Objective: Health-care workers (HCW) are at risk for psychological distress during an infectious disease outbreak, such as the coronavirus pandemic, due to the demands of dealing with a public health emergency. This rapid systematic review examined the factors associated with psychological distress among HCW during an outbreak.Method: We systematically reviewed literature on the factors associated with psychological distress (demographic characteristics, occupational, social, psychological, and infection-related factors) in HCW during an outbreak (COVID-19, SARS, MERS, H1N1, H7N9, and Ebola). Four electronic databases were searched (2000 to 15 November 2020) for relevant peer-reviewed research according to a pre-registered protocol. A narrative synthesis was conducted to identify fixed, modifiable, and infection-related factors linked to distress and psychiatric morbidity.Results: From the 4,621 records identified, 138 with data from 143,246 HCW in 139 studies were included. All but two studies were cross-sectional. The majority of the studies were conducted during COVID-19 (k = 107, N = 34,334) and SARS (k = 21, N = 18,096). Consistent evidence indicated that being female, a nurse, experiencing stigma, maladaptive coping, having contact or risk of contact with infected patients, and experiencing quarantine, were risk factors for psychological distress among HCW. Personal and organizational social support, perceiving control, positive work attitudes, sufficient information about the outbreak and proper protection, training, and resources, were associated with less psychological distress.Conclusions: This review highlights the key factors to the identify HCW who are most at risk for psychological distress during an outbreak and modifying factors to reduce distress and improve resilience. Recommendations are that HCW at risk for increased distress receive early interventions and ongoing monitoring because there is evidence that HCW distress can persist for up to 3 years after an outbreak. Further research needs to track the associations of risk and resilience factors with distress over time and the extent to which certain factors are inter-related and contribute to sustained or transient distress.

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Abstract:The purpose of this study was to examine the benefits associated with complementary and alternative medicine (CAM) treatments from the patients' perspective using a whole systems research approach as a guiding framework. We conducted five focus groups of six to eight participants each, with users of CAM recruited through experienced CAM providers and clinics. Eligible participants were aged 21 or older, had used CAM in the last 12 months, and believed the treatment to be beneficial. The focus group discussions were digitally recorded, transcribed, and analyzed through a qualitative content analysis. Responses were inductively coded for common themes, and then placed into broader conceptual categories reflecting the CAM outcome domains suggested by Verhoef and colleagues. Participants described physical health benefits including symptom relief and improved function, and positive psychological benefits such as improved coping and resilience. Social health benefits that arose from the positive aspects of the patient-practitioner relationship were also reported, including support and advocacy. In addition, participants identified empowerment, increased hope and spiritual growth as results of receiving CAM treatments. A new behavioral health outcome domain emerged as participants reported that CAM use had fostered behavioral changes such as increased exercise, smoking cessation and improving their diets. These patient-reported benefits of CAM treatment are consistent with the outcome model proposed by Verhoef and colleagues, and extend this model by identifying a new outcome domain-behavioral health outcome. The findings provide insight and direction for the development of outcome and process measures to evaluate CAM treatment effects.

Advances in understanding of the perfectionism construct have been limited by an almost exclusive reliance on a variable-centered approach. This study utilized a person-oriented approach to examine Hewitt and Flett’s conceptualization of multidimensional perfectionism in relation to health and well-being. Levels of conscientiousness, extraversion, and neuroticism were also assessed. Cluster analyses were employed to examine within-person configurations of self-oriented, other-oriented, and socially prescribed perfectionism (SPP) in university students ( n = 538) and adults with chronic illness ( n = 773). Five unique configurations were found in both samples and three clusters replicated across samples. “Extreme perfectionists” with high scores across all perfectionism dimensions reported relatively poor physical health, psychological health, psychosocial resources, and well-being along with elevated neuroticism and conscientiousness. A group distinguished by elevated SPP also reported relatively poorer outcomes along with elevated neuroticism and lower conscientiousness. In contrast, “nonperfectionists” reported relatively elevated levels of health and well-being. These profiles differed in their links with health and well-being even after taking into account key differences in conscientiousness and neuroticism. Our results illustrate the importance of employing a person-oriented approach to the study of multidimensional perfectionism, especially as it relates to physical health, mental health, and subjective well-being.

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Objectives Attention deficit hyperactivity disorder (ADHD) is associated with increased criticism from others. To date, there is little research considering the consequences of how others respond to people with ADHD. Self-compassion is a positive way of relating to oneself during difficulty. Here, we investigate whether levels of self-compassion differ between people with and without ADHD, and whether perceived criticism mediates any differences in self-compassion between people with and without ADHD. Methods A cross-sectional design was used to conduct natural group comparisons. A sample of 1203 adults (46% with a self-reported ADHD diagnosis) recruited via social media, online forums and posters completed online self-report measures of diagnostic status, ADHD traits, self-compassion and perceived criticism. Between-group comparisons of self-compassion and perceived criticism were conducted on participants grouped by diagnosis, then grouped by ADHD trait severity. Perceived criticism was tested as a mediator variable between ADHD diagnosis and self-compassion. Results Adults with an ADHD diagnosis showed significantly lower self-compassion and higher perceived criticism than the participants without ADHD. Participants high in ADHD traits but without a diagnosis had significantly similar levels of self-compassion to the diagnosed group. Mediation analysis found that higher perceived criticism partially explained the relationship between ADHD diagnosis and self-compassion, even after accounting for co-occurring mood disorder diagnosis. Conclusions Adults with ADHD are less self-compassionate than adults without ADHD. This is partially explained by the higher level of criticism they perceive from others.

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Background: Chronic medical conditions (CMCs) affect up to 35% of children and adolescents. Youth with chronic medical conditions are at an increased risk of psychological distress and reduced health-related quality of life, and report rates of mental illness up to double that of their physically healthy peers. Accessible, evidence-based interventions for young people with chronic illness are urgently required to improve their mental health and daily functioning. Self-compassion involves taking a mindful, accepting approach to difficult experiences, being aware that one is not alone in one's suffering, and being kind and understanding with oneself during challenging times. Self-compassion shares strong associations with mental health outcomes among young people and preliminary work indicates that interventions that build self-compassion have the potential to substantially improve youth mental health. Self-compassion is also associated with better physical and mental health outcomes among individuals living with CMCs. While face-to-face self-compassion training is available, there are several barriers to access for youth with CMCs. Online self-compassion training potentially offers an accessible alternative for this highrisk group.Methods: Self-Compassion Online (SCO) is a self-compassion program that has been tested with a non-clinical adult group. For the proposed trial, a reference group of youth (16-25 years) with chronic illness reviewed the program and proposed adaptations to improve its suitability for youth with chronic illness. In alignment with the SPIRIT Checklist, this paper outlines the protocol for a CONSORT-compliant, single-blind randomised controlled trial to test the efficacy of the adapted program, relative to a waitlist control, for improving self-compassion, wellbeing, distress, emotion regulation, coping and quality of life among young Australians with CMCs. Mechanisms of action and feasibility of SCO will be analysed using quantitative data and participant interviews, respectively. Finally, costutility will be analysed using health-related quality of life data.Discussion: The SCO program could provide a scalable solution for improving psychological outcomes and quality of life among youth with chronic illness. The proposed trial will be the first to determine its efficacy for improving these outcomes, relative to waitlist control.