Long-term trajectories of densely reported depressive symptoms during an extended period of the COVID-19 pandemic in Switzerland: Social worries matter.

Previous mental health trajectory studies were mostly limited to the months before access to vaccination. They are not informing on whether public mental health has adapted to the pandemic. The aim of this analysis was to 1) investigate trajectories of monthly reported depressive symptoms from July 2020 to December 2021 in Switzerland, 2) compare average growth trajectories across regions with different stringency phases, and 3) explore the relative impact of self-reported worries related to health, economic and social domains as well as socio-economic indicators on growth trajectories. As part of the population-based Corona Immunitas program of regional, but harmonized, adult cohorts studying the pandemic course and impact, participants repeatedly reported online to the DASS-21 instrument on depressive symptomatology. Trajectories of depressive symptoms were estimated using a latent growth model, specified as a generalised linear mixed model. The time effect was modelled parametrically through a polynomial allowing to estimate trajectories for participants' missing time points. In all regions level and shape of the trajectories mirrored those of the KOF Stringency-Plus Index, which quantifies regional Covid-19 policy stringency. The higher level of average depression in trajectories of those expressing specific worries was most noticeable for the social domain. Younger age, female gender, and low household income went along with higher mean depression score trajectories throughout follow-up. Interventions to promote long-term resilience are an important part of pandemic preparedness, given the observed lack of an adaptation in mental health response to the pandemic even after the availability of vaccines in this high-income context.

Level of readiness of chronic pain patients to practise active self-care.

BACKGROUND: Given the limited alleviation of chronic pain with pharmacological treatments, various nonpharmacological and self-care approaches are often proposed that require patients' motivation. OBJECTIVE: To evaluate the level of readiness (LOR) to practise different types of active self-care among chronic pain patients. METHOD: A quantitative cross-sectional survey was conducted among all chronic pain patients seeking care at the Pain Center of an academic hospital from June 2013 to March 2015. Sociodemographic data, pain characteristics, treatments and the LOR to practise active self-care were investigated. RESULTS: Among the 1524 eligible patients, 639 (41.9%) were included. The median pain duration was 8.5 years (interquartile range = 7.5). Two-thirds (63.7%) of the patients reported high pain-related disability, and 64.6% had used opioids during the previous six months. Most patients had a high (44.1%) or moderate (24.6%) LOR to practise active self-care. Multivariable multinomial regression analysis showed that independent factors associated with a high LOR were a higher level of education (relative risk ratio (RRR) = 3.42, 95% confidence interval (CI): 1.90-6.13, p < 0.001), unemployed status due to medical condition (RRR = 2.92, 95% CI: 1.30-6.56, p = 0.009), the use of dietary supplements 'against pain' (RRR = 2.77, 95% CI: 1.52-5.04, p = 0.001) and neuropathic pain characteristics (RRR = 1.80, 95% CI: 1.40-3.12, p = 0.036). Older age was a factor predicting a lower LOR (RRR = 0.97, 95% CI: 0.94-0.99, p = 0.039). Long-term chronic pain, severe pain-related disability and the presence of a mood disorder were not associated with a lower LOR. CONCLUSION: Most chronic pain patients, including those severely affected, indicated their readiness to practise active self-care methods. SIGNIFICANCE: Most chronic pain patients, even those severely affected, appeared to be ready to practise active self-care therapies and we believe that further studies are needed to investigate their impact on pain and quality of life.

A qualitative study of adolescents with medically unexplained symptoms and their parents. Part 2: How is healthcare perceived?

Medically unexplained symptoms (MUS) are common among adolescents and an important cause of clinical visits. This study sought to understand the experiences with, and perceptions of, the healthcare of adolescents who have MUS and their parents. Using a qualitative approach, six focus groups and two individual interviews were conducted with a total of ten adolescents and sixteen parents. The participants were recruited in a university hospital in Switzerland. A thematic analysis was conducted in accordance with the Grounded Theory. Six main themes emerged: needing a label for the symptoms, seeking an etiology to explain the symptoms, negotiating the medical system, medication and treatments, interactions with doctors, and the inclusion of parents during consultations. Transcending these themes, however, was the need for good communication between the adolescents, their parents and the clinicians. When explaining the symptoms, clinicians should make sure to discuss the results, investigations and lack of organic origin.

[What is behind the hidden agenda?]. / Que cache l'agenda caché?

The physicians often forget to ask their patients if they would like to discuss other complaints or topics. It is sometimes quite difficult to explore the patient's complaints; while the physicians tend to focus on the immediate problem, the patients may have not only one, but several hidden agendas during a visit. In a caring relation there is a clear advantage to clarify the implicit. The search for the hidden agenda is to improve the care of i) biomedical problems ii) the social quest presented to the physicians. The sentence "Oh, by the way, doctor..." should not be only understood as an information but also as a relational expression and a reaction to the imminent separation from the physician.

Drinking behaviour among teenagers in Switzerland and correlation with lifestyles.

UNLABELLED: Several criteria (frequency, hazardous use, drunkenness) were used to delineate four distinct groups and to analyse the relations between patterns of alcohol use and other health variables. In the 1993 Swiss Multicentre Adolescent Survey on Health, anonymous self-administered questionnaires were distributed to a national representative sample of in-school 15 to 20-year-old adolescents. Of the respondents, 25% answered a module targeting alcohol use (n = 2359) of whom 13% were totally abstinent, 55.1% were moderate drinkers (< or = 1 drink/week and < 3 times drunk), 21.7% were 'social' drinkers (> 3 times drunk and < twice driven when drunk) and 10.2% were 'problem drinkers' (> twice driven whilst drunk or > 1 drink/day). Differences between problem drinkers and the rest of the sample showed the former as being predominantly boys with an odds ratio (OR) of 6.3, having a higher lifetime prevalence rate of cannabis use (OR = 3.4), never using seat belts (OR = 2.5), having their family/peers more often involved in alcohol consumption (OR = 1.9), being predominantly apprentices (against high school pupils OR = 1.9), having cheated during courses (OR = 1.9), being a member of a gang (OR = 1.7), having stolen in a public area (OR = 1.7) and having considered suicide (OR = 1.8). CONCLUSION: Within the Swiss context, whereas moderate/occasional use of alcohol must be considered as part of an adolescents' development, regular use of alcohol, often associated with drunkenness and driving while drunk, is associated with various health hazards and problems. Preventive strategies should be built accordingly.