Search results for: anxiety disorders

Authors: C. Treerattanaphan, P. Boonpramuk, P. Singla

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Frequent, continuous speech training has proven to be a necessary part of a successful speech therapy process, but constraints of traveling time and employment dispensation become key obstacles especially for individuals living in remote areas or for dependent children who have working parents. In order to ameliorate speech difficulties with ample guidance from speech therapists, a website has been developed that supports speech therapy and training for people with articulation disorders in the standard Thai language. This web-based program has the ability to record speech training exercises for each speech trainee. The records will be stored in a database for the speech therapist to investigate, evaluate, compare and keep track of all trainees’ progress in detail. Speech trainees can request live discussions via video conference call when needed. Communication through this web-based program facilitates and reduces training time in comparison to walk-in training or appointments. This type of training also allows people with articulation disorders to practice speech lessons whenever or wherever is convenient for them, which can lead to a more regular training processes.

Keywords: web-based remote training program, Thai speech therapy, articulation disorders, speech booster

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Authors: Stephanos Vassilopoulos

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Positive psychology interventions (PPIs) targeting optimism and hope in young children are scarce. This pilot study explored the feasibility and promise of the “Feel Good - Think Positive” intervention, a brief, manualized, multicomponent group PPI for young children. The intervention aimed to enhance participants’ optimism, hope, and self-esteem while reducing their anxiety levels. Forty-one students (Mage = 9.68, SD = 1.64) participated in the intervention and provided data on optimism, hope, self-esteem, and anxiety at baseline and after the intervention was concluded. Analyses showed a significant increase in optimism and self-esteem and a significant decrease in anxiety. However, no change was observed in hope levels. The results complement previous studies of school-based PPIs and hint at the promise of designing feasible interventions that can be easily incorporated into school curriculum and produce both a promoting and a remedial effect in young children.

Keywords: positive psychology intervention, positive education, hope, children

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Authors: Neelam Vats, Madhvi Pathak Pillai, Rajender Lal, Indu Dabas

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The pressure of scoring higher marks to be able to get admission in a higher ranked institution has become a social stigma for school students. It leads to various social and academic pressures on them, causing psychological anxiety. This undue stress on students sometimes may even steer to aggressive behavior or suicidal tendencies. Human mind is always surrounded by the some desires, emotions and passions, which usually disturbs our mental peace. In such a scenario, we look for a solution that helps in removing all the obstacles of mind and make us mentally peaceful and strong enough to be able to deal with all kind of pressure. Preksha meditation is one such technique which aims at bringing the positive changes for overall transformation of personality. Hence, the present study was undertaken to assess the impact of Preksha Meditation on the academic anxiety on female teenagers. The study was conducted on 120 high school students from the capital city of India. All students were in the age group of 13-15 years. They also belonged to similar social as well as economic status. The sample was equally divided into two groups i.e. experimental group (N = 60) and control group (N = 60). Subjects of the experimental group were given the intervention of Preksha Meditation practice by the trained instructor for one hour per day, six days a week, for three months for the first experimental stage and another three months for the second experimental stage. The subjects of the control group were not assigned any specific type of activity rather they continued doing their normal official activities as usual. The Academic Anxiety Scale was used to collect data during multi-level stages i.e. pre-experimental stage, post-experimental stage phase-I, and post-experimental stage phase-II. The data were statistically analyzed by computing the two-tailed-‘t’ test for inter group comparison and Sandler’s ‘A’ test with alpha = or p < 0.05 for intra-group comparisons. The study concluded that the practice for longer duration of Preksha Meditation practice brings about very significant and beneficial changes in the pattern of academic anxiety.

Keywords: academic anxiety, academic pressure, Preksha, meditation

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Authors: Tondani Mudau, Sherine B. Van Wyk, Zuhayr Kafaar, Janan Dietrich

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Female adolescents residing in a patriarchal society such as South Africa are more inclined to embrace feminine ideologies. Internalizing these ideologies may expose female adolescents to mental health challenges such as depression and anxiety. This study explored whether the internalisation of adolescent femininity ideologies namely, objectified relationship with own body (ORB) and inauthentic self in relationships (ISR) predicted anxiety and depression in late female adolescents at Stellenbosch University. The sample of the study consisted of 1451 (18-24) female undergraduate and postgraduate students enrolled at Stellenbosch University. The mean age of the participants was 20 (SD=1.46), and most participants (39.7%) were first-year students. The study employed a cross-sectional quantitative research design. Data was collected through an online self-completion survey, the survey consisted of three sections, the first section asked biographical questions regarding age, gender, race and family background. The second section measured the internalisation of feminine ideologies by using the adolescent femininity ideology scale which has two subscales namely inauthentic self in relationship with others (ISR) and objectified relationship with one’s own body (ORB). The ISR scale had the Cronbach Alpha of 0.76, and the ORB scale had the Cronbach Alpha of 0.83. The third section measured mental health (depression and anxiety) by using the Hopkins Symptoms 25-checklist which had the Cronbach Alpha of 0.93. Data were analysed through multiple linear regression from IBM SPSS (Statistical Package for the Social Sciences Version 24). The overall results of the multiple linear regression showed that The AFIS combination accounted for 14% for anxiety as measured by the Hopkins Symptoms Checklist R² = .142, F (2, 682) = 56.431, p < .001. The combination also accounted for 24% for depression as measured by the Hopkins Symptoms Checklist R² = .239, F (2, 682) = 106.971, p < .0. The findings in this study affirm the objectification and feminist theory contentions that internalising femininity ideologies (ISR and ORB) predict negative mental health in female adolescents.

Keywords: adolescents, anxiety, depression, feminine ideologies, inauthentic self, mental health, self-objectification, South Africa

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Authors: Shameka Stanford

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This presentation will discuss how cognitive and communication disorders in the areas of executive functioning, receptive and expressive language can impact the problem-solving and decision making of individuals with such impairments. More specifically, this presentation will discuss approaches the legal defense team of capital case lawyers can add to their experience when servicing individuals who have a history of educational decline, special education, and limited intervention and treatment. The objective of the research is to explore and identify the correlations between impaired executive function skills and decision making and competency for individuals facing death penalty charges. To conduct this research, experimental design, randomized sampling, qualitative analysis was employed. This research contributes to the legal and criminal justice system related to how they view, defend, and characterize, and judge individuals with documented cognitive and communication disorders who are eligible for capital case charges. More importantly, this research contributes to the increased ability of death penalty lawyers to successfully defend clients with a history of academic difficulty, special education, and documented disorders that impact educational progress and academic success.

