Personal and work-related factors associated with post-traumatic growth in nurses: A mixed studies systematic review.

INTRODUCTION: Nurses, assuming a wide range of clinical and patient care responsibilities in a healthcare team, are highly susceptible to direct and indirect exposure to traumatic experiences. However, literature has shown that nurses with certain traits developed a new sense of personal strength in the face of adversity, known as post-traumatic growth (PTG). This review aimed to synthesize the best available evidence to evaluate personal and work-related factors associated with PTG among nurses. DESIGN: Mixed studies systematic review. METHODS: Studies examining factors influencing PTG on certified nurses from all healthcare facilities were included. Published and unpublished studies were identified by searching 12 databases from their inception until 4th February 2023. Two reviewers independently screened, appraised, piloted a data collection form, and extracted relevant data. Meta-summary, meta-synthesis, meta-analysis, as well as subgroup and sensitivity analyses were performed. Integration of results followed result-based convergent design. RESULTS: A total of 98 studies with 29,706 nurses from 18 countries were included. These included 49 quantitative, 42 qualitative, and seven mixed-methods studies. Forty-six influencing factors were meta-analyzed, whereas nine facilitating factors were meta-summarized. A PTG conceptual map was created. Four constructs emerged from the integration synthesis: (a) personal system, (b) work-related system, (c) event-related factors, and (d) cognitive transformation. CONCLUSION: The review findings highlighted areas healthcare organizations could do to facilitate PTG in nurses. Practical implications include developing intervention programs based on PTG facilitators. Further research should examine the trend of PTG and its dynamic response to different nursing factors. CLINICAL RELEVANCE: Research on trauma-focused therapies targeting nurses' mental health is lacking. Therefore, findings from this review could inform healthcare organizations on the PTG phenomenon and developing support measures for nurses through healthcare policies and clinical practice.

Effectiveness of technology-based psychosocial interventions for improving health-related outcomes of family caregivers of stroke survivors: A systematic review and meta-analysis.

AIM: To synthesize evidence regarding the effectiveness of technology-based psychosocial interventions in improving health-related outcomes among family caregivers of stroke survivors. DESIGN: A systematic review and meta-analysis was reported by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. METHODS: Randomized controlled trials that investigated the effects of psychosocial interventions delivered through information and communication technologies on self-efficacy, caregiving competence, caregiver burden, perceived social support, anxiety, depression, health-related quality of life and cost-effectiveness were included. Two researchers independently selected studies, extracted data, and appraised the quality of the included studies. Subgroup analysis, sensitivity analysis, and narrative synthesis were conducted. DATA SOURCES: Ten electronic databases (PubMed, CENTRAL, Web of Science, Scopus, CINHAL, Embase, Institution of Electrical Engineers Xplore, Ovid Medline, PsycINFO, ProQuest Dissertations and Thesis) were searched up to February 2023. RESULTS: Nineteen studies involving 1717 participants fulfilled the eligibility criteria. Technology-based psychosocial interventions significantly improved self-efficacy (SMD = .62), caregiving competence (SMD = .55), depression (SMD = -.25) and anxiety (SMD = -.35). However, perceived social support, caregiver burden, and health-related quality of life did not show significant improvements. Subgroup analyses revealed that the interventions, lasting from 4 to 6 weeks and encompassing comprehensive contents, exhibited larger effect sizes. None of the studies measured cost-effectiveness. CONCLUSION: The technology-based psychosocial interventions are effective in enhancing self-efficacy and caregiving competence, as well as alleviating anxiety, and depression among family caregivers of stroke survivors. Future research should investigate interventions delivered through various digital platforms using well-designed RCTs with in-depth qualitative data collection and measurement of health and cost-effectiveness outcomes. IMPACT: Through psychosocial interventions, healthcare providers in clinical and community settings, particularly nurses, could incorporate technologies into current stroke care practices. PATIENT OR PUBLIC CONTRIBUTION: It is not applicable as this is a systematic review. REGISTRATION: The protocol was registered on PROSPERO (CRD42023402871).

