Scaling-up problem management plus for refugees in Switzerland - a qualitative study.

BACKGROUND: Refugees are at an increased risk of developing symptoms of mental disorders but face various structural and socio-cultural barriers to accessing mental health care. The SPIRIT project (Scaling-up Psychological Interventions in Refugees In SwiTzerland) seeks to promote the resilience of refugees and improve their access to mental health care. For this purpose, Problem Management Plus (PM+), an evidence-based low-intensity psychological intervention delivered by trained non-specialist "helpers", is being scaled-up in Switzerland. OBJECTIVE: To identify factors influencing the process of the large-scale implementation of PM + for refugees in Switzerland and to develop recommendations to guide the implementation process. METHODS: 22 semi-structured interviews were conducted with key informants (Syrian refugees who previously participated in PM+, PM + helpers, health professionals working with refugees and decision-makers from the migration, integration, social, and health sectors). The data were analyzed using thematic analysis, combining an inductive and deductive approach. RESULTS: The data revealed three major themes, which might have an impact for the longer-term implementation of PM + in Switzerland. First, preconditions for successful integration in the health system prior to scaling-up such as sustainable funding or the introduction of a stepped care approach. Second, the requirements for the PM + intervention supporting scale-up such as quality control during PM + delivery, PM + modality, time and setting when PM + is offered or the views on task sharing. Third, the perceived benefits of scaling-up PM + in Switzerland. CONCLUSIONS: Our results have shown that PM + must be scaled-up within a stepped care approach, including a functioning triage system and sustainable funding. Rather than selecting one modality or setting, it seemed preferable to offer a variety of formats and settings to achieve maximum reach and benefits. A successful scale-up of PM + in Switzerland might have various benefits. Communicating them to policy-makers and health providers, might enhance their acceptability of the intervention and their willingness to adopt PM + in regulatory structure and promote it.

Development of health care workers' mental health during the SARS-CoV-2 pandemic in Switzerland: two cross-sectional studies.

BACKGROUND: Virus outbreaks such as the current SARS-CoV-2 pandemic are challenging for health care workers (HCWs), affecting their workload and their mental health. Since both, workload and HCW's well-being are related to the quality of care, continuous monitoring of working hours and indicators of mental health in HCWs is of relevance during the current pandemic. The existing investigations, however, have been limited to a single study period. We examined changes in working hours and mental health in Swiss HCWs at the height of the pandemic (T1) and again after its flattening (T2). METHODS: We conducted two cross-sectional online studies among Swiss HCWs assessing working hours, depression, anxiety, and burnout. From each study, 812 demographics-matched participants were included into the analysis. Working hours and mental health were compared between the two samples. RESULTS: Compared to prior to the pandemic, the share of participants working less hours was the same in both samples, whereas the share of those working more hours was lower in the T2 sample. The level of depression did not differ between the samples. In the T2 sample, participants reported more anxiety, however, this difference was below the minimal clinically important difference. Levels of burnout were slightly higher in the T2 sample. CONCLUSIONS: Two weeks after the health care system started to transition back to normal operations, HCWs' working hours still differed from their regular hours in non-pandemic times. Overall anxiety and depression among HCWs did not change substantially over the course of the current SARS-CoV-2 pandemic.

Experimental Induction of Emotional and Sexual Intimacy: Exploring the Validity of the German Fast Friends Procedure in Individuals with and without Childhood Maltreatment.

The Fast Friends Procedure (FFP) is a widely used experimental paradigm to induce emotional intimacy. Besides exploring the validity of a German translation of the paradigm (n = 46), we developed an extension of the FFP that induces sexual intimacy and assessed heart rate, high-frequency heart rate variability, and electrodermal activity responses to the FFP and its extension. Furthermore, we examined its applicability to individuals with childhood maltreatment (n = 56), who frequently suffer from intimacy-related difficulties. Intimacy, positive affect, liking, and attraction increased during the FFP and partly during the sexual intimacy extension in both study groups. Moreover, both groups showed physiological responses consistent with positive social interactions. The use of the German FFP and its sexual intimacy extension can thus be recommended for research in the general population and in individuals with childhood maltreatment, although more studies are needed to further validate the paradigms.

Self-worth and bonding emotions are related to well-being in health-care providers: a cross-sectional study.

