The impact of stigma on perceived quality of life and experience of anxiety and depression in individuals diagnosed with MS.

BACKGROUND: Stigma experienced by persons living with multiple sclerosis (PwMS) is underrepresented in the literature. Discovering how the experience of stigma impacts quality of life and mood symptoms in PwMS may guide future care considerations with the goal of improving overall quality of life. METHODS: A retrospective review of data from the Quality of Life in Neurological Disorders (Neuro-QoL) set of measures and PROMIS Global Health (PROMIS-GH) scale was conducted. Multivariable linear regression was used to assess relationships between baseline (first visit) Neuro-QoL Stigma, Anxiety, Depression, and PROMIS-GH. Mediation analyses examined whether mood symptoms mediated the relationship between stigma and quality of life (PROMIS-GH). RESULTS: 6,760 patients (mean age 60.2 ± 8.9 years, 27.7% male, 74.2% white) were included. Neuro-QoL Stigma was significantly related to PROMIS-GH Physical Health (beta=-0.390, 95% CI [-0.411, -0.368]; p < 0.001) and PROMIS-GH Mental Health (beta=-0.595, 95% CI [-0.624, -0.566]; p < 0.001). Neuro-QoL Stigma was also significantly related to Neuro-QoL Anxiety (beta=0.721, 95% CI [0.696, 0.746]; p < 0.001) and Neuro-QoL Depression (beta=0.673, 95% CI [0.654, 0.693]; p < 0.001). Mediation analyses revealed that both Neuro-QoL Anxiety and Depression partially mediated the relationship between Neuro-QoL Stigma and PROMIS-GH Physical and Mental Health. CONCLUSION: Results demonstrate stigma is associated with decreased quality of life in both physical and mental health domains in PwMS. Stigma was also associated with more significant symptoms of anxiety and depression. Finally, anxiety and depression play a mediating role in the relationship between stigma and both physical and mental health in PwMS. Therefore, tailoring interventions to effectively reduce symptoms of anxiety and depression in PwMS may be warranted, as it will likely improve overall quality of life and reduce negative impacts of stigma.

Assessment of Computer Assisted Rehabilitation Environment (CAREN) System Use and Mood in Patients With Multiple Sclerosis.

Background: Depression is a common comorbidity in patients with multiple sclerosis (MS) and is associated with decreased quality of life. Identifying treatments that aid psychological and physical rehabilitation in patients with MS provides valuable information for interdisciplinary teams. Methods: Seventy-five adults with MS who completed the Patient Health Questionnaire-9 (PHQ-9) and Patient-Reported Outcomes Measurement Information System (PROMIS) Global Health scale during routine physical therapy appointments where the (CAREN) system was used were studied. Data were retrospective and collected via patient-reported outcomes. Group comparisons used 2-sample t tests or Mann-Whitney U tests for continuous variables and Fisher exact tests for categorical variables. To examine self-reported depression, mean ± SD baseline scores were computed and stratified by number of CAREN sessions. Results: Patients with 5 or more sessions seemed to have lower baseline PHQ-9 and PROMIS Mental Health scores; however, no significant differences were found at the univariate level. There were no statistically significant differences in follow-up scores for the outcome measures. Conclusions: Current research evaluating the rehabilitation of patients with MS using the CAREN system is scarce. This pilot study is important to inform prospective studies exploring use of the CAREN system for psychological rehabilitation. Patients with 5 or more CAREN sessions had lower baseline PHQ-9 scores, which may suggest that mood plays a role in the selection of patients for CAREN system use. This study shows that mood is not affected by the CAREN system. More specific research needs to be completed with a more robust sample.

Recommendations to Address the Unique Clinical and Psychological Needs of Transgender Persons Living With Multiple Sclerosis.