Effectiveness of mindfulness-based interventions on mental, cognitive outcomes and neuroplastic changes in older adults with mild cognitive impairment: A systematic review and meta-analysis.

AIMS: To evaluate the effectiveness of mindfulness-based interventions (MBIs) on mental and cognitive outcomes including, anxiety, depression, attention, memory, global cognition and neuroplastic changes in older adults with mild cognitive impairment (MCI). DESIGN: Systematic review and meta-analysis. DATA SOURCE: A three-step search strategy was conducted on eight electronic databases, grey literature and reference lists from inception to February 2022. REVIEW METHODS: Randomized controlled trials (RCTs) examining MBIs on older adults with MCI were screened and assessed for risk of bias using the Cochrane Risk of Bias Tool. Meta-analysis was conducted using RevMan using a random-effect model. Narrative synthesis was performed for studies where results could not be pooled statistically. RESULTS: Ten RCTs were included in the review. Results suggested that right frontal parietal and left inferior temporal gyrus of the brain showed increased cortical thickness after receiving MBIs. There were significant interaction effects for global efficiency and significant interactions in the insular and gyrus regions. Functional connectivity between the posterior cingulate cortex, bilateral medial prefrontal cortex and left hippocampus were increased in participants undergoing MBIs. Nevertheless, meta-analysis showed non-significant pooled effects, favouring control groups on anxiety, depression, attention, memory and global cognition. CONCLUSION: This review suggested the potential effects of MBIs in improving cortical thickness and connectivity in regions associated with memory and attention. Nevertheless, the effects of MBIs compared to active control groups on depression, anxiety, attention, memory and global cognition are inconclusive due to the lack of studies and non-significant results. IMPACT: The review advocates for more rigorous studies with larger sample size and utilizing wait-list controls to evaluate the effects of MBIs. MBIs can be considered as an adjunct with other therapies to further enhance the effect on psychological and cognitive outcomes for older adults with MCI. No Patient or Public Contribution as this is a meta-analysis.

The experiences of spousal and adult child caregivers of stroke survivors in transitional care: A qualitative systematic review.

AIM: To synthesize and present the currently available literature on the experiences of spousal and adult child caregivers of stroke patients in transitional care. DESIGN: This is a qualitative systematic review. DATA SOURCES: Eight electronic databases (PubMed, CINAHL, Cochrane, Embase, Web of Science, PsychINFO, ProQuest and Scopus) were searched from September 2020 to April 2022 for relevant literature and grey literature. Qualitative studies exploring the experiences of sspousal or adult child caregivers of stroke survivors up till 1 year after discharge were included. REVIEW METHODS: The selection of articles was done by two independent reviewers who screened the titles and the abstracts of studies, and the full texts of selected articles. Quality appraisal and data extraction of selected articles were undertaken by two independent reviewers using Joanna Briggs Institute (JBI) critical appraisal tools. Data synthesis was conducted using a meta-aggregative approach recommended by JBI. RESULTS: A total of 19 papers were included in this review. A total of three synthesized findings centred around caregivers' experience with healthcare professionals, changes in their life roles and needs, effects of caregiving and how they adapted to their changes were aggregated. CONCLUSION: Spousal and adult child caregivers faced multiple barriers during transitional care, such as the lack of resources and an inability to cope with changes in their lives. Support and adequate preparation were key facilitators in easing stroke caregivers into their role. IMPACT: The findings from this review can be used to guide future implementations of caregiver education programmes and comprehensive discharge planning for stroke survivors.

Psychological impacts and online interventions of social isolation amongst older adults during COVID-19 pandemic: A scoping review.

