Development and Evaluation of a Smartphone-Based Chatbot Coach to Facilitate a Balanced Lifestyle in Individuals With Headaches (BalanceUP App): Randomized Controlled Trial.

BACKGROUND: Primary headaches, including migraine and tension-type headaches, are widespread and have a social, physical, mental, and economic impact. Among the key components of treatment are behavior interventions such as lifestyle modification. Scalable conversational agents (CAs) have the potential to deliver behavior interventions at a low threshold. To our knowledge, there is no evidence of behavioral interventions delivered by CAs for the treatment of headaches. OBJECTIVE: This study has 2 aims. The first aim was to develop and test a smartphone-based coaching intervention (BalanceUP) for people experiencing frequent headaches, delivered by a CA and designed to improve mental well-being using various behavior change techniques. The second aim was to evaluate the effectiveness of BalanceUP by comparing the intervention and waitlist control groups and assess the engagement and acceptance of participants using BalanceUP. METHODS: In an unblinded randomized controlled trial, adults with frequent headaches were recruited on the web and in collaboration with experts and allocated to either a CA intervention (BalanceUP) or a control condition. The effects of the treatment on changes in the primary outcome of the study, that is, mental well-being (as measured by the Patient Health Questionnaire Anxiety and Depression Scale), and secondary outcomes (eg, psychosomatic symptoms, stress, headache-related self-efficacy, intention to change behavior, presenteeism and absenteeism, and pain coping) were analyzed using linear mixed models and Cohen d. Primary and secondary outcomes were self-assessed before and after the intervention, and acceptance was assessed after the intervention. Engagement was measured during the intervention using self-reports and usage data. RESULTS: A total of 198 participants (mean age 38.7, SD 12.14 y; n=172, 86.9% women) participated in the study (intervention group: n=110; waitlist control group: n=88). After the intervention, the intention-to-treat analysis revealed evidence for improved well-being (treatment: ß estimate=-3.28, 95% CI -5.07 to -1.48) with moderate between-group effects (Cohen d=-0.66, 95% CI -0.99 to -0.33) in favor of the intervention group. We also found evidence of reduced somatic symptoms, perceived stress, and absenteeism and presenteeism, as well as improved headache management self-efficacy, application of behavior change techniques, and pain coping skills, with effects ranging from medium to large (Cohen d=0.43-1.05). Overall, 64.8% (118/182) of the participants used coaching as intended by engaging throughout the coaching and completing the outro. CONCLUSIONS: BalanceUP was well accepted, and the results suggest that coaching delivered by a CA can be effective in reducing the burden of people who experience headaches by improving their well-being. TRIAL REGISTRATION: German Clinical Trials Register DRKS00017422; https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00017422.

[Specially protected or stereotyped? How persons older than 65 years experienced the COVID-19 pandemic]. / Besonders geschützt oder ausgestoßen? Wie Personen im Alter über 65 Jahre die Coronapandemie erlebten.

BACKGROUND: In the COVID-19 pandemic, in Switzerland people aged 65+ years were categorized as a high-risk group, as they are at higher risk of severe COVID-19 due to higher rates of underlying health conditions. This focused attention on older adults, mostly with respect to frailty and helplessness. What is lacking is older adults' subjective views, including their state of mind and their experiences. OBJECTIVE: This study explores the subjective view of older adults and aims to examine their everyday coping during the pandemic, particularly the concrete impacts on their lives, their self-assessment as a vulnerable group, and fears about COVID-19. MATERIAL AND METHODS: The longitudinal study was conducted from April to June 2020 using a mixed methods design comprising both closed and open-ended questions. We conducted guided biweekly interviews by telephone with 40 people (22 were women) aged 65-90 years. The quantitative data included descriptive analyses. The qualitative data were evaluated by structured content analysis with inductive category formation. RESULTS: The respondents reported little change in their everyday lives. Overall, a good mood was reported. Social restrictions were experienced as a great burden. The respondents perceived their classification as a risk group as undifferentiated and arbitrary. Fear or worry about contracting the coronavirus was low. DISCUSSION: Respondents appear to have coped much better with the crisis than public discourse suggested. Activities and routines as well as support services may have been protective as strategies in everyday life. The homogeneous classification of older adults as an at-risk group ignores their resources and promotes both negative stereotypes and ageism.