Keywords: communication disorders, cognitive disorders, capital murder, death penalty, executive function

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Authors: Meng Wu, Atif Rahman, Eng Gee, Lim, Jeong Jin Yu, Rong Yan

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Context: The COVID-19 pandemic has had a profound impact on mental health, with increased rates of anxiety and depression observed. Social support, a critical factor in mental well-being, has also undergone significant changes during the pandemic. This study aims to explore the relationship between social support, anxiety, and depression during COVID-19, taking into account various demographic and contextual factors. Research Aim: The main objective of this study is to conduct a comprehensive systematic review and meta-analysis to examine the impact of social support on anxiety and depression during the COVID-19 pandemic. The study aims to determine the consistency of these relationships across different age groups, occupations, regions, and research paradigms. Methodology: A scoping review and meta-analytic approach were employed in this study. A search was conducted across six databases from 2020 to 2022 to identify relevant studies. The selected studies were then subjected to random effects models, with pooled correlations (r and ρ) estimated. Homogeneity was assessed using Q and I² tests. Subgroup analyses were conducted to explore variations across different demographic and contextual factors. Findings: The meta-analysis of both cross-sectional and longitudinal studies revealed significant correlations between social support, anxiety, and depression during COVID-19. The pooled correlations (ρ) indicated a negative relationship between social support and anxiety (ρ = -0.30, 95% CI = [-0.333, -0.255]) as well as depression (ρ = -0.27, 95% CI = [-0.370, -0.281]). However, further investigation is required to validate these results across different age groups, occupations, and regions. Theoretical Importance: This study emphasizes the multifaceted role of social support in mental health during the COVID-19 pandemic. It highlights the need to reevaluate and expand our understanding of social support's impact on anxiety and depression. The findings contribute to the existing literature by shedding light on the associations and complexities involved in these relationships. Data Collection and Analysis Procedures: The data collection involved an extensive search across six databases to identify relevant studies. The selected studies were then subjected to rigorous analysis using random effects models and subgroup analyses. Pooled correlations were estimated, and homogeneity was assessed using Q and I² tests. Question Addressed: This study aimed to address the question of the impact of social support on anxiety and depression during the COVID-19 pandemic. It sought to determine the consistency of these relationships across different demographic and contextual factors. Conclusion: The findings of this study highlight the significant association between social support, anxiety, and depression during the COVID-19 pandemic. However, further research is needed to validate these findings across different age groups, occupations, and regions. The study emphasizes the need for a comprehensive understanding of social support's multifaceted role in mental health and the importance of considering various contextual and demographic factors in future investigations.

Keywords: social support, anxiety, depression, COVID-19, meta-analysis

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Authors: Priyanka Jain, Sushila Pareek

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Skin disease is often considered to be ‘only cosmetic’ by many medical professionals and lay-people alike but unlike most internal illnesses, skin disease is often immediately visible to others and therefore people suffering from dermatological conditions may suffer serious social and emotional consequences. The purpose of this research was to compare patients suffering from acne, alopecia areata (AA) and melanosis on perceived stress, social appearance anxiety and coping. The study included 120 patients (acne = 40 AA = 40 melanosis = 40) ages ranged from 15 to 25 years. Perceived Stress Scale (PSS), Social Appearance Anxiety Scale (SAAS), and The Brief COPE were administered to the patients. Analytical evaluation was done by Kruskal Wallis and ANOVA-tests. The results of the present study clearly revealed that perceived stress and social appearance anxiety were highest in patients with AA followed by acne patients and found least in patients with melanosis. With regard to coping, self-distraction as a coping technique was found highest in patients suffering from AA followed by acne and then melanosis. Denial was highest in acne patients followed by AA and experienced least by patients with melanosis. Behavioural disengagement was almost equal in patients with melanosis and acne and a little less in patients suffering from AA Acceptance was highest in patients with melanosis, followed by AA and least in acne patients. Self-blame was found highest in patients with acne, followed by AA patients further followed by patients suffering from melanosis. This study is an attempt to stimulate professionals working in the field of dermatology and mental health to explore their supportive communication and increase awareness regarding the difficulties that patients with skin disease can face.

Keywords: coping, dermatology, perceived stress, psychosocial impact, social appearance anxiety

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Authors: Telma Fontao de Castro, Kylee Miller, Maria Xavier Araújo, Isabel Brandao, Sandra Torres

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Objective: There is a dearth of research investigating the long-term emotional functioning of individuals recovered from anorexia nervosa (AN). This 15-year longitudinal study aimed to examine whether difficulties in cognitive processing of emotions persisted after long-term AN recovery and its link to anxiety and depression. Method: Twenty-four females, who were tested longitudinally during their acute and recovered AN phases, and 24 healthy control (HC) women, were screened for anxiety, depression, alexithymia, and emotion regulation difficulties (ER; only assessed in recovery phase). Results: Anxiety, depression, and alexithymia levels decreased significantly with AN recovery. However, scores on anxiety and difficulty in identifying feelings (alexithymia factor) remained high when compared to the HC group. Scores on emotion regulation difficulties were also lower in HC group. The abovementioned differences between AN recovered group and HC group in difficulties in identifying and accepting feelings and lack of emotional clarity were no longer present when the effect of anxiety and depression was controlled. Conclusions: Findings suggest that emotional dysfunction tends to decrease in AN recovered phase. However, using an HC group as a reference, we conclude that several emotional difficulties are still increased after long-term AN recovery, in particular, limited access to emotion regulation strategies, and difficulty controlling impulses and engaging in goal-directed behavior, thus suggesting to be a trait vulnerability. In turn, competencies related to emotional clarity and acceptance of emotional responses seem to be state-dependent phenomena linked to anxiety and depression. In sum, managing emotions remains a challenge for individuals recovered from AN. Under this circumstance, maladaptive eating behavior can serve as an affect regulatory function, increasing the risk of relapse. Emotional education and stabilization of depressive and anxious symptomatology after recovery emerge as an important avenue to protect from long-term AN relapse.