AIM: To summarise the psychological impacts of social isolation amongst older adults during COVID-19 and review the benefits and limitations of online interventions used to combat social isolation. DESIGN: A scoping review was performed. DATA SOURCES: A systematic search was performed from October 2020 to January 2021 in seven electronic databases: China National Knowledge Infrastructure (CNKI), PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Cochrane Library and Web of Science. A hand search of the reference lists of included papers and WHO publications was performed. Grey literature search was carried out from Scopus, ProQuest Dissertation and Google Scholar. REVIEW METHODS: Studies were screened, appraised and extracted independently by two reviewers. Thematic analysis was used to synthesise data, which were presented in a descriptive manner and organised into categories and themes. RESULTS: Totally, 33 studies were included. Four themes and eight sub-themes emerged: (1) negative impacts and experiences of older adults during social isolation, (2) adopting coping behaviours in the midst of COVID-19, (3) online interventions to combat the consequences of social isolation, (4) barriers to online intervention. CONCLUSION: The COVID-19 pandemic has taken an emotional toll on older adults' psychological wellbeing and has highlighted the untapped strengths of older adults facing isolation. Online interventions, which could be a new normal in the COVID era, were beneficial in combating social isolation. Strategies by various stakeholders were recommended to tackle the barriers of online interventions. IMPACT: With the COVID-19 pandemic still in progress, this review provides insights on the psychological impacts of social isolation amongst older adults. Nurses in the community and long-term care facilities could adopt strategies and online intervention to better support the older adults, contribute to a stronger COVID-19 response and support system, and an overall better road to recovery from this crisis.

Effectiveness of technology-based interventions on psychological morbidities, quality of life for informal caregivers of stroke survivors: A systematic review and meta-analysis.

AIMS: To evaluate the effectiveness of technology-based interventions in reducing psychological morbidities such as depressive symptomology, anxiety, burden and improving quality of life and self-efficacy in informal caregivers of stroke survivors. DESIGN: A systematic review and meta-analysis. DATA SOURCES: An extensive search was systematically undertaken at CENTRAL, PubMed, Embase, Scopus, CINHAL, Web of Science and PsycInfo until January 2021. Grey literature and dissertations were searched in Google Scholar, ProQuest & Scholarbank@NUS. Studies involving registered trials were retrieved from Clinicaltrials.gov and CENTRAL, respectively. REVIEW METHODS: Two reviewers independently screened the trials, conducted quality appraisal and extracted the data. Quality of the studies included in the review was assessed using Cochrane Risk of bias tool. Meta-analysis was conducted using RevMan 5.4. Narrative synthesis was performed for studies where results could not be pooled statistically. The results were reported abiding Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS: This review included 15 trials with a total of 1276 informal caregivers of stroke survivors. Eleven trials were included in the meta-analysis. Subgroup analyses revealed that technology-based interventions with structured educational programs were statistically significant in reducing depressive symptoms (d = -0.27, 95% CI [-0.49 to -0.05], p = .02). Technology-based interventions with structured educational programs <3-month revealed significant effects (d = -0.31, 95% CI [-0.49 to -0.13], p = .0009). Results of narrative synthesis reported technology-based intervention with face-to-face training minimized depressive symptoms of informal caregivers. Notably, there were no statistically significant effects on anxiety, burden, quality of life and self-efficacy outcomes. CONCLUSION: Technology-based interventions had beneficial effects in alleviating depressive symptoms among informal caregivers. IMPACT: Technology-based interventions serve as a support mechanism for informal caregivers of stroke survivors who face time-constrains. Further high-quality randomized controlled trials are warranted to elucidate sustainability, optimal format and dosage of intervention.

Healing outcomes and predictors among patients with venous leg ulcers treated with compression therapy.