[Kindergarten Children's Use of Smartphones and Tablets: Associations with Social-Emotional Development and Behavioral Problems - A Scoping Review]. / Kindergartenkinder am Smartphone und Tablet: Zusammenhänge mit der sozial-emotionalen Entwicklung und Verhaltensproblemen ­ eine Scoping Review.

Young children's use of smartphones and tablets is increasingly prevalent. Smartphones and tablets are part of families' daily lives. Therefore, preschoolers are confronted with mobile devices as well, and learn to use them naturally. Specialists who work with children or deal with various aspects of early childhood development are alarmed and warn of resulting harmful effects. It is also feared that research on the impact of smartphone and tablet use on child development cannot keep pace with the rapid technological developments. This review therefore looks at associations between the use of mobile devices and social-emotional development as well as the emergence of behavioral problems in preschool children aged four to six years. A search of the literature was conducted in two databases, PsycInfo and Pubmed. Based on the title, abstract, and in some cases other parts of 861 articles, 7 articles were included.The seven articles are in different research areas, and each demonstrates important research approaches for the topic. An experimental case study with a learning app found benefits for young children's social behavior. On the other hand, a neuropsychological study pointed out that the social dimension of pretend play is missing when playing with a tablet. Other studies, cross-sectional and longitudinal, found certain associations between the use of digital devices and impaired social-emotional development as well as behavioral problems in preschool children and also identified mediators such as parental stress. In sum, however, the results do not provide a consistent picture of the role of smartphone use for social-emotional development and behavior problems in the preschool years. Further research that keeps pace with technology developments is needed.

[Can the GroupTherapy "Arriving" Support Refugee Mothers with their Young Children? Results from a Longitudinal Pilot Study]. / "Aacho" ­ ein niederschwelliges gruppentherapeutisches Angebot für geflüchtete Mütter mit Kleinkindern: Ergebnisse einer evaluativen Pilotstudie.

Refugee mothers are exposed to multiple sources of psychological distress given their migration histories and the experience of motherhood in a foreign country and often in social isolation. "Aacho" ("Arriving") is a psychoanalytic-oriented group therapy for refugee mothers with babies and toddlers in Switzerland.The present pilot study evaluated "Aacho" concomitantly and explored changes in the mothers' symptom burden, in the developmental status of their children, and in the quality of mother-child interaction. Five mother-child dyads participated in a longitudinal study with two to three time points. Mothers self-reported on symptomatology (HSCL, HTQ, SSS 8) and the groups' psychotherapists evaluated family functioning levels (HBS-L) and maternal levels of illness (CGI). In addition, the child's developmental level (Bayley-III) and the quality of mother-child interaction (CARE index) were assessed. The symptom burden of the mothers was severe over the entire study period with varying symptom development (decrease/increase). The children's language development tended to be delayed.The quality of mother-child interaction tended to increase over the study period. Refugee mothers with young children often experience severe psychological distress and require psychotherapeutic support that is specifically tailored to them. The evaluation of services offering such support poses specific methodological challenges.

Students' experience and adherence to containment measures during COVID-19 in Switzerland.

BACKGROUND: Young adults are not considered a risk group, but the public health response to COVID-19 impacts all citizens. We investigated the impact on young adults' and their adherence to containment measures addressing potential gender differences. METHODS: In April 2020 12 341 students of the Zurich University of Applied Sciences were invited to a longitudinal health survey. Survey topics spanned socio-demographic data, students' health status and behavior, COVID-19 specific impact, concerns, information sources, adherence to containment measures, and trust in government bodies. Group comparisons by gender and multivariate ordinal regression models assessing adherence to restrictions of mobility and social contacts were conducted (n = 2373). RESULTS: Mean age was 26.4 (SD = 5.6), 70% were female. 43.5% reported some concern about their own health, 2.7% stated major worries. Women experienced more conflicts (p < 0.000) and, enjoyed time with the family more (p < 0.000). Men felt less locked up (p = 0.001). The most frequented COVID-19 information source was public media (48%) and confidence in government bodies was high (82%) for both genders. Men yielded lower adjusted odds (OR; 95%-CI) of adherence regarding the following measures: social distancing (0.68; 0.53-0.87), non-utilization of public transport (0.74; 0.56-0.97), 5-person limit for social gatherings (0.47; 0.35-0.64) and the stay at home rule (0.64; 0.51-0.82). CONCLUSION: Early in the pandemic a high degree of adherence was observed in this young academic population. Containment measures restricting movement and social contact yielded considerable differences by gender, information source and perceived susceptibility to the virus. More targeted communication may increase adherence regarding mobility restrictions.

