The clinical effectiveness of the Mind/Body Program for Infertility on wellbeing and assisted reproduction outcomes: a randomized controlled trial in search for active ingredients.

STUDY QUESTION: Does the Mind/Body Program for Infertility (MBPI) perform better, due to certain distinctive elements, than a partly matched support group in improving the wellbeing and medically assisted reproduction (MAR) outcomes of women with elevated distress levels in a clinical setting? SUMMARY ANSWER: While robust enhancements occurred in the wellbeing overall, the cognitive behavioural and formalized stress management elements of the MBPI allowed a significantly stronger improvement in trait anxiety, but not in other mental health and MAR outcomes, compared with a support group. WHAT IS KNOWN ALREADY: Mind-body psychological programmes adjacent to MAR have been found to improve women's mental states and possibly increase chances of pregnancy. However, not enough is known about the programme's effectiveness among patients with elevated distress levels in routine clinical settings, nor is it clear which of its particular ingredients are specifically effective. STUDY DESIGN, SIZE, DURATION: A pre-post design, single-centre, randomized controlled trial was performed between December 2019 and October 2022 (start and end of recruitment, respectively). The sample size (n = 168) was calculated to detect superiority of the MBPI in improving fertility-related quality of life. Randomization was computer-based, with random numbers concealing identities of patients until after allocation. PARTICIPANTS/MATERIALS, SETTING, METHODS: The trial was conducted at a large university teaching hospital. A total of 168 patients were randomly assigned to the mind-body (MBPI) group (n = 84) and the fertility support (FS) control group (n = 84). Patients received a 10-week, 135-min/week group intervention, with the FS group following the same format as the MBPI group, but with a less restricted and systematic content, and without the presumed effective factors. The number of patients analysed was n = 74 (MBPI) and n = 68 (FS) for post-intervention psychological outcomes, and n = 54 (MBPI) and n = 56 (FS) for pregnancy outcomes at a 30-month follow-up. MAIN RESULTS AND THE ROLE OF CHANCE: Significant improvements occurred in both groups in all psychological domains (adjusted P < 0.001), except for treatment-related quality of life. Linear mixed-model regression analysis did not reveal significantly greater pre-post improvements in the MBPI group than in the FS group in fertility-related quality of life (difference in differences (DD) = 4.11 [0.42, 7.80], d = 0.32, adjusted P = 0.124), treatment-related quality of life (DD = -3.08 [-7.72, 1.55], d = -0.20, adjusted P = 0.582), infertility-specific stress (DD = -2.54 [-4.68, 0.41], d = -0.36, adjusted P = 0.105), depression (DD = -1.16 [3.61, 1.29], d = -0.13, adjusted P = 0.708), and general stress (DD = -0.62 [-1.91, 0.68], d = -0.13, adjusted P = 0.708), but it did show a significantly larger improvement in trait anxiety (DD = -3.60 [-6.16, -1.04], d = -0.32, adjusted P = 0.042). Logistic regression showed no group effect on MAR pregnancies, spontaneous pregnancies, or live births. LIMITATIONS, REASONS FOR CAUTION: The follow-up only covered MAR-related medical outcomes and no psychological variables, and their rates were not equal in the two groups. Biological factors other than age, aetiology, and duration of infertility may have confounded the study results. Loss to follow-up was between 5% and 10%, which may have led to some bias. WIDER IMPLICATIONS OF THE FINDINGS: The psychologically and medically heterogeneous sample, the normal clinical setting and the low attrition rate all raise the external validity and generalizability of our study. The MBPI works not only in controlled conditions, but also in routine MAR practice, where it can be introduced as a cost-effective, low-intensity psychological intervention, within the framework of stepped care. More studies are needed to further identify its active ingredients. STUDY FUNDING/COMPETING INTEREST(S): The authors received no financial support for the research, authorship, and/or publication of this article. The authors have no conflict of interest to disclose. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT04151485. TRIAL REGISTRATION DATE: 5 November 2019. DATE OF FIRST PATIENT'S ENROLMENT: 15 December 2019.

How to treat subsyndromal anxiety disorder - practical recommendations for implementation in primary care.