OBJECTIVE: This study aimed to compare the healing outcomes between three types of compression therapy-two-layer bandage (2LB), four-layer bandage (4LB), and compression stockings, and to identify the predictors of venous leg ulcer (VLU) healing. METHOD: A retrospective review of the medical records of patients diagnosed with VLU between 2011 and 2016 in Singapore was conducted. Univariate and multivariate analyses were done between healed and unhealed VLU patients at three and six months, based on potential factors, ranging from demographic profile to comorbidities and treatment-related variables. RESULTS: Data from 377 patients' medical records were analysed. The healing rates with the three types of compression system, 4LB, 2LB and compression stockings, were 22.3%, 34.9% and 8.7% respectively at three months; at six months they were 44.2%, 41.9% and 34.8% respectively. Patients on 2LB reported a significantly higher proportion of healed ulcers at three months (p=0.003) but at six months there was no difference in healing rates between the three types of therapy. At three and six months, the duration of compression therapy was found to be an independent predictor of healing (p<0.001). CONCLUSION: In this study, the 2LB appeared to show the most favourable healing outcome in the short-term but as VLUs persisted beyond the months, the type of compression system used did not make a difference in the healing outcome. Our findings suggested that, as the duration became more prolonged, VLUs became more resistant to healing despite compression therapy. Therefore, it may be necessary for clinicians to consider adjuvant therapies for hard-to-heal ulcers at an earlier stage.

Exploring the perceptions of cancer survivors of a mindfulness intervention at a tertiary hospital in Singapore: a descriptive qualitative study.

BACKGROUND: Cancer survivors often experience physical and psychological symptoms that may affect their daily activities and quality of life. A mindfulness-based psychoeducation for cancer survivors, (MindCAN) program, has been established to help cancer survivors manage their physical and psychological symptoms. This study aimed to explore perceptions of participants who attended the MindCAN program. METHODS: A descriptive qualitative study was conducted at a tertiary hospital in Singapore. Purposive sampling was used to recruit adult cancer survivors. They attended the MindCAN program that was conducted once a week for 8 weeks, comprising education and mindfulness practice. Two focus group interviews were conducted to elicit the participants' perceptions of the program. The interviews were audio-recorded and transcribed verbatim. A thematic analysis was performed to identify essential themes and subthemes. Trustworthiness, including creditability, confirmability, dependability, and transferability were ascertained. RESULTS: A total of 13 participants were recruited. Most of whom were Chinese, female, and single. The participants' perceptions were documented in five major themes: heightened awareness of the self, enriching body experiences through mindfulness practice, cultivating powerful minds and positive emotions, integrating mindfulness to daily life, and embracing interpersonal mindfulness. CONCLUSION: Overall, the MindCAN program received positive comments from cancer survivors. They reported increased self-awareness, pleasant body experiences, positive thinking and emotions, and relaxation. Future research is required to test the effectiveness of the program.

Effects of psychosocial interventions on psychological outcomes among caregivers of advanced cancer patients: a systematic review and meta-analysis.

PURPOSE: This systematic review aimed to synthesize the effectiveness of psychosocial interventions on caregivers of advanced cancer patients, in comparison with usual care, on caregivers' quality of life (QoL), anxiety, and depression symptoms. METHODS: Comprehensive searches for published and unpublished studies were performed using nine electronic databases, two trial registers, and reference lists of included studies. Two reviewers independently screened, appraised, and extracted data. The Cochrane risk of bias tool was used to appraise the methodological quality of included studies, while the Cochrane data extraction tool was used to elicit relevant information. Meta-analysis, narrative analysis, and sensitivity analysis were conducted to synthesize data. Standardized mean differences (SMD) represented effects of psychosocial interventions. RESULTS: Fifteen randomized controlled trials were included in this review. At post-intervention, findings revealed a significant small pooled effect size (SMD = 0.45) on QoL and significant moderate effect on depression (SMD = - 0.65). However, a small non-significant pooled effect size was observed on anxiety (SMD = - 0.24). At follow-up assessments, effect sizes of all outcomes were small and non-significant. Overall quality of evidence was rated very low for all outcomes and most studies had unclear or high risk of bias. Thus, results should be interpreted with caution. CONCLUSION: Psychosocial interventions were effective in improving QoL and depression among caregivers of persons with advanced cancer. However, future randomized control trials with lower risk of bias, larger sample size, detailed participant characteristics, and informative interventions are desirable.

