnout, work engagement, depression, and job-related traumatic stress. Measurements were taken on the web at baseline (time 1), immediately after intervention (time 2), and at a 6-month follow-up (time 3). To analyze the data, linear mixed effects models were used on the intention-to-treat sample. The trial was partially blinded as the information about the duration of the trial, which was different for experimental and control conditions, was public. RESULTS: At time 2, job stress was lower in the condition reflecting the cultivation process than in the one enhancing social support only (d=-0.21), and at time 3, participants in that experimental condition reported the lowest job stress when compared with all 3 remaining study groups (ds between -0.24 and -0.41). For job-related traumatic stress, we found a significant difference between study groups only at time 3: stress was lower in the experimental condition in which self-efficacy was enhanced first than in the active comparator enhancing solely social support (d=-0.24). The same result was found for work engagement (d=-0.20), which means that it was lower in exactly the same condition that was found beneficial for stress relief. There were no differences between study conditions for burnout and depression neither at time 2 nor at time 3. There was a high dropout in the study (1023/1240, 82.50% at posttest), reflecting the pragmatic nature of this trial. CONCLUSIONS: The Med-Stress internet intervention improves some components of well-being-most notably job stress-when activities are completed in a specific sequence. The decrease in work engagement could support the notion of dark side of this phenomenon, but further research is needed. TRIAL REGISTRATION: ClinicalTrials.gov NCT03475290; https://clinicaltrials.gov/ct2/show/NCT03475290. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s13063-019-3401-9.

Enabling, Not Cultivating: Received Social Support and Self-Efficacy Explain Quality of Life After Lung Cancer Surgery.

BACKGROUND: Although the effects of self-efficacy and social support on health outcomes are well established, it is crucial to find out if these predictors are chained in a specific way, with either self-efficacy prompting support receipt or with support receipt prompting self-efficacy. PURPOSE: In the context of adaptation after lung cancer surgery, this study investigated (1) the cultivation hypothesis, assuming that the relationship between self-efficacy and quality-of-life indices would be mediated by social support received from medical personnel, family, and friends, and (2) the enabling hypothesis, assuming that the association between received social support and quality-of-life indices would be mediated by self-efficacy. METHOD: Patients with the first onset of non-small-cell lung cancer (N = 102) filled in questionnaires at 3-4 days after segmentectomy or lobectomy (time 1), at 1-month follow-up (time 2), and at 4-month follow-up (time 3). RESULTS: Mediation analyses accounting for the effects of age, gender, marital status (all measured at time 1), and the mediator (measured at time 1 and time 2) yielded no support for the cultivation hypothesis. Indirect effects were observed for 0 out of 14 quality-of-life indices, measured at time 3. In contrast, the enabling hypothesis was confirmed for 11 out of 14 quality-of-life indices (physical, functional, cognitive, social, and emotional aspects; measured at time 3). CONCLUSIONS: Interventions for patients with lung cancer may focus on enhancing social support receipt within the first week after surgery, followed by a self-efficacy prompt 3 weeks later.

Women with family cancer history are at risk for poorer physical quality of life and lower self-efficacy: a longitudinal study among men and women with non-small cell lung cancer.

BACKGROUND: We investigated the determinants of trajectories of physical symptoms related to lung cancer (a quality of life [QOL] aspect) and self-efficacy among patients with non-small cell lung cancer (NSCLC). It was hypothesized that gender and family cancer history in first-degree relatives would have synergistic effects on QOL-lung cancer specific symptoms and self-efficacy. Women with family cancer history were expected to be at risk of poorer adjustment. METHODS: Quantitative, longitudinal design was applied. Participants provided their responses at 3-4 days after surgery, 1-month follow-up, and 4-month follow-up. We recruited 102 in-patients (men: 51%) with NSCLC who underwent surgery aimed at removing a lung tumor. Self-report data were collected with QLQ-LC13 and a scale for self-efficacy for managing illness. RESULTS: Mixed-models analysis indicated that trajectories of physical quality of life (symptoms of lung cancer) as well as self-efficacy were unfavorable among women with family cancer history. CONCLUSIONS: Among NSCLC patients, gender and family cancer history may be considered basic screening criteria for identifying groups of patients at risk for poorer physical QOL (higher level of physical symptoms related to lung cancer) and lower incline of self-efficacy after cancer surgery.