BACKGROUND: Anxiety is a common and disabling condition that significantly impacts quality of life. Subsyndromal anxiety (SSA) refers to anxiety symptoms that do not meet the full diagnostic criteria for an anxiety disorder but pose a risk for developing such disorders. We aimed to provide practical recommendations for the treatment of SSA in primary care settings. METHODS: A narrative review was conducted to identify strategies for recognizing and treating patients with SSA. RESULTS: The recommendations for treating SSA include lifestyle modifications such as exercise and stress reduction techniques, psychotherapy, and pharmacological treatments, including natural compounds like the lavender oil extract Silexan. Regular follow-up care is essential to monitor treatment response and address ongoing symptoms. Additionally, the use of the GAD-7 tool is recommended for accurately identifying patients with SSA. CONCLUSION: Implementing these recommendations in primary care can lead to effective treatment of SSA, preventing the development of more severe anxiety disorders. An integrative approach, combining lifestyle modifications, psychotherapy, and pharmacotherapy, including natural compounds, offers significant benefits for managing anxiety.

Anxiety is prevalent and disablingSubsyndromal anxiety is a risk factor for anxiety disordersSubsyndromal anxiety can be assessed with the GAD-7 (Generalised Anxiety Disorder-7 scale)Subsyndromal anxiety can be treated with life-style modification, psychotherapy and pharmacological treatment, including silexan, a natural compound.

[Challenges and resolutions in mental health support for medical students. Mental Health Counseling Service at Semmelweis University].

The prevalence of mental health problems is on the rise worldwide, and there appears to be a significant increase in young university students as well - a British study found a fivefold increase in the prevalence of mental health problems in adolescents over a 10-year period. In the world of medical universities, full of stressful challenges and a competitive atmosphere, the above factors put even more pressure on students. The less favorable mental state of medical students compared to students of other universities is well known and cannot be considered as specific to Hungary. There are several national and international studies that emphasize the multicausal origin of this phenomenon. In order to support the mental and physical well-being of students, to reduce dropout rates and to prevent various psychiatric disorders, the development of well-being services is advocated worldwide. In our paper, we present the curricular and extracurricular mental health promotion opportunities available to students at Semmelweis University, with a special focus on the Student Counselling Service.

Supporting employees with mental illness and reducing mental illness-related stigma in the workplace: an expert survey.

An expert survey was designed to support the development of a workplace-based multi-country intervention tackling depression, anxiety, and mental illness-related stigma in small- and medium-sized enterprises (SMEs). Academic experts and representatives of SME organisations, specific sector organisations, labour or advocacy groups, and occupational health organisations, were contacted across eight European countries and Australia. The survey comprised closed and open text questions to assess expert opinion about interventions for employees with mental health difficulties, interventions supporting their managers, and anti-stigma interventions. The survey was available in six languages. The online platform Qualtrics was used for data collection. Quantitative data was analysed through descriptive statistics and qualitative data was analysed through thematic analysis. Sixty-five of 146 experts responded, representing a 42% response rate. Results showed only 26.2% of experts agreed that employees could speak openly about mental health issues, and 81.5% of experts indicated a large or medium unmet need for support for employees with mental health issues. Psychoeducational materials, face-to-face workshops and interventions based on cognitive behavioural therapy were ranked most likely to be taken up by employees. Experts rated as most useful for managers' guidelines on how to act if an employee has mental health issues (67.7%). The greatest number of experts indicated workshops of people with lived experience of mental illness (80.0%) and awareness campaigns (78.5%) were most required to tackle stigma. Responses were consistent between experts from different countries and areas of expertise. Experts in this multinational survey assessed that interventions supporting mental health in the workplace and tackling stigma are greatly needed. A multicomponent intervention with a wide range of materials and tools is supported.

Developing a framework for evaluation: a Theory of Change for complex workplace mental health interventions.

