Terapia de Aceptación y Compromiso en conducta suicida: una revisión sistemática / Acceptance and Commitment Therapy on suicidal behavior: a systematic review

El suicidio se ha convertido en un problema social y de salud pública a nivel mundial. En este sentido, la Terapia de Aceptación y Compromiso (ACT) podría ser eficaz en su abordaje, existiendo evidencia sobre la relación entre algunos de sus componentes y la conducta suicida. Así, el presente estudio tuvo por objetivo realizar una revisión sistemática sobre la eficacia de ACT en conducta suicida. Para ello se siguió el protocolo PRISMA, empleando las siguientes bases de datos: PsycInfo, PubMed, Scopus y PsicoDoc. Inicialmente se obtuvieron 108 publicaciones potencialmente relevantes, de las cuales, finalmente, 13 fueron incluidas en la revisión. La calidad de los estudios se analizó a través de un instrumento de evaluación de riesgo de sesgos. Como resultados, a nivel general se observaron disminuciones estadísticamente significativas en ideación suicida (IS) y factores de riesgo de suicidio. Además, algunos estudios señalaron relaciones estadísticamente significativas entre un aumento de flexibilidad psicológica y la disminución de IS. Si bien los datos apuntaron a una posible eficacia de ACT en la reducción de IS, es necesario llevar a cabo mayor número de estudios experimentales que contemplen la complejidad de la conducta suicida y exploren los procesos de cambio implicados.(AU)

Suicide has emerged as a pressing global issue affecting both so-ciety and public health.In this context, Acceptance and Commitment Therapy (ACT) could prove effective in its approach, supported by evi-dence of the relationship between certain components of ACT and suicidal behavior. Thus, the present study aims to conduct a systematic review on the efficacy of ACT in suicidal behavior. For this, the PRISMA protocol was followed, using thefollowing databases: PsycInfo, PubMed, Scopus and PsicoDoc. Initially, 108 potentially relevant publicationswereobtained,13ofwhichwerefinallyincludedinthereview.Weanalyzedstudy qualityus-ingariskofbiasassessmentinstrument.Asaresult,statisticallysignificantdecreases in suicidal ideation (SI) and suicide risk factors were observed. In addition, some studies indicated statistically significant relationships be-tween increased psychological flexibility and decreasedSI.WhilethedatasuggestedthepotentialeffectivenessofACTinreducingsuicidal ideation (SI), more experimental studies are needed to consider the complexity of suicidal behavior and explore the processes of changeinvolved.(AU)

Nurse middle managers' proactive work behavior: antecedents and consequences on innovative work behavior and job performance.

PURPOSE: Healthcare organizations require more proactive behaviors from nursing professionals. However, nurse managers' proactivity has rarely been analyzed in the literature and little is known about the antecedents and consequences of their proactive behavior at work. This study examines the relationships between job characteristics (i.e. job autonomy and job variety), psychological empowerment, proactive work behavior and job effectiveness indicators (i.e. innovative work behavior, job performance). We tested a model in which psychological empowerment and proactive work behavior sequentially mediate the relationship between job characteristics and job effectiveness. DESIGN/METHODOLOGY/APPROACH: A cross-sectional study was conducted among nurse middle managers from a French hospital (N = 321). A hypothetical model was developed based on existing theory. Structural equation modeling was used to test the hypotheses. FINDINGS: Results show that psychological empowerment and proactive work behavior fully mediate the relationship between job characteristics and innovative work behavior, and partially mediate the relationship between job characteristics and job performance. ORIGINALITY/VALUE: This study provides insights for understanding how job characteristics can contribute to fostering the proactivity of nurse middle managers and how their proactive work behavior can be positively related to innovative work behavior and job performance. Findings raise several implications for hospital administrators and upper management seeking new ways to enhance nurse middle managers' proactive work behavior and push further their effectiveness at work.

Artificial intelligence and its implications for data privacy.

