Culturally based coping with COVID-19 pandemic: using constructive roles of the spiritual systems with appropriate function.

Considering the global number of confirmed COVID-19 cases and deaths, it is not strange that COVID-19 disease is a reminiscent of concepts such as death and affliction with a serious disease. Furthermore, it might remind people of issues such as the reason(s) for occurrence of deplorable events in the universe, the meaning of life, individuals' duties toward themselves and others, the relationship between the nature and human beings, and individuals' relationship with a higher being (in case there is a belief in a higher being), i.e. the subjects spirituality deals with. The constructive or destructive role of each of religious and non-religious spiritual systems at the time of crises are observed more clearly than ever. The present paper addresses roles which spiritual systems might play in facing the COVID-19 disease crisis, considering different areas of spiritual well-being and the possibility that spiritual systems might be affected by perceived challenges during a pandemic. Because of the problems interfering with overcoming COVID-19 pandemic and the risk of next waves of its epidemics and pandemics, it is necessary for health policy-makers to use all available capacities and capabilities to counteract the disease, including using both internal motivations (such as spiritual beliefs which prohibit hurting oneself and others and which emphasize performing social responsibilities) and external ones (e.g. regulations) to cope with it. It makes sense for public health officials in different countries to use more actively the potential of those spiritual systems that support COVID-19 public health recommendations, as a culturally based intervention and policy.

COVID-19 disease might remind people of issues such as the reason(s) for occurrence of deplorable events in the universe, the meaning of life, individuals' duties toward themselves and others, the relationship between the nature and human beings, and individuals' relationship with a higher being as an omnipotent (in case there is a belief in a higher being). These are the subjects which spirituality deals with. Some spiritual packages (or say spiritual systems), religious or non-religious, might respond appropriately to our questions about the above topics and help us to get through the disasters such as COVID-19 disease with the least complications and some might not. Given what health officials and scientists have said regarding COVID-19 pandemic, it is important to adhere to those spiritual systems which could help us: - Do our best in order to prevent endangerment of our life and that of other people. - Lead, despite all the bitter facts, a meaningful life during the pandemic. - When afflicted with the disease, cope with it well and also cope with the possibility of death. - Learn the lesson 'every good thing you wish for yourself, wish it for others too, and every evil thing you do not like for yourself, do not like it for others either'.

Associations between sex, age and spiritual well-being scores on the EORTC QLQ-SWB32 for patients receiving palliative care for cancer: A further analysis of data from an international validation study.

OBJECTIVE: The EORTC QOL Group has recently completed the cross-cultural development and validation of a standalone measure of spiritual well-being (SWB) for cancer patients receiving palliative care: the EORTC QLQ-SWB32. The measure includes four scales: Relationships with Others, Relationship with Self, Relationship with Someone or Something Greater, and Existential, plus a Global-SWB item. This paper reports on further research investigating relationships between sex, age and SWB for patients receiving palliative care for cancer-adjusting for other socio-demographic, clinical and function variables, including WHO performance status and EORTC QLQ-C15-PAL emotional and physical function scores. METHODS: Cross-sectional data from the validation study were used, and chi-square, independent t tests, Mann-Whitney U tests and multiple regression analyses applied. RESULTS: The study included 451 participants with advanced and incurable cancer, from 14 countries. Adjusted analyses found better scores for female participants than males on three of the four EORTC QLQ-SWB32 subscales; Relationship with others, Relationship with Someone or Something Greater and Existential plus Global-SWB. Older age was positively associated with better Relationship with Self. CONCLUSION: The findings from our participants suggest that it might be beneficial if healthcare providers seeking to address patients' spiritual needs pay particular attention to male patients, younger patients and those with poor emotional functioning.

Psychometric properties of KIDSCREEN health-related quality of life questionnaire in Iranian adolescents.