Background: People living with multiple sclerosis (MS) face challenges coping with chronic illnesses, and transgender (TGD) persons living with MS may experience additional unique challenges and barriers to care. Medical biases toward TGD people are widely reported, and best practices in TGD MS care have not been identified. Methods: A case report of a TGD person living with MS is reviewed that helped to identify and inform us regarding the unique aspects of their clinical and psychological care needs. We conducted a systematic review of the literature according to the standard methods in PubMed. The literature was reviewed and summarized for relevant topics related to the unique care needs of TGD persons living with MS, and proposed care recommendations were created. Results: We used the aforementioned case to identify and inform the special care needs and subsequently describe proposed recommendations to achieve inclusive comprehensive care of TGD persons with MS. The importance of providing an inclusive environment, comprehensive care, mental health screening, domestic violence screening, and case coordination are highlighted with the goal of providing best practice recommendations for the comprehensive inclusive care of TGD persons living with MS. Conclusions: The lack of published guidance on the care of TGD persons living with MS and our informative case have led to the proposed recommendations for the care of TGD persons living with MS.

Therapeutic Approaches to Insomnia and Fatigue in Patients with Multiple Sclerosis.

The prevalence of sleep disorders in individuals with multiple sclerosis (MS) is 3-5 times higher compared to the general population. Insomnia Disorder, defined as difficulty falling asleep, maintaining sleep or waking up too early, can lead to significant fatigue, the most common and disabling symptom of MS. In addition, fatigue and insomnia in patients with MS also can overlap with and exacerbate other psychological and physical symptoms. Cognitive behavioral therapy for insomnia (CBT-I) has been shown as an effective treatment for chronic insomnia and burgeoning research has demonstrated the effectiveness of this treatment for insomnia in individuals with a variety of comorbid medical conditions including MS. The purpose of the current review will explore the literature surrounding the prevalence and impact of sleep disorders and fatigue in MS. Additionally, this review will address practical ways to help individuals with MS manage fatigue as well as how to modify typical standard behavioral treatments for insomnia to take into account special considerations for individuals with MS based on the level of disability and other comorbid issues that impact sleep.

The COVID-19 Crisis: A Mental Health Perspective and Response Using Telemedicine.

With the outbreak of COVID-19, patients and providers were forced to isolate and become innovative in ways to continue exceptional patient care. The Cleveland Clinic went from mostly in-person medical appointments to all virtual/telemedicine care in about 2 weeks' time. In this piece, we show specifically the thought process and our conversion of the Mellen Center for Multiple Sclerosis Behavioral Medicine to ensure that our patients still receive exceptional care and patient experience. Additionally, we discuss the importance of innovating the training and supervision of postdoctoral trainees using telepsychology and virtual options.

The Impact of Children's Temperament on How Parents Resolve Safety Disagreements During Preadolescence.

OBJECTIVES: Parents play an important role in keeping their children safe. However, this becomes more difficult during preadolescence as children seek greater autonomy away from the direct supervision of adults. The current study focused on preadolescent youth (10-13 years) and examined parent-child disagreements about safety, with a focus on determining if child temperament attributes moderate the relation between how parents learn of these and resolve these disagreements. METHODS: A short-term longitudinal design was used. Parents and children retrospectively recalled safety disagreements together and then independently completed questionnaires about these. Parents then tracked disagreements over 1 month. RESULTS: The behavioral attributes of inhibitory control and risk-taking propensity both moderated the relationships between parental source of knowledge of safety disagreements and subsequent methods of resolution. CONCLUSION: Safety-promotion messaging for parents of preadolescents may need to be tailored based on child attributes to maximize effectiveness.

Parent-Child Disagreements About Safety During Preadolescence.

