The Impact of the Coronavirus Pandemic on the Contribution of Local Green Space and Nature Connection to Mental Health.

BACKGROUND: Exposure to green space and feeling connected to the natural environment have independently been associated with improved mental health outcomes. During the coronavirus pandemic, people experienced restrictions on access to the outdoors, and health data indicated a decline in mental health in the UK general population. METHODS: Data available from two independent surveys conducted prior to and during the pandemic enabled a naturally occurring comparison of mental health and its correlates prior to and during the pandemic. RESULTS: Survey responses from 877 UK residents were included in the analyses. Independent t-tests revealed significant declines in mental health scores during the pandemic. After controlling for age and gender, greater nature connection significantly predicted lower depression and stress and improved well-being. Percentage of green space did not significantly predict any mental health outcomes. Further, time point (pre- or during COVID) and the interaction of time point with green space and nature connection did not significantly predict any of the outcome measures. The findings indicate that nature connection may play an important role in promoting mental health. Strategies to improve mental health and reduce mental illness should consider the role of nature connection and the use of interventions that involve direct interaction with natural environments.

Psychological benefits of outdoor physical activity in natural versus urban environments: A systematic review and meta-analysis of experimental studies.

The impact of environmental context on the psychological benefits derived from physical activity has attracted research attention in recent years. Previous reviews have compared effects of indoor versus outdoor exercise. This review compares the effects of physical activity undertaken in outdoor green natural environments versus outdoor urban environments on psychological health outcomes in adult general populations. An electronic literature search identified 24 experimental studies meeting the inclusion criteria. Results were analysed via narrative synthesis (n = 24) and meta-analysis (n = 9) of effect on six outcomes. Narrative synthesis found in favour of the natural environment for anxiety, anger/hostility, energy, affect and positive engagement. Post-intervention effect sizes suggested duration and social context as potential moderators. The meta-analyses revealed large or moderate effects in favour of the natural environment for anxiety, fatigue, positive affect and vigour, and a small effect for depression. Results were subject to high risk of bias and heterogeneity. Physical activity undertaken outdoors in natural environments is more beneficial for a range of psychological outcomes compared with urban environments. The various effect sizes evident in the meta-analyses may be explained by differing mechanisms through which psychological gains are experienced during physical activity in nature.

Examining the effects of acquired limb loss on the family network: a grounded theory study.

BACKGROUND: Individuals with acquired limb loss are faced with various challenges. Family networks become important in facilitating coping and recovery, but the limited research into their own experiences has so far only examined spousal and parental carers. AIMS: This research aimed to: understand the experiences of acquired limb loss from the perspective of the family network; and to develop a theoretical model to explain how they experience limb loss of the other. The use of 'network' was adopted to include kin self-identified as family. METHOD: Participants (n = 14) were recruited nationally. Interviews were conducted in a process moving from unstructured, semi-structured and structured interviews, using Grounded Theory method. FINDINGS: A theoretical model was developed around the interaction of five core categories. Families witness the difficulties faced by the person with limb loss, leading to a responsibility to provide support. Families subsequently experience various challenges of limb loss; together with numerous emotional reactions. Various forms of coping are used in order to resolve these experiences. CONCLUSIONS: Families are involved in the processes and challenges of an amputation in another family member, regardless of aetiology, gender or relationship structure. The theoretical model can be understood through the integration of existing research. The issues identified indicate potential considerations for services supporting such families.IMPLICATIONS FOR REHABILITATIONThe challenges and emotions experienced by family members have potential consequences for the support offered to the person with limb loss.This could ultimately influence the physical and psychological rehabilitation of the person with limb loss.Services should support families in witnessing difficulties in the person with limb loss, adjusting to relational changes and managing health care systems.

Impacts of long-standing illness and chronic illness on working hours and household income in a longitudinal UK study.

Individuals within households encounter a variety of events including development of a disability or chronic illness. We used data from the Understanding Society, 2009-2016, to determine whether there are changes to working hours or household income as a result of an individual developing an illness. After adjusting for a variety of sociodemographic characteristics, there were few associations observed between one's own individual illness status and household income. There was a clear trend of reduction of weekly working hours with increasing severity and chronicity of the individuals' illness or disease. Individuals who were not ill, but lived in an household with an ill person worked about 30-min less per week, b = -0.69, 95% confidence interval (CI)=(-1.09, -0.30), while those with a limiting long-standing illness and a chronic disease worked 3.5 h less per week, b = -3.64, 95% CI=(-4.21, -3.08), compared to individuals with no illness in their household. Individuals with a limiting illness only had lower incomes, b = -0.04, 95% CI=(-0.07, -0.004) compared to individuals with no household illness. These associations were not greatly changed with the inclusion of reception of benefits or being cared for. Interactions were observed by gender, age being cared for and reception of benefits. Additionally, there were differences were observed by working age groups and between those who lived alone and those who did not. The findings suggest that while there is a reduction of working hours among individuals with an illness or who have an ill person in their home, household income is resilient to the experience of an illness, in the United Kingdom. However, this appeared to differ by household composition, i.e. whether individuals were of working age or whether they lived alone. Identification of households at highest risk of income reduction may serve to inform policy and appropriate distribution of services and support.