BACKGROUND: There is a gap between the necessity of effective mental health interventions in the workplace and the availability of evidence-based information on how to evaluate them. The available evidence outlines that mental health interventions should follow integrated approaches combining multiple components related to different levels of change. However, there is a lack of robust studies on how to evaluate multicomponent workplace interventions which target a variety of outcomes at different levels taking into account the influence of different implementation contexts. METHOD: We use the MENTUPP project as a research context to develop a theory-driven approach to facilitate the evaluation of complex mental health interventions in occupational settings and to provide a comprehensive rationale of how these types of interventions are expected to achieve change. We used a participatory approach to develop a ToC involving a large number of the project team representing multiple academic backgrounds exploiting in tandem the knowledge from six systematic reviews and results from a survey among practitioners and academic experts in the field of mental health in SMEs. RESULTS: The ToC revealed four long-term outcomes that we assume MENTUPP can achieve in the workplace: 1) improved mental wellbeing and reduced burnout, 2) reduced mental illness, 3) reduced mental illness-related stigma, and 4) reduced productivity losses. They are assumed to be reached through six proximate and four intermediate outcomes according to a specific chronological order. The intervention consists of 23 components that were chosen based on specific rationales to achieve change on four levels (employee, team, leader, and organization). CONCLUSIONS: The ToC map provides a theory of how MENTUPP is expected to achieve its anticipated long-term outcomes through intermediate and proximate outcomes assessing alongside contextual factors which will facilitate the testing of hypotheses. Moreover, it allows for a structured approach to informing the future selection of outcomes and related evaluation measures in either subsequent iterations of complex interventions or other similarly structured programs. Hence, the resulting ToC can be employed by future research as an example for the development of a theoretical framework to evaluate complex mental health interventions in the workplace.

Outcome assessment of a complex mental health intervention in the workplace. Results from the MENTUPP pilot study.

OBJECTIVE: Multicomponent interventions are recommendable to achieve the greatest mental health benefits, but are difficult to evaluate due to their complexity. Defining long-term outcomes, arising from a Theory of Change (ToC) and testing them in a pilot phase, is a useful approach to plan a comprehensive and meaningful evaluation later on. This article reports on the pilot results of an outcome evaluation of a complex mental health intervention and examines whether appropriate evaluation measures and indicators have been selected ahead of a clustered randomised control trial (cRCT). METHODS: The MENTUPP pilot is an evidence-based intervention for Small and Medium Enterprises (SMEs) active in three work sectors and nine countries. Based on our ToC, we selected the MENTUPP long-term outcomes, which are reported in this article, are measured with seven validated scales assessing mental wellbeing, burnout, depression, anxiety, stigma towards depression and anxiety, absenteeism and presenteeism. The pilot MENTUPP intervention assessment took place at baseline and at 6 months follow-up. RESULTS: In total, 25 SMEs were recruited in the MENTUPP pilot and 346 participants completed the validated scales at baseline and 96 at follow-up. Three long-term outcomes significantly improved at follow-up (p < 0.05): mental wellbeing, symptoms of anxiety, and personal stigmatising attitudes towards depression and anxiety. CONCLUSIONS: The results of this outcome evaluation suggest that MENTUPP has the potential to strengthen employees' wellbeing and decrease anxiety symptoms and stigmatising attitudes. Additionally, this study demonstrates the utility of conducting pilot workplace interventions to assess whether appropriate measures and indicators have been selected. Based on the results, the intervention and the evaluation strategy have been optimised.

[Effectiveness of psychotherapeutic interventions: the potentials of professional guidelines - a methodological consensus proposal].

Psychotherapeutic interventions diff er from other health care interventions in many ways, thus the indicators of evidence-based medicine should be used with modifications when necessary. Implementation of a unified evaluation and quality assurance framework would aid the psychotherapy scene in having their intervention methods acknowledged by other medical specialties as an equal healthcare intervention. Professional recommendations regarding the interventions and methods used in clinical care in the field of psychotherapy can be laid down in specific professional guidelines of the domestic healthcare regulatory practice. A professional guideline is both a starting point and a practical guide for (planning to train, in training, or trained) professionals, as well as for the healthcare funder(s). In addition, a fixed professional framework would provide a consistent and accountable reference for quality assurance for patients who wish to recover and for those consider receiving psychotherapy. Evidence-based recommendations for the practice of the profession 1) can validate the applied care practice through findings supported from a scientific point of view, 2) can consensually resolve the specific contradictions of the field through definitions 3) can also provide a basis for transparent training, administrative and financing aspects. Consistent professional decision-making must be carried out according to a uniform ranking system. The reliability of the evidence is also very important in terms of clinical applicability of a psychotherapy method.

Adherence to the iFightDepression® online self-help tool for depression - A pilot study.