Effectiveness of psychosocial interventions among older adults with mild cognitive impairment: a systematic review and meta-analysis.

OBJECTIVES: This review aimed to examine available evidence concerning the effectiveness of psychosocial interventions in improving memory, executive function, depression and activities of daily living (ADL) in older adults with MCI. METHODS: Eight electronic databases were used to conduct a comprehensive literature search for published and unpublished studies. A primary outcome was cognitive function, including memory and executive function. Secondary outcomes were depression and ADL. Two researchers independently appraised quality of included studies and extracted data. Meta-analysis, heterogeneity test, subgroup analysis and sensitivity analyses were performed. RESULTS: Ten studies (out of 1,265 records) were included in this review. Psychosocial interventions contributed to a significant improvement in memory, not executive function, depression and ADL. Subgroup analyses suggested that interventions with a longer duration, more therapeutic sessions, and individual format had larger effect sizes. Strategies found to enhance memory entailed behavior modification and activation, memory training, visual imagery, storytelling, memory aids, journaling, and exercise. CONCLUSION: Healthcare providers may offer psychosocial interventions to client with MCI in clinical settings. Higher quality trials should be conducted to increase solid evidence in this domain.

Evaluating the relationships among stress, resilience and psychological well-being among young adults: a structural equation modelling approach.

BACKGROUND: Resilience reflects individuals' ability to bounce back quickly in the face of stressful situations. Resilience is positively correlated with psychological well-being (PWB) and negatively related to poor mental health. However, there is limited longitudinal research to confirm the causal relationships between resilience and PWB. This study aimed to examine the relationships among stress, resilience, and PWB among youths in the Philippines across two samples. A descriptive comparative study was conducted and two repeated cross-sectional samples were recruited. Eligible participants were undergraduate students from a university in the Philippines regardless of sociological backgrounds. Data were collected via anonymous online questionnaires; and analyzed by using descriptive statistics and structural equation modelling (SEM). RESULTS: A total of 630 were recruited (Sample 1 = 221 and Sample 2 = 409). Most of whom were female, Filipino, Christian and students from Nursing School. Results from SEM indicated that the hypothesized two-group models had an adequate fit with sample data. Furthermore, perceived control and resilience were significant predictors of the autonomy & growth factor of PWB. Perceived stress and resilience significantly predicted the negative triad factor of PWB. These findings were comparable across the two samples providing strong evidence to support causal relationships among the study variables. CONCLUSION: There is a need to offer stress management interventions and resilience-based programs to enhance PWB. Additional research should be conducted to test the efficacy of the interventions.

Investigating the effects of a virtual reality-based stress management programme on inpatients with mental disorders: A pilot randomised controlled trial.

This study aimed to examine the effects and feasibility of a virtual screen-based stress management programme (V-DESSERTS) on inpatients with mental disorders. A single-blinded, pilot randomised controlled trial was conducted in a tertiary hospital in Singapore. Convenience sampling was used and participants were randomised into either the intervention group or the waitlisted control group (WL). The intervention group received individual-based, twice-daily sessions of the programme. Each session comprised education and virtual screen-based relaxation practice. Data were collected through self-reported questionnaires and physiological measures. The intervention group showed a significant increase in perceived relaxation and knowledge in comparison with the WL group. However, inconclusive results were observed on subjective and objective stress. The findings in this study indicated that the V-DESSERTS programme is feasible to be implemented for patients with schizophrenia, depression and bipolar disorders.

The effectiveness of mindfulness-based interventions among cancer patients and survivors: a systematic review and meta-analysis.