Keywords: alexithymia, anorexia nervosa, emotion recognition, emotion regulation

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Authors: Ge Sun, Monika Trzpis, Robbert J. de Haas, Paul M. A. Broens

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Introduction: Dynamic magnetic resonance defecography is frequently used to assess defecation disorders. We aimed to investigate the usefulness of dynamic magnetic resonance defecography for assessing the severity of defecation disorder. Methods: We included patients retrospectively from our tertiary referral hospital who had undergone dynamic magnetic resonance defecography, anorectal manometry, and anal electrical sensitivity tests to assess defecation disorders between 2014 and 2020. The primary outcome was the association between the dynamic magnetic resonance defecography variables and the severity of defecation disorders. We assessed the severity of fecal incontinence and constipation with the Wexner incontinence and Agachan constipation scores. Results: Out of the 32 patients included, 24 completed the defecation questionnaire. During defecation, the M line length at magnetic resonance correlated with the Agachan score (r = 0.45, p = 0.03) and was associated with anal sphincter pressure (r=0.39, p=0.03) just before defecation. During rest and squeezing, the H line length at imaging correlated with the Wexner incontinence score (r=0.49, p=0.01 and r=0.69, p< 0.001, respectively). H line length also correlated positively with the anal electrical sensation threshold during squeezing (r=0.50, p=0.004) and during rest (r= 0.42, p=0.02). Conclusions: The M and H line lengths at dynamic magnetic resonance defecography can be used to assess the severity of constipation and fecal incontinence respectively and reflect anatomic changes of the pelvic floor. However, as these anatomic changes are generally late-stage and irreversible, anal manometry seems a better diagnostic approach to assess early and potentially reversible changes in patients with defecation disorders.

Keywords: defecation disorders, dynamic magnetic resonance defecography, anorectal manometry, anal electrical sensitivity tests, H line, M line

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Authors: Uma Kanth, Amy Cook

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Conceptual Metaphor Theory (CMT) proposes that metaphor is fundamental to human thought. CMT utilizes embodied cognition, in that emotions are conceptualized as effects on the body because of a coupling of one’s bodily experiences and one’s somatosensory system. Time perception is a function of embodied cognition and conceptual metaphor in that one’s experience of time is inextricably dependent on one’s perception of the world around them. A hallmark of depressive disorders is the distortion in one’s perception of time, such as neurological dysfunction and psychomotor retardation, and yet, to the author’s best knowledge, previous studies have not before linked CMT, embodied cognition, and depressive disorders. Therefore, the focus of this paper is the investigation of how the applications of CMT and embodied cognition (especially regarding time perception) have promise in improving current techniques to treat depressive disorders. This paper aimed to extend, through a thorough review of literature, the theoretical basis required to further research into CMT and embodied cognition’s application in treating time distortion related symptoms of depressive disorders. Future research could include the development of brain training technologies that capitalize on the principles of CMT, with the aim of promoting cognitive remediation and cognitive activation to mitigate symptoms of depressive disorder.

Keywords: depression, conceptual metaphor theory, embodied cognition, time

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Authors: Mary Jane B. Suarez

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Public speaking anxiety (PSA), also known as speech anxiety, is innumerably persistent in any traditional communication classes, especially for students who learn English as a second language. The speech anxiety intensifies when communication skills assessments have taken their toll in an online or a remote mode of learning due to the perils of the COVID-19 virus. Both teachers and students have experienced vast ambiguity on how to realize a still effective way to teach and learn speaking skills amidst the pandemic. Communication skills assessments like public speaking, oral presentations, and student reporting have defined their new meaning using Google Meet, Zoom, and other online platforms. Though using such technologies has paved for more creative ways for students to acquire and develop communication skills, the effectiveness of using such assessment tools stands in question. This mixed method study aimed to determine the factors that affected the public speaking skills of students in a communication class, to probe on the assessment gaps in assessing speaking skills of students attending online classes vis-à-vis the implementation of remote and blended modalities of learning, and to recommend ways on how to address the public speaking anxieties of students in performing a speaking task online and to bridge the assessment gaps based on the outcome of the study in order to achieve a smooth segue from online to on-ground instructions maneuvering towards a much better post-pandemic academic milieu. Using a convergent parallel design, both quantitative and qualitative data were reconciled by probing on the public speaking anxiety of students and the potential assessment gaps encountered in an online English communication class under remote and blended learning. There were four phases in applying the convergent parallel design. The first phase was the data collection, where both quantitative and qualitative data were collected using document reviews and focus group discussions. The second phase was data analysis, where quantitative data was treated using statistical testing, particularly frequency, percentage, and mean by using Microsoft Excel application and IBM Statistical Package for Social Sciences (SPSS) version 19, and qualitative data was examined using thematic analysis. The third phase was the merging of data analysis results to amalgamate varying comparisons between desired learning competencies versus the actual learning competencies of students. Finally, the fourth phase was the interpretation of merged data that led to the findings that there was a significantly high percentage of students' public speaking anxiety whenever students would deliver speaking tasks online. There were also assessment gaps identified by comparing the desired learning competencies of the formative and alternative assessments implemented and the actual speaking performances of students that showed evidence that public speaking anxiety of students was not properly identified and processed.

Keywords: blended learning, communication skills assessment, public speaking anxiety, speech anxiety

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Authors: Horesh Reinman Netta

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Objectives: To examine the relationship between stressful life events and recurrent major depressive disorders Methods: Three groups of 50 subjects were assessed. One group had a recurrent major depressive disorder with melancholic features; the second group met the criteria for borderline personality disorder, and the third consisted of healthy controls. The Structured Clinical Interview for AXIS I DSM-IV Disorders sand the Structured Clinical Interview for AXIS II DSM-IV Disorders were used for diagnosis. The Israel Psychiatric Epidemiology Research Interview (IPERI) Life Event Scale and the Coddington Life Events Schedule (CLES) were used to measure life events which were confirmed with a confirmatory semi-structured interview. The Beck Depression Inventory and the Satisfaction from Life scales were also administered. Results : The total number of loss-related events in childhood and in the year preceding the first episode was significantly higher in the affective disorder group than in the two control groups. Total number of LE, uncontrolled and independent events were also more common in the depressed patients in the year preceding the first episode. No category of SLE was differentiated among any of the three groups during any period of time following the first depressive episode. Conclusions: SLE play an important role in the onset of affective disorders. There appear to be specific kinds of SLE occurring in childhood and in the year preceding a first episode that have particular significance. SLE may have a lesser role in the maintenance of this illness.

