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1.
Surg Clin North Am ; 103(1): 169-185, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36410348

RESUMO

Survivorship focuses on individual's health and well-being. Assessing for cancer recurrence is a follow-up priority for survivors and providers. However, providers also emphasize the importance of assessing for adherence to ongoing treatment. Providers should also assess for sequelae of local-regional and systemic treatment. Assessing for mental health is important, as many cancer survivors experience anxiety or depression. Finally, survivors should be encouraged to have ongoing visits with their primary care to ensure screening for other health conditions. This article reviews the recommendations for survivorship and the level of evidence supporting each aspect of high-quality survivorship care.


Assuntos
Sobreviventes de Câncer , Neoplasias , Humanos , Seguimentos , Sobreviventes/psicologia , Qualidade da Assistência à Saúde , Neoplasias/terapia
2.
Artigo em Inglês | MEDLINE | ID: mdl-36360954

RESUMO

Even now, ten years after the Great East Japan Earthquake (GEJE), thousands of residents of Fukushima Prefecture are still living as evacuees. To understand the mental health states and needs for psychological care of the survivors, we conducted a questionnaire survey of survivors who were evacuated from Fukushima to Ibaraki due to the nuclear power plant accident and of the residents of two areas in Ibaraki where damage was particularly severe due to the tsunami or liquefaction. Our results show that stress related to participants' hometowns and to the disaster was a risk factor for depression and post-traumatic stress among the survivors in the medium to long term in all regions examined. Other risk factors for post-traumatic stress differed by region. This study shows that in a complex disaster such as the GEJE, where damage is widespread, the causes of damage and the experiences of disaster survivors differ greatly from region to region and that risk factors for depression and post-traumatic stress among disaster survivors over the medium to long term may also differ. To provide appropriate care to disaster survivors, it is necessary to determine what is causing the risk of depression and post-traumatic stress at any given time and in specific regions.


Assuntos
Terremotos , Acidente Nuclear de Fukushima , Humanos , Tsunamis , Saúde Mental , Japão/epidemiologia , Centrais Nucleares , Sobreviventes/psicologia
3.
Br J Community Nurs ; 27(11): 558-566, 2022 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-36327204

RESUMO

There are approximately 1.3 million stroke survivors in the UK, with the majority of them relying on family caregivers for support. However, the needs of family caregivers are not routinely assessed by most services. The aim of this study was to explore the experiences of stroke family caregivers following the implementation of the Care Act, 2014. A total of 16 semi-structured, digitally recorded face-to-face qualitative interviews were conducted with a purposive sample of stroke family caregivers in north-west England. Thematic analysis was undertaken. Two themes were identified: the effects of caregiving and the unmet needs of the family caregivers. Despite changes to legislation, family caregivers of stroke survivors continue to experience challenges, such as financial problems, information needs, and a lack of respite and emotional support when providing care. Existing approaches to identifying and supporting caregiver needs are insufficient. Proactive approaches are required to ensure the needs of family caregivers are identified and addressed on a regular basis.


Assuntos
Cuidadores , Acidente Vascular Cerebral , Humanos , Cuidadores/psicologia , Sobreviventes/psicologia , Pesquisa Qualitativa , Inglaterra , Família/psicologia
4.
BMC Psychiatry ; 22(1): 720, 2022 Nov 18.
Artigo em Inglês | MEDLINE | ID: mdl-36401197

RESUMO

BACKGROUND: Knowledge on healthcare utilization after mass trauma is needed to strengthen the public health preparedness to such incidents. Using register-based data, this study had a unique opportunity to investigate how young survivors' use of primary care physicians (PCP) and mental health services (MHS) changed after a terrorist attack. METHODS: We examined register-based data on PCP and MHS consultations among 255 survivors (52% male) of the 2011 Utøya youth camp attack in Norway 3 years before and after the attack, and their reason for encounter with the PCP according to the International Classification for Primary Care (ICPC- 2). RESULTS: The PCP and MHS consultation rates (CR) were higher in female than male survivors both acutely and at long-term. The mean yearly CRs increased from 2.25 to 4.41 for PCP and 1.77 to 13.59 for MHS the year before and after the attack in female survivors, and from 1.45 to 3.65 for PCP and 1.02 to 11.77 for MHS in male survivors. The third year post-attack CRs for PCP were 3.55 and 2.00; and CRs for MHS were 5.24 and 2.30 in female and male survivors, respectively. Among female survivors, 76% consulted PCP and 12% MHS the year preceding the attack; post-attack 93% consulted PCP and 73% MHS the first year; decreasing to 87 and 40% the third year. Among male survivors, 61% consulted PCP and 7% MHS the year preceding the attack; post-attack 86% consulted PCP and 61% MHS the first year, and 67 and 31% the third year. As for PCP consultations, there was a particular increase in psychological reasons for encounter following the attack. CONCLUSIONS: This study indicates that it is important to anticipate an increased healthcare utilization several years following mass trauma, particularly of MHS. Both PCP and MHS practitioners played important roles in providing healthcare for psychological problems in young survivors of terrorism in a country with universal and largely publicly financed healthcare and a gatekeeping system. The healthcare utilization could be different in countries with other health systems or psychosocial care responses to mass trauma.