OBJECTIVES: Much research has examined how parents manage safety issues for young children, however, little is known about how they do so in the preadolescent years when children's demand for autonomy increases. The current study focused on youth in this transition stage (10-13 years) and examined parent-child disagreements about safety, including how parents learn of these, react to these, and resolve these (Aim 1), if the parent-child relationship or sex of the child impacts these processes (Aim 2), and the nature and reasons why children intentionally keep safety-relevant secrets from their parents (Aim 3). METHODS: A short-term longitudinal design was applied. Parents initially completed questionnaires and, with their child, retrospectively recalled safety disagreements. Over the next month, parents tracked safety disagreements and children tracked secrets they withheld from parents. RESULTS: The findings revealed significant gender differences: Daughters were more likely than sons to spontaneously disclose safety issues to their parents, and parents were more likely to discuss the issue and provide teaching to daughters than sons. Relationship quality emerged as an important factor, particularly for boys: A positive parent-child relationship predicted increased parental teaching in response to a safety-relevant issue for boys only. Children kept secrets from their parents about safety-relevant information in order to maintain their autonomy and independence. CONCLUSION: Parent-child disagreements about safety are influenced by the positive nature of the parent-child relationship and differ for sons and daughters.

An evaluation of the Cool 2 Be Safe program: an evidence-based community-disseminated program to positively impact children's beliefs about injury risk on playgrounds.

Falls from playground equipment during play are a leading cause of injury for elementary school children. Changes to playground design and surfacing materials can reduce injury risk. However, there is also a need for intervention programs to reduce risky play behaviors by children that are associated with falls. The Cool 2 Be Safe program was developed based on past research that identified effective strategies for targeting injury beliefs that predict risk behaviors on playgrounds among individually tested elementary school children. The current study evaluated the effectiveness of delivering these activities as an integrated program and in a group format in after school programs organized by Boys and Girls Clubs of Canada. The clubs were provided all program and extensive training materials, and a webinar training session was conducted for facilitators. Observations of sessions provided data on fidelity of program delivery. Pre- and post-intervention data assessing children's injury beliefs were collected via survey, with children participating in four structured activity sessions in small groups between premeasures and post-measures. The training materials proved to be quite effective; observational data indicated 88 % compliance with the procedures. Comparing children's pre- and post-responses revealed positive changes in injury-risk beliefs that have been shown to predict reduced risk taking on playgrounds. This initial evaluation suggests that the Cool 2 Be Safe community program holds much promise as a means for addressing the issue of fall-risk behaviors by elementary school children on playgrounds.

What features of images affect parents' appraisal of safety messages? Examining images from the A Million Messages programme in Canada.

BACKGROUND: Enhancing caregivers' awareness of children's injury risks and increasing knowledge about strategies for injury prevention often involve presenting parents with written materials and accompanying images. OBJECTIVES: To assess parents' appraisals of different variations of images and identify those features that enhance their attention to safety messages. METHODS: Eight images showing risk situations were taken from the A Million Messages safety education parent-directed programme in Canada and modified to create a corresponding image that clearly showed negative consequences for the child, and facial expressions of fear and/or upset. Mothers with young children were presented with the eight pairs of images (negative consequence vs risk situation) and asked to select the best accompaniment to a safety message and to provide an explanation for their choice. Each image was then also rated for fit to the safety message, communication of danger, emotional arousal and attention elicitation. RESULTS: The images depicting negative consequences were chosen for most comparisons (78%) and higher scores were assigned to these images for all four features rated by parents (danger communicated, emotions evoked, attention elicitation and fit to the safety message). Moreover, ratings of danger, emotions and attention predicted 'fit to safety message' scores. CONCLUSIONS: Depicting negative consequences and showing negative emotions is important to maximise the effectiveness of images in communicating danger and evoking attention and concern when targeting parents with child-safety messaging.

Only kids who are fools would do that! Peer social norms influence children's risk-taking decisions.

OBJECTIVES: The current research examined the impact of peer social norms on the physical risk-taking decisions of elementary-school children. METHOD: Children 6-12 years of age completed a novel video-viewing decision task in which they observed risk and non-risk child behaviors on a playground and, after each behavior, indicated their willingness to model each of the behaviors in their own video, both before and after exposure to peer-communicated social norms (encouragement, discouragement). RESULTS: Exposure to peer social norms resulted in significant changes in risk taking, with changes predicted from ratings of perceived social norms and appraisals of injury vulnerability and severity. CONCLUSION: Exposure to peer social norms can provide another means by which injury prevention programs can aim to reduce injury-risk behaviors among school-age children.