Smartphones in the nursery: Parental smartphone use and parental sensitivity and responsiveness within parent-child interaction in early childhood (0-5 years): A scoping review.

The omnipresence of smartphones has not stopped at the door to the nursery. It is especially important to better understand the impact of parental smartphone use on relationships at the beginning of children's lives. Babies and toddlers are essentially dependent on caregivers' sensitive and responsive behaviors within the context of the development of attachment patterns. Disturbances in parental sensitivity can have a negative impact on attachment-related interactional processes between parents and children and on child outcomes, such as self-regulatory capacity. The goal of this review is to compile existing research on the impact of parental mobile device use through technoference or absorption on parental sensitivity and responsiveness within parent-child interactions in the early years (0-5). We conducted a thorough search of the databases PsycInfo and PubMed, additionally consulting data sources such as Google Scholar and Google. In this review, we included 12 studies with a variety of methodical approaches. The research so far indicates that parental smartphone use may be associated with changes in parental sensitivity and responsiveness. Absorption in the device appears to contribute to this association more strongly than short interruptions of relating per se (technoference). However, to better understand these processes, more in-depth, longitudinal research is needed.

La omnipresencia de los teléfonos inteligentes no se ha detenido a la puerta de la guardería. En especial, es importante entender mejor el impacto del uso de teléfonos inteligentes por parte de los padres en sus relaciones al comienzo de las vidas de sus niños. Los bebés y niños pequeñitos son esencialmente dependientes del comportamiento sensible y atento de quienes les cuidan, dentro del contexto del desarrollo de patrones de afectividad. Las interrupciones en la sensibilidad de los padres pueden tener un impacto negativo en los procesos interaccionales relacionados con la afectividad entre padres y niños y en los resultados en el niño tales como la capacidad de autorregularse. El propósito de la presente revisión es compilar la investigación existente acerca del impacto que el uso de aparatos móviles por parte de los padres a través de la tecno-conferencia o absorción tiene sobre la sensibilidad y la atención dentro de las interacciones padres-niños en los primeros años (0-5). Llevamos a cabo una investigación exhaustiva de los bancos de datos PsycInfo y PubMed, consultando adicionalmente las fuentes de datos como el Investigador Google y Google. En esta revisión incluimos 12 estudios con una variedad de acercamientos metodológicos. La investigación hasta ahora indica que el uso de los teléfonos inteligentes por parte de los padres pudiera estar asociado con cambios en la sensibilidad y atención de los padres. La absorción en los aparatos parece contribuir a esta asociación más fuertemente que interrupciones cortas o relacionadas de por sí (tecno-conferencia). Sin embargo, para entender mejor estos procesos, se necesita una más profunda y longitudinal investigación.

L'omniprésence des téléphones smartphones ne s'est pas arrêtée à la porte de la chambre du bébé. Il est particulièrement important de mieux comprendre l'impact de l'utilisation parentale des smartphones sur les relations au début de la vie des enfants. Les bébés et les petits enfants sont essentiellement dépendants des comportements sensibles et réactifs des aidants naturels dans le contexte du développement de patterns d'attachement. Des perturbations de la sensibilité parentale peuvent avoir un impact négatif sur les processus interactionnels liés à l'attachement entre les parents et les enfants et sur les résultats de l'enfant, comme par exemple la capacité régulatoire. Le but de ce passage en revue est de compiler les recherches qui existent sur l'impact de l'utilisation parentale des appareils mobiles à travers la technoférence ou l'absorption sur la sensibilité parentale et la réaction au sein des interactions parent-enfant durant les premières années (0-5 ans). Nous avons fait une recherche approfondie des bases de données PsycInfo et PubMed, et également consulté des sources de données telles que Google Scholar et Google. Dans cette revue nous incluons 12 études avec une variété d'approches médicales. Jusqu'à présent les recherches indiquent que l'utilisation parentale du smartphone peut être lié à des changements dans la sensibilité parentale et la réaction. Le fait d'être absorbé par le téléphone semble contribuer à cette association plus fortement que de courtes interruptions à la relation en elle-même (technoférence). Cependant, afin de mieux comprendre ces processus, des recherches plus approfondies et longitudinales sont nécessaires.

