Burnout study during the COVID-19 pandemic in Thailand: psychometric evaluation of the Maslach Burnout Inventory-Human Services Survey for Medical Personnel.

Objectives: This study aimed (1) to determine the psychometric properties of a Thai version of the Maslach Burnout Inventory-Human Services Survey for Medical Personnel (MBI-HSS [MP]) and (2) to examine the mean scores of burnout and associated factors during the COVID-19 pandemic. Methods: Forward and back translations of the MBI-HSS (MP) questionnaire were performed. The Thai version was subsequently completed by 682 Thai physicians and nurses who worked during the COVID-19 pandemic. Exploratory factor analysis was performed on the first subsample (n = 341) by conducting Kaiser Mayer-Olkin sampling adequacy measurement and Bartlett's test of sphericity whereas confirmatory factor analysis (CFA) was performed on the second subsample (n = 341) using fit indices of the normed chi-square (χ2/df), the comparative fit index, the Tucker-Lewis index, and the root mean square error of approximation. This version's internal consistency was investigated using Cronbach's alpha coefficient. Demographic profiles were evaluated with descriptive and analytical statistics. Results: The Thai version of the MBI-HSS (MP) displayed good psychometric characteristics, as the Cronbach's alpha values of the 3 burnout factors ranged from 0.843 to 0.945. The CFA also showed good fit indices (χ2/df = 4.473; P < 0.001; RMSEA = 0.075 (95%CI = 0.055-0.079); CFI = 0.946; and TLI = 0.936). The physicians' mean EE, DP, and PA scores were 25.28 ± 13.27, 7.15 ± 6.11, and 36.83 ± 8.13, respectively, whereas The nurses' mean EE, DP, and PA scores were 23.10 ± 14.14, 4.43 ± 5.06, and 35.67 ± 10.24, respectively. Healthcare professionals who were younger, single, had fewer years of practice, and had more working hours per week tended to express more burnout scores. Conclusions: The Thai version of the MBI-HSS (MP) demonstrates good psychometric properties in assessing burnout among healthcare professionals. Several factors may be pivotal in intensifying burnout.

Prevalence of Depressive Symptoms and Their Impact on Perceived Stress and Quality of Life Among Patients with Psoriasis.

Objective: This study aimed to investigate the prevalence of depressive symptoms in patients with psoriasis and the association between depressive symptoms, perceived stress level, and quality of life of the participants. Methods: Patients with psoriasis were invited to complete the Thai versions of the Patient Health Questionnaire, Perceived Stress Scale-10, Psoriasis Disability Index, and Simplified Psoriasis Index. To identify significantly related factors of depression, the independent sample t-test or Mann-Whitney U-test was performed to compare continuous variables between groups, and the chi-square test or Fisher's exact test was used to compare categorical variables between groups. The association between the severity of depression and other variables was examined using Spearman's correlation coefficient. Results: Of the 150 participants assessed, 32 (21.3%) had depressive symptoms. Elevated stress scores, subjective psychosocial impact of psoriasis, self-perceived current severity of psoriasis, and impaired quality of life were significantly associated with depressive symptoms. Depressive symptom severity was determined to be positively correlated with perceived stress, quality-of-life impairment, current severity, and the psychosocial impact of psoriasis. Conclusion: Depressive symptoms are prevalent among patients with psoriasis. Those with high scores for perceived stress, a psychosocial impact of psoriasis, or disease severity should be evaluated for depression, as it can hamper their quality of life.

Developing a global practice-based framework of person-centred care from primary data: a cross-national qualitative study with patients, caregivers and healthcare professionals.

