Effect of distinct psychological interventions on changes in selfreported distress,depression and loneliness among older adults during COVID-19

BACKGROUND Older adults have been considered a primary at-risk population during the coronavirus disease 2019(COVID-19)pandemic,and many efforts have been and still are directed toward supporting them and enhancing their capacity to cope with the pandemic.Evidence shows that by enhancing proactive coping abilities through psychological interventions,in which cognitive-behavioral and mindfulness techniques are taught and practiced effectively,these interventions have supported older adults throughout the pandemic.However,the underlying mechanisms by which specific intervention components affect various mental states such as distress,depression and loneliness among older adults remain unclear and warrant investigation.AIM To determine the effect of an intervention using cognitive-behavioral and mindfulness techniques on changes in distress,depression and loneliness.METHODS We performed a secondary analysis on data from a previous study in which community-dwelling older adults attended a short-term,internet-based intervention during the first COVID-19 wave in Israel.The intervention included seven sessions during which various cognitive-behavioral and mindfulness techniques were learned and practiced.In-session changes in psychological distress were measured using the Subjective Units of Distress Scale(SUDS),which participants rated at the beginning and end of each session.Participants also filled out questionnaires that evaluated levels of depression[Patient Health Questionnaire(PHQ-9)]and loneliness(UCLA loneliness Scale)prior to and after the entire intervention process.The effect of in-session changes in the SUDS on changes in post-intervention depression and loneliness levels were assessed,as a proxy for distinct technique effectiveness.RESULTS The findings indicated in-session differences in terms of a decrease in psychological distress(SUDS).Sessions that included relaxation exercises and guided imagery,as well as sessions that included cognitive restructuring and mindfulness meditation,demonstrated the largest decreases in in-session psychological distress(≥35%).Two multivariate regression models,one for levels of post-intervention depression(PHQ-9 score)and the other for levels of post-intervention loneliness(UCLA loneliness score),were fitted.The results revealed two statistically significant explanatory variables for depression:The SUDS difference for sessions in which cognitive restructuring and mindfulness meditation were practiced,beta=-0.25,95%CI:-1.23 to-0.1,and the pre-intervention level of depression,beta=0.62,95%CI:0.37-0.75.The second model for loneliness revealed only one significant explanatory variable:The SUDS difference for sessions in which relaxation and guided imagery were practiced,beta=0.41,95%CI:0.14-0.65.CONCLUSION Different psychological techniques seem to have different effects on distress,loneliness and depression.Understanding the pathways by which distinct techniques affect negative mental symptoms has implications for future intervention design.

Simple pain measures reveal psycho-social pathology in patients with Crohn's disease

AIM To determine whether pain has psycho-social associations in adult Crohn's disease(CD) patients.METHODS Patients completed demographics, disease status, Patient Harvey-Bradshaw Index (P-HBI), Short Form Health Survey (SF-36), Short Inflammatory Bowel Disease Questionnaire (SIBDQ), and five sociopsychological questionnaires: Brief Symptom Inventory, Brief COPE Inventory, Family Assessment Device, Satisfaction with Life Scale, and Work Productivity and Activity Impairment Questionnaire. Pain sub-scales in P-HBI, SF-36 and SIBDQ measures were recoded into 4 identical scores for univariate and multinomial logistic regression analysis of associations with psycho-social variables.RESULTS The cohort comprised 594 patients, mean age 38.6±14.8 years, women 52.5%, P-HBI 5.76±5.15. P-HBI, SF-36 and SIBDQ broadly agreed in their assessment of pain intensity. More severe pain was significantly associated with female gender, low socioeconomic status, unemployment, Israeli birth and smoking. Higher pain scores correlated positively with psychological stress, dysfunctional coping strategies, poor family relationships, absenteeism, presenteeism, productivity loss and activity impairment and all WPAI sub-scores. Patients exhibiting greater satisfaction with life had less pain. The regression showed increasing odds ratios for psychological stress (lowest 2.26, highest 12.17) and female gender (highest 3.19) with increasing pain. Internet-recruited patients were sicker and differed from hardcopy questionnaire patients in their associations with pain.CONCLUSION Pain measures in P-HBI, SF-36 and SIBDQ correlate with psycho-social pathology in CD. Physicians should be aware also of these relationships in approaching CD patients with pain.