BACKGROUND: Interacting with patients can elicit a myriad of emotions in health-care providers. This may result in satisfaction or put providers at risk for stress-related conditions such as burnout. The present study attempted to identify emotions that promote provider well-being. Following eudaimonic models of well-being, we tested whether certain types of emotions that reflect fulfilment of basic needs (self-worth, bonding with patients) rather than positive emotions in general (as suggested by hedonic models) are linked to well-being. Specifically, we hypothesized that well-being is associated with positive emotions directed at the self, which reflect self-worth, and positive as well as negative emotions (e.g., worry) directed at the patient, which reflect bonding. However, we expected positive emotions directed at an object/situation (e.g., curiosity for a treatment) to be unrelated to well-being, because they do not reflect fulfilment of basic needs. METHODS: Fifty eight physicians, nurses, and psychotherapists participated in the study. First, in qualitative interviews, they reported their emotions directed at the self, the patient, or an object/situation during distressing interactions with patients. These emotions were categorised into positive emotions directed towards the self, the patient, and an object/situation, and negative emotions directed towards the patient that reflect bonding. Second, providers completed questionnaires to assess their hedonic and eudaimonic well-being. The well-being scores of providers who did and did not experience these emotions were compared. RESULTS: Providers who experienced positive emotions directed towards the self or the patient had higher well-being than those who did not. Moreover, for the first time, we found evidence for higher well-being in providers reporting negative patient-directed emotions during distressing interactions. There was no difference between providers who did and did not experience positive object/situation-directed emotions. CONCLUSIONS: These findings may point towards the importance of "eudaimonic" emotions rather than just positive emotions in interactions with patients. Emotions such as contentment with oneself, joy for the patient's improvement, and, notably, grief or worry for the patient may build a sense of self-worth and strengthen bonding with the patient. This may explain their association with provider well-being.

Construct validity of the German version of the Emotion Reactivity Scale.

BACKGROUND: Emotional reactivity is an important construct to consider when studying mental disorders. This study was conducted to translate and assess the factor structure, construct validity and internal consistency of a German version of the Emotion Reactivity Scale (ERS), which is an originally English questionnaire assessing three components of emotional reactivity: sensitivity, intensity and persistence of emotions. METHODS: The German ERS and a range of questionnaires used to assess convergent and discriminant validity were completed by 334 German speaking Swiss participants. RESULTS: Confirmatory factor analysis showed strong support for a bi-factor model, with evaluation indices pointing to a unidimensional construct rather than to domain specific factors. The questionnaire showed good reliability and the factor structure was similar across gender. The ERS showed convergent validity with general psychopathology, behavioral inhibition, negative affect, orienting sensitivity, depressive symptoms and symptoms of disordered eating, and discriminant validity with behavioral activation and alcohol consumption. CONCLUSIONS: Findings support the construct validity of the German ERS and suggest that it assesses a unidimensional construct with high internal consistency. Accounting for the unidimensional nature of the scale and aiming for efficient assessment tools, future research could, based on these findings, develop and evaluate the psychometric properties of a short version of the ERS.

Physician-Specific Symptoms of Burnout Compared to a Non-Physicians Group.

Physician burnout is a systemic problem in health care due to its high prevalence and its negative impact on professional functioning and individual well-being. While unique aspects of the physician role contributing to the development burnout have been investigated recently, it is currently unclear whether burnout manifests differently in physicians compared to the non-physician working population. We conducted an individual symptom analysis of burnout symptoms comparing a large sample of physicians with a non-physician group. In this cross-sectional online study, burnout was assessed with the Maslach Burnout Inventory-General Survey. We matched physicians with non-physicians regarding their age, gender, educational level, occupational status, and total burnout level using a "nearest neighbour matching" procedure. We then conducted a series of between-groups comparisons. Data of 3846 (51.0% women) participants including 641 physicians and 3205 non-physicians were analysed. The most pronounced difference was that physicians were more satisfied with their work performance (medium effect size (r = 0.343). Our findings indicate minor yet significant differences in burnout phenomenology between physicians and non-physicians. This demonstrates unique aspects of physician burnout and implies that such differences should be considered in occupational research among physicians, particularly when developing burnout prevention programs for physicians.

Adults with a history of childhood maltreatment with and without mental disorders show alterations in the recognition of facial expressions.