INTRODUCTION: Health-related quality of life (HRQOL), which is receiving increasing attention, is a multidimensional concept that encompasses different areas including the physiological, psychological, social, and spiritual aspects of life. The KIDSCREEN-52 questionnaire is designed to measure the HRQOL of 8-18-year-old children and adolescents. The aim of this study was to develop a Persian version of KIDSCREEN-52 and analyze the validity and reliability of the translated version. METHOD: The KIDSCREEN-52 was translated into Persian in keeping with the international cross-cultural translation guidelines. A cross-sectional study was performed in the city of Tehran during 2012-2013. 328 students ranging in age from 8 to 18 years were enrolled in the study. The reliability for each dimension was estimated using Cronbach's alpha coefficient. To examine the validity of the questionnaire, a confirmatory factor analysis (CFA) was conducted. RESULTS: The Cronbach's alpha coefficient was higher than 0.7 in all ten dimensions except self-perception. Validity of this questionnaire was confirmed by CFA. (Relative chi square (χ (2)/df) = 1.73; root-mean-square error of approximation = 0.047; normed fit index = 0.93; Tucker-Lewis index = 0.97; comparative fit index = 0.97; and relative fit index = 0.92.) CONCLUSION: The Persian version of KIDSCREEN-52 is reliable and valid and can be used as a self-administered instrument for measuring HRQOL in children and adolescents in Iran.

The 12-item medical outcomes study short form health survey version 2.0 (SF-12v2): a population-based validation study from Tehran, Iran.

BACKGROUND: The SF-12v2 is the improved version of the SF-12v1. This study aimed to validate the SF-12v2 in Iran. METHODS: A random sample of the general population aged 18 years and over living in Tehran, Iran completed the instrument. Reliability was estimated using internal consistency and validity was assessed using known-groups comparison and convergent validity. In addition the factor structure of the questionnaire was extracted by performing both exploratory and confirmatory factor analyses (EFA and CFA). RESULTS: In all, 3685 individuals were studied (1887 male and 1798 female). Internal consistency for both summary measures was satisfactory. Cronbach's α for the Physical Component Summary (PCS-12) was 0.87 and for the Mental Component Summary (MCS-12) it was 0.82. Known-groups comparison showed that the SF-12v2 discriminated well between men and women and those who differed in age and educational status (P < 0.05). Furthermore, as hypothesized the physical functioning, role physical, bodily pain and general health subscales correlated higher with the PCS-12, while the vitality, social functioning, role emotional and mental health subscales correlated higher with the MCS-12. Finally the exploratory factor analysis indicated a two-factor structure (physical and mental health) that jointly accounted for 59.9% of the variance. The confirmatory factory analysis also indicated a good fit to the data for the two-latent structure (physical and mental health). CONCLUSION: Although the findings could not be generalized to the Iranian population, overall the findings suggest that the SF-12v2 is a reliable and valid measure of health related quality of life among Iranians and now could be used in future health outcome studies. However, further studies are recommended to establish its stability, responsiveness to change, and concurrent validity for this health survey in Iran.

What do predict anxiety and depression in breast cancer patients? A follow-up study.

INTRODUCTION: Psychological adjustment following cancer occurrence remains a key issue among the survivors. This study aimed to investigate psychological distress in patients with breast cancer following completion of breast cancer treatments and to determine its associated factors. MATERIALS AND METHODS: This was a prospective study of anxiety and depression in breast cancer patients. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale at three points in time: baseline (pre-diagnosis), 3 months after initial treatment and 1 year after completion of treatment (in all 18 months follow-up). At baseline, the questionnaires were administered to all the suspected patients while both patients and the interviewer were blind to the final diagnosis. Socio-demographic and clinical data included age, education, marital status, disease stage and initial treatment. Repeated measure analysis was performed to compare anxiety and depression over the study period. Logistic regression analysis was performed to determine variables that predict anxiety and depression. RESULTS: Altogether 167 patients were diagnosed with breast cancer. The mean age of breast cancer patients was 47.2 (SD = 13.5) years, and the vast majority underwent mastectomy (82.6%). At 18 months follow-up, data for 99 patients were available. The results showed that anxiety and depression improved over the time (P < 0.001) although at 18-month follow-up, 38.4% and 22.2% of the patients presented with severe anxiety and depression, respectively. 'Fatigue' was found to be a risk factor for developing anxiety and depression at 3 months follow-up [odds ratio (OR) = 1.04, 95% Confidence interval (CI) = 1.01-1.07 and OR = 1.04, 95% CI = 1.02-1.07 respectively]. At 18 months follow-up, anxiety was predicted by 'pain' (OR = 1.02, 95% CI = 1.00-1.05), whereas depression was predicted by both 'fatigue' (OR = 1.06, 95% CI = 1.02-1.09) and 'pain' (OR = 1.05, 95% CI = 1.01-1.08). CONCLUSION: Although the findings indicated that the levels of anxiety and depression decreased over time, a significant number of women had elevated anxiety and depression at the 18 months follow-up. This suggests that all women should be routinely screened for psychological distress and that quality cancer care include processes to treat that 30% of women who have elevated psychological distress. In addition, if breast cancer patients indicated that they are suffering from fatigue or pain, these women who are at particular risk should be especially screened.