Contemporary, multidisciplinary research sheds light on data privacy implications of artificial intelligence (AI). This review adopts an AI ecosystem perspective and proposes a process-outcome continuum to classify AI technologies; this perspective helps to understand the nuances of AI relative to psychological aspects of privacy decision-making. Specifically, different types of AI affect traditionally studied privacy decision-making frameworks including the privacy calculus, psychological ownership, and social influence in varied ways. By understanding how the process- or outcome-orientation of an AI technology affects privacy decision-making, we explain how AI creates privacy benefits but also poses challenges. Future research is needed across privacy decision-making, but also more generally at the intersection of privacy and AI, to help foster an ethical, sustainable society.

Similarities and differences in the psychological factors associated with generalised problematic internet use, problematic social media use, and problematic online gaming.

Problematic online behaviours are a concern among university students. Although previous research has identified that psychological distress, cognitive distortions, conscientiousness and neuroticism traits, motor impulsivity, and emotion regulation strategies have a significant direct effect on generalised problematic Internet use (GPIU), problematic social media use (PSMU), and problematic online gaming (POG), it is still necessary to determine the extent to which these psychological factors, taken together, are associated with each of the problematic online behaviours. In a sample of 690 Spanish university students, the present study examined the relationship of these psychological factors with GPIU, PSMU, and POG. Correlation and regression analyses were performed. Results reported that (1) high psychological distress, low conscientiousness trait and high motor impulsivity were common associated factors of GPIU and PSMU, but not of POG; (2) high levels of cognitive distortions and cognitive reappraisal were common associated factors of GPIU, PSMU and POG; and (3) expressive suppression and neuroticism trait had no effect on any of the three problematic online behaviours. The findings will help to develop effective prevention and intervention strategies for each problematic online behaviour in the university context.

Mechanisms of end-of-life communication contributing to optimal care at the end of life: a review of reviews.

BACKGROUND: End-of-life communication is an essential component of high-quality care, but its potential mechanisms for improving care are not well understood. OBJECTIVES: To summarise the potential mechanisms by which end-of-life communication may contribute to enhanced end-of-life care in any setting. DESIGN: An overview of systematic reviews, with a narrative synthesis of results. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Study quality was assessed using the AMSTAR (A MeaSurement Tool to Assess Reviews) tool. DATA SOURCES: CINAHL, MEDLINE, Cochrane, SSCI and PsycINFO databases, were searched from inception to January 2024. Manual searches were also conducted. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Systematic reviews (published in English) related to end-of-life communication, where the target population was adult patients in their last year of life, relatives, caregivers and/or healthcare professionals involved in communicating with dying patients. RESULTS: We reviewed 35 eligible studies. The reviews suggest potential mechanisms of effective end-of-life communication including collaborative decision-making, tailoring communication to individuals, using effective communication strategies and incorporating communication skills into practice. The reviews also highlighted barriers related to patients, professionals and organisations. CONCLUSION: This review highlights a nuanced understanding of potential mechanisms of end-of-life communication, emphasising the need for tailored training, policy enhancements and interprofessional collaboration. It calls on healthcare professionals to reflect on their practices, advocating for co-designing a person-centred communication model that addresses patient preferences at the end of life. Importantly, in culturally diverse contexts, there is a need for a communication paradigm that embraces diversity to provide truly empathetic and effective end-of-life care. This concise roadmap may foster compassionate, dignified and effective end-of-life communication. TRIAL REGISTRATION NUMBER: Protocol registered with PROSPERO (CRD42022271433, 29 March 2022).

Anxiety and resilience in palliative medicine physicians.