[The helpers' stress: Effectiveness of a web-based intervention for professionals working with trauma survivors in reducing job burnout and improving work engagement]. / Stres pomagajacych - efektywnosc interwencji internetowej dla osób pracujacych z ofiarami traumy w obnizaniu wypalenia zawodowego i wzmacnianiu zaangazowania w prace.

BACKGROUND: The study aimed at evaluating effectiveness of the web-based intervention, "The Helpers' Stress," in reducing job burnout and enhancing work engagement among professionals working with trauma survivors. MATERIAL AND METHODS: Participants were randomly allocated to 1 of the 3 intervention modules: 1 - the self-efficacy enhancement (N = 87), 2 - the social support enhancement (N = 85), or to 3 - the educational module (comparison group, N = 81). Participants completed the online questionnaires before the intervention (T1), immediately after (T2), and 4 weeks after the intervention (T3). RESULTS: Due to high drop-out rate at T2 and T3 in social support enhancement module, we excluded from analysis participants assigned to this condition. Participants assigned to the self-efficacy enhancement module presented higher levels of self-efficacy (at T2 and T3), compared to those assigned to the educational module. Job burnout decreased significantly between T1 and T2, and between T2 and T3, and work engagement increased significantly between T1 and T2, and between T1 and T3, among participants assigned to both modules mentioned above. Self-efficacy (T2) mediated the relationship between the group assignment (educational module vs. self-efficacy enhancement module) and respectively job burnout (T3) or work engagement (T3). CONCLUSIONS: The results of our study highlight the role of self-efficacy in reducing job burnout and increasing work engagement. Med Pr 2016;67(2):223-237.

Cultivating secondary traumatic growth among healthcare workers: the role of social support and self-efficacy.

OBJECTIVE: This 2-study longitudinal investigation examined the indirect effects of secondary traumatic stress (STS) on secondary traumatic growth via two mediators: perceived social support and secondary trauma self-efficacy. In particular, we tested if the 2 hypothetical mediators operate sequentially, that is, with secondary trauma self-efficacy facilitating social support (i.e., cultivation hypothesis) and/or social support enhancing self-efficacy (i.e., enabling hypothesis). METHOD: Participants in Study 1 (N = 293 at Time 1, N = 115 at Time 2) were behavioral healthcare providers working with U.S. military personnel suffering from trauma. Study 2 was conducted among Polish healthcare workers (N = 298 at Time 1, N = 189 at Time 2) providing services for civilian survivors of traumatic events. RESULTS: In both studies, multiple mediational analyses showed evidence for the cultivation hypothesis. The relationship between STS at Time 1 and secondary traumatic growth at Time 2 was mediated sequentially by secondary trauma self-efficacy at Time 1 and social support at Time 2. The enabling hypothesis was not supported. CONCLUSION: Education and development programs for healthcare workers may benefit from boosting self-efficacy with the intent to facilitate perceived social support.

Social support and quality of life among lung cancer patients: a systematic review.

OBJECTIVE: This systematic review analyzed the relationships between social support and quality of life (QOL) indicators among lung cancer patients. In particular, the patterns of relationships between different social support facets and sources (received and perceived support from healthcare professionals, family, and friends) and QOL aspects (emotional, physical symptoms, functional, and social) as well as the global QOL index were investigated. METHODS: The review yielded 14 original studies (57% applying cross-sectional designs) analyzing data from a total of 2759 patients. RESULTS: Regarding healthcare professionals as support source, corroborating evidence was found for associations between received support (as well as need for and satisfaction with received support) and all aspects of QOL, except for social ones. Overall, significant relations between support from healthcare personnel and QOL were observed more frequently (67% of analyzed associations), compared with support from families and friends (53% of analyzed associations). Corroborating evidence was found for the associations between perceived and received support from family and friends and emotional aspects of QOL. Research investigating perceived social support from unspecified sources indicated few significant relationships (25% of analyzed associations) and only for the global QOL index. CONCLUSIONS: Quantitative and qualitative differences in the associations between social support and QOL are observed, depending on the source and type of support. Psychosocial interventions may aim at enabling provision of social support from healthcare personnel in order to promote emotional, functional, and physical QOL among lung cancer patients.