Factors affecting quality of care in family planning clinics: a study from Iran.

BACKGROUND: Despite good contraceptive coverage rates, recent studies in Iran have shown an alarmingly high incidence of unplanned pregnancy. OBJECTIVE: To determine factors affecting quality of family planning services, a cross-sectional study was performed from June to August 2006 on women visiting urban Primary Health Care clinics in a provincial capital in western Iran. The primary focus of the study was on provider-client interaction. METHOD: We used a slightly edited version of a UNICEF checklist and a convenient sampling method to assess quality of care in 396 visits to the family planning sections at 25 delivery points. RESULTS: Poor performance was observed notably in Counselling and Choice of method sections. In logistic regression analysis, the following factors were found to be associated with higher quality of care: provider experience [OR (odds ratio)=1.9, CI(0.95) (confidence interval)=1.2-3.0], low provider education (OR=6.7, CI(0.95)=4.0-10.8), smaller workload at the clinic (OR=3.7, CI(0.95)=2.0-6.7), and 'new client' status (OR=4.2, CI(0.95)=2.6-6.7). CONCLUSION: This study identified the issues of counselling and information exchange as the quality domains in serious need of improvement; these areas are expected to be the focus of future training programmes for care providers. Also, priority should be given to devising effective supervision mechanisms and on-the-job training of senior nursing and midwifery graduates to make them more competent in delivering basic family planning services.

Anxiety and depression in patients with gastrointestinal cancer: does knowledge of cancer diagnosis matter?

BACKGROUND: Gastrointestinal cancer is the first leading cause of cancer related deaths in men and the second among women in Iran. An investigation was carried out to examine anxiety and depression in this group of patients and to investigate whether the knowledge of cancer diagnosis affect their psychological distress. METHODS: This was a cross sectional study of anxiety and depression in patients with gastrointestinal cancer attending to the Tehran Cancer Institute. Anxiety and depression was measured using the Hospital Anxiety and Depression Scale (HADS). This is a widely used valid questionnaire to measure psychological distress in cancer patients. Demographic and clinical data also were collected to examine anxiety and depression in sub-group of patients especially in those who knew their cancer diagnosis and those who did not. RESULTS: In all 142 patients were studied. The mean age of patients was 54.1 (SD = 14.8), 56% were male, 52% did not know their cancer diagnosis, and their diagnosis was related to esophagus (29%), stomach (30%), small intestine (3%), colon (22%) and rectum (16%). The mean anxiety score was 7.6 (SD = 4.5) and for the depression this was 8.4 (SD = 3.8). Overall 47.2% and 57% of patients scored high on both anxiety and depression. There were no significant differences between gender, educational level, marital status, cancer site and anxiety and depression scores whereas those who knew their diagnosis showed a significant higher degree of psychological distress [mean (SD) anxiety score: knew diagnosis 9.1 (4.2) vs. 6.3 (4.4) did not know diagnosis, P < 0.001; mean (SD) depression score: knew diagnosis 9.1 (4.1) vs. 7.9 (3.6) did not know diagnosis, P = 0.05]. Performing logistic regression analysis while controlling for demographic and clinical variables studied the results indicated that those who knew their cancer diagnosis showed a significant higher risk of anxiety [OR: 2.7, 95% CI: 1.1-6.8] and depression [OR: 2.8, 95% CI: 1.1-7.2]. CONCLUSION: Psychological distress was higher in those who knew their cancer diagnosis. It seems that the cultural issues and the way we provide information for cancer patients play important role in their improved or decreased psychological well-being.

The Edinburgh Postnatal Depression Scale (EPDS): translation and validation study of the Iranian version.