OBJECTIVE: To identify the relationship between the degree of anxiety and the capacity for resilience in palliative care physicians. METHODS: Cross-sectional analytical study with non-probability sampling. We included 42 Colombian Palliative Care Physicians and administered a sociodemographic questionnaire, the Zung Anxiety Scale and the Resilience Scale. RESULTS: 42 palliative care physicians with an average age of 41 participated in the study. Anxious symptoms were present in 100% of the physicians evaluated. Mild or moderate anxiety was identified in 93.7% of the population and 6.3% of people with severe anxiety symptoms. Less than half of the participants considered demonstrated high levels of resilience. We found an inverse and significant correlation between the factors that make up the Resilience Scale and the manifestation of psychological and physical symptoms of anxiety. CONCLUSION: Our results reflect that the population of palliative care physicians has a higher risk and exposure to developing anxiety and its adverse outcomes. We found higher anxiety levels compared with other studies so this population requires greater vigilance and intervention in treating and preventing mental health difficulties.

The role of motivation in shaping social inclusion of people with intellectual disabilities in physical-sports activity contexts.

The present study aims to test a model in which basic psychological needs (BPN) satisfaction in physical-sport activity contexts is associated with self-determined motivation, which, in turn, would predict the social inclusion of people with intellectual disabilities. A total of 286 people with intellectual disabilities (53.5% men) who reported engaging in physical-sport activities responded to a validated questionnaire about the satisfaction of their BPN, motivation (using the Self-determination index [SDI]), and social inclusion. A Pearson's bivariate correlation and structural equation modeling were conducted. The resulting model was reanalyzed in a multigroup analysis to test its invariance across self and proxy reports. Positive associations were found between the satisfaction of the BPN and the SDI. However, the SDI and social inclusion were positively associated only in proxy reports (ßself = 0.07 vs. ßproxy = 0.30). The tested model established positive relationships between the BPN and SDI in autonomy (ßself = 0.21 vs. ßproxy = 0.18), competence (ßself = 0.47 vs. ßproxy = 0.53), and relatedness (ßself = 0.21 vs. ßproxy = 0.23). Further research is needed to understand the factors leading to discrepancies between participants and proxies when relating the SDI to social inclusion in the context of physical-sport activity. However, the results obtained suggest that it would be optimal to develop contexts of practice for people with intellectual disabilities in which the satisfaction of their BPN is favored and that this has a positive impact on their motivation and social inclusion.

Differing worldviews: The politics of happiness, meaning, and psychological richness.

OBJECTIVE/BACKGROUND: Conservative ideology, broadly speaking, has been widely linked to greater happiness and meaning in life. Is that true of all forms of a good life? We examined whether a psychologically rich life is associated with political orientation, system justification, and Protestant work ethic, independent of two other traditional forms of a good life: a happy life and a meaningful life. METHOD: Participants completed a questionnaire that assessed conservative worldviews and three aspects of well-being (N = 583 in Study 1; N = 348 in Study 2; N = 436 in Study 3; N = 1,217 in Study 4; N = 2,176 in Study 5; N = 516 in Study 6). RESULTS: Happiness was associated with political conservatism and system justification, and meaning in life was associated with Protestant work ethic. In contrast, zero-order correlations showed that psychological richness was not associated with conservative worldviews. However, when happiness and meaning in life were included in multiple regression models, the nature of the association shifted: Psychological richness was consistently inversely associated with system justification and on average less political conservatism, suggesting that happiness and meaning in life were suppressor variables. CONCLUSIONS: These findings suggest that happiness and meaning in life are associated with conservative ideology, whereas psychological richness is not.

The effect of right ventricle septal pacing versus apical pacing in dual-chamber pacemakers on patients' anxiety and depression: a one-year follow-up study.