Secondary traumatic stress among mental health providers working with the military: prevalence and its work- and exposure-related correlates.

Our research assessed the prevalence of secondary traumatic stress (STS) among mental health providers working with military patients. We also investigated personal, work-related, and exposure-related correlates of STS. Finally, using meta-analysis, the mean level of STS symptoms in this population was compared with the mean level of these symptoms in other groups. Participants (N = 224) completed measures of indirect exposure to trauma (i.e., diversity, volume, frequency, ratio), appraisal of secondary exposure impact, direct exposure to trauma, STS, and work characteristics. The prevalence of STS was 19.2%. Personal history of trauma, complaints about having too many patients, and more negative appraisals of the impact caused by an indirect exposure to trauma were associated with higher frequency of STS symptoms. A meta-analysis showed that the severity of intrusion, avoidance, and arousal symptoms of STS was similar across various groups of professionals indirectly exposed to trauma (e.g., mental health providers, rescue workers, social workers).

Clinical Psychology and the COVID-19 Pandemic: A Mixed Methods Survey Among Members of the European Association of Clinical Psychology and Psychological Treatment (EACLIPT).

Background: The COVID-19 pandemic has affected people globally both physically and psychologically. The increased demands for mental health interventions provided by clinical psychologists, psychotherapists and mental health care professionals, as well as the rapid change in work setting (e.g., from face-to-face to video therapy) has proven challenging. The current study investigates European clinical psychologists and psychotherapists' views on the changes and impact on mental health care that occurred due to the COVID-19 pandemic. It further aims to explore individual and organizational processes that assist clinical psychologists' and psychotherapists' in their new working conditions, and understand their needs and priorities. Method: Members of the European Association of Clinical Psychology and Psychological Treatment (EACLIPT) were invited (N = 698) to participate in a survey with closed and open questions covering their experiences during the first wave of the pandemic from June to September 2020. Participants (n = 92) from 19 European countries, mostly employed in universities or hospitals, completed the online survey. Results: Results of qualitative and quantitative analyses showed that clinical psychologists and psychotherapists throughout the first wave of the COVID-19 pandemic managed to continue to provide treatments for patients who were experiencing emotional distress. The challenges (e.g., maintaining a working relationship through video treatment) and opportunities (e.g., more flexible working hours) of working through this time were identified. Conclusions: Recommendations for mental health policies and professional organizations are identified, such as clear guidelines regarding data security and workshops on conducting video therapy.

A Data-Driven Clustering Method for Discovering Profiles in the Dynamics of Major Depressive Disorder Using a Smartphone-Based Ecological Momentary Assessment of Mood.

Background: Although major depressive disorder (MDD) is characterized by a pervasive negative mood, research indicates that the mood of depressed patients is rarely entirely stagnant. It is often dynamic, distinguished by highs and lows, and it is highly responsive to external and internal regulatory processes. Mood dynamics can be defined as a combination of mood variability (the magnitude of the mood changes) and emotional inertia (the speed of mood shifts). The purpose of this study is to explore various distinctive profiles in real-time monitored mood dynamics among MDD patients in routine mental healthcare. Methods: Ecological momentary assessment (EMA) data were collected as part of the cross-European E-COMPARED trial, in which approximately half of the patients were randomly assigned to receive the blended Cognitive Behavioral Therapy (bCBT). In this study a subsample of the bCBT group was included (n = 287). As part of bCBT, patients were prompted to rate their current mood (on a 1-10 scale) using a smartphone-based EMA application. During the first week of treatment, the patients were prompted to rate their mood on three separate occasions during the day. Latent profile analyses were subsequently applied to identify distinct profiles based on average mood, mood variability, and emotional inertia across the monitoring period. Results: Overall, four profiles were identified, which we labeled as: (1) "very negative and least variable mood" (n = 14) (2) "negative and moderate variable mood" (n = 204), (3) "positive and moderate variable mood" (n = 41), and (4) "negative and highest variable mood" (n = 28). The degree of emotional inertia was virtually identical across the profiles. Conclusions: The real-time monitoring conducted in the present study provides some preliminary indications of different patterns of both average mood and mood variability among MDD patients in treatment in mental health settings. Such varying patterns were not found for emotional inertia.

