Burnout and mental distress among community health workers in low- and middle-income countries: a scoping review of studies during the COVID-19 pandemic

Community health workers(CHWs)represent the backbone of primary health systems,especially in many low-and middle-income countries(LMICs).The coronavirus disease 2019(COVID-19)pandemic stretched health sys-tems and increased the workload for CHWs.The objective of this scoping review was to identify the mental health symptoms experienced among CHWs in LMICs during the COVID-19 pandemic.We searched PubMed for published literature,from January 1,2020 to December 31,2022 that focused on documenting the experiences of burnout,distress,and mental health symptoms among CHWs in LMICs.The quality of included studies was assessed using the Joanna Briggs Institute Critical Appraisal Tool.Included studies were grouped into the follow-ing broad thematic categories:(1)symptoms experienced;(2)drivers of different mental health symptoms;and(3)strategies for coping with different symptoms.We identified 10 cross-sectional,qualitative,and observational studies from 11 LMICs in South and Southeast Asia,South America,and Eastern/Southern Africa that assessed the mental health burden CHWs faced during the pandemic.The studies identified disorders and symptoms such as depression,anxiety,fear,burnout,worsened stress,and fatigue.Contributing factors included increased work-load,financial constraints,and an understaffed and underequipped workplace.CHWs reported using different adaptive responses like humor,support from family and colleagues,denial,and substance use,and asked for recommended regular mental health checkups and counseling.More research and policies should be targeted to-wards promoting the mental wellbeing of CHWs to help ensure responsive and resilient health systems in LMICs in the face of future emerging public health threats.

Mental distress evaluation and intervention for cancer patients

Mental distress is prevalent among cancer patients.Many measurements have been developed to screen and evaluate such distress.About one-third of the persons with cancer will experience significant levels of distress,requiring targeted psychosocial intervention.Mental distress has been endorsed as the sixth vital sign by the International Psycho-Oncology Society(IPOS) in 2009.The need for effective screening and psychological interventions is well recognized as a necessary,integral part of oncology care.This systematic review examines the psychometric properties of the existing tools used to screen patients for emotional distress and the applicable intervention methods.

Mental Distress among Medical Students in Khartoum, Sudan 2022

Background: Young adults in Sudan face numerous challenges that make it difficult for them to maintain their mental health. Due to the academic workload and performance expectations, medical students suffer from a high prevalence of mental distress. Objectives: to estimate the prevalence of mental distress among medical students and determine the associated factors. Methods: a cross-sectional survey was conducted among medical students in Khartoum, Sudan, using an electronic questionnaire. Mental distress was screened in the period from June 19 to July 30, 2022, using the self-reporting questionnaire (SRQ-20). Descriptive statistics in the form of frequencies and percentages were used to display data. Odds ratios (ORs) with a 95% confidence interval were estimated using univariate and multivariate logistic regression analysis to determine associations between mental distress and related factors. Results: A total of 432 valid responses were received with a mean age of 20.37. The Overall prevalence of mental distress (SRQ-20 > 8) in medical students was 241 (55.8%). The prevalence was significantly associated with gender (P-Value > 0.001), type of university (P-Value = 0.001), academic level of education (P-Value = 0.026), and family history of mental illness (P-value = 0.001). Conclusion: More than half of the medical students who were screened for mental distress had mental distress. Higher odds are associated with being a female student, attending a private university, studying at a higher academic level, and having a family history of mental illness. This study recommends a review of the academic processes and implementing institutional preventive strategies that target at-risk groups.

Confinement Following Child Birth and Associated Postpartum Mental Distress

Objective: This study sought to explore confinement following childbirth and its association with mental distress. Methods: A descriptive-analytical cross sectional study design was used. The study was conducted in two districts of Zambia representing an urban and rural setting, targeting parenting mothers during the first two months after delivery. Systematic random sampling technique was used to select the participants. Every second case seen at the study sites between March to August 2017 was selected to participate in the study. The data were collected using the Edinburgh Postnatal Depression Scale and analyzed using the Statistical Package for Social Sciences (SPSS) version 22. Pearson correlation coefficient was used to determine the relationship between the dependent and independent variables while binary logistic regression was used to check the combined impact of independent variables on mental distress. Ethical approval was obtained from the local Research Ethics Committees. Participation in the study was voluntary. Results: A total of 200 women participated in the study. The results revealed a high prevalence of mental distress, with 42 percent of women reporting severe levels, and 36.0 percent showing moderate levels. A statistically significant relationship was found between mental distress and confinement (X&#178 = 29.289;P = 0.001), residential type (X&#178 = 16.863;P = 0.001), and age (X&#178 = 17.996;P = 0.006). Suicidal thoughts during confinement were also found to be prevalent in 16 percent of the participants. Binary logistic regression revealed that changes in confinement period from below 2 weeks to between 2 weeks and 1 month raised the odds of suffering mental distress 5.127 times while changes from a confinement period of between 2 weeks and 1 month to over 1 month raised the odds of suffering mental distress 7.737 times. Conclusion: The study results confirmed an association between confinement and mental distress, revealing that the longer the confinement, the more at risk the women were of mental distress.