BACKGROUND: Anxiety and depression are potentially harmful outcomes of permanent cardiac pacemakers. Dual-chamber P.P.M. is frequently used to treat life threatening bradycardia. The study aims to estimate the effect of the right ventricular PM lead position on recipients' anxiety and depression before, 6 months, and 1 year after implantation. RESULTS: A statistically significant correlation was discovered between the studied groups regarding HADS depression score after 6 months (p 0.013) and 1 year (p 0.013). A statistically non-significant difference was found among the studied groups at any point of time regarding baseline (p 0.063), after 6 months (p 0.054), or after 1 year (p 0.099). Significance was found between HADS anxiety score (p 0.015) or depression score after 1 year and the incidence of complications (p 0.001). CONCLUSIONS: A strong relationship was found between the level of depression and the R.V. site of implantation, as patients with the apical group had higher levels of depression post-implantation. The septal position has less stress and depression on the patient's well-being than the apical one.

Psychological resilience in the relationship between family function and illness uncertainty among family members of trauma patients in the intensive care unit.

BACKGROUND: Severe trauma accounts for a main factor inducing mortality for individuals aged < 45 years in China, which requires admission to intensive care unit (ICU) to receive comprehensive treatment. Family members of patients with unanticipated and life-threatening trauma during their ICU stays often experience psychosocial distress due to illness uncertainty. Previous research has shown that family function and psychological resilience are associated with illness uncertainty, respectively. However, little is known about the current situation and interacting mechanism between family function, psychological resilience, and illness uncertainty of family members for ICU trauma patients. Therefore, this study focused on exploring the current situation and relationships between these three factors in family members for ICU trauma patients. METHODS: The convenience sampling approach was adopted in the present cross-sectional survey, which involved 230 family members for ICU trauma patients from 34 hospitals in Chongqing, China. Related data were extracted with self-reporting questionnaires, which included sociodemographic characteristic questionnaire, the Family Adaptability, Partnership, Growth, Affection and Resolve Scale (APGAR), the 10-item Connor-Davidson Resilience Scale (10-CD-RISC) and the Mishel's Illness Uncertainty Scale for Family Members (MUIS-FM). Pearson correlation analysis was conducted to examine the correlations between various variables. Additionally, a structural equation model was adopted to assess the mediating effect of psychological resilience on family function and illness uncertainty. RESULTS: According to our results, family members for ICU trauma patients experienced high illness uncertainty with moderate family dysfunction and low psychological resilience. Family function directly affected illness uncertainty and indirectly affected illness uncertainty through psychological resilience in family members of ICU trauma patients. CONCLUSIONS: Family function and psychological resilience are the protective factors for reducing illness uncertainty. Healthcare providers should take effective measures, including family-functioning improvement and resilience-focused interventions, for alleviating illness uncertainty in family members of ICU trauma patients.

Testing the feasibility and preliminary efficacy of Meaningful Activity for Managing Behavioral Symptoms of Distress (MAC-4-BSD) intervention for residents with dementia in assisted living: Protocol description.

The purpose of this manuscript is to describe the protocol for an Alzheimer's Association-funded cluster randomized trial that focuses on engaging assisted living residents with dementia in meaningful activity to help address their behavioral symptoms of distress using a theoretically based approach, Meaningful Activity for Managing Behavioral Symptoms of Distress (MAC-4-BSD). The development of MAC-4-BSD was based on the Social Ecological Model and Social Cognitive Theory. The MAC-4-BSD intervention includes the following four steps: (1) Assessment of the assisted living physical environment and policies to facilitate meaningful activity; (2) Education of staff about implementation of meaningful activity; (3) Assessment of resident preferences and goals for meaningful activity; (4) Mentoring and motivating staff and residents to facilitate engagement in meaningful activity. The overall aim of this study will be to determine the feasibility and preliminary efficacy of implementing the MAC-4-BSD intervention and test whether it will improve residents' engagement in meaningful activity, behavioral symptoms of distress, and quality of life as well as the environment and policies to promote meaningful activity in assisted living.

The mediating role of psychological well-being on the effect of fear of future violent events at work on nurses' intention to migration.