Background and purpose:

The aim of the current observational study was to examine the level of adherence of Hungarian patients suffering from depression, using iFightDep­ression (iFD) guided online self-help tool with and without an extra weekly phone call support as well as identifying the predictors of adherence. Our hypotheses were: the additional weekly phone-calls would increase the adherence with the online self-help tool; furthermore, symptoms of depression will significantly decrease in the weekly phone support group.

During the 6 weeks of iFD® intervention, patients were divided into two groups: the first, alongside of the treatment as usual (TAU) and iFD®, received a 20-minu­tes weekly phone call support while the other group partook in only the TAU+iFD® intervention. Measures: number of completed modules and Patient Health Questionnaire-9. The study included 102 participants with diagnosis of depression (70% female, mean age: 36.9 [SD = 11.40] ys). 

Participants completed on average 4.8 (SD = 1.73) out of 6 modules. The intervention group with additional phone support completed more modules than the group of no additional phone calls (Z = –5.416, p < 0.001, rank Cohen’s d = –1.267). Participants with higher level of education completed more modules than those with lower level of education (Z = –2.198, p = 0.028, rank Cohen’s d = –0.444). Baseline depressive symptoms correlated negatively with the number of completed modules (rS = –0.22, p = 0.028). Depressive symptoms were significantly reduced between the two measurement points (main effect of time: (F(1) = 179.173, p < 0.001, partial η2 = 0.642), the improvement was significantly larger in the iFD® + phone support group (time × group interaction: F(1) = 6.492, p = 0.012, partial η2 = 0.061).

Weekly phone support increased treatment adherence. Negative correlation of symptom severity with adherence suggests that iFD can be effective in mild or moderate forms of depression. With regards to sociodemographic variables, only the level of education showed significant correlation with adherence. Our results support applicability of the iFD intervention in various kinds of sociodemographic groups.

Personality traits and psychological complaints under patients suffering from headaches.

Background and purpose:

Although headaches are often comorbid with psychological symptoms, the underlying psychological processes, e.g. the role of personality dimensions as headache determinants remains unclear. Studies found associations between headaches and various personality traits; according to the Big Five model of personality, persons suffering from headaches exhibit a higher rate in neuroticism, while a lower rate in extraversion, openness to experiences and positive emotions. This is the first study to clarify the associations among duration, intensity, and frequency of headaches and personality dimensions. Through this study we could get into the personality dimensions in the background of pain experience and that which personality dimensions bear a part in the behaviour of the persons, who suffered from headache, but do not seek treatment through this complaint. 

Treated (Group1) and untreated (Group2) headache patients and healthy controls (Group3) were investigated (total of 360 participants). The main headache components of intensity, duration, and frequency were used as dependent variables with personality dimensions in the Big Five concept investigated by the NEO-PI-R Personality Inventory.

Employing multiple regression analysis, facets of personality described 14.7% of headache intensity, 10.9 % of duration, and 18.7 % of frequency variance. Group1 and Group2 reached significantly higher values on the dimension of anxiety, depression, and vulnerability to stress than Group3. Group1 showed a significantly higher value on trust personality dimension than Group3 and Group2. Group3 exhibited a significantly higher value in the trust dimension than Group2. Concerning vulnerability to stress, the highest value was yielded by the “treated and suffering from headaches” group and there was a significant difference also with the “untreated and suffering from headaches” group and with the control group. In this dimension, the “untreated and suffering from headaches” group’s point value was significantly higher than the control group’s (p<0.01, U=-4.501).

Our study demonstrates that the three headache components are not independent from personality traits, and personality traits may interact with treatment seeking behavior even in the presence of significant headache complaints. The role of the personality traits are significant in the intensity, duration and frequency of headaches. 

Seeds that bloom on stony ground - Concept paper of the future perspectives of the unexploited capacities of positive clinical psychology in Hungary.

Positive psychology has fully examined the flourishing among healthy people but neglected to understand how "optimal human functioning" can apply to the life experiences of a vulnerable person. Considering methodological issues, this article gives a brief overview on how the conceptualization of mental health and mental disorders affects the consideration of strengths along with the presence of dysfunction with the emergence of positive psychology. First, we summarize the shortcomings of the applicability of clinical positive psychology, focusing especially on Hungarian clinical practice. Second, we discuss the problems with the conceptualization of mental health in positive psychological framework. Third, we propose a model, the Maintainable Positive Mental Health Theory based on capacities and competences. Finally, we conclude with methodological questions and present a research protocol. The key finding of our review is that the opportunity exists for psychiatrists and psychologists to embrace disability as part of human experiences and to show how people with vulnerabilities can be supported to recover. (Neuropsychopharmacol Hung 2022; 24(3): 113-119).