PURPOSE: Cancer is one of the leading causes of morbidity and mortality worldwide. Cancer negatively affects individuals' quality of life and overall health. Mindfulness-based interventions appear to be promising in the reduction of cancer-related and treatment-related symptoms. This review aimed to systematically summarize and synthesize the best available evidence concerning the effectiveness of mindfulness-based interventions on anxiety, depression, quality of life, fatigue, stress, posttraumatic growth, and mindfulness among adult cancer patients and survivors. METHODS: A literature search was conducted across 10 electronic databases. Only randomized controlled trials were eligible. Two reviewers independently screened the studies, extracted data, and performed quality assessment using the Cochrane risk of bias assessment tool. Meta-analyses were conducted using review manager software, and standardized mean difference (SMD) was used to determine intervention effects. Subgroup analyses were performed for cancer type, gender, and interventions. Heterogeneity was examined using the Chi2 and I2 statistics. RESULTS: Twenty-nine studies were included with a total of 3476 participants. Those who received mindfulness-based interventions reported significantly lower anxiety, depression, fatigue, and stress and greater quality of life, posttraumatic growth, and mindfulness than respondents in control groups. Mindfulness-based art therapy (MBAT) produced the strongest intervention effect on anxiety (SMD = - 2.48) and depression (SMD = - 2.21), followed by mindfulness-based stress reduction program (MBSR) and mindfulness-based care recovery (MBCR). The interventions were effective across different cancer types. CONCLUSION: Mindfulness-based interventions can be used as an adjuvant therapy for the management of cancer-related symptoms among cancer patients and survivors.

Online HOPE intervention on mental health literacy among youths in Singapore: An RCT protocol.

AIMS: The study aims to examine the effectiveness of the online HOPE intervention to increase mental health literacy (MHL), psychological well-being (PWB); and in reducing stress among youths aged 18-24 living in Singapore. DESIGN: The study will be conducted in two phases. The first phase will adopt a single-group pre-post repeated quasi-experimental research design. The second phase adopts a two-group, parallel randomized control trial, with a pre-test, posttest and follow-up. METHODS: The study will be conducted in a University in Singapore, in 2019-2021. Participants will be recruited and randomly assigned into one of the two groups. Approval from the institutional review board has been obtained in August 2019. Research funding from National Youth Fund has been obtained in November 2019. Outcome measures will be measured using Depression Literacy Questionnaire, Anxiety literacy Questionnaire, validated depression vignette, Ryff's PWB Scale and Perceived Stress Scale, at baseline, postintervention and 2 months' follow-up. Participants' perceptions of the intervention will be measured qualitatively. DISCUSSION: The online HOPE intervention had been developed based on the principles of the Self-Efficacy Theory. IMPACT: There is no research about MHL intervention in Singapore. Low MHL prevents early help-seeking and delays treatment. Hence, this study highlights the importance of mental health public education as primary care. Increased MHL will enhance early help-seeking behaviours, promoting early recovery and enhancing the health of the young people worldwide.

A "Journey to regain life" after joint replacement surgery: A qualitative descriptive study.

BACKGROUND: Prolonged preoperative waiting times from six months to two years for joint replacement surgery are detrimental to patients' quality of life due to increasing physical dysfunction, pain, joint stiffness, worsening mental health, and limited independence in daily life. AIM: This study explored the perceptions of elderly patients undergoing joint replacement surgery. METHOD: A qualitative descriptive design guided by the social cognitive theory was used to conduct repeated semi-structured interviews with 14 elderly participants at a local acute tertiary hospital in Singapore. FINDINGS: Three themes emerged from the data: (1) beginning of pain, (2) finding a solution, and (3) recovering from old body. CONCLUSIONS: While considering the cultural beliefs of the participants, the study highlighted the elderly participants' journey to regain life by sharing their experiences during the pre-operative, intra-operative and post-operative periods. In each of these phases, the triadic determinants of the social cognitive theory highlighted the importance of the interplay between the environment, person and behaviour.

Nurses' perception of knowledge, attitudes and reported practice towards patients with eating disorders: A concurrent mixed-methods study.