AIM: To evaluate the effect of the fear of violence of nurses working in Turkey on their intention to migrate and to examine the mediating role of psychological well-being on this effect. BACKGROUND: Many countries are concerned about nurses' fear of violence and their intention to migrate. The fear of violence at work may influence nurses' intention to migrate. Additionally, psychological well-being may impact this process. However, the impact of the fear of violence at work on the intention to migrate, as well as the moderating effect of psychological well-being in a nursing context, is not well understood. METHODS: We conducted this cross-sectional study on a sample of 221 nurses from two public hospitals. We collected survey data between November 2022 and January 2023 using three scales. We analyzed the data using SPSS, AMOS, and HAYES. We followed the STROBE statement guidelines for cross-sectional studies. RESULTS: Nurses reported a moderate intention to migrate and a moderate to high level of fear of violence and psychological well-being. Fear of violence is positively associated with the intention to migrate. Mediation analyses indicated that the association between fear of violence and intention to migration was mediated by psychological well-being. DISCUSSION AND CONCLUSION: The fear among nurses of being exposed to violence increases their intention to migrate. However, high psychological well-being can reduce this intention. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Nursing managers, policymakers, and decision-makers need to take serious precautions against the fear of violence in the future and make necessary improvements for nurses who witness violence. To achieve this, it can begin by paying attention to the high psychological well-being of each nurse.

Four-year comparative analysis of return to sport and psychological recovery following ACL revision: Artificial ligament vs. anterior tibial tendon allograft.

Background: Research on return to sport and psychological recovery in anterior cruciate ligament (ACL) revision remains scarce. The clinical efficacy of artificial ligament in ACL revision requires further exploration. Our objectives were (1) to compare the midterm clinical outcomes of artificial ligament versus allogenic tendon graft in ACL revision and (2) to analyze the effects of employing artificial ligament on return to sport and psychological recovery in ACL revision. Methods: This cohort study included the cases receiving ACL revision from 2014 to 2021 in Sports Medicine Department of Huashan Hospital. The grafts used were Ligament Advanced Reinforcement System (LARS) and ATT allograft. We recorded patients' baseline data. The final follow-up assessment included subjective scales, physical examination, and return to sport status. We recorded the rates and timings of return to sport. Subjective scales included the 2000 International Knee Documentation Committee (IKDC) subjective score, Lysholm Knee Scaling Score (LKSS), Knee injury and Osteoarthritis Outcome Score (KOOS), Tegner activity score, Marx activity rating score, and Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI). Anterior knee stability was assessed using the KT-1000 arthrometer. Results: Fifty cases (LARS group: 27; ATT group: 23) enrolled and 45 (LARS group: 23; ATT group: 22) completed evaluations with a median follow-up period of 49 months. At recent follow-up, LARS group outperformed in knee stability (1.0 ± 1.9 mm vs. 2.6 ± 3.0 mm, P = 0.039), confidence (86.7 ± 12.4 vs. 69.4 ± 18.6, P < 0.001), emotion (82.7 ± 11.3 vs. 70.7 ± 16.2, P < 0.001), KOOS knee function (78.7 ± 8.8 vs. 69.5 ± 11.0, P = 0.003), quality of life (79.1 ± 16.1 vs. 66.4 ± 19.5, P = 0.014), Tegner score (6.3 ± 1.9 vs. 5.2 ± 2.1, P < 0.001), and Marx activity score (10.7 ± 3.7 vs. 7.9 ± 4.0, P = 0.012). The LARS group had significantly higher return rates: recreational (91.3 % vs. 63.6 %, P = 0.026), knee cutting and pivoting (87.0 % vs. 59.1 %, P = 0.035), competitive (78.3 % vs. 45.5 %, P = 0.023), and pre-injury (56.5 % vs. 27.3 %, P = 0.047). For return timings, the LARS group was earlier at recreational (11.2 ± 3.9 vs. 27.8 ± 9.0 weeks, P < 0.001), knee cutting and pivoting (17.2 ± 5.8 vs. 35.6 ± 13.8 weeks, P < 0.001), competitive (24.8 ± 16.2 vs. 53.2 ± 22.0 weeks, P < 0.001), and pre-injury levels (32.8 ± 11.0 vs. 72.8 ± 16.9 weeks, P < 0.001). Conclusion: In ACL revision, using LARS demonstrated improved joint stability and functionality compared to using allogenic ATT four years postoperative. Patients accepting the LARS procedure exhibited higher rates and earlier timings of return to various levels of sport, indicating enhanced confidence and emotional resilience. The translational potential of this article: In ACL revision, the choice of artificial ligament to shorten recovery time, thereby enabling patients to return to sport more quickly and effectively, is thought-provoking. The research value extends beyond mere graft selection, guiding future clinical trials and studies. This research enhances our understanding of the application value of artificial ligament in ACL revision, emphasizing the importance of psychological recovery and updating our perceptions of return to sport levels post-revision. It stimulates exploration into personalized rehabilitation programs and treatment strategies, aiming to optimize clinical outcomes and meet the real-world needs of patients with failed ACL reconstruction.