BACKGROUND: The Edinburgh Postnatal Depression Scale (EPDS) is a widely used instrument to measure postnatal depression. This study aimed to translate and to test the reliability and validity of the EPDS in Iran. METHODS: The English language version of the EPDS was translated into Persian (Iranian language) and was used in this study. The questionnaire was administered to a consecutive sample of 100 women with normal (n = 50) and caesarean section (n = 50) deliveries at two points in time: 6 to 8 weeks and 12 to 14 weeks after delivery. Statistical analysis was performed to test the reliability and validity of the EPDS. RESULTS: Overall 22% of women at time 1 and 18% at time 2 reported experiencing postpartum depression. In general, the Iranian version of the EPDS was found to be acceptable to almost all women. Cronbach's alpha coefficient (to test reliability) was found to be 0.77 at time 1 and 0.86 at time 2. In addition, test-rest reliability was performed and the intraclass correlation coefficient was found to be 0.80. Validity as performed using known groups comparison showed satisfactory results. The questionnaire discriminated well between sub-groups of women differing in mode of delivery in the expected direction. The factor analysis indicated a three-factor structure that jointly accounted for 58% of the variance. CONCLUSION: This preliminary validation study of the Iranian version of the EPDS proved that it is an acceptable, reliable and valid measure of postnatal depression. It seems that the EPDS not only measures postpartum depression but also may be measuring something more.

Psychological distress among Bam earthquake survivors in Iran: a population-based study.

BACKGROUND: An earthquake measuring 6.3 on the Richter scale struck the city of Bam in Iran on the 26th of December 2003 at 5.26 A.M. It was devastating, and left over 40,000 dead and around 30,000 injured. The profound tragedy of thousands killed has caused emotional and psychological trauma for tens of thousands of people who have survived. A study was carried out to assess psychological distress among Bam earthquake survivors and factors associated with severe mental health in those who survived the tragedy. METHODS: This was a population-based study measuring psychological distress among the survivors of Bam earthquake in Iran. Using a multi-stage stratified sampling method a random sample of individuals aged 15 years and over living in Bam were interviewed. Psychological distress was measured using the 12-item General Health Questionnaire (GHQ-12). RESULTS: In all 916 survivors were interviewed. The mean age of the respondents was 32.9 years (SD = 12.4), mostly were males (53%), married (66%) and had secondary school education (50%). Forty-one percent reported they lost 3 to 5 members of their family in the earthquake. In addition the findings showed that 58% of the respondents suffered from severe mental health as measured by the GHQ-12 and this was three times higher than reported psychological distress among the general population. There were significant differences between sub-groups of the study sample with regard to their psychological distress. The results of the logistic regression analysis also indicated that female gender; lower education, unemployment, and loss of family members were associated with severe psychological distress among earthquake victims. CONCLUSION: The study findings indicated that the amount of psychological distress among earthquake survivors was high and there is an urgent need to deliver mental health care to disaster victims in local medical settings and to reduce negative health impacts of the earthquake adequate psychological counseling is needed for those who survived the tragedy.

Psychological Distress Among Bam Earthquake Survivors in Iran: A Population-based study

Backgrond: An earthquake measuring 6.3 on the Ritcher scale struck the city of Bam in Iran on the 26th at 5.26 A.M. It was devasting, and left over 40,000 dead and around 30,000 injured. The profound tragedy of thousands killed has caused emotional an psychological trauma of tens of thousands of people who have survived. A study was carried otu to assess psychological distress among Bam earthquake survivors and factors associated with serever mental health in those who survived the tragedy. Methods: This was population-based study measuring psychological distress amoong the survivors of Bam earthquake in Iran. Using a multi-stage stratified sampling method a random sample of individual aged 15 years and over living in Bam wee interviewed. Psychologial distress was measured using the 12-item General Health Questionnaire (GHW-12). Results: In all 916 survivors were interviewed. The mean age of the respondents was 32.9 years (SD=12.4), mostly were males (53%), married (66%) and had secndary school education (50%). Forty-one percent reported they lost 3 to 5 members of their family in the earthquake. In addition the findigns showed that 58% of the repondents suffered from severe mental health as measured by the GHQ-12 and this was three times higher than reported psychological distress among the general population. There were significant differences between sub-groups of the study sample with regard to their psychological distress. The results of the logistic regression analysis also indicated that female gender; lower education, unemployment, and loss of family members were associated with severe physcological distress among earthquake victims. (AU)