Mental health and health-related quality of life among healthcare workers in Indonesia during the COVID-19 pandemic: a cross-sectional study.

OBJECTIVES: Healthcare workers (HCWs) are the front lines during the COVID-19 pandemic. They are more exposed to COVID-19 than other professions. Studies from other countries have shown that the mental health and health-related quality of life (HRQoL) of HCWs were affected during this pandemic. However, studies on mental health in Indonesia remain scarce and no study has evaluated the HRQoL among HCWs. Thus, this study was designed to explore the mental health status and HRQoL among HCWs in Indonesia. DESIGN: This was a cross-sectional study. SETTING: This was an open online survey in Indonesia conducted from December 2020 to February 2021. PARTICIPANTS: This study involved HCWs who worked during the COVID-19 pandemic. Of the 502 respondents who accessed the online questionnaire, 392 were included in the analysis. OUTCOMES: Mental health status was measured using the 21-item Depression, Anxiety and Stress Scale and HRQoL was measured using the second version of the 12-item Short-Form Health Survey (SF12v2). RESULTS: The prevalence of depression, anxiety and stress among HCWs was 29.4%, 44.9% and 31.8%, respectively. Using the SF12v2 questionnaire, 354 (90.3%) HCWs were found to have impaired physical component and 156 (39.8%) HCWs have impaired mental component. CONCLUSION: The prevalence of mental health problems among HCWs was high in Indonesia. HRQoL, particularly the physical component, was affected in most HCWs. Thus, policymakers should give more attention to the mental health and HRQoL of HCWs during the COVID-19 pandemic.

Health professionals' attitudes toward religiosity and spirituality: a NERSH Data Pool based on 23 surveys from six continents.

Background In order to facilitate better international and cross-cultural comparisons of health professionals (HPs) attitudes towards Religiosity and/or Spirituality (R/S) we updated the NERSH Data Pool. Methods We performed both a network search, a citation search and systematic literature searches to find new surveys. Results We found six new surveys (N=1,068), and the complete data pool ended up comprising 7,323 observations, including 4,070 females and 3,253 males. Most physicians (83%, N=3,700) believed that R/S had "some" influence on their patients' health (CI95%) (81.8%-84.2%). Similarly, nurses (94%, N=1,020) shared such a belief (92.5%-95.5%). Across all samples 649 (16%; 14.9%-17.1%) physicians reported to have undergone formal R/S-training, compared with nurses where this was 264 (23%; 20.6%-25.4%). Conclusions Preliminary analysis indicates that HPs believe R/S to be important for patient health but lack formal R/S-training. Findings are discussed. We find the data pool suitable as a base for future cross-cultural comparisons using individual participant data meta-analysis.

Physicians' religious/spiritual characteristics and their behavior regarding religiosity and spirituality in clinical practice: A meta-analysis of individual participant data.

BACKGROUND: Religiosity and/or spirituality (R/S) of physicians have been reported to inform behavior regarding religiosity and spirituality in clinical practice (R/S-B). Our aim was to study this association. METHODS: Building upon a large international data pool of physician values we performed network and systematic literature searches using Google Scholar, Web of Science, Embase, Medline, and PsycInfo. Measures for R/S and R/S-B were selected for comparability with existing research. We performed a two-stage IPDMA using R/S coefficients from sample-wise multiple regression analyses as summary measures. We controlled for age, gender, and medical specialty. An additional sub-analysis compared psychiatrists to non-psychiatrists. RESULTS: We found 11 eligible surveys from 8 countries (n = 3159). We found a positive association between R/S and R/S-B with an overall R/S coefficient of 0.65 (0.48-0.83). All samples revealed a positive association between R/S and R/S-B. Only 2 out of the 11 samples differed from the overall confidence interval. Psychiatrists had a higher degree of R/S-B, but associations with R/S did not differ compared to non-psychiatrists. CONCLUSIONS: We confirmed a significant association between R/S and R/S-B in this study. Despite large cultural differences between samples, coefficients remained almost constant when controlling for confounders, indicating a cultural independent effect of R/S on R/S-B, which to our knowledge has not been documented before.Such interaction can constitute both facilitators and barriers for high quality health care and should be considered in all aspects of patient and relationship-centered medicine.

Relationship between disability and pain to post-traumatic stress disorder, depression, and anxiety in patient with postoperative brachial plexus injury (BPI).