Examining the Theoretical Framework of Behavioral Activation for Major Depressive Disorder: Smartphone-Based Ecological Momentary Assessment Study.

BACKGROUND: Behavioral activation (BA), either as a stand-alone treatment or as part of cognitive behavioral therapy, has been shown to be effective for treating depression. The theoretical underpinnings of BA derive from Lewinsohn et al's theory of depression. The central premise of BA is that having patients engage in more pleasant activities leads to them experiencing more pleasure and elevates their mood, which, in turn, leads to further (behavioral) activation. However, there is a dearth of empirical evidence about the theoretical framework of BA. OBJECTIVE: This study aims to examine the assumed (temporal) associations of the 3 constructs in the theoretical framework of BA. METHODS: Data were collected as part of the "European Comparative Effectiveness Research on Internet-based Depression Treatment versus treatment-as-usual" trial among patients who were randomly assigned to receive blended cognitive behavioral therapy (bCBT). As part of bCBT, patients completed weekly assessments of their level of engagement in pleasant activities, the pleasure they experienced as a result of these activities, and their mood over the course of the treatment using a smartphone-based ecological momentary assessment (EMA) application. Longitudinal cross-lagged and cross-sectional associations of 240 patients were examined using random intercept cross-lagged panel models. RESULTS: The analyses did not reveal any statistically significant cross-lagged coefficients (all P>.05). Statistically significant cross-sectional positive associations between activities, pleasure, and mood levels were identified. Moreover, the levels of engagement in activities, pleasure, and mood slightly increased over the duration of the treatment. In addition, mood seemed to carry over, over time, while both levels of engagement in activities and pleasurable experiences did not. CONCLUSIONS: The results were partially in accordance with the theoretical framework of BA, insofar as the analyses revealed cross-sectional relationships between levels of engagement in activities, pleasurable experiences deriving from these activities, and enhanced mood. However, given that no statistically significant temporal relationships were revealed, no conclusions could be drawn about potential causality. A shorter measurement interval (eg, daily rather than weekly EMA reports) might be more attuned to detecting potential underlying temporal pathways. Future research should use an EMA methodology to further investigate temporal associations, based on theory and how treatments are presented to patients. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02542891, https://clinicaltrials.gov/ct2/show/NCT02542891; German Clinical Trials Register, DRKS00006866, https://tinyurl.com/ybja3xz7; Netherlands Trials Register, NTR4962, https://www.trialregister.nl/trial/4838; ClinicalTrials.Gov, NCT02389660, https://clinicaltrials.gov/ct2/show/NCT02389660; ClinicalTrials.gov, NCT02361684, https://clinicaltrials.gov/ct2/show/NCT02361684; ClinicalTrials.gov, NCT02449447, https://clinicaltrials.gov/ct2/show/NCT02449447; ClinicalTrials.gov, NCT02410616, https://clinicaltrials.gov/ct2/show/NCT02410616; ISRCTN registry, ISRCTN12388725, https://www.isrctn.com/ISRCTN12388725.

I believe I can craft! introducing Job Crafting Self-Efficacy Scale (JCSES).

Job crafting is beneficial for employees and organizations. To better predict these behaviors, we introduce the concept of job crafting self-efficacy (JCSE) and define it as an individual's beliefs about their capability to modify the demands and resources of their job to better fit their needs. This article describes the development and validation of a scale to measure JCSE. We conducted a qualitative study to design and four quantitative studies to test the psychometric properties of this scale among Polish and American employees in both paper-and-pencil and online versions. Three independent (N1 = 364; N2 = 432; N3 = 403) confirmatory factor analyses demonstrated a good fit to a 3-factor solution comprising JCSE beliefs about increasing (a) structural job resources, (b) social job resources, and (c) challenging job demands. The 9-item JCSE Scale had good internal consistency, high time stability, and good validity. It correlated positively with general self-efficacy. JCSE explained unique variance in job crafting behaviors over and above general self-efficacy, and was more important in predicting job crafting than contextual factors. We demonstrate the role of social cognitions in shaping job redesign behaviors and provide a useful tool to evaluate the effectiveness of interventions dedicated to empowering JCSE.