Assuntos
Serviços de Saúde Mental , Transtornos de Estresse Pós-Traumáticos , Terrorismo , Adolescente , Masculino , Feminino , Humanos , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/terapia , Transtornos de Estresse Pós-Traumáticos/psicologia , Terrorismo/psicologia , Sobreviventes/psicologia , Aceitação pelo Paciente de Cuidados de Saúde , Encaminhamento e Consulta , Atenção Primária à Saúde
5.
Int J Geriatr Psychiatry ; 37(12)2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36317324

RESUMO

OBJECTIVES: The aim was to confirm the relationship between social support (SS), post-stroke depression (PSD), and quality of life (QOL) and determine the mediating effect of PSD in stroke survivors. Additionally, we tested the impact of economic development level (in developed or developing countries) on the relationship between SS, PSD, and QOL. METHODS: This study utilized meta-analytic structural equation modeling on systematically searched articles from PubMed, MEDLINE, Cochrane Library, Scopus, PsycINFO, Web of Science, China National Knowledge Infrastructure, and WanFang data published from inception to February 2022. Collect the sample size (n) of each study and the associations of observed variables, and conduct meta-analysis path analysis using AMOS 23.0 to assess the relationships. Concurrently, the effects of the national economic development level were extracted for moderator analysis. RESULTS: A total of 28 studies (N = 3967) were included for analysis. SS and PSD were significant predictors of QOL (both p < 0.01). PSD mediated the relationship between SS and QOL (ß = 0.31; 95% confidence interval 0.273-0.345; p < 0.01). Furthermore, in developed countries, SS was not statistically correlated with PSD (p = 0.811) compared to developing countries. CONCLUSIONS: Improving SS may help improve the QOL of stroke patients. PSD should be addressed using a comprehensive approach that includes interventions to enhance the QOL. Additionally, people have different psychological reactions to SS at different stages of economic development; thus, further research is needed to develop different measurement standards for patients according to the country's level of economic development.


Assuntos
Qualidade de Vida , Acidente Vascular Cerebral , Humanos , Depressão/etiologia , Análise de Classes Latentes , Sobreviventes/psicologia , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/psicologia , Apoio Social
6.
Cancer Control ; 29: 10732748221132522, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36192670

RESUMO

OBJECTIVES: Breast cancer is the most common cancer among women in Taiwan, and treatment and coping with the disease become prominent features in a survivor's life. Here, we examined Taiwanese survivors' perceived causes of breast cancer, the influence of support networks on their perceptions, and the behavioral changes they made to prevent recurrences. METHODS: In this qualitative study, we used an explanatory approach involving semi-structured in-depth interviews based on grounded theory. We recruited (via physician referrals) 29 survivors aged ≥20 who had received their initial diagnosis at least 6 months earlier. RESULTS: Although the participants had made behavioral changes in many areas of their lives after diagnosis, most still believed that "stress and emotions" were the most crucial factor in causing cancer. They strongly emphasized reducing stress levels to prevent recurrences. However, when maintaining healthy behaviors became stressful, they chose to level off healthy lifestyles for the sake of their emotional well-being. They made career changes to improve their quality of life yet continued to experience a deep fear of recurrence. Adopting behavioral changes leading to healthy lifestyles and following regular follow-ups helped to reduce their anxiety concerning recurrence. CONCLUSION: The participants' behavioral changes were strongly associated with the perceived causes of cancer. Health-promotion programs aimed at breast cancer prevention should focus on participants' subjective perception of the cause of cancer.