[Adolescent Drop-Out from Psychodynamic and Cognitive-Behaviour Psychotherapy from the Therapist's Perspective: A Qualitative Interview Study in Germany and Switzerland]. / Therapieabbrüche Jugendlicher in psychodynamischer und kognitiv-verhaltenstherapeutischer Psychotherapie aus Therapeutensicht: Eine qualitative Interviewstudie in Deutschland und der Schweiz.

Therapy drop-outs in adolescence remain a prevalent and complex problem with inconsistent research findings: Although a number of possible predictors have been identified, such as difficult family situations and development-related autonomy efforts, the underlying mechanisms and processes are hardly explained. In this qualitative study, 24 interviews were conducted with resident child and youth psychotherapists. The therapists reported a self-chosen drop-out case from their practice. Additionally, they were asked about their views on what they consider typical for adolescent dropouts. The content analysis yielded factors relating to three topics as reasons for dropouts from the therapist's perspective. The area of therapy included themes such as setting variables or disagreement about therapy goals. The family and environment area included reasons concerning the family, e. g., lack of parental support or parents opposing therapy. Finally, reasons such as therapy being too demanding, lack of motivation or loyalty conflicts were assigned to the adolescents. To conclude, a sensitive handling seems to be necessary when trying to balance the adolescent's striving for autonomy and their therapeutic needs as well as finding the right dosage of parental involvement with parents who are often in need of treatment themselves.

The Impact of Patients' and Therapists' Views of the Therapeutic Alliance on Treatment Outcome in Psychotherapy.

This article reports about the role of psychotherapists in creating a good enough therapeutic alliance as the basic task for other therapeutic factors come into play. Data from a naturalistic study involving 237 patients treated by 68 psychotherapists using 10 different psychotherapy approaches were analyzed in a process-outcome research design. The results show that therapists had to adapt their alliance perspectives to patients' level of alliance ratings as treatments progressed. Treatment concepts did not play a role in outcome. The view of a similar quality of the therapeutic alliance seems to be an indispensable precondition for favorable treatment outcomes. Successful treatments were conducted more often by therapists who showed significant convergence of alliance ratings over time, whereas discrepant alliance ratings correlated significantly with unsuccessful treatments.

Attachment anxiety and avoidance as mediators of the association between childhood maltreatment and adult personality dysfunction.

This paper tests the hypothesis that the association between childhood maltreatment and adult personality dysfunction is at least partially attributable to insecure attachment, that is that attachment style mediates the relationship between childhood maltreatment and adult personality dysfunction. Associations between childhood trauma, as measured by the Childhood Trauma Questionnaire (CTQ), anxious and avoidant attachment in romantic relationships, as measured by the Experiences in Close Relationships-Revised (ECR-R), and five personality domains, as measured by the Severity Indices of Personality Problems (SIPP-118), were examined in a sample of 72 psychiatric inpatients. The SIPP-118 domains included relational capacities, identity integration, self-control, responsibility, and social concordance. The direct effect of childhood trauma on all SIPP-118 domains was not significant after controlling for the indirect effect of attachment. In regression modeling, a significant indirect effect of childhood trauma via adult attachment style was found for SIPP-118 relational capacities, identity integration, self-control, and social concordance. Specifically, anxious attachment was a significant mediator of the effect of childhood trauma on self-control, identity integration, and relational domains. These results suggest that childhood trauma impacts a broad range of personality domains and does so in large part through the pathway of anxious romantic attachment style.

Effects of sex and gender in ten types of psychotherapy.

OBJECTIVE: This paper addresses the results of two samples of a large naturalistic (effectiveness study) outpatient process-outcome study in Switzerland (Practice-Oriented Outpatient Psychotherapy Study). Ten different types of psychotherapy were investigated by looking at the role of the sex or gender of therapists and patients with regard to treatment outcome by including several nonspecific therapeutic factors. METHOD: Ten different types of psychotherapy, 237 patients, and 68 therapists were included in the study. A subsample of 116 cases was analyzed with regard to therapists' technical interventions. RESULTS: Sex and gender issues of both therapists and patients did not play a crucial role in any type of psychotherapy investigated. Gender issues appeared to play an indirect role. Female therapists intervene more empathically, whereas male therapists tend to use more confrontational techniques. CONCLUSIONS: Since the results show that therapists differ substantially with regard to their intervention techniques due to their sex, they should become more conscious of their interventions by considering patients' severity of psychological problems and patients' level of psychological functioning so as to not over or underchallenge them.