Mediated effects of social support for healthy nutrition: fruit and vegetable intake across 8 months after myocardial infarction.

The authors investigated relationships among family support for healthy nutrition, fruit and vegetable intake, and social-cognitive mediators such as intention, self-efficacy, and planning. Participants were 130 myocardial infarction survivors (64% men) treated in 4 clinics in Poland. The authors collected self-reported data across 8 months during and after cardiac rehabilitation (at the beginning of rehabilitation, 2 weeks after rehabilitation, and 6 months later). Results indicate that directly after rehabilitation, less than 20% of patients met recommended guidelines for fruit and vegetable intake, with a further decrease in fruit and vegetable consumption over time (14% and 12% at follow-ups). Family support predicted patients' behavior at follow-up, with self-efficacy playing a mediating role. Although regular formation of action plans predicted fruit and vegetable intake, it did not mediate social support-behavior relationships.

[A job crafting measure: psychometric properties of the Polish version of the Job Crafting Scale]. / Narzedzie do pomiaru przeksztalcania pracy: Wlasciwosci psychometryczne polskiej wersji Job Crafting Scale.

BACKGROUND: The interest among researchers and practitioners in job crafting has been growing for the last dozen of years. Job crafting refers to behaviors that employees engage in to align aspects of their jobs with their own skills and needs. The aim of this paper was to analyze psychometric properties of the Polish version of a job crafting measure - the Job Crafting Scale (JCS). MATERIAL AND METHODS: The original JCS consists of 21 items and has 4 subscales: Increasing Structural Job Resources, Increasing Social Job Resources, Increasing Challenging Job Demands, and Decreasing Hindering Job Demands. Confirmatory factor analysis, internal consistency analysis, theoretical validity analysis and test-retest stability analysis were carried out among 249 white collar workers who use information and communication technology (ICT) in their daily work. Multigroup confirmatory factor analysis and invariance test were carried out among 228 white collar workers using ICT and additionally working in a team for most of the week. RESULTS: The Polish version of the JCS displays satisfactory internal consistency, theoretical validity, and test-retest stability. The results of the confirmatory factor analysis showed a 4-dimensional structure of the JCS. Four items were excluded from the Polish version of the JCS because of low factor loadings. The results of invariance test showed that factor loadings were invariant across groups. CONCLUSIONS: The Polish version of the JCS consists of 17 items and - like the original scale - has 4 subscales. Additional studies are recommended to confirm the internal structure of the JCS and measurement invariance across different occupational groups. Med Pr. 2019;70(4):445-57.

Positive Emotions at Work and Job Crafting: Results From Two Prospective Studies.

To date, research confirmed the effects of job crafting on the functioning of employees and organizations. In contrast, the evidence for the predictors of job crafting is limited. Based on broaden-and-build (B&B) theory, it may be assumed that high positive emotions at work would predict high job crafting behaviors at follow-ups. In line with social cognitive theory (SCT), it may be hypothesized that self-efficacy would mediate the relationship between positive emotions at work and following job crafting behaviors. The hypotheses were tested in a three-wave prospective study (Study 1, N = 124), with individual beliefs measured as the predictors. In a three-wave prospective Study 2 (N = 99), individual perceptions of collective flow at work and collective efficacy were assessed. Results of Studies 1 and 2 indicated that positive emotions at work predicted increasing structural resources, a job crafting dimension. Moreover, findings of Study 2 showed that collective flow at work predicted another job crafting dimension, i.e., increasing social resources. These results may inform good practices and help in designing individual- and team-level interventions enhancing job crafting behaviors.