Assuntos
Neoplasias da Mama , Sobreviventes de Câncer , Neoplasias da Mama/terapia , Sobreviventes de Câncer/psicologia , Feminino , Humanos , Qualidade de Vida/psicologia , Recidiva , Sobreviventes/psicologia , Taiwan/epidemiologia
7.
Br Dent J ; 233(8): 666-670, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36307712

RESUMO

Introduction Seven percent of the adult population in the UK, including one in six women, report unwanted sexual experiences before the age of 16. The impacts of psychological trauma following child sexual abuse (CSA) creates difficulties for many survivors in accessing dental care due to fears of reminders of abuse, the power imbalance with the dentist and triggered traumatic responses.Aims To analyse and report CSA survivor perspectives of dental care and offer suggestions for practice.Method Qualitative semi-structured interviews of 17 CSA survivors generated data as part of a broader study investigating trust and trustworthiness in survivor-professional relationships. The range of dental interactions and the needs survivors described when receiving dental treatment are presented. Transcripts were analysed using NVivo software and thematic analysis methodology.Results Three main themes were identified: the dental encounter ('it really panics me'); the opportunity to disclose; and choice and control.Conclusion This is the first UK study to present qualitative data from CSA survivors about their experiences of dental care. Survivors wish to access dental care but tailored support is needed to ameliorate reminders of abuse and traumatic stress triggers. Trauma-informed care may address difficulties with treatment if dental staff adopt flexible approaches and work collaboratively with survivors to facilitate relational safety. (Please note, in this paper, 'survivors' refers to those sexually abused as children).


Assuntos
Abuso Sexual na Infância , Maus-Tratos Infantis , Trauma Psicológico , Adulto , Humanos , Feminino , Criança , Sobreviventes/psicologia , Abuso Sexual na Infância/psicologia , Odontologia
9.
Sci Rep ; 12(1): 16921, 2022 Oct 08.
Artigo em Inglês | MEDLINE | ID: mdl-36209281

RESUMO

The aim of this study was to assess postacute coronavirus disease 2019 (COVID-19) syndrome (PACS) symptoms according to the onset of the infection while evaluating the effect of COVID-19 vaccination on the symptoms of PACS. We conducted a retrospective single-center cohort study in which nonhospitalized COVID-19 survivors and healthy controls were compared for the occurrence of PACS. The total number of patients in this study was 472. At 6-12 and > 12 months after the infection, COVID-19 survivors had a significantly higher incidence of posttraumatic stress disorder (PTSD) and anxiety than the non-COVID-19 cohort. Furthermore, depression, cognitive deficit, tics, impaired quality of life and general health impairment were significantly more prevalent among COVID-19 survivors at < 6 months, 6-12 months and > 12 months than in the non-COVID-19 cohort. However, respiratory symptoms were significantly more prevalent among COVID-19 survivors only in the first 6 months after infection. In addition, cognitive deficit (OR = 0.15; 95% CI 0.03-0.87) and impaired quality of life (B = - 2.11; 95% CI - 4.21 to - 0.20) were significantly less prevalent among vaccinated COVID-19 survivors than among nonvaccinated survivors. Longitudinal studies are needed to establish the time that should elapse after COVID-19 infection for the symptoms of PACS to appear. Randomized clinical trials are needed to assess the possibility that COVID-19 vaccines might relieve PACS symptoms.


Assuntos
COVID-19 , Transtornos de Estresse Pós-Traumáticos , COVID-19/epidemiologia , Vacinas contra COVID-19 , Estudos de Coortes , Humanos , Prevalência , Qualidade de Vida , Estudos Retrospectivos , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Sobreviventes/psicologia
10.
Eur J Psychotraumatol ; 13(2): 2117222, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36186156

RESUMO

Background: From 1949 to 1990, about 500,000 children and adolescents in the former German Democratic Republic (GDR) were placed in institutional care. Many of these individuals experienced physical and sexual abuse as well as general maltreatment. While this population group is in great need of psychosocial support, few low-threshold interventions aimed at the needs of adult survivors of institutional childhood abuse exist. Objective: This pilot study examines the efficacy of an internet-based imagery rescripting intervention in reducing psychopathological symptoms, within a population of survivors of institutional abuse from state childcare institutions, in the former GDR. Additionally, a case study is presented, depicting the treatment of a woman suffering from PTSD after having been institutionalised in the former GDR. Method: Participants received 10 internet-based writing assignments, based on the principles of imagery rescripting, specifically tailored to the needs of survivors of institutional childhood abuse in the GDR. The participants received personalised feedback on their assignments. Symptoms of posttraumatic stress disorder (PTSD), complex posttraumatic stress disorder (CPTSD), depression, and anxiety were assessed at pre- and post-treatment. Results: A total of 15 participants completed the intervention (mean age 56.2 years; 66.7% female). Paired t-tests showed a significant reduction of PTSD, CPTSD, depression, and anxiety symptoms. Large effect sizes were found for PTSD (d = 1.26), CPTSD (d = .97), depression (d = 1.08) and anxiety (d = 1.20). Conclusion: The results of this pilot study provide preliminary evidence for the efficacy and feasibility of the intervention in treating psychopathological symptoms in survivors of institutional abuse in the GDR. The case study additionally demonstrates the applicability of the intervention. A randomised controlled trial should be applied to further evaluate the intervention and its effects. Trial registration: German Clinical Trials Register identifier: DRKS00020266..