Keywords: modd dosorders, recurrent depression, stress, life events

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Authors: Mylene T. Caytap-Milan

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This study was materialized with the purpose of determining the anxieties of students towards spoken English, sources of the specified anxiety, coping mechanisms to counter the apprehensions, and teacher management to reduce the anxiety within the classroom. Being qualitative in nature, interview as the data gathering tool was utilized with an audio-recorder. Participants of the study included thirteen teachers and students of speech classes in a state university in Region I, Philippines. Data elicited were transcribed in verbatim, confirmed by the participants, coded and categorized, and themed accordingly. A triangulation method was applied to establish the stronger validity of the data. Findings confirmed teachers’ and students’ awareness of the existence of Anxiety in speaking English (ASE). Based on the data gathered from the teachers, the following themes on students’ ASE were identified: (1) No Brain and Mouth Coordination, (2) Center of Attention, and (3) Acting Out Loud. However, the following themes were formulated based on the responses made by the students themselves: (1) The Common Feeling, (2) The Incompetent Me, and (3) The Limelight. With regard the sources of students’ ASE according to teachers are the following: (1) It Began at Home, (2) It Continued in School, (3) It’s not for me at all. On the other hand, the sources of students’ ASE according to students themselves are: (1) It Comes from Within, (2) It wasn’t Nursed Well, and (3) They’re Looking for Errors. In terms of coping with ASE, students identified the following mechanisms, which were themed into: (1) Acceptance, (2) Application, and (3) Apathy. Moreover, to reduce the ASE phenomenon within the classroom, the teachers demonstrate the following roles according to themes: (1) The Compass, (2) The Counselor, (3) The Referee, (4) The Polyglot, and (5) The English Nazi. Based on the findings, the following conclusions were drawn: (1) ASE can both serve positive and negative influences to the English speaking skills of students, (2) ASE can be reduced with teachers’ provision of more English speaking opportunities and with students’ initiative of personal training, (3) ASE can be reduced when English is introduced and practiced by children at an early age, and (4) ASE is inevitable in the affective domain thus teachers are encouraged to apply psychological positivism in the classroom. Studies related to the present undertaking may refer to the succeeding recommendations: (1) experiment on activities that will reduce anxiety ASE, (2) involve a psychologist for more critical but reliable results and recommendations, and (3) conduct the study among high school and primary students.

Keywords: coping mechanisms, sources, speaking anxiety, teacher management

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Authors: Agodo Mugenyi Herbert

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Background: A high prevalence of both HIV infection and mental disorders exists in Sub-Saharan Africa, however there is little integration of care for mental health disorders among HIV-infected individuals. The study aimed at determining the management of common mental disorders among HIV/AIDS clients attending Antiretroviral clinic in Hoima regional referral hospital. Significancy of the study: The information generated by this study would help mental health advocates, ministry of health, Civil society organizations in HIV programming to advocate for enhanced mental health care for PLWHA. The result will be used in policy development and lobbying for integration of mental health care in HIV/AIDS care. Methods: This study applied a cross sectional design. It involved data collection from clients with HIV/AIDS attending ART clinic in Hoima regional referral hospital at one specific point in time. It aimed at providing data on the entire population under study. Data was collected from Hoima Regional Referral Hospital at the ART clinic. Data analysis was performed using SPSS version 24. Results: 66 HIV/AIDS clients and 10 health workers in the ART clinic who participated fully completed the study. The overall prevalence of at least one form of mental disorder was 83%. Majority of the health care practitioner do not use pharmacological, psychological, and social interventions to manage such disorders. Conclusion: These results are suggestive of a significant proportion of the HIV-infected patients experiencing psychological difficulty for which they do not receive treatment Recommendations: Current care practices applied to patients with HIV/AIDS should be integrated more generally to include treatment services to identify and manage common mental disorders.

Keywords: common mental disorders, mental health, mental illness, and severe mental illness

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Authors: Mafunda Esther

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The paper seeks to find out and document the impact of culture and religion on disability, specifically language impairment and health care seeking practices of the Shona people. Its main objectives are to explore the cultural and religious beliefs that affect the utilization of rehabilitation services in a rural community in Zimbabwe. The other objective of the paper is to describe how language impairment is presented and understood by people living in a Zimbabwean rural area. The research is qualitative interpretive phenomenological research, and it utilizes the case study approach using semi structured interviews and focus group discussions. Results from the research established that religious and cultural beliefs determine how the Shona people view disability, and this guides their health care seeking practices. The research is important since communication disorders occur in populations worldwide though they are not always recognized as such. The lack of recognition of and the attitudes toward speech and languages disorders, as well as the beliefs about the causes of such disorders, affect people's attitudes toward the treatment of the disorders.

Keywords: culture, religion, disability, language impairment

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Authors: Lamia Bouzgarrou, Amira Omrane, Naima Bouatay, Chaima Harrathi, Samia Machroughl, Ahmed Mhalla

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Background and Aims: Professionals of health care sector are exposed to psychosocial constraints like stress, harassment, violence, which can lead to many mental health problems such as, depression, addictive behavior, and burn-out. Moreover, it’s well established that caregivers affected to intensive care units are more likely to experience such constraints and mental health problems. For these caregivers, the mental health state may affect care quality and patient’s safety. This study aims either to identify occupational psychosocial constraints and their mental health consequences among paramedical and medical caregivers affected to intensive units in Tunisian public hospital. Methods: An exhaustive three months cross-sectional study conducted among medical and paramedical staffs of intensive care units in three Tunisian university hospitals. After informed consent collection, we evaluated work-related stress, workplace harassment, depression, anxious troubles, addictive behavior, and self-esteems through an anonymous self-completed inquiry form. Five validated questionnaires and scales were included in this form: Karasek's Job Content Questionnaire, Negative Acts Questionnaire, Rosenberg, Beck depression inventory and Hamilton Anxiety scale. Results: We included 129 intensive unit caregivers; with a mean age of 36.1 ± 1.1 years and a sex ratio of 0.58. Among these caregivers, 30% were specialist or under-specialization doctors. The average seniority in the intensive care was 6.1 ± 1.2 (extremes=1 to 40 years). Atypical working schedules were noted among 36.7% of the subjects with an imposed choice in 52.4% of cases. During the last 12 months preceding the survey, 51.7% of care workers were absent from work because of a health problem with stops exceeding 15 days in 11.7%. Job strain was objective among 15% of caregivers and 38.33% of them were victims of moral harassment. A low or very low self-esteem was noted among 40% of respondents. Moreover, active smoking was reported by 20% subjects, alcohol consumption by 13.3% and psychotropic substance use by 1.7% of them. According to Beck inventory and Hamilton Anxiety scale, we concluded that 61.7% of intensive care providers were depressed, with 'severe' depression in 13.3% of cases and 49.9% of them present anxious disorders. Multivariate analysis objective that, job strain was correlated with young age (p=0.005) and shorter work seniority (p=0.001). Workplace and moral harassment was more prevalent among females (p=0.009), under-specialization doctor (p=0.021), those affected to atypical schedules (p=0.008). Concerning depression, it was more prevalent among staff in job strain situation (p = 0.004), among smokers caregivers (p = 0.048), and those with no leisure activity (p < 0.001). Anxious disorders were positively correlated to chronic diseases history (p = 0.001) and work-bullying exposure (p = 0.004). Conclusions: Our findings reflected a high frequency of caregivers who are under stress at work and those who are victims of moral harassment. These health professionals were at increased risk for developing psychiatric illness such depressive and anxious disorders and addictive behavior. Our results suggest the necessity of preventive strategies of occupational psychosocial constraints in order to preserve professional’s mental health and maximize patient safety and quality of care.