INTRODUCTION: Person-centred care (PCC) is internationally recognised as a critical component of high-quality healthcare. However, PCC evolved in a few high-income countries and there are limited data exploring this concept across the vast majority of countries which are low- and middle-income. This study aimed to appraise and adapt a PCC model across three serious physical conditions in three middle-income countries and generate an evidence-based framework and recommendations for globally relevant PCC. METHODS: Cross-national, cross-sectional qualitative study. In depth, semistructured interviews conducted with: advanced cancer patients in Jordan (n=50), their caregivers (n=20) and healthcare professionals (HCPs) (n=20); chronic obstructive pulmonary disease patients in South Africa (n=22), their caregivers (n=19) and HCPs (n=22); heart failure patients in Thailand (n=14), their caregivers (n=10) and HCPs (n=12). Data were analysed using framework analysis. Santana et al's PCC model (2018) and Giusti et al's systematic review (2020) were used to construct an a priori coding frame for deductive analysis, with additional inductive coding for coding that did not fit the frame. RESULTS: The findings both reveal specific practical actions that contribute towards delivering PCC and highlight new cross-national domains of person-centredness: interdependency and collectivism; bringing care into the home and community; equity and non-discrimination; addressing health and illness within the context of limited resources; and workforce well-being. CONCLUSION: The data suggest that PCC requires particular structural features of the healthcare system to be in place, such as professional education in PCC values and partnerships with community-based workers. These structures may better enable PCC processes, including tailored information sharing and providing genuine opportunities for patients to do the things that matter to them, such as making informed care decisions and sustaining social relationships. PCC must also accommodate a collectivist perspective and support the well-being of the workforce.

Mindfulness-based interventions reducing and preventing stress and burnout in medical students: A systematic review and meta-analysis.

OBJECTIVE: Stress and burnout are serious problems that impair the well-being and academic performance of medical students. Published systematic reviews and meta-analyses on interventions to reduce the stress experienced by medical students did not conclude which interventions are the most effective due to the heterogeneity of the studies. To enhance the hierarchy of evidence, our study selected only randomized controlled studies. The aims were to obtain more reliable outcomes and to precisely summarize the specific interventions which effectively reduce the stress levels and burnout of medical students. METHODS: We performed a systematic review and meta-analysis according to PRISMA guidelines. Medical databases (Embase, Ovid, and CINAHL) were searched for relevant randomized controlled studies published up to December 2019. Two treatment timepoints (postintervention, and the 6-month follow-up) were chosen. Stress measure outcomes were the main outcomes. A random effects model was used. An intention-to-treat analysis was conducted. RESULTS: Six high-quality studies were found. They compared the efficacies of mindfulness-based interventions and clerkship as usual (N = 689). The stress measurement scores of each mindfulness-based intervention at postintervention were significantly better than those of the control groups, with medium effect size and low heterogeneity (95% CI 0.07-0.51; p = 0.01; I-squared index = 45%). At the 6-month follow-up, the mindfulness groups had significantly better results than the control groups, with medium effect size and negligible heterogeneity (95% CI 0.06-0.55; p = 0.02; I-squared index = 0%). DISCUSSION: The results indicate that mindfulness-based interventions are effective in reducing subjective stress in medical students at both the short- and long-term intervention timepoints.

Predictors for quality of life among older adults with depressive disorders: A prospective 3-month follow-up cohort study.

PURPOSE: The study aimed to investigate the predictive factors for quality of life among subjects with late-life depression. DESIGN AND METHODS: Data including depressive symptoms assessed by the Hamilton Rating Scale of Depression (HAMD), geriatric depression scale (GDS), perceived stress scale (PSS), multidimensional scale for perceived social support, and the EQ-5D scale were collected at baseline and at 3-month follow-up from 264 participants. FINDINGS: After controlling for covariates, time, GDS, PSS, HAMD, and living alone were confirmed predictors for change of EQ-5D scores. PRACTICE IMPLICATIONS: Perceived stress is important, and intervention to reduce stress especially in early treatment of depressive disorder should be encouraged.

The validity and reliability of the PHQ-9 in screening for post-stroke depression.

