Mental health in individuals with severe mental disorders during the covid-19 pandemic: a longitudinal investigation.

Research on the long-term mental health impact of the COVID-19 pandemic across mental disorders is limited, and information on the impact of public health policy measures with varying strictness is missing. This study therefore aimed at investigating psychological distress among residents of Tyrol (Austria) and South Tyrol (Italy) at the early stages of the pandemic and 5 months thereafter and examined how sociodemographic, protective, and risk factors relate to change over time. One hundred and fifteen people with severe mental illness (SMI; schizophrenia spectrum disorder, bipolar disorder, major depressive disorder with psychotic features) or major depressive disorder without psychotic features (MDD) and 481 community controls without mental disorders participated in an online survey. Next to the collection of sociodemographic and COVID-19 related variables, the Brief Symptom Checklist, the Resilience Scale, the Multidimensional Scale of Perceived Social Support, the Three-Item Loneliness Scale, and the Multidimensional State Boredom Scale-Short Form were used to assess psychological distress, resilience, perceived social support, loneliness, and boredom. Levels of psychological symptoms and the prevalence of psychological distress were significantly higher in individuals with MDD compared to the other two groups, and Italian participants were more prone to anxiety than those from Austria. Psychological distress was predicted by a lower degree of both resilience and perceived social support as well as loneliness and boredom. Notably, the prevalence of clinically relevant psychological symptoms remained unchanged among each group over time. These results underscore the relevance of tailored prevention and mitigation strategies to meet the specific needs of people both with and without mental disorders.

Developing an e-learning course on the use of PRO measures in oncological practice: health care professionals' preferences for learning content and methods.

PURPOSE: Implementation of patient-reported outcome measures (PROMs) in clinical routine requires knowledge and competences regarding their use. In order to facilitate implementation, an e-learning course for health care professionals (HCPs) on the utilisation of European Organisation for Research and Treatment of Cancer (EORTC) PROMs in oncological clinical practice is being developed. This study aimed to explore future users' educational needs regarding content and learning methods. METHODS: The sequential mixed methods approach was applied. A scoping literature review informed the guideline for qualitative interviews with HCPs with diverse professional backgrounds in oncology and cancer advocates recruited using a purposive sampling strategy. An international online survey was conducted to validate the qualitative findings. RESULTS: Between December 2019 and May 2020, 73 interviews were conducted in 9 countries resulting in 8 topic areas (Basic information on PROs in clinical routine, Benefits of PRO assessments in clinical practice, Implementation of PRO assessments in clinical routine, Setup of PRO assessments for clinical application, Interpretation of PRO data, Integration of PROs into the communication with patients, Use of PROs in clinical practice, Self-management recommendations for patients based on PROs) subsequently presented in the online survey. The online survey (open between 3 June and 19 July 2020) was completed by 233 HCPs from 33 countries. The highest preference was indicated for content on interpretation of PRO data (97%), clinical benefits of assessing PRO data (95.3%) and implementation of routine PRO data assessment (94.8%). Regarding learning methods, participants indicated a high preference for practical examples that use a mixed approach of presentation (written, audio, video and interactive). CONCLUSION: Educational needs for an integration of PROs in communication in clinical care and coherent implementation strategies became evident. These results inform the development of an e-learning course to support HCPs in the clinical use of EORTC PRO measures.

Reality Meets Belief: A Mixed Methods Study on Character Strengths and Well-Being of Hospital Physicians.

Positive psychology deals with factors that make life most worth living and focuses on enhancing individual potentials. Particularly, character strengths can positively contribute to well-being and work-related health, bearing a promising potential for professions, such as physicians, who are at risk for burnout or mental illnesses. This study aims to identify beneficial character strengths by examining the quantitative and qualitative data. In a cross-sectional multi-method study, 218 hospital physicians completed an online survey assessing their character strengths and their general and work-related well-being, comprising thriving, work engagement, and burnout dimensions (outcome variables). Quantitative data were analyzed for the total sample and by tertiary split. Additionally, interview-gathered opinions of four resident physicians and four medical specialist educators were collected to expand the perspective on which character strengths might be beneficial for the well-being of the resident physicians. The highest significant correlations between character strengths and outcome variables were found for hope and thriving (r = 0.67), zest, and work engagement (r = 0.67) as well as emotional exhaustion (r = -0.47), perseverance/leadership and depersonalization (r = -0.27), bravery, and reduced personal accomplishment (r = -0.39). Tertiary splits revealed that some correlations were not consistent across the entire scale continuum, for example, creativity was only significantly correlated with comparatively high levels of thriving (r = 0.28) or forgiveness with comparatively high levels of depersonalization (r = -0.34). Humility, social intelligence, and teamwork showed predominantly low correlations with all outcome variables (r = -0.17 - 0.34), although humility was stated by all interviewed medical specialist educators to be the most relevant for the well-being at work, and the latter two by three resident physicians, respectively. Different perspectives resulting from quantitative and qualitative data in terms of beneficial character strengths for work-related well-being may be driven by different work experiences, professional understandings, generational beliefs, or social expectations. Some significant correlations between character strengths and well-being outcomes varied depending on low, medium, or high outcomes. This raises questions about suitable work-related well-being interventions, as simple single intervention approaches (one intervention fits all) may not work for the respective outcome levels. These new findings warrant further research on how to foster the well-being of resident physicians at work.