Factors influencing patients' recovery and the efficacy of a psychosocial post-discharge intervention: post hoc analysis of a randomized controlled trial.

PURPOSE: The aim of this post hoc analysis was to examine self-reported recovery following a post-discharge intervention and to focus on the moderators of this intervention programme. METHODS: RCT using parallel group block randomisation, including 151 patients with ≤3 hospitalisations within the last 3 years, a GAF score ≤60, and aged 18-64 years, assessed at two psychiatric hospitals from Zurich, Switzerland, between September 2011 and February 2014. In the present study, the main outcome was the OQ-45 as assessed prior to discharge from the index hospitalisation and at 12-month follow-up. Participants received either the post-discharge intervention provided by a social worker or treatment as usual (TAU). RESULTS: Patients in the intervention group showed substantially less recovery over the 12-month observation period than controls (d = 0.44). In the TAU group, 15.6 % remained clinically impaired at 12-month follow-up as opposed to 48.1 % in the intervention group (p = 0.001). Among participants in the intervention group, an interdisciplinary meeting of significant network members was associated with less recovery (d = 0.46). Involuntary index admission (d = 0.42) and high educational degree (d = 0.52) were significant moderators of the intervention. Both factors related to less recovery over time in the intervention group relative to TAU. CONCLUSIONS: According to the OQ-45, this psychosocial post-discharge intervention revealed an unintended negative effect on self-reported recovery over time. Specifically, the meeting of significant network members related to a moderate deteriorating effect, suggesting that the involvement of some carers, relatives, or friends may cause harm to the patient. Considering with reservation pending replication, these findings could have important implications for brief interventions targeted at patients' social networks. FUNDING: This study was supported by a private foundation. TRIAL REGISTRATION: ISRCTN58280620.

The Societal Costs of Schizophrenia in Switzerland.

BACKGROUND: Schizophrenia is a severe mental disorder that typically develops in early adulthood and becomes chronic in most cases. The disease is associated with elevated health care utilization, impaired functionality and the loss of life years and quality of life. The prevalence and costs of schizophrenia are not yet known for Switzerland. AIMS OF THE STUDY: This study aims to estimate the prevalence of schizophrenia in Switzerland and to assess its burden on patients, caregivers and society as a whole. METHODS: A hospital registry was combined with an outpatient physician survey and health insurance claims data to capture all patients living in the northern part of the canton of Zurich. Structured interviews with outpatient physicians were held to obtain information on outpatient care in private practices. Total costs included direct medical and nonmedical costs and lost production. All costs were calculated for the year 2012 from a societal perspective using a prevalence-based bottom-up approach. Intangible costs were expressed as quality-adjusted life years (QALY). Uncertainty and its sources were addressed in univariate and probabilistic sensitivity analyses. RESULTS: The point prevalence of schizophrenia in Switzerland was estimated at 0.39% of the population. The average costs of schizophrenia in 2012 were EUR 39,408 per patient. Lost production accounted for 64% (EUR 25,108) of the total cost of illness, direct medical costs for 24% (EUR 9,507) and care by relatives or in residential homes for the mentally ill for 12% (EUR 4,793). Inpatient hospital care amounted to EUR 6,242 per year or 66% of direct medical costs. DISCUSSION: The results show the high burden of schizophrenia on patients, caregivers and society. The prevalence estimate can be considered a lower bound because undiagnosed cases were not identified by our empirical strategy. The estimated costs are conservative because the costs of comorbidities were not considered. The strengths of this study are the full coverage of the sample region by a combination of different data sources and the careful evaluation of parameter uncertainty. The main limitation is the small sample size for the assessment of private practice outpatient care. IMPLICATIONS FOR HEALTH POLICIES AND FURTHER RESEARCH: The high costs of inpatient hospital care demonstrate the potential benefits of effectively preventing relapses associated with readmissions to inpatient care. Considering the high burden of lost production and the early onset of the disease, programs for reintegration into the labor market have high potential to reduce the costs of schizophrenia. Future research should address the evolution of costs over the disease course. This information would allow for assessing the cost-effectiveness of early detection and interventions that alter disease progression.