Resilience in the face of pandemic: exploring the influence of psychological flexibility on turnover intentions and burnout among critical care nurses in COVID-19 hospitals.

AIM: Assess the levels of psychological flexibility, burnout, and turnover intention among critical care nurses and assess the impact of psychological flexibility on burnout, and turnover intention among critical care nurses. BACKGROUND: Burnout and turnover intentions among critical care nurses are rapidly increasing because of the challenges of COVID-19. There is a need for evidence-based interventions like psychological flexibility to be addressed in research to overcome those challenges. METHODS: A descriptive correlational research. A convenient sample of 200 critical care nurses working in COVID-19 hospitals from two governorates in Egypt. The sociodemographic and clinical data sheet, the work-related acceptance and action questionnaire, the Copenhagen burnout inventory, and the adopted version of the staff nurses' intention to leave the nursing profession questionnaire were used. RESULTS: The majority of critical care nurses reported a moderate level of psychological flexibility (75.5%, Mean = 31.23), a moderate level of burnout (65.5%, Mean = 59.61), and low to moderate levels of intention to leave (73%, Mean = 5.95). Psychological flexibility has a statistically significant negative correlation with burnout (PC = -0.304, Sig = 0.000) and the intention to leave (PC = -0.258, Sig = 0.000). In addition, psychological flexibility has a predictable effect on decreasing burnout (R2 = 0.232) and intention to leave (R2 = 0.127) among critical care nurses. CONCLUSION: critical care nurses in COVID-19 hospitals reported varied levels of burnout and an intention to leave that must be considered. The effect of psychological flexibility on burnout and intention to turnover highlighted the importance of improving it among critical care nurses by applying acceptance and commitment therapy as a management intervention.

Examining the role of patient-reported external factors and risk of relapse in anti-neutrophilic cytoplasmic autoantibody vasculitis.

The role of stressors, insect bites, and infections on disease relapse of ANCA vasculitis has yet to be entirely explored, with limited retrospective studies focused on disease onset from small participant cohorts. Our study analyzes longitudinal survey data from 2011-2022 to evaluate this perspective from a large ANCA vasculitis cohort. We collected surveys every three to six months to obtain information on self-reported psychological stressors and significant life events, insect bites, and infections throughout clinical disease. We defined cohorts as those who relapsed (Relapse Cohort) and controls as those who did not relapse (Remission Cohort) during the study period. Survey responses were retrospectively reviewed during a 15-month timeframe prior to relapse or during 15 months of remission and categorized by type of stress event, insect bite, and infections at every available 3-month interval. There were no significant differences in stress and insect bites between the relapse and remission cohorts. Patients who relapsed reported more frequent upper respiratory infections and other infections, such as those affecting the skin and eyes, but there were no significant differences in the incidence of pulmonary or urinary infections compared to the remission cohort. There was a significant difference in reported upper respiratory infections 9 to 15 months prior to the relapse date, indicating a remote history of infections as a potentially significant physical stressor that may contribute to disease relapse. More frequent patient-reported infections, specifically upper respiratory infections, may contribute to patient vulnerability to relapse. Counseling and close monitoring of patients after infectious symptoms could aid in earlier detection of disease flares. Future studies are essential to further understand the importance of distal risk factors and how they impact relapse.