Antecedentes: Desde 1949 a 1990, alrededor de 500.000 niños y adolescentes en la antigua República Democrática Alemana (RDA) fueron internados en instituciones. Muchas de estas personas experimentaron abuso físico y sexual, así como malos tratos en general. Si bien este grupo de población tiene una gran necesidad de apoyo psicosocial, existen pocas intervenciones elementales dirigidas a las necesidades de los sobrevivientes adultos de abuso infantil institucional.Objetivo: Este estudio piloto examina la eficacia de una intervención de reescritura de imágenes vía Internet para reducir los síntomas psicopatológicos, en una población de sobrevivientes de abuso institucional de instituciones estatales de cuidado infantil, en la antigua RDA. Además, se presenta un estudio de caso que describe el tratamiento de una mujer que sufre de TEPT después de haber sido institucionalizada en la antigua RDA.Método: Los participantes recibieron 10 asignaciones de escritura vía Internet, basadas en los principios de la reescritura de imágenes, específicamente adaptadas a las necesidades de los sobrevivientes de abuso infantil institucional. Los participantes recibieron comentarios personalizados sobre sus tareas. Los síntomas del trastorno de estrés postraumático (TEPT), el trastorno de estrés postraumático complejo (TEPT-C), la depresión y la ansiedad se evaluaron antes y después del tratamiento.Resultados: Un total de 15 participantes completaron la intervención (edad media 56,2 años; 66,7% mujeres). Las pruebas t pareadas mostraron una reducción significativa de los síntomas TEPT, TEPT-C, depresión y ansiedad. Se encontraron tamaños de efecto grandes para TEPT (d = 1,26), TEPT-C (d = 0,97), depresión (d = 1,08) y ansiedad (d = 1,20).Conclusión: Los resultados de este estudio piloto proporcionan evidencia preliminar de la eficacia y viabilidad de la intervención en el tratamiento de síntomas psicopatológicos en sobrevivientes de abuso institucional en la RDA. El estudio de caso demuestra además la aplicabilidad de la intervención. Se debe aplicar un ensayo controlado aleatorizado para evaluar más a fondo la intervención y sus efectos.


Assuntos
Imagens, Psicoterapia , Sobreviventes , Adolescente , Adulto , Criança , Feminino , Alemanha Oriental , Humanos , Imagens, Psicoterapia/métodos , Internet , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Sobreviventes/psicologia
11.
PLoS One ; 17(10): e0275743, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36269731

RESUMO

BACKGROUND: The acute respiratory distress syndrome (ARDS) is a life-threatening condition with the risk of developing hypoxia and thus requires for invasive mechanical ventilation a long-term analgosedation. Yet, prolonged analgosedation may be a reason for declining health-related quality of life (HRQoL) and the development of psychiatric disorders. METHODS: We used data from the prospective observational nation­wide ARDS study across Germany (DACAPO) to investigate the influence of sedation and analgesia on HRQoL and the risk of psychiatric symptoms in ARDS survivors 3, 6 and 12 months after their discharge from the intensive care unit (ICU). HRQoL was measured with the Physical and Mental Component Scale of the Short­Form 12 Questionnaire (PCS­12, MCS­12). The prevalence of psychiatric symptoms (depression and post­traumatic stress disorder [PTSD]) was assessed using the Patient Health Questionnaire­9 and the Post­Traumatic Stress Syndrome­14. The associations of analgosedation with HRQoL and psychiatric symptoms were investigated by means of multivariable linear regression models. RESULTS: The data of 134 ARDS survivors (median age [IQR]: 55 [44-64], 67% men) did not show any significant association between analgosedation and physical or mental HRQoL up to 1 year after ICU discharge. Multivariable linear regression analysis (B [95%­CI]) yielded a significant association between symptoms of psychiatric disorders and increased cumulative doses of ketamine up to 6 months after ICU discharge (after 3 months: depression: 0.15 [0.05, 0.25]; after 6 months: depression: 0.13 [0.03, 0.24] and PTSD: 0.42 [0.04, 0.80)]). CONCLUSIONS: Up to 1 year after ICU discharge, analgosedation did not influence HRQoL of ARDS survivors. Prolonged administration of ketamine during ICU treatment, however, was positively associated with the risk of psychiatric symptoms. The administration of ketamine to ICU patients with ARDS should be with caution. TRIAL REGISTRATION: Clinicaltrials.gov: NCT02637011 (Registered 15 December 2015, retrospectively registered).