Keywords: health care sector, intensive care units, mental health, psychosocial constraints

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Authors: Lito M. Amit, Venecio U. Ultra, Young-Woong Song

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The business process outsourcing (BPO) in the Philippines is expanding rapidly attracting more than 2% of total employment. Currently, the BPO industry is confronted with several issues pertaining to sustainable productivity such as meeting the staffing gap, high rate of employees’ turnover and workforce retention, and the occupational health and safety (OHS) of call center agents. We conducted a survey of OHS programs and health concerns among call center agents in the Philippines and determined the sociocultural factors that affect the vulnerability of call center agents to occupational health risks and hazards. The majority of the agents affirmed that OHS are implemented and OHS orientation and emergency procedures were conducted at employment initiations, perceived favorable and convenient working environment except for occasional noise disturbances and acoustic shock, visual, and voice fatigues. Male agents can easily adjust to the demands and changes in their work environment and flexible work schedules than female agents. Female agents have a higher tendency to be pressured and humiliated by low work performance, experience a higher incidence of emotional abuse, psychological abuse, and experience more physical stress than male agents. The majority of the call center agents had a night-shift schedule and regardless of other factors, night shift work brings higher stress to agents. While working in a call center, higher incidence of headaches and insomnia, burnout, suppressed anger, anxiety, and depressions were experienced by female, younger (21-25 years old) and those at night shift than their counterpart. Most common musculoskeletal disorders include body pain in the neck, shoulders and back; and hand and wrist disorders and these are commonly experienced by female and younger workers. About 30% experienced symptoms of cardiovascular and gastrointestinal disorders and weakened immune systems. Overall, these findings have shown the variable vulnerability by a different subpopulation of call center agents and are important in the occupational health risk prevention and management towards a sustainable human resource for BPO industry in the Philippines.

Keywords: business process outsourcing industry, health risk of call center agents, socio-cultural determinants, Philippines

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Authors: Shakirat Abimbola Adesola, Shuaib Akintunde Asifat, Jelili Olalekan Amoo

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This paper presented the impact of students’ emotions on learning when receiving lectures and when taking tests. It was observed that students experience different types of emotions during the study, and this was found to have a significant effect on their academic performance. A total of one thousand six hundred and seventy-five (1675) students from the department of Computer Science in two Colleges of Education in South-West Nigeria took part in this study. The students were randomly selected for the research. Sample comprises of 968 males representing 58%, and 707 females representing 42%. A structured questionnaire, of Motivated Strategies for Learning Questionnaire (MSLQ) was distributed to the participants to obtain their opinions. Data gathered were analyzed using the IBM SPSS 20 to obtain ANOVA, descriptive analysis, stepwise regression, and reliability tests. The results revealed that emotion moderately shape students’ motivation and engagement in learning; and that self-regulation and self-determination do have significant impact on academic performance. It was further revealed that test anxiety has a significant correlation with academic performance.

Keywords: motivation, self-determination, test anxiety, academic performance, and academic engagement

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Authors: B. Sadek, N. Khan, Shreesh K. Ojha, Adel Sadeq, D. Lazewska, K. Kiec-Kononowicz

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The involvement of Histamine H3 receptors (H3Rs) in memory and the potential role of H3R antagonists in pharmacological control of neurodegenerative disorders, e.g., Alzheimer disease (AD) is well established. Therefore, the memory-enhancing effects of the H3R antagonist DL77 on MK801-induced cognitive deficits were evaluated in passive avoidance paradigm (PAP) and novel object recognition (NOR) tasks in adult male rats, applying donepezil (DOZ) as a reference drug. Animals pretreated with acute systemic administration of DL77 (2.5, 5, and 10 mg/kg, i.p.) were significantly ameliorated in regard to MK801-induced memory deficits in PAP. The ameliorative effect of most effective dose of DL77 (5 mg/kg, i.p.) was abrogated when animals were pretreated with a co-injection with the H3R agonist R-(α)-methylhistamine (RAMH, 10 mg/kg, i.p.). Moreover, and in the NOR paradigm, DL77 (5 mg/kg, i.p.) reversed MK801-induced deficits long-term memory (LTM), and the DL77-provided procognitive effect was comparable to that of reference drug DOZ, and was reversed when animals were co-injected with RAMH (10 mg/kg, i.p.). However, DL77(5 mg/kg, i.p.) failed to alter short-term memory (STM) impairment in NOR test. Furthermore, DL77 (5 mg/kg) failed to induce any alterations of anxiety and locomotor behaviors of animals naive to elevated-plus maze (EPM), indicating that the ameliorative effects observed in PAP or NOR tests were not associated to alterations in emotions or in natural locomotion of tested animals. These results reveal the potential contribution of H3Rs in modulating CNS neurotransmission systems associated with neurodegenerative disorders, e.g., AD.