Outdoor recreational activity experiences improve psychological wellbeing of military veterans with post-traumatic stress disorder: Positive findings from a pilot study and a randomised controlled trial.

TRIAL REGISTRATION: The authors confirm that all ongoing and related trials for this intervention are registered. The studies reported in this manuscript are registered as clinical trials at ISRCTN: Pilot ID- ISRCTN15325073 RCT ID- ISRCTN59395217.

An Evaluation of Service Provision and Novel Strength Assessment on Patient Outcomes in a UK-Based Pulmonary Rehabilitation Setting.

This study's purpose was to (i) assess the impact of a 7-week pulmonary rehabilitation (PR) programme upon patient outcomes; incremental shuttle walk test (ISWT), COPD assessment tool (CAT), Clinical COPD Questionnaire (CCQ) and the Hospital Anxiety and Depression Scale (HADS); (ii) assess the impact of COPD severity on ISWT, psychological functioning and quality of life measures following PR; (iii) assess the feasibility of incorporating individually prescribed one repetition maximum (1RM) training loads into the existing strength training programme. Patients were people with COPD enrolled onto one of three versions (locations A, B and C) of a 7-week PR programme, which consisted of group exercise sessions and a social plus education element. Two locations incorporated individually prescribed training loads. Minimal clinically important changes (MCICs) are reported for the ISWT across all locations. Statistically significant changes in both CAT and the CCQ were found, with MCIC's evident for CAT score overall and individually at location B. MCIC's were not found for the CCQ. No statistically significant or MCICs were evident for the HADS. MCIC's were present only in patients with mild to moderate severity for the ISWT. For the CAT, moderate, severe and very severe patients with COPD experienced MCIC's. MCIC's and statistically significant increases in 1RM strength were seen at both locations. These findings evidence an effective PR service. Basic strength exercise programming and assessment are feasible and should be implemented in PR services to maximise patient outcomes.

"I'm Still Fighting for the Two of Us": How Partners of UK Veterans Construct Their Experience of Living with Combat-Related Trauma.

There has been little qualitative research into the experiences of UK partners of veterans with PTSD. This study therefore aimed to explore how partners constructed their experiences of living with the condition. Fifteen female partners of male UK veterans were recruited and interviewed. Using a social constructionist thematic analysis, five themes were constructed: the women's need to subdue own emotional and behavioral responses; dilemmas about whether the veteran was unwell or 'bad'; attempts at negotiating multiple roles; challenging the narrative of veterans as heroes; and the relational struggle with the transition to nonmilitary life. This study highlighted the importance of considering the veteran as existing within a relational and cultural context, and the need to include partners in therapeutic interventions.

The longitudinal relationship between acceptance and anxiety and depression in people who have had a stroke.

OBJECTIVES: The role that acceptance may play in anxiety and depression has received little attention in stroke, unlike other chronic conditions. This study aimed to clarify whether acceptance of a stroke is related to anxiety and depression post-stroke when controlling for social support. DESIGN: A longitudinal design was employed with 35 participants completing measures at two time points: three-month and nine-month post-stroke. METHODS: Forty-one stroke patients, who were three-month post-stroke, were recruited from a stroke service register. Participants completed measures of anxiety, depression, social support and acceptance at two time points, six months apart. RESULTS: Acceptance was moderately and negatively correlated with anxiety and depression at three- and nine-month post-stroke. Acceptance showed a moderate and positive correlation with emotional and practical social support at Time 1 but not at Time 2. Acceptance at Time 1 was a stronger predictor of both anxiety and depression at Time 2 than emotional or practical social support. CONCLUSIONS: Acceptance is an important area to consider in relation to rehabilitation and adjustment following a stroke.

Measuring Emotional Intelligence Enhances the Psychological Evaluation of Chronic Pain.

The assessment of emotional factors, in addition to other psychosocial factors, has been recommended as a means of identifying individuals with chronic pain who may not respond to certain pain treatments. Systematic reviews of the evidence regarding the prediction of responsiveness to a treatment called the spinal cord stimulator (SCS) have yielded inconclusive results. Emotional intelligence is a term which refers to the ability to identify and manage emotions in oneself and others and has been shown to be inversely associated with emotional distress and acute pain. This study aims to investigate the relationship between emotional intelligence, chronic pain, and the more established psychosocial factors usually used for SCS evaluations by clinical psychologists in medical settings. A sample of 112 patients with chronic pain on an acute hospital waiting list for SCS procedures in a pain medicine service were recruited. Psychological measures were completed including: a novel measure of emotional intelligence; usual measures of emotional distress and catastrophizing; and a numerical rating scale designed to assess pain intensity, pain-related distress, and interference. As predicted, findings revealed significant associations between most of the measures analyzed and current pain intensity. When entered into a simultaneous regression analysis, emotional intelligence scores remained the only significant predictor of current pain intensity. There are potential clinical, ethical, and organizational implications of emotional intelligence processes partially predicting pain in patients on a waiting list for a medical procedure. These results may offer new insight, understanding, and evaluation targets for clinical psychologists in the field of pain management.