Case-finding for mental distress in primary health care: An evaluation of the performance of a five-item screening instrument

Background: There is an increased interest in developing better and more accurate methods to recognize and manage mental health problems in primary care settings. Abbreviated screening instruments for mental distress are useful tools for research and clinical practice. The present study seeks to investigate whether only a few questionnaire items from the Self-Reporting- Questionnaire-10 (SRQ-10) can be a robust method in the screening for Mental Distress in Primary Health care. Methods: We compared the screening accuracy of a short, five-item (SRQ-5) version of the SRQ-10 with that of the SRQ-20, General Health Questionnaire 12 (GHQ-12) using the DSM-IV axis as a gold standard and analyzed its performance in different diagnostic entities. We also assessed the correlation, sensitivity and specificity between the 4 instruments. All the instruments were administered to 400 primary health care attendees. Results: The estimated prevalence of mental distress was 13.6% in the study sample (Depression 11%, anxiety disorders 1.8%). The SRQ-5 was highly correlated to SRQ-10 (0.923, p < 0.001), SRQ-20 (0.764, p < 0.001) and only moderately correlated to GHQ-12 (0.417, p < 0.001). The SRQ-5 had high properties for identifying mental distress. The AUC for overall mental distress was 0.925 while that for depression and anxiety were 0.915 and 0.849 respectively. Conclusion: This validation showed that in moving from SRQ with 10 or 20 items to one with merely 5 items, we do not seem to lose the screening prowess of the instrument. The SRQ-5 represents a simplified and less time-consuming screening instrument with strong performance characteristics. We therefore recommend it for inclusion into existing patient assessment protocols, thus enhancing case finding at primary health care level.

Mental Wellbeing Monitoring in a Sample of Emergency Medical Service Personnel

Background: There have been concerns regarding the mental wellbeing of emergency medical service staff, particularly when faced with multiple trauma exposures. This study aimed to describe a cross-sectional view of the mental wellbeing status of emergency medical service workers, as well as to comment on the usefulness of an electronic survey tool to reach staff that is distributed across large geographical areas. Methods: The data presented here are drawn from an anonymous, voluntary, electronic survey, made available via the internet, to emergency medical service workers in the Western Cape province of South Africa. This paper reports on four domain expressions of mental wellbeing, namely disordered mood, problematic substance use, post-traumatic stress disorder, and domestic discord. Results: Elevated rates were reported by this sample, across all four distress domains, i.e. mood disorder = 12.3%;problematic substance use = 14.9%;post-traumatic stress disorder = 11.9%;and domestic discord = 11.9%. These rates were generally similar to data from comparable emergency worker groups, and much higher than local population estimates. Conclusions: The data support earlier findings that emergency medical work is associated with increased risk for symptoms of psychological distress, which present a strong case for regular organizational monitoring of employees’ mental wellbeing. In this regard, a brief, internet delivered, survey-type tool showed promise for screening employees, in order to guide further streaming of distressed individuals towards appropriate support services. Further work is required to develop clear mechanisms for referral and intervention in order to optimize a confidential and supportive monitoring program.

赔礼道歉在祭奠利益保护中的适用

赔礼道歉作为一种源于道德领域的民事责任,祭奠利益亦兼具法律性和道德性,祭奠利益纠纷中当事人大多会提出“赔礼道歉”的诉讼请求,但现行法律尚未明确规定祭奠利益的保护路径,赔礼道歉的适用需要审判组织基于现行法律进行适当解释和论证:在明确祭奠利益的“一般人格权”定位的前提下,基于案件当事人受到损害大小和行为人的过错程度,分析祭奠利益和言论自由的保护顺序,进而确定赔礼道歉与其他民事责任的适用。《民法典》第一千条将“赔礼道歉”与“消除影响、恢复名誉”并列,审判组织善用“公开或公布”的替代执行方式,在一定程度上也能发挥抚慰创伤、惩戒教化的功能,但需统一裁判文书中适用“赔礼道歉”时的表达。

文化工业的数字转向:阿多诺视角下的精神困境与艺术使命

在数字资本主义时代,文化工业的转向标志着一种新的文化生产方式的形成,数字技术的发展暴露出文化工业滥用艺术要素的本质,进而加剧了文化产品的同质化和低俗化,并通过对大众精神世界的操控,实现了数字资本的意识形态再生产。对数字资本主义文化生产机制的分析,能够揭示其内在的矛盾和冲突,探讨艺术在当代所面临的挑战和使命。艺术创作应成为对数字资本逻辑的批判性反思,通过揭示技术对人的异化,以及对社会问题的关注,引领大众进行反思和反抗,并创作出具有思想性和艺术性的作品,以实现对数字资本主义意识形态的解构和超越。