Keywords: histamine H3 receptor, antagonist, learning and memory, Alzheimer's disease, neurodegeneration, passive avoidance paradigm, novel object recognition, behavioral research

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Authors: Maria Sana Amin, Anum Atiq, Haya Fatimah

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Secure attachment in childhood creates a healthy love attitude in the adulthood. Child secure attachment develops a positive relation attitude in their adulthood, similarly, anxiety-avoidant attachment develops negative attitude toward relations. The aim of this paper is twofold: 1) We investigate the relationship between Friendship Attitude and Attachment Styles; and 2) explore the impact of gender on Love Attitudes and Attachment styles. Data was collected by convincing sampling among the students of University of Management and Technology age group 18- 25. The sample consists 60 young adults (Male=36, Female =54). The Love Attitudes Scales subscale Storage was used to measure attitudes towards friendship love and The Experiences in Close Relationships-Revised questionnaire was used to measure Adult Attachment Style. The result of Independent T-Test analysis shows that there was no significant difference in anxiety for female and male conditions; t (58) =-.768, p=.446 and avoidance for female and male conditions; t (58) =1.63, p=.108. Moreover, also there was no significant difference in friendship love for female (M=27.37, SD=6.371) and male (M=26.08, SD=5.709) conditions; t (58) =-.820, p=.416. Pearson correlation analysis shows significantly negative correlation between love attitude-friendship and attachment style- avoidance, (r=-.433, p=.008) among male and love attitude-friendship and attachment style- avoidance (r=-.438, p=.032) among female. There are no gender differences in attachment styles i.e. anxiety, avoidance and their relationship with friendship love attitude. People have avoidant attachment find it hard to fall in love and develop intimacy, and they tend to search for independence.

Keywords: avoidance attachment style, anxiety attachment style, friendship love attitude, gender difference/similarity

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Authors: J. Raub, H. Schillok, L. Kaupe, C. Jung-Sievers, G. Pitschel-Walz, M. Bühner, J. Gensichen, F. D. Pokal-Gruppe

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Introduction: In Germany, depression ranks among the top ten diseases with the highest disease burden and often occurs with comorbidities. Collaborative Care (CC), a concept developed in the United States for the primary care management of chronic diseases, has been identified as an efficient model for the treatment of depression in general medicine. A recent meta-analysis highlights research gaps regarding CC in patients with psychiatric multimorbidity. The highest prevalence of psychiatric comorbidities in depression is observed in anxiety disorders, post-traumatic stress disorder (PTSD), and substance use disorders. Methods: We conducted a literature search following the PRISMA guidelines with three components: Collaborative Care, Depression and randomized controlled trial on the common databases. We focused on the examination of psychiatric comorbidities in depression, specifically Posttraumatic Stress Disorder (PTSD) and Substance Use Disorder (SUD). Results: During the screening process, we identified nine relevant articles related to PTSD, the number of articles related to Substance Use Disorder (SUD) was ten. We examined a total of 8,634 individuals. Our literature review did not reveal any overall significant superiority of the Collaborative Care model compared to Usual Care in patients with depression with comorbid Substance Use Disorder (SUD) or Posttraumatic Stress Disorder (PTSD). Discussion: Five studies demonstrate a faster and statistically significant improvement in depression outcomes among patients with Substance Use Disorder (SUD) and Posttraumatic Stress Disorder (PTSD). Currently, several randomized controlled trials on the topic of Collaborative Care in depression with psychiatric comorbidity are ongoing, such as miCare, Claro and COMET.

Keywords: Depression, primary care, collaborative care, PTSD, Substance use Disorder

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Authors: Najmeh Hamid, Vajiheh Hamedy , Zahra Rostamianasl

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Background: Cancer is one of the medical problems that have been associated with pain. Moreover, the pain is combined with negative emotions such as anxiety, depression and anger. Poor pain management causes negative effects on the quality of life, which results in negative effects that continue a long time after the painful experiences. Objectives: The aim of this research was to compare the effectiveness of Common Cognitive Behavioral Therapy for Pain and its computerized version on the reduction of pain intensity, depression, anger and anxiety in children with cancer. Methods: The research method of this “Randomized Controlled Clinical Trial” was a pre, post-test and follow-up with a control group. In this research, we have examined the effectiveness of Common Cognitive Behavioral Therapy for Pain and its computerized version on the reduction of pain intensity, anxiety, depression and anger in children with cancer in Ahvaz. Two psychological interventions (cognitive behavioral therapy for pain and the computerized version) were compared with the control group. The sample consisted of 60 children aged 8 to 12 years old with different types of cancer at Shafa hospital in Ahwaz. According to the including and excluding criteria such as age, socioeconomic status, clinical diagnostic interview and other criteria, 60 subjects were selected. Then, randomly, 45 subjects were selected. The subjects were randomly divided into three groups of 15 (two experimental and one control group). The research instruments included Spielberger Anxiety Inventory (STAY-2) and International Pain Measurement Scale. The first experimental group received 6 sessions of cognitive-behavioral therapy for 6 weeks, and the second group was subjected to a computerized version of cognitive-behavioral therapy for 6 weeks, but the control group did not receive any interventions. For ethical considerations, a version of computerized cognitive-behavioral therapy was provided to them. After 6 weeks, all three groups were evaluated as post-test and eventually after a one-month follow-up. Results: The findings of this study indicated that both interventions could reduce the negative emotions (pain, anger, anxiety, depression) associated with cancer in children in comparison with a control group (p<0.0001). In addition, there were no significant differences between the two interventions (p<0.01). It means both interventions are useful for reducing the negative effects of pain and enhancing adjustment. Conclusion: we can use CBT in situations in which there is no access to psychologists and psychological services. In addition, it can be a useful alternative to conventional psychological interventions.

Keywords: pain, children, psychological intervention, cancer, anger, anxiety, depression

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Authors: Georgitta Joseph Valiyamattam

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Autism spectrum disorders (ASD) are a growing phenomenon in India with over 10 million cases being recorded. Children with various levels and forms of ASD can be a major challenge both within the context of regular or special schooling. According to statistics by the Centers for Disease Control and Prevention (CDC), one in every 88 children today is born with autism spectrum disorder (ASD) against a ratio of one in 110 few years back. The growing number of children with autism spectrum disorders places greater demands on health services and necessitates the roping in of non-traditional modes of treatment to complement or even substitute traditional health care methods when possible. Research evidence, particularly from Western countries, as also some parts of Asia, suggests that animal-assisted therapy, or zootherapy, may be used as an effective individual or complementary therapeutic tool for increasing overall wellbeing and quality of life among children with Autism spectrum disorders. The paper through a case-study format seeks to evaluate the efficacy (initial stage) of animal assisted therapy (canine-therapy with visiting dog: breed-Golden retriever), as a non-conventional treatment modality for improving cognitive functioning and managing the behavioral and psychological symptoms of Autism Spectrum Disorders. As a pilot study forming the basis for subsequent larger application of AAT, it analyses areas of efficacy as also the challenges faced, both with regard to the mode of therapy, as also particular to the Indian setting.