BACKGROUND: Orthopedic trauma patients have the risk to experience mental disorders, including depression, anxiety, post-traumatic stress disorder (PTSD), and other mental disorders. However, studies that analyze the relationship between mental disorders in orthopedic trauma patients, especially post-operative brachial plexus injury (BPI), are still difficult to find. This study aims to evaluate the relationship between disability and pain to post-traumatic stress disorder, depression, and anxiety in patient with postoperative BPI. MATERIALS AND METHODS: It was an observational analysis with cross-sectional design study. Data were collected from July 2019 to September 2019. All subjects were patients of Orthopedics Clinic Dr. Soetomo General Academic Hospital Surabaya. The Disabilities of the Arm, Shoulder, and Hand (DASH) score was used to determine the disability level in patients. Visual Analog Score (VAS) was an instrument for assessing pain scale and mental disorders used Mini International Psychiatry Interview (MINI). RESULTS: There were 41 subjects met the research criteria, consisted of 10 men (24.39%) and 31 women (75.61%), aged 12-63 years. Based on the status of education, most subjects were graduated from junior/senior high school with 28 subjects (68.29%). The most common cause of BPI was traffic accidents as many as 37 people (90.24%). Mental disorders diagnosed from MINI found ten people (24.39%) were diagnosed with major depression; two subjects (4.87%) had generalized anxiety disorder. The average VAS score was 5.15 and the average DASH score was 52.02. There was no significant difference in VAS scores in the major depression group and PTSD group. However, there was an association between DASH score and depression (p < 0.05). Surprisingly, this study found the risk of suicide among BPI (7.3%) and one person with psychotic disorders (2.43%). CONCLUSION: The level of disability and pain in orthopedic trauma patients with depression tend to more severe than without depression.

The International NERSH Data Pool of Health Professionals' Attitudes Toward Religiosity and Spirituality in 12 Countries.

The amount of research concerned with the values of health professionals (HPs) is steadily growing. Around the world HPs face similar challenges when patients express their existential and spiritual views. How HPs engage these views, and the degree of embedment into consultations, differ across cultures. Today, more than ever before, researchers in this field need to share experiences and build new knowledge upon local findings. To meet this demand, we founded the international collaboration "Network for Research on Spirituality and Health" ( https://NERSH.org ). One of the central projects of our network has been to build a large international data pool of health professionals' attitudes toward religiosity and spirituality. Today the data pool hosts answers from more than 6,000 health professionals from 17 separate surveys derived from 12 countries. Data were gathered by either the questionnaire "Religion and Spirituality in Medicine, Perspectives of Physicians" (RSMPP) or its successor 'NERSH Questionnaire'. In this article we describe the methodology behind the construction of the data pool. We also present an overview of five available scales related to HP religiosity and spirituality, including a description of scale reliability and dimensionality.

Correlation between depression level and headache severity: A study among medical students during the COVID-19 pandemic.

Headache is the most prevailing disorder and the third leading cause of disability worldwide. The prevalence of primary headaches has been reported to increase by 2-4 times in patients with psychiatric comorbidities, including depression. This study sought to assess the correlation between depression level and headache severity among medical students. To the best of our knowledge, this is the first study to evaluate the correlation between depression level and headache severity in Indonesia. A cross-sectional study was conducted among students of Airlangga University in 2021. To evaluate the level of depression and the severity of headache, Depression Anxiety Stress Scales (DASS-42) and Headache Impact Test 6 (HIT-6) were used, respectively. A set of validated questionnaires were used to assess students' demographic characteristics. A total of 82 medical students were included in this study and most of them were female (86.6%). The third-semester students represented the highest proportion (45.2%) of subjects. The mean age and body mass index (BMI) were 19.88 ± 1.03 and 22.55±4.44, respectively. The average DASS-42 score was 10.98±11.47 which indicated a mild depression level. The average HIT-6 score was 45.74±6.130 which revealed a mild impact. The data of Spearman correlation suggested that headache severity was significantly correlated with depression level (r=0.396, p<0.001). This study provides insights on the importance of stress management and depression prevention to decrease the risk of headache, and vice versa.

Determinants of Tobacco Smoking Addiction in Rural Indonesian Communities.

Purpose: To analyze the determinants of tobacco smoking addiction in rural areas. Methods: A cross-sectional study was conducted on February 2020. The self-administered questionnaire (α = 0.908) and Perceived Stress Scale-10 were used as tobacco smoking determinants and the WHO ASSIST questionnaire V3.0 to determine its addiction risk. Their correlations were analyzed by Spearman's rank-order approach using the SPSS version 23.0. Results: Among 75 male respondents that participated in this study, those on low, moderate, and high addiction risk were 45 (60.00%), 23 (30.67%), and 7 (9.33%), respectively, and significantly correlated with the research questionnaire that consisted three parts: 1. awareness toward the health risk; 2. social control; 3. mass media role in tobacco smoking (p=0.014, 0.004, and 0.009 respectively), but there was no significant correlation with the stress level (p=0.287). Conclusion: Increased awareness toward the health risk, good social control, and mass media reporting the danger of tobacco smoking is significantly in correlation with the decreased addiction in rural areas. However, the high perceived stress has no correlation with its increase.