论《湖南民歌》中的女性困境和女性意识

湖南民歌作为民间文化的瑰宝,流传久远,受到广大人民群众的喜爱。《湖南民歌》中有许多以女性为主题的篇目,这些篇目从女性视角讲述了底层劳动女性所面临的生存困境,以及女性主体意识的觉醒。在物质和精神的双重压迫下,她们拒绝不幸的婚姻,追求自由的爱情、独立的人格和平等的社会地位,都体现出她们对封建男权主义压迫的反抗。

大学生就业心理困境及其调适策略

在高校毕业生人数逐年递增而就业形势日益严峻的情况下,大学毕业生面临前所未有的就业压力,这势必给他们造成一定程度的心理困境。在探析高校毕业生“安排式”心理、“从众式”心理和“消极式”心理等就业心理困境以及深入剖析社会、高校和个人原因的基础上,提出个体心理调适的策略,即自我定位适当,树立正确的职业价值观;增强自主创业的意识,做活力新潮的大学生;调整就业心态,提高应变能力和心理承受力。同时,提出成功调适的外在条件在于:一方面,社会需调整就业政策,完善就业市场;加强创业机制建设,增强学生创业信心。另一方面,高校需推进思想政治教育,培育适切的就业价值观;加强社会实践活动,探究实践育人模式。

震后9个月部分受灾群众精神痛苦现况调查

目的:探讨汶川地震后9个月受灾群众的精神痛苦状况及相关因素,寻找快速评估抑郁发作、自杀倾向和创伤后应激障碍(post-traumatic stress disorder,PTSD)的方法。方法:利用方便取样,对绵阳永兴板房区和秀水镇农村的受灾群众(n=321)进行三步梯度评估。(1)使用心理健康自评问卷(Self-Re-porting Questionnaire-20,SRQ20)及PTSD筛查表(7-items Screening Scale for PTSD,PTSD7)对所有受试进行初步筛查;(2)对SRQ20≥10分或PTSD7≥4分者进行抑郁(Self-Rating Depression Scale,SDS)和焦虑自评量表(Self-Rating Anxiety Scale,SAS),及简明国际神经精神访谈(Mini-International Neuropsychiat-ric Interview,MINI)中文版"自杀倾向"评定,对PTSD7≥4者还进行MINI"PTSD"诊断评估;(3)对SDS评分≥50者进行MINI"抑郁发作"和"PTSD"诊断评估。结果:(1)315人完成评估,其中SRQ20评分≥10或PTSD7评分≥4者占53.0%;SDS评分≥50者占37.1%,其中存在自杀倾向者18.4%;符合MINI目前抑郁发作及PTSD者分别占25.7%和27.3%,两者共病18.1%。(2)永兴板房区受试PTSD7评分及MINI"PTSD"检出率均高于秀水镇受试[(3.6±1.8)vs.(2.9±1.7),33.0%vs.16.0%;均P<0.001]。(3)Logistic回归分析显示,震时躯体受伤是目前抑郁发作(OR=2.579)和PTSD(OR=1.917)的危险因素;震后搬迁次数是PTSD的危险因素(OR=1.189)。结论:(1)震后9个月受灾群众仍存在明显的抑郁发作、PTSD及自杀倾向。震时躯体受伤对抑郁发作和PTSD有长期影响,震后多次搬迁可能促进PTSD发生及症状加重。(2)SRQ20及PTSD7与MINI结合使用可作为灾后精神痛苦的快速评估方法。

中晚期肺癌患者心理痛苦管理的效果评价

目的评价心理痛苦管理对中晚期肺癌患者的干预效果。方法将297例中晚期肺癌患者按随机数字法分为干预组(150例)和对照组(147例)。对照组按常规进行护理,护理措施包括基础护理、健康教育、一般性心理指导等;干预组在此基础上,以"NCCN心理痛苦治疗临床指引"为指导,对患者实施心理痛苦管理。比较干预前后两组患者心理痛苦、生活质量、行为功能状态。结果干预后,干预组的显著心理痛苦检出率、心理痛苦水平显著低于对照组(均P<0.01),生活质量(除经济困难)、行为功能状态评分优于对照组(P<0.05,P<0.01)。结论中晚期肺癌患者心理痛苦程度严重,心理痛苦管理能改善患者的心理痛苦、提高患者的生活质量和行为功能状态。