Assuntos
Ketamina , Síndrome do Desconforto Respiratório , Transtornos de Estresse Pós-Traumáticos , Masculino , Humanos , Feminino , Qualidade de Vida/psicologia , Sobreviventes/psicologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Unidades de Terapia Intensiva
12.
Artigo em Inglês | MEDLINE | ID: mdl-36231811

RESUMO

OBJECTIVE: The relationship with the body is a relevant issue for breast cancer survivors. Oncological treatments damage their bodies due to scars, weight gain, and other side effects. Starting from the efficacy of psychological interventions for breast cancer survivors, a tailored psychological support program was provided to promote overall well-being after illness dealing with bodily signals and related emotions and thoughts. This study presents changes in the description of the relationship with their bodies as well as participants' emotions and thoughts before and after a psychological intervention. METHODS AND MEASURES: Eighteen women answered questions related to their bodies before and after the psychological intervention. Results were analyzed in accordance with the procedure of the Word Association Analysis through the T-Lab software and the Qualitative Thematic Analysis. RESULTS: Participants reported a great awareness of their bodies and the desire to take care of them daily. In particular, the body is now perceived as a helper to sustain breast cancer survivors in their everyday activities. CONCLUSION: The words and the themes that characterized the participants' reports highlighted the impact of cancer diagnosis and oncological therapies on breast cancer survivors. The participation in the psychological intervention focused on self-compassion towards their body helps women to create an improved body perception.


Assuntos
Neoplasias da Mama , Sobreviventes de Câncer , Imagem Corporal/psicologia , Neoplasias da Mama/psicologia , Neoplasias da Mama/terapia , Sobreviventes de Câncer/psicologia , Feminino , Humanos , Pesquisa Qualitativa , Sobreviventes/psicologia
13.
Crit Care Med ; 50(12): 1778-1787, 2022 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-36205494

RESUMO

OBJECTIVES: To engage critical care end-users (survivors and caregivers) to describe their emotions and experiences across their recovery trajectory, and elicit their ideas and solutions for health service improvements to improve the ICU recovery experience. DESIGN: End-user engagement as part of a qualitative design using the Framework Analysis method. SETTING: The Society of Critical Care Medicine's THRIVE international collaborative sites (follow-up clinics and peer support groups). SUBJECTS: Patients and caregivers following critical illness and identified through the collaboratives. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Eighty-six interviews were conducted. The following themes were identified: 1) Emotions and experiences of patients-"Loss of former self; Experiences of disability and adaptation"; 2) Emotions and experiences of caregivers-"Emotional impacts, adopting new roles, and caregiver burden; Influence of gender roles; Adaptation, adjustment, recalibration"; and 3) Patient and caregiver-generated solutions to improve recovery across the arc of care-"Family-targeted education; Expectation management; Rehabilitation for patients and caregivers; Peer support groups; Reconnecting with ICU post-discharge; Access to community-based supports post-discharge; Psychological support; Education of issues of ICU survivorship for health professionals; Support across recovery trajectory." Themes were mapped to a previously published recovery framework (Timing It Right) that captures patient and caregiver experiences and their support needs across the phases of care from the event/diagnosis to adaptation post-discharge home. CONCLUSIONS: Patients and caregivers reported a range of emotions and experiences across the recovery trajectory from ICU to home. Through end-user engagement strategies many potential solutions were identified that could be implemented by health services and tested to support the delivery of higher-quality care for ICU survivors and their caregivers that extend from tertiary to primary care settings.