Background: Individuals with child maltreatment (CM) experiences show alterations in emotion recognition (ER). However, previous research has mainly focused on populations with specific mental disorders, which makes it unclear whether alterations in the recognition of facial expressions are related to CM, to the presence of mental disorders or to the combination of CM and mental disorders, and on ER of emotional, rather than neutral facial expressions. Moreover, commonly, recognition of static stimulus material was researched.Objective: We assessed recognition of dynamic (closer to real life) negative, positive and neutral facial expressions in individuals characterised by CM, rather than a specific mental disorder. Moreover, we assessed whether they show a negativity bias for neutral facial expressions and whether the presence of one or more mental disorders affects recognition.Methods: Ninety-eight adults with CM experiences (CM+) and 60 non-maltreated (CM-) adult controls watched 200 non-manipulated coloured video sequences, showing 20 neutral and 180 emotional facial expressions, and indicated whether they interpreted each expression as neutral or as one of eight emotions.Results: The CM+ showed significantly lower scores in the recognition of positive, negative and neutral facial expressions than the CM- group (p < .050). Furthermore, the CM+ group showed a negativity bias for neutral facial expressions (p < .001). When accounting for mental disorders, significant effects stayed consistent, except for the recognition of positive facial expressions: individuals from the CM+ group with but not without mental disorder scored lower than controls without mental disorder.Conclusions: CM might have long-lasting influences on the ER abilities of those affected. Future research should explore possible effects of ER alterations on everyday life, including implications of the negativity bias for neutral facial expressions on emotional wellbeing and relationship satisfaction, providing a basis for interventions that improve social functioning.

Child maltreatment (CM) in adults is linked to emotion recognition alterations if no current mental disorders are present.Interpretation of positive, negative and neutral facial expressions is impaired.Adults with a history of CM tend to interpret neutral expressions as negative.

Efficacy of a brief psychological intervention to reduce distress in healthcare workers during the COVID-19 pandemic: A randomized controlled trial.

INTRODUCTION: The COVID-19 pandemic has led to a sharp increase in mental health problems among healthcare workers (HCWs). Accessible interventions for HCWs are needed to reduce distress during the pandemic. OBJECTIVE: This study evaluated the efficacy of a brief psychological intervention (RECHARGE) delivered by videoconferencing to reduce psychological distress in HCWs. METHOD: This single-blind, parallel, randomized controlled trial enrolled HCWs in Switzerland who screened positive for psychological distress. Participants were randomly allocated to RECHARGE, that taught behavioral strategies or active treatment as usual (ATAU). Primary outcome was the total score on the Kessler Psychological Distress Scale (K10) measured at baseline, post-intervention, 2-month (primary outcome time point), and 6-month follow-up. Secondary outcomes included worry, anxiety and depression, burnout, traumatic stress, moral injury distress, and work performance. RESULTS: Between August 2020 and May 2021, 160 HCWs were enrolled in the study (RECHARGE = 82, ATAU = 78). Relative to ATAU, at 2 months RECHARGE led to a greater reduction in psychological distress (mean difference = 1.86, 95% confidence interval [CI .28, .34], p = .02; effect size = .37), and greater reductions in worry, burnout, and moral injury distress. These effects were not maintained at 6 months. CONCLUSIONS: This trial provides initial evidence that a brief psychological intervention delivered via videoconferencing results in significant reductions in mental health problems arising during the COVID-19 pandemic. Booster sessions or digital tools may be needed to maintain the initial gains achieved by RECHARGE. This intervention may have utility in improving the mental health of HCWs both during pandemics and everyday stressors. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Don't get too close to me: depressed and non-depressed survivors of child maltreatment prefer larger comfortable interpersonal distances towards strangers.

Background: Childhood maltreatment (CM) is frequently linked to interpersonal problems such as difficulties in social relationships, loneliness, and isolation. These difficulties might partly stem from troubles regulating comfortable interpersonal distance (CIPD). Objective: We experimentally investigated whether CM manifests in larger CIPD and whether all subtypes of CM (i.e., physical, emotional, or sexual abuse and physical or emotional neglect) affect CIPD. Methods: Using the stop-distance method (i.e. a team member approached participants until the latter indicated discomfort), we assessed CIPD in 84 adults with a self-reported history of CM (24 with depressive symptoms) and 57 adult controls without a history of CM (without depressive symptoms). Results: Adults with CM showed a larger CIPD (Mdn = 86 cm) than controls (Mdn = 68 cm), and CIPD was largest for those with CM combined with current depressive symptoms (Mdn = 145 cm) (p's < .047). In the latter group, all subtypes of CM were associated with a larger CIPD compared to controls (p's < .045). In the CM group without depressive symptoms, only those with emotional abuse (p = .040) showed a larger CIPD than controls. Conclusions: These results add to findings of differential socio-emotional long-term consequences of CM, depending upon the subtype of CM. Future research should explore whether a larger CIPD has a negative impact on social functioning in individuals exposed to CM, particularly in those with depressive symptoms. HIGHLIGHTS: Adults with child maltreatment (CM) prefer larger physical distances.• This effect is more pronounced in those with CM and depressive symptoms.• Troubled regulation of physical distance might contribute to interpersonal problems.