Keywords: animal assisted therapy, autism, canine therapy, analyzing initial efficacy

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Authors: Elżbieta Turska

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Introduction: One of the most difficult times in a person’s life is adolescence. The experiences in this period may shape the future life of this person to a large extent. This is the reason why many young people experience sadness, dejection, hopelessness, sense of worthlessness, as well as losing interest in various activities and social relationships, all of which are often classified as mood disorders. As many as 15-40% adolescents experience depressed moods and for most of them they resolve and are not carried into adulthood. However, (5-6%) of those affected by mood disorders develop the depressive syndrome and as many as (1-3%) develop full-blown clinical depression. Materials: A large questionnaire was given to 2508 students, aged 13–16 years old, and one of its parts was the Burns checklist, i.e. the standard test for identifying depressed mood. The questionnaire asked about many aspects of the student’s life, it included a total of 53 questions, most of which had subquestions. It is important to note that the data suffered from many problems, the most important of which were missing data and collinearity. Aim: In order to identify the correlates of mood disorders we built predictive models which were then trained and validated. Our aim was not to be able to predict which students suffer from mood disorders but rather to explore the factors influencing mood disorders. Methods: The problems with data described above practically excluded using all classical statistical methods. For this reason, we attempted to use the following Artificial Intelligence (AI) methods: classification trees with surrogate variables, random forests and xgboost. All analyses were carried out with the use of the mlr package for the R programming language. Resuts: The predictive model built by classification trees algorithm outperformed the other algorithms by a large margin. As a result, we were able to rank the variables (questions and subquestions from the questionnaire) from the most to least influential as far as protection against mood disorder is concerned. Thirteen out of twenty most important variables reflect the relationships with parents. This seems to be a really significant result both from the cognitive point of view and also from the practical point of view, i.e. as far as interventions to correct mood disorders are concerned.

Keywords: mood disorders, adolescents, family, artificial intelligence

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Authors: Erika R. Chambriard, Sandro C. Izidoro, Davidson P. Mendes, Douglas E. V. Pires

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Work-related illnesses and disorders have been a constant aspect of work. Although their nature has changed over time, from musculoskeletal disorders to illnesses related to psychosocial aspects of work, its impact on the life of workers remains significant. Despite significant efforts worldwide to protect workers, the disparity between changes in work legislation and actual benefit for workers’ health has been creating a significant economic burden for social security and health systems around the world. In this context, this study aims to propose, test and validate a modular prototype that allows for work environmental aspects to be assessed, monitored and better controlled. The main focus is also to provide a historical record of working conditions and the means for workers to obtain comprehensible and useful information regarding their work environment and legal limits of occupational exposure to different types of environmental variables, as means to improve prevention of work-related accidents and disorders. We show the developed prototype provides useful and accurate information regarding the work environmental conditions, validating them with standard occupational hygiene equipment. We believe the proposed prototype is a cost-effective and adequate approach to work environment monitoring that could help elucidate the links between work and occupational illnesses, and that different industry sectors, as well as developing countries, could benefit from its capabilities.

Keywords: Arduino prototyping, occupational health and hygiene, work environment, work-related disorders prevention

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Authors: Nuo Xu, Sijing Chen

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Background: Childbirth is considered a critical traumatic event throughout our lives, positively or negatively impacting the mother's physiology, psychology, and even the whole family. Adverse birth experiences, such as labor pain, anxiety, and fear can negatively impact the mother. Studies had shown that the immersive nature of VR can distract attention from pain and increase focus on interventions for pain relief. However, the existing studies that applied VR to maternal delivery were still in their infancy and showed disparate results, and the small sample size is not representative, so this review analyzed the effects of VR in labor, such as on maternal pain and anxiety, with a view to providing a basis for future applications. Search strategy: We searched Pubmed, Embase, Web of Science, the Cochrane Library, CINAHL, China National Knowledge Infrastructure, Wan-Fang database from the building to November 17, 2021. Selection Criteria: Randomized controlled trials (RCTs) that intervened the pregnant women aged 18-35 years with gestational >34 weeks and without complications with VR technology were contained within this review. Data Collection and Analysis: Two researchers completed the study selection, data extraction, and assessment of study quality. For quantitative data we used MD or SMD, and RR (risk ratio) for qualitative data. Random-effects model and 95% confidence interval (95% CI) were used. Main Results: 12 studies were included. Using VR could relieve pain during labor (MD=-1.81, 95% CI (-2.04, -1.57), P< 0.00001) and active period (SMD=-0.41, 95% CI (-0.68, -0.14), P= 0.003), reduce anxiety (SMD=-1.39, 95% CI (-1.99, -0.78), P< 0.00001) and improve satisfaction (RR = 1.32; 95% CI (1.10, 1.59); P = 0.003), but the effect on the duration of first (SMD=-1.12, 95% CI (-2.38, 0.13), P=0.08) and second (SMD=-0.22, 95% CI (-0.67, 0.24), P=0.35) stage of labor was not statistically significant. Conclusions: Compared with conventional care, VR technology can relieve labor pain and anxiety and improve satisfaction. However, extensive experimental validation is still needed.

Keywords: virtual reality, delivery, labor pain, anxiety, meta-analysis, systematic review

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Authors: Takashi Kaburagi, Masashi Takenaka, Yosuke Kurihara, Takashi Matsumoto

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Major depressive disorder (MDD) is one of the most common mental illnesses today. It is believed to be caused by a combination of several factors, including stress. Stress can be quantitatively evaluated using the State-Trait Anxiety Inventory (STAI), one of the best indices to evaluate anxiety. Although STAI scores are widely used in applications ranging from clinical diagnosis to basic research, the scores are calculated based on a self-reported questionnaire. An objective evaluation is required because the subject may intentionally change his/her answers if multiple tests are carried out. In this article, we present a modified index called the “multi-channel Laterality Index at Rest (mc-LIR)” by recording the brain activity from a wider area of the frontal lobe using multi-channel functional near-infrared spectroscopy (fNIRS). The presented index aims to measure multiple positions near the F_pz defined by the international 10-20 system positioning. Using 24 subjects, the dependencies on the number of measuring points used to calculate the mc-LIR and its correlation coefficients with the STAI scores are reported. Furthermore, a simple linear regression was performed to estimate the STAI scores from mc-LIR. The cross-validation error is also reported. The experimental results show that using multiple positions near the Fpz will improve the correlation coefficients and estimation than those using only two positions.