Assuntos
Assistência ao Convalescente , Cuidadores , Humanos , Cuidadores/psicologia , Alta do Paciente , Cuidados Críticos , Sobreviventes/psicologia
14.
JAMA ; 328(18): 1827-1836, 2022 11 08.
Artigo em Inglês | MEDLINE | ID: mdl-36286084

RESUMO

Importance: Extracorporeal membrane oxygenation (ECMO) is used as temporary cardiorespiratory support in critically ill patients, but little is known regarding long-term psychiatric sequelae among survivors after ECMO. Objective: To investigate the association between ECMO survivorship and postdischarge mental health diagnoses among adult survivors of critical illness. Design, Setting, and Participants: Population-based retrospective cohort study in Ontario, Canada, from April 1, 2010, through March 31, 2020. Adult patients (N=4462; age ≥18 years) admitted to the intensive care unit (ICU), and surviving to hospital discharge were included. Exposures: Receipt of ECMO. Main Outcomes and Measures: The primary outcome was a new mental health diagnosis (a composite of mood disorders, anxiety disorders, posttraumatic stress disorder; schizophrenia, other psychotic disorders; other mental health disorders; and social problems) following discharge. There were 8 secondary outcomes including incidence of substance misuse, deliberate self-harm, death by suicide, and individual components of the composite primary outcome. Patients were compared with ICU survivors not receiving ECMO using overlap propensity score-weighted cause-specific proportional hazard models. Results: Among 642 survivors who received ECMO (mean age, 50.7 years; 40.7% female), median length of follow-up was 730 days; among 3820 matched ICU survivors who did not receive ECMO (mean age, 51.0 years; 40.0% female), median length of follow-up was 1390 days. Incidence of new mental health conditions among survivors who received ECMO was 22.1 per 100-person years (95% confidence interval [CI] 19.5-25.1), and 14.5 per 100-person years (95% CI, 13.8-15.2) among non-ECMO ICU survivors (absolute rate difference of 7.6 per 100-person years [95% CI, 4.7-10.5]). Following propensity weighting, ECMO survivorship was significantly associated with an increased risk of new mental health diagnosis (hazard ratio [HR] 1.24 [95% CI, 1.01-1.52]). There were no significant differences between survivors who received ECMO vs ICU survivors who did not receive ECMO in substance misuse (1.6 [95% CI, 1.1 to 2.4] per 100 person-years vs 1.4 [95% CI, 1.2 to 1.6] per 100 person-years; absolute rate difference, 0.2 per 100 person-years [95% CI, -0.4 to 0.8]; HR, 0.86 [95% CI, 0.48 to 1.53]) or deliberate self-harm (0.4 [95% CI, 0.2 to 0.9] per 100 person-years vs 0.3 [95% CI, 0.2 to 0.3] per 100 person-years; absolute rate difference, 0.1 per 100 person-years [95% CI, -0.2 to 0.4]; HR, 0.68 [95% CI, 0.21 to 2.23]). There were fewer than 5 total cases of death by suicide in the entire cohort. Conclusions and Relevance: Among adult survivors of critical illness, receipt of ECMO, compared with ICU hospitalization without ECMO, was significantly associated with a modestly increased risk of new mental health diagnosis or social problem diagnosis after discharge. Further research is necessary to elucidate the potential mechanisms underlying this relationship.


Assuntos
Oxigenação por Membrana Extracorpórea , Transtornos Relacionados ao Uso de Substâncias , Adulto , Humanos , Feminino , Pessoa de Meia-Idade , Adolescente , Masculino , Estado Terminal/terapia , Oxigenação por Membrana Extracorpórea/efeitos adversos , Saúde Mental , Estudos Retrospectivos , Alta do Paciente , Assistência ao Convalescente , Sobreviventes/psicologia , Avaliação de Resultados em Cuidados de Saúde , Ontário/epidemiologia
15.
Artigo em Inglês | MEDLINE | ID: mdl-36231808

RESUMO

OBJECTIVE: This study used narrative interviewing and grounded theory analysis to discover the phases of trauma integration for Japanese women who had experienced intimate partner violence (IPV). METHOD: We interviewed 23 Japanese women who had experienced IPV using the Clinical Ethnographic Narrative Interviews (CENI) from November 2017 to September 2018 in Tokyo, Japan. The data from 11 participants who had achieved trauma integration using the Trauma Recovery Rubric were analyzed using a modified grounded theory approach. RESULTS: Six phases of the trauma integration journey after IPV were discovered: (1) Chaos, (2) Burning out, (3) Focusing, (4) Challenging, (5) Deepening insights, and (6) Re-building. The survivors described the processes of exploration of themselves and their reactions to their concurrent challenges. They focused on finding ways to protect, re-discover, and re-embrace themselves by healing from physical, psychological, and spiritual distresses. They also rebuilt relationships with others and acquired knowledge and skills to achieve a new life. Notably, the primary components of their recovery processes were changes in self-perception and self-interpretation of the trauma itself and its impacts on one's life and within oneself from multiple angles. In addition, traditional Japanese norms and gender roles, such as beliefs concerning the "ideal life of a woman" and fear of not behaving differently from others, profoundly influenced their recovery process. CONCLUSION: This study highlights the importance of incorporating individuals' cultures and their phase, needs, and personal self-development timeframes when developing trauma integration interventions.