Efficacy of an Internet-based intervention for job stress and burnout among medical professionals: study protocol for a randomized controlled trial.

BACKGROUND: Medical professionals are at high risk of job stress and burnout. Research shows that work-related stress can be reduced through enhancing psychological resources, in particular, self-efficacy and perceived social support. These psychological resources can operate either individually or sequentially: in line with the cultivation hypothesis, self-efficacy precedes and cultivates perceived social support, whereas according to the enabling hypothesis it is perceived social support that comes first and enables self-efficacy. Based on this theoretical framework we developed an internet-based intervention, Med-Stress, dedicated to healthcare providers and aimed at reducing job stress and burnout. Med-Stress contains two modules that enhance self-efficacy and perceived social support, which are tested in four variants reflected in four study conditions. We expect that sequential enhancement of resources: self-efficacy and social support or social support and self-efficacy will yield larger posttest results than individual enhancement. METHODS: In this four-arm randomized controlled trial we will test four variants of the Med-Stress intervention. The trial is open for professionally active medical providers aged at least 18 years (N = 1200) with access to an Internet-connected device. We will compare the effects of two experimental conditions reflecting cultivation and enabling effects of self-efficacy and perceived social support (sequential enhancement of resources), and two active controls strengthening self-efficacy or perceived social support. Job stress and job burnout will be the primary outcomes, whereas depression, job-related traumatic stress, and work engagement will be secondary ones. Additionally, we will measure perceived social support, self-efficacy to manage job stress and burnout, and the ability to obtain social support, exposure to traumatic events, and users' expectancy and credibility of the intervention. All assessments will be applied before the intervention, at posttest (at 3 or 6 weeks depending on the study condition), and at 6-month and 12-month follow up. In the case of experimental groups, additional measurements will be taken after enhancing each resource. DISCUSSION: Resource-based interventions are relatively context-free and could potentially benefit medical professionals across the field. If Med-Stress is successful, its most effective variant could be implemented in the healthcare system as a standalone, supportive tool for employees. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03475290 Registered on 23 March 2018.

Coping self-efficacy mediates the effects of negative cognitions on posttraumatic distress.

Although cognitive distortions have predicted posttraumatic distress after various types of traumatic events, the mechanisms through which cognitive distortions influence posttraumatic distress remain unclear. We hypothesized that coping self-efficacy, the belief in one's own ability to manage posttraumatic recovery demands, would operate as a mediator between negative cognitions (about self, about the world, and self-blame beliefs) and posttraumatic distress. In the cross-sectional Study 1, data collected among 66 adult female victims of child sexual abuse indicated that coping self-efficacy mediated the effects of negative cognitions about self and about the world on posttraumatic distress. The same pattern of results was found in a longitudinal Study 2, conducted among 70 survivors of motor vehicle accidents. Coping self-efficacy measured at 1 month after the trauma mediated the effects of 7-day negative cognitions about self and about the world on 3-month posttraumatic distress. In both studies self-blame was not related to posttraumatic distress and the effect of self-blame on posttraumatic distress was not mediated by coping self-efficacy. The results provide insight into a mechanism through which negative cognitions may affect posttraumatic distress and highlight the potential importance of interventions aimed at enhancing coping self-efficacy beliefs.

How job and family demands impact change in perceived stress: A dyadic study.

OBJECTIVES: The aim of this two-wave study has been to test the spillover and crossover of job and family demands on changes in perceived stress at work and in the family. Specifically, we proposed that demands from one domain (work or family) spilled over to another domain through interrrole conflict (work-family/family-work conflict) and context-specific self-efficacy. Additionally, we hypothesized that changes in perceived stress were impacted not only by a person's own demands through interrole conflict but also by the demands of one's significant other, in the process of crossover. MATERIAL AND METHODS: The study was of dyadic design and it was conducted online, among 130 heterosexual couples, at 2 time points separated by 3 months interval. Hypotheses were verified by means of the path analysis. RESULTS: No support was found for the spillover of job and family demands on changes in perceived stress through interrole conflict and self-efficacy, neither for women nor for men. With regard to the crossover, no support was found for the actor effects, i.e., a person's demands did not impact changes in one's own work- and family-related perceived stress but partial support was found for the partner effects, i.e., women's job demands were associated with men's changes in work and family-related stress through women's work-family conflict, and men's family demands were associated with women's change in family-related perceived stress through men's family-work conflict. CONCLUSIONS: The study is a longitudinal test of the Spillover-Crossover model and Work-Home Resources model demonstrating that job and family demands are transmitted across domains and across partners in the intimate relationships through the interrole conflict but the nature of this crossover is different for men and women. Int J Occup Med Environ Health 2018;31(2)199-215.