Mental Health Profiles in Clinical and Non-clinical Samples in Light of the Maintainable Positive Mental Health Theory: Protocol Paper.

Clinical psychology has invested a lot of energy in the thorough examination of the characteristics of mental disorders, but less in the implication of the accessible mental health capacities in the recovery phase. Our aim in the present study is to verify the two-continuum mental health model in clinical and non-clinical samples in the light of the Maintainable Positive Mental Health Theory. A further aim is to investigate the interrelationship between positive mental health and mental disorder by examining various groups of mental disorders with different levels of severity. We also examine the prevalence of the diagnostic categories of the Complete Mental Health Model. Furthermore, we aim to identify mental health profiles and their correlates. In the present paper, we introduce the protocol for the ongoing research. A cross-sectional, case-control design is employed to investigate the two-continuum model of mental health. The clinical sample (n = 400) is recruited from four Hungarian hospitals. The non-clinical sample (n = 400) is collected using an online self-report survey-based research design. The two-continuum model of mental health will be tested using exploratory factor analysis and confirmatory factor analysis, with the symptoms of mental disorders and mental health as outcome variables. We will then separate groups of mental disorders according to the leading symptoms. Analysis of variance will be used to examine mental health as the dependent variable at a certain severity level in different mental disorder groups. Analysis of covariance will be used to identify the effect of different sociodemographic indicators.The prevalence of the diagnostic categories of the Complete Mental Health Model will be calculated and compared using chi-square tests. Finally, mental health profiles will be identified using latent profile analysis. Our study draws attention to the fact that "optimal human functioning" can be understood in ways that includes, and not excludes, people living with mental disorder.

Factor structure of The Opening Minds Stigma Scale for Health Care Providers and psychometric properties of its Hungarian version.

BACKGROUND: The Opening Minds Stigma Scale for Health Care Providers (OMS-HC) is a widely used questionnaire to measure the stigmatising attitudes of healthcare providers towards patients with mental health problems. The psychometric properties of the scale; however, have never been investigated in Hungary. We aimed to thoroughly explore the factor structure of the OMS-HC and examine the key psychometric properties of the Hungarian version. METHODS: The OMS-HC is a self-report questionnaire that measures the overall stigmatising attitude by a total score, and three subscales can be calculated: Attitude, Disclosure and Help-seeking, and Social Distance. Our study population included specialists and trainees in adult and child psychiatry (n = 211). Exploratory and confirmatory factor analyses were performed, and higher-order factors were tested. We calculated the test-retest reliability on a subgroup of our sample (n = 31) with a follow-up period of 1 month. The concurrent validity of the scale was measured with the Mental Illness: Clinician's Attitudes-4 scale (MICA-4). RESULTS: Three factors were extracted based on a parallel-analysis. A bifactor solution (a general factor and three specific factors) showed an excellent model-fit (root mean square error of approximation = 0.025, comparative fit index = 0.961, and Tucker-Lewis index = 0.944). The model-based reliability was low; however, the general factor showed acceptable reliability (coefficient omega hierarchical = 0.56). The scale demonstrated a good concurrent validity with the MICA-4 [intraclass correlation coefficient (ICC) = 0.77]. The test-retest reliability was excellent for the general factor (ICC = 0.95) and good for the specific factors (ICC = 0.90, 0.88, and 0.84, respectively). CONCLUSIONS: The three dimensions of the OMS-HC was confirmed, and the scale was found to be an adequate measure of the stigmatising attitude in Hungary. The bifactor model is more favourable as compared to the three correlated factor model; however, despite the excellent internal structure, its model-based reliability was low.

[Reflection about the practice of spirituality and whether this will change psychotherapy].

No abstract available.

A qualitative study of culturally embedded factors in complementary and alternative medicine use.