Possession and Applicability of Signature Character Strengths: What Is Essential for Well-Being, Work Engagement, and Burnout?

Signature character strengths can foster health-related outcomes in work and private life, thus being particularly important for endangered occupational groups like physicians. However, situational circumstances need to allow character strengths demonstration (applicability) first to enable their application. Therefore, this study addresses the role of (1) applicability of signature character strengths in work and private life beyond their possession and (2) relationships with well-being, work engagement, and burnout dimensions (emotional exhaustion, depersonalization, and reduced personal accomplishment). Hospital physicians (N = 274) completed an online survey examining their signature character strengths and applicability, well-being, work engagement, and burnout dimensions. The top-five individual signature character strengths were fairness, honesty, judgment, kindness, and love. Hierarchical multiple linear regressions revealed that the possession as well as the applicability of signature character strengths was important in work and private life, but to different degrees. Possessing fairness, honesty, or kindness indicated significant positive relations with subjective well-being, whereas judgment and kindness seemed to negatively interact with reduced personal accomplishment. Hospital physicians' applicability of fairness, honesty, judgment, and love was particularly essential for their psychological well-being and work engagement, whereas the applicability of fairness (reduced personal accomplishment) and judgment (emotional exhaustion, depersonalization) at work interacted negatively with the respective outcomes. Therefore, creating awareness for individual signature character strengths as well as providing applicability in hospitals and private life could be a promising approach to improve physicians' well-being and consequently patient care as well as the performance of the health-care system in general.

Development of Cynicism in Medical Students: Exploring the Role of Signature Character Strengths and Well-Being.

Reports of medical students experiencing burnout-related symptoms (e.g., cynicism) have increased in recent years. Little is known about the developmental process of this phenomenon and its relations with signature character strengths and well-being. The aim of this longitudinal analysis was to explore changes in the level of cynicism of medical students while in preclinical education. We further examined how the applicability of signature character strengths and well-being are related to this developmental process. Medical students (N = 99) participated in three online surveys over 3 years during medical school. Latent growth modeling, latent class growth modeling, general mixed modeling was conducted, and post hoc mixed ANOVA, Friedman test and Welch test analyses were examined. The results showed an increase in cynicism among medical students from first to last measurement. Two groups with distinct developmental trajectory patterns of cynicism were identified. Students with high levels of cynicism (high-level group) and students with changing levels of cynicism (increasing group) perceived higher applicability of signature character strengths in private life compared to the study context. Moreover, the high-level group experienced significantly lower psychological well-being (in particular mastery, optimism, and relationship) in their first year of medical education. This explorative study offers a comprehensive understanding of cynicism development in medical students during medical school and its relations to the applicability of signature character strengths and well-being. Prospective replication studies are needed to replicate the results obtained in this study.

Character Strengths Profiles in Medical Professionals and Their Impact on Well-Being.

Character strengths profiles in the specific setting of medical professionals are widely unchartered territory. This paper focused on an overview of character strengths profiles of medical professionals (medical students and physicians) based on literature research and available empirical data illustrating their impact on well-being and work engagement. A literature research was conducted and the majority of peer-reviewed considered articles dealt with theoretical or conceptually driven 'virtues' associated with medical specialties or questions of ethics in patient care (e.g., professionalism, or what makes a good physician). The virtues of compassion, courage, altruism, and benevolence were described most often. Only a limited number of papers addressed character strengths of medical students or physicians according to the VIA-classification. Those articles showed that the VIA-character strengths fairness, honesty, kindness, and teamwork were considered most often by respondents to be particularly important for the medical profession. Available cross-sectional (time span: six years) and longitudinal (time span: three years) data regarding VIA-character strengths profiles of medical professionals were analyzed (N = 584 medical students, 274 physicians). These profiles were quite homogenous among both groups. The character strengths fairness, honesty, judgment, kindness, and love had the highest means in both samples. Noteworthy differences appeared when comparing medical specialties, in particular concerning general surgeons and psychiatrists, with the former reporting clearly higher levels of e.g., honesty (d = 1.02) or prudence (d = 1.19). Long-term results revealed significant positive effects of character strengths on well-being and work engagement (e.g., perseverance on physicians' work engagement) but also significant negative effects (e.g., appreciation of beauty and excellence on students' well-being). Further, hope was significantly associated both positively with physicians' well-being and negatively with students' work engagement, possibly indicating specific issues concerning medical education or hospital working conditions. According to the modern-day physician's pledge, medical professionals should pay attention to their own well-being and health. Therefore, promoting self-awareness and character building among medical professionals could be a beneficial strategy.