Keywords: frontal lobe, functional near-infrared spectroscopy, state-trait anxiety inventory score, stress

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Authors: Junaid Hamid Bhat

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Background: Musculoskeletal disorders are one of the main causes of occupational illness. Mechanisms and the factors like repetitive work, physical effort and posture, endangering the risk of musculoskeletal disorders would now appear to have been properly identified. Teacher’s exposure to work-related musculoskeletal disorders appears to be insufficiently described in the literature. Little research has investigated the prevalence and risk factors of musculoskeletal disorders in teaching profession. Very few studies are available in this regard and there are no studies evident in India. Purpose: To determine the prevalence of musculoskeletal disorders and to identify and measure the association of such risk factors responsible for developing musculoskeletal disorders among school teachers. Methodology: An observational cross sectional study was carried out. 500 school teachers from primary, middle, high and secondary schools were selected, based on eligibility criteria. A signed consent was obtained and a self-administered, validated questionnaire was used. Descriptive statistics was used to compute the statistical mean and standard deviation, frequency and percentage to estimate the prevalence of musculoskeletal disorders among school teachers. The data analysis was done by using SPSS version 16.0. Results: Results indicated higher pain prevalence (99.6%) among school teachers during the past 12 months. Neck pain (66.1%), low back pain (61.8%) and knee pain (32.0%) were the most prevalent musculoskeletal complaints of the subjects. Prevalence of shoulder pain was also found to be high among school teachers (25.9%). 52.0% subjects reported pain as disabling in nature, causing sleep disturbance (44.8%) and pain was found to be associated with work (87.5%). A significant association was found between musculoskeletal disorders and sick leaves/absenteeism. Conclusion: Work-related musculoskeletal disorders particularly neck pain, low back pain, and knee pain, is highly prevalent and risk factors are responsible for the development of same in school teachers. There is little awareness of musculoskeletal disorders among school teachers, due to work load and prolonged/static postures. Further research should concentrate on specific risk factors like repetitive movements, psychological stress, and ergonomic factors and should be carried out all over the country and the school teachers should be studied carefully over a period of time. Also, an ergonomic investigation is needed to decrease the work-related musculoskeletal disorder problems. Implication: Recall bias and self-reporting can be considered as limitations. Also, cause and effect inferences cannot be ascertained. Based on these results, it is important to disseminate general recommendations for prevention of work-related musculoskeletal disorders with regards to the suitability of furniture, equipment and work tools, environmental conditions, work organization and rest time to school teachers. School teachers in the early stage of their careers should try to adapt the ergonomically favorable position whilst performing their work for a safe and healthy life later. Employers should be educated on practical aspects of prevention to reduce musculoskeletal disorders, since changes in workplace and work organization and physical/recreational activities are required.

Keywords: work related musculoskeletal disorders, school teachers, risk factors funding, medical and health sciences

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Authors: Jill Villarreal, Kristalyn Cooksey, Kai Lloyd, Daniel Ha

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Little research has been conducted to examine college students' reading attitudes, including students' perceptions of reading behaviors and reading abilities. This is problematic, as reading assigned course material is a critical component to an undergraduate student's academic success. For this study, flyers were electronically disseminated to instructors at 24 public and 10 private U.S. institutions in “Reading-Intensive Departments” including Psychology, Sociology, Education, Business, and Communications. We requested the online survey be completed as an in-class activity during the fall 2019 and spring 2020 semesters. All participants voluntarily completed the questionnaire anonymously. Of the participants, 280 self-identified their race as Black and 280 self-identified their race as White. Of the participants, 177 self-identified their gender as Male and 383 self-identified their Gender as Female. Participants ranged in age from 18-24. Factor analysis found four dimensions resulting from the questions regarding reading. The first we interpret as “Reading Proficiency”, accounted for 19% of the variability. The second dimension was “Reading Anxiety” (15%), the third was “Textbook Reading Ability” (9%), and the fourth was “Reading Enjoyment” (8%). Linear models on each of these dimensions revealed no effect of Age, Gender, Race, or Income on “Reading proficiency”. The linear model of “Reading Anxiety” showed a significant effect of race (p = 0.02), with higher anxiety in white students, as well as higher reading anxiety in female students (p < 0.001). The model of “Textbook Reading Ability” found a significant effect of race (p < 0.001), with higher textbook problems in white students. The model of “Reading Enjoyment” showed significant effects of race (p = 0.013) with more enjoyment for white students, gender (p = 0.001) with higher enjoyment for female students, and age (p = 0.033) with older students showing higher enjoyment. These findings suggest that gender, age, and race are important factors in many aspects of college students' reading attitudes. Further research will investigate possible causes for these differences. In addition, the effectiveness of college-level programs to reduce reading anxiety, promote the reading of textbooks, and foster a love of reading will be assessed.

Keywords: age, college, gender, race, reading

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Authors: Briony Gray, Glenn Simpson, Hajira Dambha-Miller, Andrew Farmer

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Multimorbidity may be strongly affected by a variety of conditions, factors, and variables requiring higher demands on health and social care services, infrastructure, and expenses. Holding one or more conditions increases one’s risk for development of future conditions; with patients over 65 years old at highest risk. Psychosocial factors such as anxiety and depression are rising exponentially globally, which has been amplified by the COVID19 pandemic. These are highly correlated and predict poorer outcomes when held in coexistence and increase the likelihood of comorbid physical health conditions. While possible future reform of social and healthcare systems may help to alleviate some of these mounting pressures, there remains an urgent need to better understand the potential role health behaviours and psychosocial conditions - such as anxiety and depression – may have on aging populations. Using the UK healthcare scene as a lens for analysis, this study uses big data collected in the UK Longitudinal Study of Aging (ELSA) to examine the role of anxiety and depression in ageing populations (65yrs+). Using logistic regression modelling, results identify the 10 most significant variables correlated with both anxiety and depression from data categorised into the areas of health behaviour, psychosocial, socioeconomic, and life satisfaction (each demonstrated through literature review to be of significance). These are compared with wider global research findings with the aim of better understanding the areas in which social and healthcare reform can support multimorbidity interventions, making suggestions for improved patient-centred care. Scope of future research is outlined, which includes analysis of 59 total multimorbidity variables from the ELSA dataset, going beyond anxiety and depression.

Keywords: multimorbidity, health behaviours, patient centred care, psychosocial factors

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