BACKGROUND: Within the intercultural milieu of medical pluralism, a nexus of worldviews espousing distinct explanatory models of illness, our research aims at exploring factors leading to complementary and alternative medicine (CAM) use with special attention to their cultural context. METHODS: The results are based on medical anthropological fieldwork (participant observation and in-depth interviews) spanning a period from January 2015 to May 2017 at four clinics of Traditional Chinese Medicine in Budapest, Hungary. Participant observation involved 105 patients (males N = 42); in-depth interviews were conducted with patients (N = 9) and practitioners (N = 9). The interviews were coded with Interpretative Phenomenological Analysis; all information was aggregated employing Atlas.ti software. RESULTS: In order to avoid the dichotomization of "push and pull factors," results obtained from the fieldwork and interviews were structured along milestones of the patient journey. These points of reference include orientation among sources of information, biomedical diagnosis, patient expectations and the physician-patient relationship, the biomedical treatment trajectory and reasons for non-adherence, philosophical congruence, and alternate routes of entry into the world of CAM. All discussed points which are a departure from the strictly western therapy, entail an underlying socio-cultural disposition and must be scrutinized in this context. CONCLUSIONS: The influence of one's culturally determined explanatory model is ubiquitous from the onset of the patient journey and exhibits a reciprocal relationship with subjective experience. Firsthand experience (or that of the Other) signifies the most reliable source of information in matters of illness and choice of therapy. Furthermore, the theme of (building and losing) trust is present throughout the patient journey, a determining factor in patient decision-making and dispositions toward both CAM and biomedicine.

[Guidelines and recommendations in the treatment of eating disorders].

The importance of eating disorders is increasing in the psychiatric practice, underlined by the epidemiological data and the severity of these disorders. In the treatment several approaches can be found, and some of these are controversial. Following the rules of evidence-based medicine an increasing number of guidelines were published. Eating disorders are prevalent and often show a serious course, the guidelines summarizing the recent knowledge in the literature are very useful for the therapists. The present guideline aims to help the everyday practice. It overviews the principles of the treatment of eating disordered patients, the steps of diagnostics, and the therapeutical methods. Many basic and practical techniques are also presented. It discusses the skills which are necessary for the treatment of eating disorders, and the therapeutical traps as well.

[Recognition, care and prevention of suicidal behaviour in adults].

Suicide is a major public health problem everywhere in the world and in the WHO European Region suicide accounts for over 120,000 deaths per year. 1. Recognition and diagnosis: An underlying psychiatric disorder is present in up to 90% of people who completed suicide. Comorbidity with depression, anxiety, substance abuse and personality disorders is high. In order to achieve successful prevention of suicidality, adequate diagnostic procedures and appropriate treatment for the underlying disorder are essential. 2. Treatment and care: Acute intervention should start immediately in order to keep the patient alive. Existing evidence supports the efficacy of pharmacological treatment and cognitive behavioural therapy (including dialectical behavior therapy and problem-solving therapy) in preventing suicidal behaviour. Some other psychological treatments are promising, but the supporting evidence is currently insufficient. Studies show that antidepressant and mood stabilizer treatments decrease the risk for suicidality among responders in mood disorder patients. However, the risk of suicidal behaviour in depressed patients treated with antidepressants exists during the first 10-14 days of treatment, which requires careful monitoring. Short-term supplementary medication with anxiolytics and hypnotics in the case of anxiety and insomnia is recommended. Treatment with antidepressants of children and adolescents should only be given under supervision of a specialist. Long-term treatment with lithium has been shown to be very effective in preventing both suicide and attempted suicide in patients with unipolar and bipolar depression. Treatment with clozapine is effective in reducing suicidal behaviour in patients with schizophrenia. Other atypical antipsychotics are promising but more evidence is required. 3. Family and social support: The suicidal person should always be motivated to involve family in the treatment. Psychosocial treatment and support is recommended, as the majority of suicidal patients have problems with relationships, work, school and lack functioning social networks. 4. SAFETY: A secure home, public and hospital environment, without access to suicidal means is a necessary strategy in suicide prevention. Each treatment option, prescription of medication and discharge of the patient from hospital should be carefully evaluated against the involved risks. 5. Education of treatment team: Training of general practitioners is effective in the prevention of suicide. It improves treatment of depression and anxiety, quality of the provided care and attitudes towards suicide. Continuous training including discussions about ethical and legal issues is necessary for psychiatrists and other mental health professionals. Multidisciplinary treatment teams including psychiatrist and other professionals such as psychologist, social worker, and occupational therapist are always preferable, as integration of pharmacological, psychological and social rehabilitation is recommended especially for patients with chronic suicidality. 6. Public aspects: Not only the health care workers are responsible for suicide prevention. All members of our society (including community/political leaders as well as religious and civil organizations) have their own task with more or less competence and responsibility.