Religious Values in Clinical Practice are Here to Stay.

Research to date has shown that health professionals often practice according to personal values, including values based on faith, and that these values impact medicine in multiple ways. While some influence of personal values are inevitable, awareness of values is important so as to sustain beneficial practice without conflicting with the values of the patient. Detecting when own personal values, whether based on a theistic or atheistic worldview, are at work, is a daily challenge in clinical practice. Simultaneously ethical guidelines of tone-setting medical associations like American Medical Association, the British General Medical Council and Australian Medical Association have been updated to encompass physicians' right to practice medicine in accord with deeply held beliefs. Framed by this context, we discuss the concept of value-neutrality and value-based medical practice of physicians from both a cultural and ethical perspective, and reach the conclusion that the concept of a completely value-neutral physician, free from influence of personal values and filtering out value-laden information when talking to patients, is simply an unrealistic ideal in light of existing evidence. Still we have no reason to suspect that personal values, whether religious, spiritual, atheistic or agnostic, should hinder physicians from delivering professional and patient-centered care.

Religious values of physicians affect their clinical practice: A meta-analysis of individual participant data from 7 countries.

BACKGROUND: Observational studies indicate that religious values of physicians influence clinical practice. The aim of this study was to test prior hypotheses of prevalence of this influence using a meta-analysis design. METHODS: Based on a systematic literature search we performed individual participant data meta-analysis (IPDMA) on data based on 2 preselected questionnaires. Ten samples from 7 countries remained after exclusion (n = 3342). IPDMA was performed using a random-effects model with 2 summary measures: the mean value of the scale "Religiosity of Health Professionals"; and a dichotomized value of the question "My religious beliefs influence my practice of medicine." Also, a sensitivity analysis was performed using a mixed-models design controlling for confounders. RESULTS: Mean score of religiosity (95% confidence interval [CI]) was significantly lower in the European subgroup (8.46 [6.96-9.96]) compared with the Asian samples India (10.46 [9.82-10.21]) and Indonesia (12.52 [12.19-12.84]), whereas Brazil (9.76 [9.54-9.99]) and USA (10.02 [9.82-10.21]) were placed in between. The proportion of the European physicians who agreed to the statement "My religious beliefs influence my practice of medicine" (95% CI) was 42% (26%-59%) compared with Brazil (36% [29%-43%]), USA (57% [54%-60%]), India (58% [52%-63%]), and Indonesia (91% [84%-95%]). CONCLUSIONS: Although large cross-cultural variations existed in the samples, 50% of physicians reported to be influenced by their religious beliefs. Religiosity and influence of religious beliefs were most pronounced in India, Indonesia, and a European faith-based hospital. Education regimes of current and future physicians should encompass this influence, and help physicians learn how their personal values influence their clinical practice.

Spirituality, Religiosity, and Health: a Comparison of Physicians' Attitudes in Brazil, India, and Indonesia.

BACKGROUND: One of the biggest challenges in the spirituality, religiosity, and health field is to understand how patients and physicians from different cultures deal with spiritual and religious issues in clinical practice. PURPOSE: The present study aims to compare physicians' perspectives on the influence of spirituality and religion (S/R) on health between Brazil, India, and Indonesia. METHOD: This is a cross-sectional, cross-cultural, multi-center study carried out from 2010 to 2012, examining physicians' attitudes from two continents. Participants completed a self-rated questionnaire that collected information on sociodemographic characteristics, S/R involvement, and perspectives concerning religion, spirituality, and health. Differences between physicians' responses in each country were examined using chi-squared, ANOVA, and MANCOVA. RESULTS: A total of 611 physicians (194 from Brazil, 295 from India, and 122 from Indonesia) completed the survey. Indonesian physicians were more religious and more likely to address S/R when caring for patients. Brazilian physicians were more likely to believe that S/R influenced patients' health. Brazilian and Indonesians were as likely as to believe that it is appropriate to talk and discuss S/R with patients, and more likely than Indians. No differences were found concerning attitudes toward spiritual issues. CONCLUSION: Physicians from these different three countries had very different attitudes on spirituality, religiosity, and health. Ethnicity and culture can have an important influence on how spirituality is approached in medical practice. S/R curricula that train physicians how to address spirituality in clinical practice must take these differences into account.