The role of therapists' treatment adherence, professional experience, therapeutic alliance, and clients' severity of psychological problems: Prediction of treatment outcome in eight different psychotherapy approaches. Preliminary results of a naturalistic study.

In this naturalistic study, 262 audiotaped psychotherapy sessions--randomly drawn from 81 individual therapies from eight different psychotherapy approaches--were rated completely on treatment adherence using a newly developed rating manual. In the therapy sessions, a relatively low percentage of treatment specific interventions (ranging from 4.2% to 27.8%) was found for all eight approaches, 50% to 73% of the interventions were nonspecific or common, and approximately 18% to 27% were intervention techniques from other approaches. Different types of psychotherapy differed highly significantly in levels of treatment adherence. There was no statistically significant association between the type of psychotherapy and its outcome, or between the degree of therapists' treatment fidelity and the treatment outcome. However, there were significant associations between therapists' degree of professional experience, clients' initial psychological burden, and treatment response. Clients' severity of psychological problems prior to treatment predicted quality of therapeutic alliance while therapists' treatment adherence was predicted by therapists' professional experience and by the quality of the therapeutic alliance. We discuss the seemingly indirect importance of treatment adherence for psychotherapy outcome that we found in this study in relation to findings from other studies and in the context of the role of schools within psychotherapy.

Trend in loneliness among Swiss university students during the first year of the COVID-19 pandemic.

BACKGROUND: The need to maintain physical and social distance between people and the stay-at-home recommendation/order to contain the spread of COVID-19 have raised concerns about the possible increase in loneliness. However, few studies have analyzed trends or changes in loneliness in samples of young adults. The present study aimed to explore the prevalence of loneliness and its change during the COVID-19 pandemic. PARTICIPANTS AND PROCEDURE: This is a repeated cross-sectional study analyzing data collected through six online surveys between April 2020 and March 2021 from 5,669 university students in Switzerland. Logistic regression models were used to examine trends in loneliness and associations between loneliness, well-being, life at home, COVID-19 symptoms and tests. RESULTS: Loneliness decreased between April 2020 and May-June 2020. In contrast, loneliness was higher in December 2020, January and March 2021 compared to April 2020. Loneliness was associated with younger age, studying architecture, design and civil engineering or engineering, enjoying time spent with family/partner, experiencing tensions and conflicts at home, boredom, feeling locked up and subjective well-being and current health. CONCLUSIONS: Our findings highlight an increase in loneliness during the second wave of the COVID-19 pandemic, although a seasonality effect cannot be excluded. Public health systems and educational institutions need to monitor the effects of social distancing measures and reduced social contact on students' loneliness and well-being.

Visually detected NREM Stage 2 sleep spindles in kindergarten children are associated with current and future emotional and behavioural characteristics.

Sleep electroencephalogram spindles are associated with efficient cortical-subcortical connectivity, and intellectual and learning abilities. In the present study, we assessed healthy preschoolers with a twofold aim: (i) to explore associations of non-rapid eye movement S2 spindles with emotional/behavioural characteristics cross-sectionally; and (ii) longitudinally. A total of 43 children who were 5 years old underwent objective sleep electroencephalogram monitoring in their homes. Emotional and behavioural dimensions were assessed by parents and teachers with the Strengths & Difficulties Questionnaire at baseline and at follow-up 1 year later. Non-rapid eye movement S2 spindles were visually scored and compared with Strengths & Difficulties Questionnaire dimensions. High non-rapid eye movement S2 spindle density was associated with less internalizing behaviour, more prosocial behaviour and a low total problem score. In girls, high non-rapid eye movement S2 spindle density was related to low hyperactivity, while in boys it was associated with less internalizing behaviour, more externalizing behaviour and more hyperactivity. Longitudinally, a higher number of non-rapid eye movement S2 spindles at 5 years old predicted fewer peer problems 12 months later. In kindergarten children, high non-rapid eye movement S2 spindle density is associated with observable current and future favourable emotional/behavioural patterns. However, gender differences were also found, as should be taken into account in future studies.

Network coordination following discharge from psychiatric inpatient treatment: a study protocol.