Assuntos
Violência por Parceiro Íntimo , Feminino , Teoria Fundamentada , Humanos , Violência por Parceiro Íntimo/psicologia , Japão , Autoimagem , Sobreviventes/psicologia
16.
Medicina (Kaunas) ; 58(10)2022 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-36295556

RESUMO

While the roots of burn care date back several millennia, recognition and treatment of psychiatric trauma has had a more contemporary journey. Our understanding of burn care has evolved largely separately from our understanding of psychiatry; however, proper care of the burn patient relies on the comprehension of both disciplines. Historically, high burn mortality rates have caused clinicians to focus on the physiological causes of burn mortality. As burn care improved in the 20th century, providers began to focus on the long-term health outcomes of burn patients, including mitigating mental health consequences of trauma. This shift coincided with advances in our understanding of psychological sequelae of trauma. Subsequently, an association between burn trauma and mental illness began to emerge. The current standard of care is the result of thousands of years of evolving practices and theories, yet our understanding of the pathophysiology of depression among survivors of severe burn injury is far from complete. By taking measure of the past, we aim to provide context and evidence for our current standards and emphasize areas for future lines of research.


Assuntos
Queimaduras , Transtornos de Estresse Pós-Traumáticos , Humanos , Depressão/etiologia , Depressão/psicologia , Queimaduras/complicações , Sobreviventes/psicologia
17.
Psychiatr Danub ; 34(3): 578-586, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36257010

RESUMO

BACKGROUND: COVID-19 pandemic, which still continues to affect the whole world, has led to an increase in PTSD symptoms in societies, especially individuals who have been diagnosed with the disease and recovered are at significant risk for PTSD have been reported. Although it has been observed that PTSD symptoms of individuals who were infected in the past epidemics such as SARS and Ebola continued for a long time even after the epidemic, it is noteworthy that the studies conducted during the COVID-19 process do not focus enough on people who survived the COVID-19 disease. The purpose of this study is to determine the direct and indirect impact of positivity on PTSD symptoms of individuals who have recovered from COVID-19 and the role of rumination and fear of COVID-19 as potential mediators in this effect. SUBJECTS AND METHODS: In the study, the Impact of Event Scale-Revised, Ruminative Response Scale, Positivity Scale, and Fear of COVID-19 Scale were applied to 551 Turkish participants, who survived the COVID-19 disease. SEM-based mediation analysis was used to test hypothesized relationships. RESULTS: Mediating roles of fear of COVID-19 and rumination between positivity and PTSD were tested. Results indicated that rumination and fear of COVID-19 had a full mediating role in the relationship between positivity and PTSD. CONCLUSION: These findings pointed out that positivity might be an indirect protective disposition against COVID-19-related PTSD and might reduce risk factors associated with PTSD among COVID-19 survivors. Mental health practices for COVID-19 patients should aim to increase positive thinking, since they have ruminative thoughts about transmission of the virus and hospitalization process and these thoughts may lead to negative mental health conditions. In this sense, positive psychology-focused implementations can be organized for COVID-19 patients and survivors.


Assuntos
COVID-19 , Transtornos de Estresse Pós-Traumáticos , Humanos , COVID-19/psicologia , Medo , Pandemias , Transtornos de Estresse Pós-Traumáticos/psicologia , Sobreviventes/psicologia
18.
Sci Rep ; 12(1): 18127, 2022 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-36307529

RESUMO

This study investigated whether the associations between emotion regulation and cognitive appraisals and symptoms of posttraumatic stress disorder (PTSD) differ between Asian American and European American trauma survivors. Asian American (n = 103) and European American (n = 104) trauma survivors were recruited through mTurk and completed an on-line questionnaire assessing cognitive appraisals, emotion regulation and PTSD symptomatology. The European American group reported greater trauma-specific rumination, psychological inflexibility, seeking out others for comfort, and negative self-appraisals than the Asian American group. The Asian American group reported greater secondary control appraisals and cultural beliefs about adversity than the European American group. Second, cultural group moderated the associations between (a) brooding rumination, (b) fatalism, (c) self-blame, and (d) negative communal self-appraisals and PTSD symptoms. These associations were larger for the European American group than the Asian American group. Third, there was an indirect pathway from self-construal (independent and interdependent) to PTSD symptoms through certain emotion regulation approaches and cognitive appraisals. Additionally, cultural group was found to moderate several of these indirect effects. These findings highlight the importance of considering cultural background and cultural values in understanding the processes involved in PTSD. Further research in this area is needed.