Interrole conflict and self-efficacy to manage work and family demands mediate the relationships of job and family demands with stress in the job and family domains.

BACKGROUND AND OBJECTIVES: This study derives from Work-Home Resources model (ten Brummelhuis, L. L., & Bakker, A. B. (2012). A resource perspective on the work-home interface: The work-home resources model. American Psychologist, 67(7), 545-556. doi: 10.1037/a0027974 ) and Social Cognitive Theory (Bandura, A. (1986). Social foundations of thought and action: A social cognitive theory. Englewood Cliffs, NJ, US: Prentice-Hall, Inc.) to investigate mechanisms responsible for the effect of job and family demands on work- and family-related perceived stress. We hypothesized that interrole conflict and self-efficacy to manage work and family demands operate either independently or sequentially transmitting the effects of demands on perceived stress. DESIGN: A sample of 100 employees of various occupations participated in the study conducted online in two waves: Time 1 (T1) and Time 2 (T2) with a three-month interval. METHOD: Regression analysis with bootstrapping was applied. RESULTS: Interrole conflict (T1) did not mediate the relationships between demands (T1) and perceived stress (T2), whereas self-efficacy (T1) mediated only those between family demands (T1) and stress (T2). However, data supported the sequential mediation hypotheses: Demands (T1) were associated with increased interrole conflict (T1) which in turn decreased self-efficacy (T1) and ultimately resulted in the elevated perceived stress at work and in the family (T2). CONCLUSIONS: Demands originating in one domain can impact stress both in the same and other life areas through the sequence of interrole conflict and context-specific self-efficacy.

Attitudes towards digital treatment for depression: A European stakeholder survey.

BACKGROUND: The integration of digital treatments into national mental health services is on the agenda in the European Union. The E-COMPARED consortium conducted a survey aimed at exploring stakeholders' knowledge, acceptance and expectations of digital treatments for depression, and at identifying factors that might influence their opinions when considering the implementation of these approaches. METHOD: An online survey was conducted in eight European countries: France, Germany, Netherlands, Poland, Spain, Sweden, Switzerland and The United Kingdom. Organisations representing government bodies, care providers, service-users, funding/insurance bodies, technical developers and researchers were invited to participate in the survey. The participating countries and organisations reflect the diversity in health care infrastructures and e-health implementation across Europe. RESULTS: A total of 764 organisations were invited to the survey during the period March-June 2014, with 175 of these organisations participating in our survey. The participating stakeholders reported moderate knowledge of digital treatments and considered cost-effectiveness to be the primary incentive for integration into care services. Low feasibility of delivery within existing care services was considered to be a primary barrier. Digital treatments were regarded more suitable for milder forms of depression. Stakeholders showed greater acceptability towards blended treatment (the integration of face-to-face and internet sessions within the same treatment protocol) compared to standalone internet treatments. Organisations in countries with developed e-health solutions reported greater knowledge and acceptability of digital treatments. CONCLUSION: Mental health stakeholders in Europe are aware of the potential benefits of digital interventions. However, there are variations between countries and stakeholders in terms of level of knowledge about such interventions and their feasibility within routine care services. The high acceptance of blended treatments is an interesting finding that indicates a gradual integration of technology into clinical practice may fit the attitudes and needs of stakeholders. The potential of the blended treatment approach, in terms of enhancing acceptance of digital treatment while retaining the benefit of cost-effectiveness in delivery, should be further explored. FUNDING: The E-COMPARED project has received funding from the European Union Seventh Framework Programme (FP7/2007-2013) under grant agreement no. 603098.