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Objectives

Self-management is essential in diabetes care but can be demanding. Diabetes distress may impair glycemic control, increase complications, and reduce quality of life. This study evaluated the psychometric properties of the Swedish versions of the Diabetes Self-Management Questionnaire (DSMQ) and the Diabetes Distress Scale (DDS-17).

Methods

Adults with type 2 diabetes (n = 192) participated in this cross-sectional study with a test-retest design. The instruments were translated using forward-backward translation and tested with Cronbach’s alpha (α), intraclass and Spearman’s correlation coefficients, and confirmatory factor analysis.

Results

Cronbach’s α for the DSMQ was 0.82 (subscales 0.10-0.79). The subscale Healthcare use had an α of 0.10. Cronbach’s α for the DDS was 0.93 (subscales 0.85-0.89). Test-retest reliability measured with the intraclass correlation coefficient showed an agreement of 0.87 for the DSMQ and 0.84 for the DDS. Convergent validity tested with Spearman’s rank correlation coefficient showed a small correlation between the DSMQ total score and HbA1c (r = −0.23). The DDS showed a moderate correlation with the Perceived Stress Scale (r = 0.38). Structural validity was assessed with confirmatory factor analysis and showed an acceptable fit for the tested 3-factor solution of the DSMQ (comparative fit index 0.899, Tucker-Lewis Index 0.858, root mean square error of approximation 0.082, and standardized root mean square residual 0.060) and for the proposed 4-factor solution of the DDS (comparative fit index 0.917, Tucker-Lewis Index 0.900, root mean square error of approximation 0.091, and standardized root mean square residual 0.063).

Conclusions

The DSMQ appears reliable and valid, with reservations regarding 1 subscale, whereas the DDS-17 appears both reliable and valid, demonstrating satisfactory psychometric properties for the Swedish type 2 diabetes population.

Background: It is thought that pets have positive effects on psychosocial factors and physical activity. However, earlier findings are inconsistent. In this study, we investigated the link between dog/cat ownership and social integration, mental and physical health and physical activity.

Methods: This cross-sectional study comprised 4604 people, aged 50-64, from the Swedish CArdioPulmonary bioImage Study (SCAPIS). Questionnaire data were used to assess dog/cat ownership. Social integration was self-reported and collected by the Interview Schedule for Social Interaction. Mental health was investigated with the SF-12 questionnaire, and physical activity was self-reported. Multiple linear regressions and ordinal regressions were used to investigate the relationships with dog/cat ownership. The analyses were adjusted for potential confounders.

Results: Dog owners (n = 745) reported less social integration than non-dog owners, both regarding number of social contacts (adjusted odds ratio (aOR) 0.80, 95% confidence interval (CI) 0.69, 0.92) and availability of close relationships (aOR 0.79, CI 0.67, 0.94). No differences in mental health status regarding dog/cat ownership were detected. Dog owners reported 2 hours more weekly walking time on average (p < 0.001) and 2 hours less sitting time (p = 0.016) compared to non-dog owners. A dose-response relationship was found regarding the dog owners' responsibility for the dogs' exercise and the reported amount of walking (p < 0.001). Cat owners (n = 1032) walked approximately 20 minutes less per week than non-cat owners (p = 0.02).

Conclusions: Dog ownership was associated with less social integration and no differences in mental health were found between dog/cat owners compared to non-owners. Dog owners were more physically active, and there was a dose-response relationship between the proportion of the engagement in the dog's daily exercise and the time spent walking. The relationship between dog ownership and physical activity is relevant in relation to cardiovascular health.

Aim

To explore the occurrence of diabetes distress and its associations with diabetes self-management, sociodemographic factors, treatment regimen and late complications in individuals with type 2 diabetes in Sweden.

Methods

A cross-sectional study was conducted among 193 adults with type 2 diabetes between 2021 and 2023. Data were collected through questionnaires and linked to the Swedish National Diabetes Registry. Diabetes distress was assessed using the Diabetes Distress Scale (DDS-17), and self-management was measured with the Diabetes Self-Management Questionnaire (DSMQ). Linear regression analyses were performed with DDS scores as the outcome variable.

Results

Moderate or high levels of diabetes distress were reported by 47.6% of participants, with regimen-related distress being the most prevalent subtype. Higher levels of diabetes distress were significantly associated with poorer diabetes self-management, particularly regarding dietary control, physical activity, and healthcare use. Having a partner was associated with lower regimen-related distress. No significant associations were observed between diabetes distress and treatment regimen or diabetes-related complications.

Conclusions

Diabetes distress appears to be high among individuals with type 2 diabetes in Sweden and is closely linked to self-management. Clinical indicators, such as treatment regimens or diabetes complications alone, cannot reliably identify individuals experiencing distress. These findings underscore the need for systematic screening.