BACKGROUND: Inadequate discharge planning following inpatient stays is a major issue in the provision of a high standard of care for patients who receive psychiatric treatment. Studies have shown that half of patients who had no pre-discharge contact with outpatient services do not keep their first outpatient appointment. Additionally, discharged patients who are not well linked to their outpatient care networks are at twice the risk of re-hospitalization. The aim of this study is to investigate if the Post-Discharge Network Coordination Program at ipw has a demonstrably significant impact on the frequency and duration of patient re-hospitalization. Subjects are randomly assigned to either the treatment group or to the control group. The treatment group participates in the Post-Discharge Network Coordination Program. The control group receives treatment as usual with no additional social support. Further outcome variables include: social support, change in psychiatric symptoms, quality of life, and independence in daily functioning. METHODS/DESIGN: The study is conducted as a randomized controlled trial. Subjects are randomly assigned to either the control group or to the treatment group. Computer generated block randomization is used to assure both groups have the same number of subjects. Stratified block randomization is used for the psychiatric diagnosis of ICD-10, F1. Approximately 160 patients are recruited in two care units at Psychiatrie-Zentrum Hard Embrach and two care units at Klinik Schlosstal Winterthur. DISCUSSION: The proposed post-discharge network coordination program intervenes during the critical post-discharge period. It focuses primarily on promoting the integration of the patients into their social networks, and additionally to coordinating outpatient care and addressing concerns of daily life. TRIAL REGISTRATION ISRCTN: ISRCTN58280620.

Estimating the prevalence and characteristics of people in severe social isolation in 29 European countries: A secondary analysis of data from the European Social Survey round 9 (2018-2020).

The main aim of the present study was to estimate the prevalence of people in severe social isolation as a proxy for high risk of hikikomori using data from 29 European countries. The relationship between the presence/absence of severe social isolation and demographic and psychosocial variables was also investigated. Publicly available data from the European Social Survey (ESS) round 9 collected between August 2018 and January 2020 were used. Data from the ESS round 1 (September 2002 -December 2003) and round 10 (September 2020 -May 2022) were also examined to investigate changes in the prevalence of severe social isolation over time. Analyses were restricted to the working-age population (15-64 years). A complex sampling design to obtain weighted prevalence and results was used. The study protocol was preregistered online on the Open Science Framework (https://osf.io/6a7br/). The weighted prevalence of severe social isolation was 2.01% for the sample from the ESS 1, 1.77% for the sample from the ESS 9, and 1.71% for the sample from the ESS 10, indicating a decrease over time, mainly in males. Logistic regression models showed that different sociodemographic factors (e.g., being retired, being permanently sick or disabled, doing housework, living in Central and Eastern Europe, living uncomfortably on household income, having no income) were associated with severe social isolation. Further, feeling unsafe when walking alone in the neighbourhood after dark, low social trust, and support, decreased happiness and lack of future planning correlated with severe social isolation after adjustment for the effect of sociodemographic factors was made. In this study, the prevalence of severe social isolation as a proxy for hikikomori in European countries is in line with that found by previous representative studies conducted in Asian countries. The novelty of the findings as well as implications for hikikomori research are discussed according to recent scientific literature.

Factors Related to Non-compliance With Non-pharmaceutical Interventions to Mitigate the Spread of SARS-CoV-2: Results From a Survey in the Swiss General Adult Population.

Background: Non-pharmaceutical interventions (NPI) play an important role in national efforts to control and contain the spread of SARS-CoV-2, but some people do not comply with these public health measures. The aim of this study was thus to describe this group of noncompliant people. Methods: A random sample of 1,157 people was drawn from the adult general population of Switzerland based on a three-stepped quota scheme considering the variables age (18-31, 32-45, 46-59, and ≥60 years), sex (male and female), and language region (German-, French-, and Italian-speaking Switzerland). We assessed a global scale of non-compliance with NPI based on several individual measures such as wearing face masks and social distancing. As predictor variables we included objective sociodemographic variables (e.g., age, sex) and easy measurable constructs (e.g., fears and worries about COVID-19, trust in medical experts). Results: Out of 14 predictor variables tested, seven were statistically significantly associated with increased non-compliance with NPI: male sex, younger age, self-identification as low-risk group, judging the consequences of an infection with SARS-CoV-2 as non-serious, less worries and fears about the pandemic, not obtaining regular information from health authorities, and not trusting in medical experts. The most parsimonious multivariable prediction model included the variables younger age, low appraisal of negative consequences, less fear and worries, not obtaining regular information from health authorities, and not trusting in medical experts. The model accounted for 27.9% of variance explained in non-compliance with NPI. Conclusion: Young adults who perceive COVID-19 as mostly harmless/inconsequential and who ignore and/or mistrust information from health authorities and medical experts, are the population most likely to be noncompliant with NPI. These findings may help to target a group of people at high risk of infection and to efficiently concentrate educational and interventional public health measures.