Altered sensorimotor processing in irritable bowel syndrome: Evidence for a transdiagnostic pathomechanism in functional somatic disorders.

Objective: A recent hypothesis suggests that functional somatic symptoms are due to altered information processing in the brain, with rigid expectations biasing sensorimotor signal processing. First experimental results confirmed such altered processing within the affected symptom modality, e.g., deficient eye-head coordination in patients with functional dizziness. Studies in patients with functional somatic symptoms looking at general, trans-symptomatic processing deficits are sparse. Here, we investigate sensorimotor processing during eye-head gaze shifts in irritable bowel syndrome (IBS) to test whether processing deficits exist across symptom modalities. Methods: Study participants were seven patients suffering from IBS and seven age- and gender-matched healthy controls who performed large gaze shifts toward visual targets. Participants performed combined eye-head gaze shifts in the natural condition and with experimentally increased head moment of inertia. Head oscillations as a marker for sensorimotor processing deficits were assessed. Bayes statistics was used to assess evidence for the presence or absence of processing differences between IBS patients and healthy controls. Results: With the head moment of inertia increased, IBS patients displayed more pronounced head oscillations than healthy controls (Bayes Factor 10 = 56.4, corresponding to strong evidence). Conclusion: Patients with IBS show sensorimotor processing deficits, reflected by increased head oscillations during large gaze shifts to visual targets. In particular, patients with IBS have difficulties to adapt to the context of altered head moment of inertia. Our results suggest general transdiagnostic processing deficits in functional somatic disorders.

Loneliness Is Associated with Depressive Affect, But Not with Most Other Symptoms of Depression in Community-Dwelling Individuals: A Network Analysis.

There is a strong relationship between loneliness and depression, but depression is a heterogeneous disorder. We examined the profile of depressive symptoms most strongly related to loneliness. Study participants were 2007 community-dwelling individuals (median age 31 years, 70.4% women) who completed an online survey on loneliness (single-item question: "never", "sometimes", "often"), depressive symptoms (Patient Health Questionnaire-9) and demographics. The relationship between loneliness and depressive symptoms was evaluated with linear regression and network analyses. The prevalence of loneliness (sometimes or often) and of moderate depression was 47.1% and 24.0%, respectively. Loneliness explained 26% of the variance in the total depressive symptom score (p < 0.001), independent of covariates. This result was almost exclusively explained by the relationship with a single depression symptom ("feeling down, depressed, or hopeless"), irrespective of whether loneliness was treated as a nominal or continuous variable. The findings of our study suggest that the role of loneliness in depression should not only be investigated at the syndrome level, but also at the symptom level. Studies are warranted to test whether targeted treatment of depressive affect is particularly effective against loneliness.

Emotion network density in burnout.

BACKGROUND: Health care workers are often affected by burnout, resulting in reduced personal well-being and professional functioning. Although emotional exhaustion is considered a core component of burnout, little is known about the dynamics of emotions and their relation to burnout. We used network analysis to investigate the correlation between the density of a negative emotion network, a marker for emotional rigidity in person-specific networks, and burnout severity. METHODS: Using an ecological momentary assessment design, the intensity of negative emotions of forty-three health care workers and medical students was assessed five times per day (between 6 am and 8 pm) for 17 days. Burnout symptoms were assessed at the end of the study period with the Maslach Burnout Inventory. Multilevel vector autoregressive models were computed to calculate network density of subject-specific temporal networks. The one-sided correlation between network density and burnout severity was assessed. The study protocol and analytic plan were registered prior to the data collection. RESULTS: We found a medium-sized correlation between the negative emotion network density and burnout severity at the end of the study period r(45) = .32, 95% CI = .09-1.0, p = .014). CONCLUSIONS: The strength of the temporal interplay of negative emotions is associated with burnout, highlighting the importance of emotions and emotional exhaustion in reaction to occupational-related distress in health care workers. Moreover, our findings align with previous investigations of emotion network density and impaired psychological functioning, demonstrating the utility of conceptualizing the dynamics of emotions as a network.

Health Care Workers' Mental Health During the First Weeks of the SARS-CoV-2 Pandemic in Switzerland-A Cross-Sectional Study.