BACKGROUND: Depression affects about 30% of stroke survivors within 5 years. Timely diagnosis and management of post-stroke depression facilitate motor recovery and improve independence. The original version of the Patient Health Questionnaire-9 (PHQ-9) is recognized as a good screening tool for post-stroke depression. However, no validation studies have been undertaken for the use of the Thai PHQ-9 in screening for depression among Thai stroke patients. METHODS: The objectives were to determine the criterion validity and reliability of the Thai PHQ-9 in screening for post-stroke depression by comparing its results with those of a psychiatric interview as the gold standard. First-ever stroke patients aged ≥45 years with a stroke duration 2 weeks-2 years were administered the Thai PHQ-9. The gold standard was a psychiatric interview leading to a DSM-5 diagnosis of depressive disorder and adjustment disorder with a depressed mood. The summed-scored-based diagnosis of depression with the PHQ-9 was obtained. Validity and reliability analyses, and a receiver operating characteristic curve analysis, were performed. RESULTS: In all, 115 stroke patients with a mean age of 64 years (SD: 10 years) were enrolled. The mean PHQ-9 score was 5.2 (SD: 4.8). Using the DSM-5 criteria, 11 patients (9.6%) were diagnosed with depressive disorder, 12 patients (10.5%) were diagnosed with adjustment disorder with a depressed mood. Both disorders were combined as a group of post-stroke depression. The Thai PHQ-9 had satisfactory internal consistency (Cronbach's alpha: 0.78). The algorithm-based diagnosis of the Thai PHQ-9 had low sensitivity (0.52) but very high specificity (0.94) and positive likelihood ratio (9.6). Used as a summed-scored-based diagnosis, an optimal cut-off score of six revealed a sensitivity of 0.87, specificity of 0.75, positive predictive value of 0.46, negative predictive value of 0.95, and positive likelihood ratio of 3.5. The area under the curve was 0.87 (95% CI: 0.78-0.96). CONCLUSIONS: The Thai PHQ-9 has acceptable psychometric properties for detecting a mixture of major depression and adjustment disorder in post-stroke patients, with a recommended cut-off score of ≥6 for a Thai population.

Thai psychiatrists and burnout: A national survey.

OBJECTIVES: To explore the prevalence and factors that contribute to burnout among Thai psychiatrists. BACKGROUND: The practice of psychiatry can lead to emotional fatigue. As rates of emotional illness in Thailand continue to climb, increasing demands are placed on a limited number of psychiatrists. This can lead to burnout, and multiple negative physical and mental health outcomes. MATERIALS AND METHODS: Electronic questionnaires were sent to all 882 Thai psychiatrists and residents via a private social media group managed by the Psychiatric Association of Thailand. The questionnaire included demographic data, the Maslach Burnout Inventory (MBI), the Proactive Coping Inventory, and questions about strategies that Thai psychiatrists believed reduce/prevent burnout. RESULTS: Questionnaires were sent and 227 (25.7%) responded. According to MBI, 112 (49.3%) of respondents reported high level of emotional exhaustion, and 60 (26.4%) had a high level of depersonalization. Nearly all respondents (99.6%) maintained a high level of personal accomplishment. Working more than 50 hours per week (p = 0.003) and more patients per day (p = 0.20) were associated with higher levels of burnout. Feeling satisfied with work (p<0.001) and having a good support system from family (p = 0.027) and colleagues (p = 0.033) were associated with lower levels of burnout. The coping mechanisms related to lower levels of burnout included more emotional support seeking (p = 0.005), more proactive coping (p = 0.047), and less avoidance (p = 0.005). CONCLUSIONS: Compared to a previous study on burnout among Thai psychiatrists in 2011, in this study, the prevalence of high levels of burnout had increased dramatically from 17.1% to 49.3%. An intervention to decrease workload, strengthen social support and encourage proactive coping mechanisms may be beneficial for relieving burnout.

The impact of residual symptoms on relapse and quality of life among Thai depressive patients.

PURPOSE: Residual symptoms of depressive disorder are major predictors of relapse of depression and lower quality of life. This study aims to investigate the prevalence of residual symptoms, relapse rates, and quality of life among patients with depressive disorder. PATIENTS AND METHODS: Data were collected during the Thai Study of Affective Disorder (THAISAD) project. The Hamilton Rating Scale for Depression (HAMD) was used to measure the severity and residual symptoms of depression, and EQ-5D instrument was used to measure the quality of life. Demographic and clinical data at the baseline were described by mean ± standard deviation (SD). Prevalence of residual symptoms of depression was determined and presented as percentage. Regression analysis was utilized to predict relapse and patients' quality of life at 6 months postbaseline. RESULTS: A total of 224 depressive disorder patients were recruited. Most of the patients (93.3%) had at least one residual symptom, and the most common was anxiety symptoms (76.3%; 95% confidence interval [CI], 0.71-0.82). After 3 months postbaseline, 114 patients (50.9%) were in remission and within 6 months, 44 of them (38.6%) relapsed. Regression analysis showed that residual insomnia symptoms were significantly associated with these relapse cases (odds ratio [OR] =5.290, 95% CI, 1.42-19.76). Regarding quality of life, residual core mood and insomnia significantly predicted the EQ-5D scores at 6 months postbaseline (B =-2.670, 95% CI, -0.181 to -0.027 and B =-3.109, 95% CI, -0.172 to -0.038, respectively). CONCLUSION: Residual symptoms are common in patients receiving treatment for depressive disorder and were found to be associated with relapses and quality of life. Clinicians need to be aware of these residual symptoms when carrying out follow-up treatment in patients with depressive disorder, so that prompt action can be taken to mitigate the risk of relapse.