[Factors determining the selection of treatment options of complementary and alternative medicine]. / A komplementer és alternatív medicina felé orientálódó terápiaválasztást meghatározó tényezok.

INTRODUCTION: Complementary and alternative medicine have undoubtedly been gaining ground on the healthcare market, thus the vital question arises why patients choose these treatments, oftentimes at the cost of discontinuing the Western medical therapy. AIM: The aim of the authors was to investigate and scrutinize factors leading to the utilization of various alternative medical services. METHOD: The basis of this qualitative research was medical anthropological fieldwork conducted at a clinic of Traditional Chinese Medicine including participant observation (355 hours), unstructured interviews with patients (n = 93) and in-depth interviews (n = 14). RESULTS: Patients of alternative medical systems often do not receive a diagnosis, explanation or cure for their illness from Western medicine, or they do not agree with what they are offered. In other instances, patients choose alternative medicine because it exhibits a philosophical congruence with their already existing explanatory model, that is, previous concepts of world, man or illness. CONCLUSIONS: A particular therapy is always part of a cultural system and it is embedded in a specific psycho-social context, hence choice of therapy must be interpreted in accordance with this perspective.

The role of dog therapy in clinical recovery and improving quality of life: a randomized, controlled trial.

BACKGROUND: Any illness places a significant burden on patients, including deterioration in quality of life. Animal assisted therapy may be helpful in the rehabilitation process and in the treatment of patients to alleviate this phenomenon. METHODS: A randomized, controlled research was conducted in 2019 and 2020 in a rehabilitation center in Budapest. In our study, the control and experimental groups received the same therapy, but the rehabilitation treatment of the intervention group was complemented by dog therapy. Patients were evaluated by means of the short form Beck Depression Inventory, State-Trait Anxiety Inventory, Illness Intrusiveness Ratings Scale, Visual Analog Scale for pain and the WHO-5 Well-being Index. For statistical analysis paired T-test and ANCOVA was performed. RESULTS: 58 participants in both groups took part in the research. Results confirm that both groups showed statistically significant improvement in all outcome measures, except for depression symptoms in dog therapy group. Quality of life of the participants improved significantly, their pain and anxiety levels were significantly reduced, they felt significantly less burdened by the disease in their daily lives. Therapeutic-dog sessions had a large effect on patients' quality of life and anxiety. CONCLUSIONS: There is a strong case for animal assisted therapy as a complementary therapy in the rehabilitation program, and it is proposed that consideration should be given to the application of this method on a larger scale within health care. The study was retrospectively registered at ISRCTN Registry (registration number: ISRCTN10208787) on 15/03/2022.

The SCREENIVF Hungarian version is a valid and reliable measure accurately predicting possible depression in female infertility patients.

Infertility patients, often in high distress, are entitled to being informed about their mental status compared to normative data. The objective of this study was to revalidate and test the accuracy of the SCREENIVF, a self-reported tool for screening psychological maladjustment in the assisted reproduction context. A cross-sectional, questionnaire-based online survey was carried out between December 2019 and February 2023 in a consecutive sample of female patients (N = 645, response rate 22.9%) in a university-based assisted reproduction center in Hungary. Confirmatory factor analysis and cluster and ROC analyses were applied to test validity, sensitivity and specificity in relation to Beck Depression Inventory (BDI) scores. Model fit was optimal (chi-square = 630.866, p < 0.001; comparative fit index = 0.99; root-mean-square error of approximation = 0.018 (90% CI 0.013-0.023); standardized-root-mean-square-residual = 0.044), and all dimensions were reliable (α > 0.80). A specific combination of cutoffs correctly predicted 87.4% of BDI-scores possibly indicative of moderate-to-severe depression (χ2(1) = 220.608, p < 0.001, Nagelkerke R2 = 0.462, J = 66.4). The Hungarian version of the SCREENIVF is a valid and reliable tool, with high accuracy in predicting BDI-scores. Low response rate may affect generalizability. The same instrument with different cutoffs can serve various clinical goals.