Perils and opportunities in using large language models in psychological research.

The emergence of large language models (LLMs) has sparked considerable interest in their potential application in psychological research, mainly as a model of the human psyche or as a general text-analysis tool. However, the trend of using LLMs without sufficient attention to their limitations and risks, which we rhetorically refer to as "GPTology", can be detrimental given the easy access to models such as ChatGPT. Beyond existing general guidelines, we investigate the current limitations, ethical implications, and potential of LLMs specifically for psychological research, and show their concrete impact in various empirical studies. Our results highlight the importance of recognizing global psychological diversity, cautioning against treating LLMs (especially in zero-shot settings) as universal solutions for text analysis, and developing transparent, open methods to address LLMs' opaque nature for reliable, reproducible, and robust inference from AI-generated data. Acknowledging LLMs' utility for task automation, such as text annotation, or to expand our understanding of human psychology, we argue for diversifying human samples and expanding psychology's methodological toolbox to promote an inclusive, generalizable science, countering homogenization, and over-reliance on LLMs.

A Nation-Wide Survey of Program Directors at a Large Health Care Organization: Prevalence and Perceptions of Resident Wellness Activities.

Background: This study evaluated wellness programs in a large hospital network to determine residency program directors' (PDs) perspectives on their wellness programs' state, including wellness prioritization, frequency of wellness activities, and wellness' influence on decision-making across organizational levels. Methods: In 2021, 211 PDs were sent surveys on program policies, program implementation frequency, perceptions of the administration's ability to prioritize wellness, funding sources, and perceptions of resident wellness' impact on decision-making. Results: Among 211 contacted programs, 148 surveys were completed (70.1%). The majority reported having wellness programs, committees, and funding. Fewer than 25% reported having a chief wellness officer. PDs perceived that fellow colleagues in their institution linked wellness to markers of institutional success to a greater extent than other available options (ie, Accreditation Council for Graduate Medical Education [ACGME] requirements, budgetary concerns, resident input, core faculty priorities, and education quality). Financial well-being was perceived as least connected to wellness. Perceptions of wellness were rated across 3 organizational levels: program, institution, and organization. Across all levels, ACGME requirements (31.0%-32.8%) and budgetary/financial concerns (21.9%-37.0%) were perceived as having the most significant influence on overall decision-making, whereas resident wellness was rated lower in influence (8.0%-12.2%). Most programs allowed residents to attend mental health appointments without using paid time off (87.9%) and while on duty (83.1%). Conclusion: The frequency of wellness activities varied greatly across programs. PDs reported challenges making resident self-care and personal development a priority and perceived resident wellness as having limited importance to decision-making at higher levels.

A Qualitative Follow-Up to a Survey of Program Directors on Wellness Programming at a Large Healthcare Organization: Interviews of High- and Low-Exemplar Programs.

Background: The current research used a qualitative approach to understand which factors facilitate and hinder wellness programming in residency programs. Methods: Program directors identified from a previous quantitative study as having residency programs with notably more or less resident wellness programming than others (ie, high- and low-exemplars, respectively) were contacted. In total, semi-structured interviews were conducted over Zoom with 7 low-exemplars and 9 high-exemplars. Results: The results of this qualitative examination suggest common themes across the 2 exemplar groups, such as wanting more resources for resident wellness with fewer barriers to implementation, viewing wellness as purpose-driven, and seeing wellness as a shared responsibility. There were also critical distinctions between the exemplar groups. Those high in wellness programming expressed more of an emphasis on connections among residents in the program and between the faculty and residents. In contrast, those low in wellness programming described more barriers, such as staffing problems (ie, turnover and lack of faculty wellness) and a lack of integration between the varying levels involved in graduate medical education (GME) operations (ie, between GME programs and sponsoring hospitals, and between GME facilities and the larger health care organization). Conclusion: This study provides insight into program directors' experiences with wellness programming at a large health care organization. The results could point to potential next steps for investigating how the medical education community can improve resident wellness programming.