Eating disorders are complex disorders requiring specialised care, thus knowledge and attitudes are crucial for management. This study aims to examine nurses' knowledge, attitudes, reported practice, and perceptions towards patients with eating disorders in Singapore. A concurrent mixed-methods study was carried out in Southeast Asia's only psychiatric unit with eating disorders programme. Twenty nurses were recruited using census sampling. Quantitative data were analysed with descriptive and inferential statistics, while qualitative data were analysed with content and thematic analysis. Certain personal factors were associated with nurses' levels of perceived knowledge. Different attitudes towards managing these patients were identified during interview sessions.

Mental health literacy levels.

Globally, mental disorders affect 25% of the society. This discursive paper aims to illustrate the mental health literacy levels in the public. Mental health literacy (MHL) is the understanding of mental health conditions, which helps in their prevention, recognition and treatment. Unfortunately, the public has minimal understanding of mental disorders, leading to poor recognition and delay in treatment. There is a need to conduct good quality research to assess the MHL levels among public and tailor interventions to enhance MHL among the public. This will ensure early detection of mental disorders, leading to early recovery and greater quality of life among the society. Nurses have a great role to play in leading these public educations, and enhancing a healthy and happy nation.

Exploring predictors of medication adherence among inpatients with schizophrenia in Singapore's mental health settings: A non-experimental study.

Schizophrenia is a mental disorder, which is marked by frequent relapses. The main reason for relapse is nonadherence to antipsychotics. A cross-sectional, correlational research study was conducted with a convenience sample of 92 participants. The primary aim of this study was to explore the predictors of medication adherence among inpatients with schizophrenia hospitalised at tertiary hospitals in Singapore. Post-hoc analysis revealed that insight, religion, side effects, types of antipsychotics, social support from significant others, nurse-client relationship, were significant predictive factors. Results from this study added knowledge to the nursing literature about medication adherence of schizophrenia patients and in Singapore setting.

Therapist-Supported Internet-Based Cognitive Behavior Therapy for Stress, Anxiety, and Depressive Symptoms Among Postpartum Women: A Systematic Review and Meta-Analysis.

BACKGROUND: A growing number of meta-analyses have supported the application of therapist-supported Internet-based cognitive behavior therapy (iCBT) for psychological disorders across different populations, but relatively few meta-analyses have concentrated on postpartum women. OBJECTIVE: This meta-analysis evaluated the efficacy of therapist-supported iCBT in improving stress, anxiety, and depressive symptoms among postpartum women. METHODS: A total of 10 electronic databases were used to search for published and unpublished trials. Cochrane Collaboration tool for assessing risk of bias was utilized to measure methodological quality. Meta-analysis was performed using the RevMan software (Review Manager version 5.3 for Windows from the Nordic Cochrane Centre, the Cochrane Collaboration, 2014). Among the 789 studies identified, 8 randomized controlled trials were selected, involving 1523 participants across 6 countries. RESULTS: More than half (65%) of the eligible studies had a low risk of bias with no heterogeneity. Results revealed that therapist-supported iCBT significantly improved stress (d=0.84, n=5), anxiety (d=0.36, n=6), and depressive symptoms (d=0.63, n=8) of the intervention group compared with those of the control group at post-intervention. CONCLUSIONS: This review revealed that therapist-supported iCBT significantly improves stress, anxiety, and depressive symptoms among postpartum women with small to large effects. Future effectiveness studies should establish the essential components, format, and approach of iCBT with optimal levels of human support to maximize a long-term effect.

Knowledge, Attitudes and Challenges of Healthcare Professionals Managing People With Eating Disorders: A Literature Review.

This review consolidates findings regarding knowledge and attitudes of healthcare professionals, together with challenges faced while caring for patients with eating disorders. A rigorous and systematic approach was taken to identify 21 articles, which include 12 quantitative, 7 qualitative, and 2 mixed-method papers. Healthcare professionals' knowledge and attitudes toward patients with eating disorders will be discussed, while identifying if factors like age, gender, work experience or profession have an impact on these two variables. Challenges faced during care provision will also be examined. Methodological limitations and knowledge gaps from these articles will be discussed, together with implications of this review.