Differences in patient outcomes between a 6, 7 and 8 week pulmonary rehabilitation programme: A service evaluation.

OBJECTIVE: To investigate changes and differences in patient outcomes over time for 6, 7 and 8 week pulmonary rehabilitation programmes in order to identify optimal duration. SETTING: Community based pulmonary rehabilitation programmes in the East of England. PARTICIPANTS: In total 363 participants completed one of the three pulmonary rehabilitation programmes. Patients with a chronic respiratory condition showing a commitment to the pulmonary rehabilitation programme and no contraindications to exercise were included. INTERVENTION: Pulmonary rehabilitation twice a week for 6, 7 or 8 weeks. MAIN OUTCOME MEASURES: St Georges Respiratory Questionnaire (SGRQ), Clinical COPD Questionnaire (CCQ), Hospital Anxiety and Depression Scale (HADS) and Incremental Shuttle Walk Test (ISWT). RESULTS: All programmes showed improvements in ISWT post rehabilitation, with the 8 week programme showing the greatest improvement. CONCLUSION: Findings show that greatest improvements in terms of exercise capacity may be seen from 8 week pulmonary rehabilitation programmes, but that improvement for the ISWT can be obtained from 6, 7 or 8 week programmes.

Social rank and symptom change in eating disorders: a 6-month longitudinal study.

BACKGROUND: Following previous cross-sectional research adopting an evolutionary approach to social rank and eating disorders, the present study explored the predictive value of social rank for changes in eating disorder symptoms in a 6-month longitudinal study. METHODS: Seventy-three women and men with a history of eating disorders were followed up over 6 months. A broad range of measures of social rank were used to determine whether social rank at baseline predicted residual changes in eating disorder symptoms. RESULTS: Low social rank (in terms of perceived external entrapment and submissive behaviour) predicted an increase in symptoms of anorexia but not symptoms of bulimia. The predictive value of low social rank was not mediated by changes in depressive symptoms. CONCLUSION: Perceived low rank predicts an increase in anorexic symptoms. However, further research is required to determine the precise nature of how social rank exerts its influence on the development of eating disorder symptoms. KEY PRACTITIONER MESSAGE: Self-perceived low social rank predicts an increase in anorexic symptoms but not bulimic symptoms. The effect of low social rank on changes in anorexic symptoms was not mediated by changes in depressive symptoms. Interventions for anorexia nervosa may need to incorporate techniques for increasing status and/or self-compassion.

Assessing positive and negative changes in the aftermath of adversity: psychometric evaluation of the changes in outlook questionnaire.

The Changes in Outlook Questionnaire (CiOQ; S. Joseph, R. Williams, & W. Yule, 1993) is a 26-item self-report measure that was designed to assess positive and negative changes in the aftermath of adversity. This article had 3 aims: 1st, to investigate the factor structure of the CiOQ; 2nd, to test for internal consistency reliability and convergent and discriminant validity; and, 3rd, to investigate the association between positive and negative changes in outlook, posttraumatic stress, and psychological distress. Three studies are reported. Study 1 provides evidence that positive and negative changes are statistically separable and that the 2-factor model is a better fit than the 1-factor model. Studies 2 and 3 provide evidence for internal consistency reliability, convergent and discriminant validity of the CiOQ, and its associations with posttraumatic stress and psychological distress. In conclusion, the CiOQ has much promise for research on responses to stressful and traumatic events.

Age- and ability-related differences in young readers' use of conjunctions.

Two studies investigating young readers' use of conjunctions are reported. In Study One, 145 eight- to ten-year-olds completed one of two narrative cloze tasks in which different types of conjunction were deleted. Performance for additive conjunctions was not affected by age in this study, but older children were more likely to select the target conjunction than were younger children for temporal, causal, and adversative terms. Performance was superior in the cloze task in which they were given a restricted choice of responses (three vs. seven). In Study Two, 35 eight- and nine-year-old good and poor comprehenders completed the three-choice cloze task. The poor comprehenders were less likely to select the target terms in general. Sentence-level comprehension skills did not account for their poor performance. The results indicate that understanding of the semantic relations expressed by conjunctions is still developing long after these terms are used correctly in children's speech. The findings are discussed in relation to the role of conjunctions in text comprehension.