The Impact of a 4-Domain Wellness-Initiative Curriculum on Internal Medicine Resident Physicians.

Background: There is a trend toward fostering well-being, or the state of being happy and healthy, within the medical community. Historically, resident physicians have faced high rates of distress during training. A structured well-being curriculum in residency programs may shift residents' mindsets from survival and resilience to one centered on purpose, engagement, and joy. Methods: An original well-being curriculum was administered to residents in person at a single institution every 5 weeks for approximately 10 well-being workshops, totaling around 20 hours of curriculum exposure during every academic year. The well-being curriculum was divided into 4 domains: cognitive distortions and problematic mindsets, mindfulness and meditation, creative outlets, and self-compassion.Residents exposed to at least 1 year of the well-being curriculum were asked to answer an anonymous survey. Four questions were asked for each of the 4 domains. The first and second questions asked how familiar they were with the topic before and after the workshops on a scale of 1-5 of familiarity. The third and fourth questions asked how much the knowledge acquired influenced their professional and personal life on a scale of 1-5 of influence. Results: Before curriculum exposure, the average for moderate or higher levels of knowledge across all domains was 22.7%, which improved to 77.3% after curriculum completion. Overall, 58.6% of participants felt the knowledge of the domains was moderately or extremely influential in their professional lives and 83.6% in their personal lives. There were no significant differences between post-graduate year 2 and post-graduate year 3 residents for any domains examined before and after the wellness workshops. Conclusion: A 4-domain well-being curriculum practiced in a group setting positively impacted participating residents in their personal and professional lives. Further studies need to be performed on a larger scale to assess if the curriculum fits the needs of the broader medical community.

A Multi-Wave Study of Factors Associated With Resident Engagement, Depression, Burnout, and Stay Intent.

Background: Many studies have documented the epidemic of mental ill-being among resident physicians, but fewer have focused on mental well-being or on guiding intervention design to make progress toward positive change in residency programs to support resident thriving. Informed by the job demands-resources model (JD-R) and positive psychology, the current study examines 4 potential predictors of residents' ill-being (burnout, depression) and well-being (engagement, stay intent) that are malleable and thus capable of change through intervention: psychological capital (PsyCap), supervising physicians' autonomy-supportive leadership style (ASL), social support, and meaningful work. Methods: Three waves of data were collected between November 2017 and September 2018 at a large hospital system in the United States. Due to participant response rates, we were unable to conduct a planned longitudinal analysis. Therefore, for each wave, Bayesian regression analyses were used to examine cross-sectional relationships between the 4 predictors and each outcome. Results: Although findings varied across the study's 3 waves, the outcomes were largely as expected. With only 1 exception (depressive symptoms in Wave 2), meaningful work significantly predicted all outcome variables in the expected direction across all 3 waves. PsyCap significantly predicted burnout, depressive symptoms, and engagement in the expected direction across all 3 waves. ASL significantly predicted engagement in the expected direction across all 3 waves, as well as depressive symptoms and stay intent in 2 waves, and burnout in 1 wave. Social support significantly negatively predicted depressive symptoms in all 3 waves and burnout in 1 wave. Conclusion: Applying the JD-R framework and a positive psychology lens can open new pathways for developing programming to support resident thriving. Meaningful work, PsyCap, ASL, and social support all significantly predicted 1 or more outcomes related to resident thriving (burnout, depression, engagement, stay intent) across all 3 waves. Thus, this study provides theoretical and practical implications for future intervention studies and designing current programming for resident thriving.