精神分裂症患者照顾者心理痛苦及其影响因素研究

目的探讨精神分裂症患者照顾者心理痛苦水平,并分析其影响因素。方法采用一般资料调查表、心理痛苦温度计对杭州市某三级医院126名精神分裂症患者照顾者进行问卷调查。结果精神分裂症患者照顾者心理痛苦得分为(7.12±0.48)分,处于重度水平。中度及以上心理痛苦的照顾者99名,占78.57%;照顾者文化程度、照顾者家庭人均月收入、患者病程和患者有无医疗保险均为照顾者心理痛苦水平的影响因素。结论精神分裂症患者照顾者心理痛苦处于重度水平,医护工作者可通过传授照顾者内观心理疗法、园艺疗法等综合措施缓解其心理痛苦水平。

我国产品责任制度:守成与创新

相对于《产品质量法》有关产品责任的规定,《侵权责任法》第五章既有守成的一面也有诸多创新规定,在解释上不可完全适用特别法优先的原则或新法优先的原则,而是要将两个法律的相关规定有机结合起来进行系统的解释,方能正确适用。《侵权责任法》没有对产品责任中的"损害"进行重新界定,产品自身的财产损失不属于产品责任的"损害";精神损害赔偿适用于产品责任案件,惩罚性赔偿规定的适用有待最高人民法院作出更具有可操作性的司法解释。

大学生心理健康状况分析与研究

大学生是否身心健康,能否适应现代竞争社会的各种压力和挑战,对于国家未来发展起着重要的作用。大学生的心理健康问题日益突出,在生活适应性、学业、人际交往、恋爱、家庭、就业、情绪等方面都存在一定的心理困扰和心理矛盾,这些问题已不同程度地影响了其正常的生活、学习和工作。因此,探讨提高大学生心理健康水平的措施与对策是非常必要的。

论航空旅客的精神损害赔偿

航空旅客在空难中死亡、伤残、惊吓、行李毁损或遗失、航班延误、超售和拒载等情形下都可能遭受精神损害,由此引发了不同类型的精神损害赔偿。航空旅客精神损害赔偿是否应有限额,立法与司法存在差异;航空旅客精神损害事实、因果关系、赔偿数额以及法律适用的判定等均与法官自由裁量权密切相关。

精神安宁权法律地位探析

对公民精神安宁利益的忽视是导致我国精神损害赔偿案件适用范围过窄的根本原因。最好的解决办法莫过于给予公民的精神安宁利益应有的法律地位。人类史也是一部权利发现史,我们应该不惮于明确精神安宁权是一项独立人格权,是精神损害赔偿案件的受害权利标的,并相应地在国家赔偿、刑事犯罪及违约等领域广泛承认精神损害赔偿。

我国刑事附带民事诉讼拒斥精神损害赔偿的立场批判与制度重构

我国法上的刑事附带民事诉讼程序在设立之初具有一定的合理性,但是发展到当下已发生目的异化,刑事附带民事诉讼程序在性质上成为一种特别的刑事诉讼程序,服务于刑事诉讼的目的,而不是维护受害人私权,这就是它拒斥精神损害赔偿的根本原因。在我国日益重视国民民事权益保障、重视公民人格尊严的当下,刑事附带民事诉讼的保守立场已经与马克思主义的人本观以及社会主义核心价值观相悖,必须予以改变。改变制度的路径有多种,比较务实的选择是分步进行。首先从刑事附带民事诉讼程序纳入精神损害赔偿开始,逐步变革,直到废弃刑事附带民事诉讼程序,让刑事的归于刑事,民事的归于民事。

初治肺结核患者心理健康状况及其影响因素分析

目的了解初治肺结核患者心理健康状况及其影响因素。方法采用分层整群随机抽样的方法抽取样本,通过自制调查表和凯斯勒心理疾患量表(Kessler 10,K10)获取数据信息。结果参与调查的578例初治肺结核患者中,K10分值均值为18.70±7.89。logistic回归分析结果显示,肺结核病情严重程度、体育锻炼、躯体健康状况、睡眠质量以及日常生活是否经常有压力感对患者心理健康状况有显著影响。结论初治肺结核患者心理健康状况有待提高,应当加强心理关怀与指导。

居家治疗肺结核患者心理健康状况及影响因素分析

目的:了解居家治疗肺结核患者心理健康状况及影响因素。方法:采用分层整群随机抽样方法抽取样本,利用自制调查表和Kessler10量表获取数据信息,并用SPSS 13.0软件进行统计分析。结果:参与调查的722例居家治疗肺结核患者中,心理健康状况差者243人,占33.66%;心理健康状况好的479人,占66.34%。影响心理健康状况的主要因素为性别、经济状况、生活满意度、病情严重程度(P<0.05)。结论:居家治疗肺结核患者心理健康状况不容乐观,应加强心理指导与关怀。