Depression and pain: testing of serial multiple mediators.

PURPOSE: Despite the fact that pain is related to depression, few studies have been conducted to investigate the variables that mediate between the two conditions. In this study, the authors explored the following mediators: cognitive function, self-sacrificing interpersonal problems, and perception of stress, and the effects they had on pain symptoms among patients with depressive disorders. PARTICIPANTS AND METHODS: An analysis was performed on the data of 346 participants with unipolar depressive disorders. The 17-item Hamilton Depression Rating Scale, Mini-Mental State Examination, the pain subscale of the health-related quality of life (SF-36), the self-sacrificing subscale of the Inventory of Interpersonal Problems, and the Perceived Stress Scale were used. Parallel multiple mediator and serial multiple mediator models were used. An alternative model regarding the effect of self-sacrificing on pain was also proposed. RESULTS: Perceived stress, self-sacrificing interpersonal style, and cognitive function were found to significantly mediate the relationship between depression and pain, while controlling for demographic variables. The total effect of depression on pain was significant. This model, with an additional three mediators, accounted for 15% of the explained variance in pain compared to 9% without mediators. For the alternative model, after controlling for the mediators, a nonsignificant total direct effect level of self-sacrificing was found, suggesting that the effect of self-sacrificing on pain was based only on an indirect effect and that perceived stress was found to be the strongest mediator. CONCLUSION: Serial mediation may help us to see how depression and pain are linked and what the fundamental mediators are in the chain. No significant, indirect effect of self-sacrificing on pain was observed, if perceived stress was not part of the depression and/or cognitive function mediational chain. The results shown here have implications for future research, both in terms of testing the model and in clinical application.

Level of agreement between self-rated and clinician-rated instruments when measuring major depressive disorder in the Thai elderly: a 1-year assessment as part of the THAISAD study.

PURPOSE: Whether self-reporting and clinician-rated depression scales correlate well with one another when applied to older adults has not been well studied, particularly among Asian samples. This study aimed to compare the level of agreement among measurements used in assessing major depressive disorder (MDD) among the Thai elderly and the factors associated with the differences found. PATIENTS AND METHODS: This was a prospective, follow-up study of elderly patients diagnosed with MDD and receiving treatment in Thailand. The Mini International Neuropsychiatric Inventory (MINI), 17-item Hamilton Depression Rating Scale (HAMD-17), 30-item Geriatric Depression Scale (GDS-30), 32-item Inventory of Interpersonal Problems scale, Revised Experience of Close Relationships scale, ten-item Perceived Stress Scale (PSS-10), and Multidimensional Scale of Perceived Social Support were used. Follow-up assessments were conducted after 3, 6, 9, and 12 months. RESULTS: Among the 74 patients, the mean age was 68±6.02 years, and 86% had MDD. Regarding the level of agreement found between GDS-30 and MINI, Kappa ranged between 0.17 and 0.55, while for Gwet's AC1 the range was 0.49 to 0.91. The level of agreement was found to be lowest at baseline, and increased during follow-up visits. The correlation between HAMD-17 and GDS-30 scores was 0.17 (P=0.16) at baseline, then 0.36 to 0.41 in later visits (P<0.01). The PSS-10 score was found to be positively correlated with GDS-30 at baseline, and predicted the level of disagreement found between the clinicians and patients when reporting on MDD. CONCLUSION: The level of agreement between the GDS, MINI, and HAMD was found to be different at baseline when compared to later assessments. Patients who produced a low GDS score were given a high rating by the clinicians. An additional self-reporting tool such as the PSS-10 could, therefore, be used in such under-reporting circumstances.