Objective: The current SARS-CoV-2 pandemic poses various challenges for health care workers (HCWs). This may affect their mental health, which is crucial to maintain high quality medical care during a pandemic. Existing evidence suggests that HCWs, especially women, nurses, frontline staff, and those exposed to COVID-19 patients, are at risk for anxiety and depression. However, a comprehensive overview of risk and protective factors considering their mutual influence is lacking. Therefore, this study aimed at exploring HCWs' mental health during the SARS-CoV-2 pandemic in Switzerland, investigating the independent effect of various demographic, work- and COVID-related factors on HCWs' mental health. Methods: In an exploratory, cross-sectional, nation-wide online survey, we assessed demographics, work characteristics, COVID-19 exposure, and anxiety, depression, and burnout in 1,406 HCWs during the beginning of the SARS-CoV-2 pandemic in Switzerland. Network analysis was used to investigate the associations among the included variables. Results: Women (compared to men), nurses (compared to physicians), frontline staff (compared to non-frontline workers), and HCWs exposed to COVID-19 patients (compared to non-exposed) reported more symptoms than their peers. However, these effects were all small. Perceived support by the employer independently predicted anxiety and burnout after adjustment for other risk factors. Conclusion: Our finding that some HCWs had elevated levels of anxiety, depression, and burnout underscores the importance to systematically monitor HCWs' mental health during this ongoing pandemic. Because perceived support and mental health impairments were negatively related, we encourage the implementation of supportive measures for HCWs' well-being during this crisis.

Burnout, depression and anxiety among Swiss medical students - A network analysis.

It is well established that burnout in medical students is associated with depression and anxiety at a syndromal level. Moreover, there is an ongoing debate about the extent to which burnout overlaps with depression and anxiety. The emerging network approach to psychopathology offers a new perspective on the interrelations between mental disorders focusing on symptom-level association. In this cross-sectional study, we exploratively investigated the associations among burnout, depression, and anxiety in 574 swiss medical students using a network analytic approach for the first time. Symptoms of depression and anxiety were assessed with the Patient Health Questionnaire and Generalized Anxiety Disorder respectively. Burnout was assessed with two single-item questions, one referring to emotional exhaustion and the other to depersonalization. We found a dense network in which at least one dimension of burnout was related to eleven of the sixteen included symptoms. This suggests that burnout is closely related to depression and anxiety but also has its own characteristics. Notably, suicidal ideation was not associated with either emotional exhaustion or depersonalization after adjusting for the influence of the remaining symptoms of anxiety and depression. Hence, the well-documented relationship between burnout and suicidal ideation in medical students may be entirely mediated by the experience of anxiety and depression. Hence, the well-documented relationship between burnout and suicidal ideation in medical students might be fully mediated by the experience of anxiety and depression. The collection of the sample after the first wave of infections during the SARS-CoV2 pandemic and the non-representativeness of the investigated sample limit the study's generalizability.

Physical and psychological health of medical students involved in the coronavirus disease 2019 response in Switzerland.

Students involved in the COVID-19 response reported a similar proportion of COVID-19 symptoms or confirmed diagnoses, but lower levels of anxiety, depression and burnout compared with their non-involved peers.

Emotion Transfer, Emotion Regulation, and Empathy-Related Processes in Physician-Patient Interactions and Their Association With Physician Well-Being: A Theoretical Model.

Physicians experience many emotionally challenging situations in their professional lives, influencing their emotional state through emotion contagion or social appraisal processes. Successful emotion regulation is crucial to sustain health, enable well-being, foster resilience, and prevent burnout or compassion fatigue. Despite the alarmingly high rate of stress-related disorders in physicians, affecting not only physician well-being, but also outcomes such as physician performance, quality of care, or patient satisfaction, research on how to deal with emotionally challenging situations in physicians is lacking. Based on extant literature, the present article proposes a theoretical model depicting emotions, emotion regulation, and empathy-related processes and their relation to well-being in provider-client interactions. This model serves as a basis for future research and interventions aiming at improving physician well-being and professional functioning. As a first step, interviews with 21 psychiatrists were conducted. Results of qualitative and initial quantitative analyses provided detailed descriptions of the model's components confirming its usefulness for detecting mechanisms linking emotion regulation and well-being in psychiatrist-patient interactions. Additionally, results lend preliminary support for the validity of the model, suggesting that successful regulation of emotions (i.e., achieving a desired emotional state) elicited by cyclical transfer processes in provider-client interactions is associated with both short- and long-term well-being and resilience. Furthermore, empathy-related emotions and their regulation seem to be linked to well-being. Based on the results of the present study, a prospective longitudinal study is under preparation, which is intended to inform effective interventions targeting emotion transfer, empathy-related processes, and emotion regulation in physicians' professional lives. The model and results are also potentially applicable to other health care and social services providers.