Change in Alcohol Consumption and Binge Drinking in University Students During the Early COVID-19 Pandemic.

Objectives: Young adults have been overly affected by the containment measures against COVID-19 and, consequently, worsening in mental health and change in health behavior have been reported. Because the life phase of emerging adulthood is crucial for developing health behaviors, this study aims to examine increase in alcohol consumption, single and multiple binge drinking, and associated factors in students during lockdown and post-lockdown periods. Methods: A prospective open cohort study design with nine survey time points between April 2020 and June 2021 was conducted. The present study uses pooled data from the first survey T0 (3 April to 14 April) and follow-ups at T1 (30 April to 11 May 2020) and T2 (28 May to 8 June 2020). Students from all faculties of the Zurich University of Applied Sciences (ZHAW) (N = 12'431) were invited. Of the 1,300 students who participated at baseline and in at least one follow-up, 1,278 (98.3%) completed the questionnaires, final net sample size was 947. Generalized Estimating Equations (GEE) models were used to investigate the factors associated with increases in alcohol consumption based on number of occasions/last 30 days; drinks/week, and binge drinking at T0, and respective changes at T1 and T2 (increases, decreases, no change). Results: Overall, 20% of Swiss university students reported an increased alcohol consumption and 26% engaged in binge drinking. Number of drinks at baseline was associated with a higher probability of increased alcohol consumption, as well as engaging in single and multiple binge drinking events. Higher anxiety scores were associated with a higher probability to increase the alcohol consumption and engaging at least once in binge drinking. Additional factors associated with any binge drinking were male gender, younger age and not living with parents. Higher perceived social support was only associated with engaging in heavy binge drinking. Conclusions: A substantial number of students developed a more risky health behavior regarding alcohol consumption. It is important to identify at risk students and design target prevention including factors such as age, gender and social norms. Further, health behavior and determinants of health behaviors of students should be carefully monitored during the further course of the pandemic.

Generalized Anxiety among Swiss Health Professions and Non-Health Professions Students: An Open Cohort Study over 14 Months in the COVID-19 Pandemic.

To date, little is known about the long-term trajectory of generalized anxiety disorder (GAD) symptoms in health professions (HP) students over the course of the pandemic. Like health professionals in general, HP students may have a significantly greater susceptibility to GAD symptoms due to their involvement in the health care system and the associated specific stressors and risks during the COVID-19 pandemic. The HEalth in Students during the Corona pandemic study (HES-C) provided the opportunity to investigate the long-term course of GAD symptoms with eight measurement points over 14 months in 9380 HP and non-HP students in Switzerland between March 2020 and June 2021. We employed logistic regression models with clustered sandwich standard errors to estimate unadjusted and adjusted prevalence of GAD symptoms. In the full model, we adjusted for age, gender, nationality, social status, social support, self-efficacy, and COVID-19 symptoms in the past 4 weeks. At baseline, the estimated adjusted GAD symptom prevalence was 17.6% (95% CI = 14.4-20.7) in HP students and 24.4% (95% CI = 22.3-26.5) in their peers. With the peak of the second SARS-CoV-2 infection wave in October/November 2020, GAD symptom prevalence substantially increased and then remained stable over time, despite changes in the epidemiological situation and its associated containment measures. At the last follow-up in June 2021, GAD symptom prevalence in HP and non-HP students was 22.9% (95% CI = 16.3-29.5) and 36.9% (95% CI = 32.9-40.9), respectively. Absolute differences in GAD symptom prevalence between student groups over all eight measurement points ranged from 6.2% to 14.9% (all p < 0.05). Non-HP students are identified as a specifically vulnerable group. Accordingly, target group-specific public health campaigns and interventions should be developed with the aim to strengthen their resources, reducing GAD symptoms, and preventing chronification.