Stability of WISC-IV process scores.

Forty-three students were administered on two occasions approximately 11 months apart the complete Wechsler Intelligence Scale for Children-Fourth Edition, including the seven process components of Block Design No Time Bonus, Digit Span Forward (DSF), Digit Span Backward (DSB), Cancellation Random (CAR), Cancellation Structured (CAS), Longest Digit Span Forward (LDSF), and Longest Digit Span Backward (LDSB). Mean ages at first and second testing were 7.77 years (SD = 1.91) and 8.74 years (SD = 1.93), respectively. Mean Full-Scale IQ at initial testing was 111.63 (SD = 10.71). Process score stability coefficients ranged from .75 on DSF to .32 on CAS. Discrepancy score stabilities ranged from .45 on DSF minus DSB to .05 on CAS minus CAR. Approximately 21% of participants increased their LDSF on retest, and 16.3% showed a gain on LDSB. Caution must be exercised when interpreting process scores, and interpretation of discrepancy scores should probably be avoided.

Advancing our understanding of mothers' safety rules for school-age children.

OBJECTIVE: Teaching safety rules is a common way parents attempt to moderate injury risk for elementary-school children, but few studies have examined the nature of this teaching. The present study explored whether mothers' safety rules varied with type of injury (falls, poisoning, burns and cuts), the nature of these teaching strategies about rules, and how effective these rules were to moderate children's risk behaviour when in a setting having 'contrived' hazards that were targeted by these rules. METHODS: Mothers completed an interview about safety rules, and children's behaviour was unobtrusively observed in a 'contrived hazards' situation having hazards relevant to falls, poisoning, burns and cuts. RESULTS: Mothers had significantly fewer rules addressing fall risks than other types of injuries, and fall-related rules were highly hazard-specific in nature, rather than aimed at teaching general principles for appraising fall risks. For all types of injuries except falls, children interacted with fewer hazards for which there were rules. CONCLUSIONS: Rules can have preventive properties that can serve to moderate children's interacting with hazards when alone, but this seems to vary depending on the type of rule that has been taught. Given that falls are a leading cause of injury hospitalization for children and that parents are not emphasizing fall prevention as much as other types of injuries, efforts should be extended to promote parents' shifting their prevention approaches to better address this particular injury risk.

A measure that relates to elementary school children's risk of injury: the supervision attributes and risk-taking questionnaire (SARTQ).

OBJECTIVES: The aim of this study was to examine the psychometric properties of the supervision attributes and risk-taking questionnaire (SARTQ), which is a new measure of caregiver supervision and child risk-taking that applies to elementary school children 7-10 years of age. METHODS: Using a prospective design, scores on the SARTQ were related to children's recent and long-term history of injuries and to parents' supervision scores that were derived based on measuring their home supervision practices over 8 weeks. RESULTS: Subscale scores on the SARTQ related differentially to measures of supervision and child injury scores, providing support for the criterion validity of this new measure. CONCLUSION: Results from this initial test of the SARTQ suggest that it holds promise as a measure that is relevant to understanding injury risk for elementary school children.

"I think he is in his room playing a video game": parental supervision of young elementary-school children at home.

OBJECTIVES: Using a prospective design, this research examined supervision of young elementary-school children at home and how this relates to child injury, parent permissiveness, and children's risk-taking propensity. METHODS: Mothers reported children's history of injuries and recorded home supervision over a 2-month interval on a weekly basis. Children independently completed diaries about daily events, including injuries. RESULTS: Children spent 24% of time alone, mostly supervised intermittently or not at all. Parent permissiveness was associated with increased time unsupervised, while children's risk-taking propensity was associated with decreased time unsupervised. Greater direct supervision was associated with fewer injuries, while more indirect and non-supervision time emerged as risk factors and were associated with more frequent injury. CONCLUSIONS: These results extend those from preschool-aged children and suggest that caregiver supervision influences risk of injury across a broad age range throughout childhood. Implications for children's safety are discussed.