Assuntos
Regulação Emocional , Transtornos de Estresse Pós-Traumáticos , Humanos , Transtornos de Estresse Pós-Traumáticos/psicologia , Americanos Asiáticos , Sobreviventes/psicologia , Cognição
19.
BMJ Open ; 12(9): e061876, 2022 09 20.
Artigo em Inglês | MEDLINE | ID: mdl-36127077

RESUMO

INTRODUCTION: A substantial proportion of intensive care unit (ICU) survivors develop psychological impairments after ICU treatment, part of the postintensive care syndrome, resulting in a decreased quality of life. Recent data suggest that an ICU-specific virtual reality intervention (ICU-VR) for post-ICU patients is feasible and safe, improves satisfaction with ICU aftercare, and might improve psychological sequelae. In the present trial, we firstly aim to determine whether ICU-VR is effective in mitigating post-traumatic stress disorder (PTSD)-related symptoms and secondly to determine the optimal timing for initiation with ICU-VR. METHODS AND ANALYSIS: This international, multicentre, randomised controlled trial will be conducted in 10 hospitals. Between December 2021 and April 2023, we aim to include 300 patients who have been admitted to the ICU ≥72 hours and were mechanically ventilated ≥24 hours. Patients will be followed for 12 consecutive months. Patients will be randomised in a 1:1:1 ratio to the early ICU-VR group, the late ICU-VR group, or the usual care group. All patients will receive usual care, including a mandatory ICU follow-up clinic visit 3 months after ICU discharge. Patients in the early ICU-VR group will receive ICU-VR within 2 weeks after ICU discharge. Patients in the late VR group will receive ICU-VR during the post-ICU follow-up visit. The primary objective is to assess the effect of ICU-VR on PTSD-related symptoms. Secondary objectives are to determine optimal timing for ICU-VR, to assess the effects on anxiety-related and depression-related symptoms and health-related quality of life, and to assess patient satisfaction with ICU aftercare and perspectives on ICU-VR. ETHICS AND DISSEMINATION: The Medical Ethics Committee United, Nieuwegein, the Netherlands, approved this study and local approval was obtained from each participating centre (NL78555.100.21). Our findings will be disseminated by presentation of the results at (inter)national conferences and publication in scientific, peer-reviewed journals. TRIAL REGISTRATION NUMBER: NL9812.


Assuntos
Qualidade de Vida , Realidade Virtual , Estado Terminal/psicologia , Humanos , Unidades de Terapia Intensiva , Estudos Multicêntricos como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Sobreviventes/psicologia
20.
BMJ Open ; 12(9): e060454, 2022 09 27.
Artigo em Inglês | MEDLINE | ID: mdl-36167379

RESUMO

OBJECTIVES: Social determinants of health (SDoH) contribute to health outcomes. We identified SDoH that were modified by critical illness, and the effect of such modifications on recovery from critical illness. DESIGN: In-depth semistructured interviews following hospital discharge. Interview transcripts were mapped against a pre-existing social policy framework: money and work; skills and education; housing, transport and neighbourhoods; and family, friends and social connections. SETTING: 14 hospital sites in the USA, UK and Australia. PARTICIPANTS: Patients and caregivers, who had been admitted to critical care from three continents. RESULTS: 86 interviews were analysed (66 patients and 20 caregivers). SDoH, both financial and non-financial in nature, could be negatively influenced by exposure to critical illness, with a direct impact on health-related outcomes at an individual level. Financial modifications included changes to employment status due to critical illness-related disability, alongside changes to income and insurance status. Negative health impacts included the inability to access essential healthcare and an increase in mental health problems. CONCLUSIONS: Critical illness appears to modify SDoH for survivors and their family members, potentially impacting recovery and health. Our findings suggest that increased attention to issues such as one's social network, economic security and access to healthcare is required following discharge from critical care.


Assuntos
Estado Terminal , Determinantes Sociais da Saúde , Cuidadores/psicologia , Estado Terminal/psicologia , Estado Terminal/terapia , Humanos , Pesquisa Qualitativa , Sobreviventes/psicologia
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