Baseline characteristics of depressive disorders in Thai outpatients: findings from the Thai Study of Affective Disorders.

BACKGROUND: The Thai Study of Affective Disorders was a tertiary hospital-based cohort study developed to identify treatment outcomes among depressed patients and the variables involved. In this study, we examined the baseline characteristics of these depressed patients. METHODS: Patients were investigated at eleven psychiatric outpatient clinics at tertiary hospitals for the presence of unipolar depressive disorders, as diagnosed by the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The severity of any depression found was measured using the Clinical Global Impression and 17-item Hamilton Depression Rating Scale (HAMD) clinician-rated tools, with the Thai Depression Inventory (a self-rated instrument) administered alongside them. Sociodemographic and psychosocial variables were collected, and quality of life was also captured using the health-related quality of life (SF-36v2), EuroQoL (EQ-5D), and visual analog scale (EQ VAS) tools. RESULTS: A total of 371 outpatients suffering new or recurrent episodes were recruited. The mean age of the group was 45.7±15.9 (range 18-83) years, and 75% of the group was female. In terms of diagnosis, 88% had major depressive disorder, 12% had dysthymic disorder, and 50% had a combination of both major depressive disorder and dysthymic disorder. The mean (standard deviation) scores for the HAMD, Clinical Global Impression, and Thai Depression Inventory were 24.2±6.4, 4.47±1.1, and 51.51±0.2, respectively. Sixty-two percent had suicidal tendencies, while 11% had a family history of depression. Of the major depressive disorder cases, 61% had experienced a first episode. The SF-36v2 component scores ranged from 25 to 56, while the mean (standard deviation) of the EQ-5D was 0.50±0.22 and that of the EQ VAS was 53.79±21.3. CONCLUSION: This study provides an overview of the sociodemographic and psychosocial characteristics of patients with new or recurrent episodes of unipolar depressive disorders.

The effect of telephone-based intervention (TBI) in alcohol abusers: a pilot study.

OBJECTIVE: The present study was to examine the efficacy of Telephone-based intervention (TBI) with alcohol abusers. MATERIAL AND METHOD: Sixty individuals suffering from alcohol abuse were randomly assigned to either the intervention group (n=30) (in which the TBI was modified based on the combination of motivational interviewing and supportive techniques), or the control group (n=30) (in which the participants received mail concerning health promotion). Each participant in the intervention group received individual weekly therapy sessions of 20 to 30 minutes via telephone for six weeks. Simultaneously, the participants in the control group received weekly mails for six weeks. Assessment was done at weeks 0, 6, and 18. The primary outcome was defined as a change in the amount of alcohol consumed and the number ofdays spent drinking. Anxiety, depression, and self-esteem were also compared between the two groups. All were analyzed by intention-to-treat. RESULTS: After 18 weeks, 54 out of the original 60 participants had complete data sets. The mean amount and frequency of alcohol consumption was significantly lower in the intervention group than in the control group (4.1 days +/- 2.0 vs. 2.8 days +/- 2.0, p < 0.01). At the end of week six, 37.3% of participants in the experiment group (compared with 11.8% of the control) had successfully decreased their alcohol consumption (f = 16.49, df = I, p < 0.001, with an NNT = 1.69). The frequency of drinking, as determined by the number of drinking days per week, was significantly lower in the experiment group from baseline than in the control group at week 6 (2 = 18.20, df= 1, p < 0.001, with an NNT = 1.8). There was no difference between week 6 and the end of week 18 regarding amount and frequency of drinking in both groups. There was no difference in depressive, anxiety and self-esteem scores between the two groups over time and these factors were found to have no effect on alcohol consumption in either group. A common problem reported in the telephone group was connection failures. CONCLUSION: Telephone motivational interviews showed promise in being effective in reducing the frequency and amount of drinking for non-treatment-seeking primary care patients who abuse alcohol. Moreover, the effect of the intervention lasted for at least three months. Limitations of the present study are discussed.