Anxiety and depressive disorders are global health challenges, placing a significant burden on adults and healthcare systems in low- and middle-income countries (LMICs), such as Ghana. Social determinants of mental health, including poor healthcare access and poverty, may be associated with their prevalence. However, a paucity of prevalence data poses challenges for intervention planning and resource allocation. This review aimed to (1) examine the prevalence of anxiety and depressive disorders and symptoms among adults in Ghana, and (2) explore social determinants of mental health potentially associated with anxiety and depressive disorders and symptoms. We searched electronic databases and secondary sources from inception until September 30, 2024. Meta-analyses were performed to estimate the pooled prevalence. Narrative synthesis explored social determinants potentially associated with anxiety and depressive disorders and symptoms. We included 38 studies (22,587 adults). Pooled point prevalence of anxiety and depressive disorders and symptoms was 40.3% (95% confidence interval [CI]: 31.8-49.4%) and 33.0% (95% CI: 27.7-38.8%), respectively. Most studies (37 studies) reported the prevalence of symptoms and not disorders. Social determinants of mental health, including educational attainment and urban environment, were associated with higher levels of anxiety symptoms, while ethnicity and traumatic experiences were associated with higher levels of depressive symptoms. There was a high degree of heterogeneity, and the majority of studies used self-report screening tools, which may have skewed prevalence estimates. More than a third of adults in Ghana were found to experience anxiety and depressive symptoms, and social determinants of mental health may be associated with prevalence. High-quality research and contextually appropriate interventions targeting the identified social determinants of mental health associated with anxiety and depressive symptoms are needed to reduce disparities and improve the mental well-being of adults in Ghana.

Background: Patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) or Takotsubo syndrome (TS) often suffer from poor mental health and low quality-of-life post event, with no current evidence-based treatments available. This study aimed to evaluate the effects of an internet-delivered cognitive behavioral therapy program on stress and anxiety symptoms in patients diagnosed with myocardial infarction with nonobstructive coronary arteries or TS.

Methods: A parallel, multicenter, randomized controlled trial with a wait-list control group was conducted. Patients with elevated symptoms of stress or anxiety were included (the 14-item perceived stress scale ≥25 or hospital anxiety and depression scale, anxiety subscale ≥8). The primary outcome was normalized stress and anxiety levels 10 to 12 weeks after randomization. Secondary outcomes included normalized stress and anxiety separately and symptoms as continuous measures.

Results: A total of 88 patients were randomized (treatment: 45, control: 43). The treatment group showed a greater, though not statistically significant proportion of normalized patients (odds ratio, 2.37 [95% CI, 0.88-6.38], P=0.09). Secondary analyses indicated treatment effects on anxiety normalization and on symptoms as continuous measures (effect sizes: d=0.44-0.67). There was also an interaction between treatment and diagnosis (TS versus non-TS), favoring a treatment effect in TS patients (P=0.016).

Conclusions: The patient-tailored internet-delivered cognitive behavioral therapy program reduced stress and anxiety symptoms in patients with myocardial infarction with nonobstructive coronary arteries or TS and normalized anxiety symptoms in a greater proportion of treated patients than controls. Exploratory analyses indicated that patients with TS may experience greater benefit from the internet-delivered cognitive behavioral therapy intervention, but this warrants further research.

Objective: Cardiac anxiety (CA) is common and has been associated with increased morbidity and mortality in patients after acute myocardial infarction (AMI). While beta-blockers are widely used in secondary prevention after AMI and have proven anxiolytic effects among psychiatric patients, little is known of their effect on CA among AMI-patients. This study aimed to investigate the effect of beta-blockers on CA in post-AMI patients with preserved cardiac function. Methods: In this parallel-group, open-label, registry-based randomized clinical trial, assessments with the Cardiac Anxiety Questionnaire (CAQ) were obtained at hospitalization and at two follow-up points (6-10 weeks and 12-14 months) after AMI. Analyses were based on the intention-to-treat (ITT) principle using multiple linear regression, calculating both short- and long-term effects. Stratified analyses were also conducted in groups with low, moderate and high baseline values on the CAQ. Results: From August 2018 through June 2022, 806 patients were enrolled. In the main analysis, no treatment effect of beta-blocker on CA was observed at either follow-up. In stratified analyses, the levels of CA symptoms were lower for those randomized to beta-blocker treatment in the group with moderate baseline CA, at follow-up 2 (beta = -0.12; 95 % CI -0.22, -0.02; P = 0.016). Conclusions: This trial found no evidence of an effect of beta-blockers on CA among AMI-patients with preserved cardiac function. However, lacking information on beta-blocker adherence limits the possibility of drawing firm conclusions. Furthermore, there might be a differential effect among patients depending on their baseline CA level, as patients with moderate baseline CA randomized to beta-blockers reported lower CA during follow-up than controls.

The objective of this study was to investigate respiratory parameters, including minute ventilation, tidal volume,and respiratory rate, and the role of thoracic mobility in women with FM compared to healthy controls. Thiscase-control study included 38 women with fibromyalgia and 44 age-matched healthy women. Respiratory ratewas measured using a portable monitor and tidal volume was assessed through spirometry. The minute venti-lation was calculated by multiplying tidal volume by respiratory rate. Thoracic mobility was evaluated bymeasuring chest expansion. Pressure pain threshold was assessed over paraspinal muscles between C7-T7 byalgometry to evaluate pain sensitivity. Perceived stress was assessed using the questionnaire Perceived StressScale  10. Women with fibromyalgia exhibited significantly higher minute ventilation (p<0.032), respiratoryrate (p<0.001), and lower tidal volume (p<0.001) compared to healthy controls. Thoracic mobility was reducedin participants with fibromyalgia. Group differences in minute ventilation disappeared when adjusting forperceived stress, suggesting a psychological influence on respiratory parameters. However, differences in res-piratory rate and tidal volume were still significant. Fibromyalgia is associated with altered breathing function,including higher respiratory rate and lower tidal volume. Thoracic mobility and stress may contribute to thesechanges.Perspective: Compared to healthy controls, women with fibromyalgia exhibit an altered breathing pattern whichconsists of higher minute ventilation due to increased respiratory rate. Reduced thoracic mobility and perceivedstress may contribute to this condition. Including the respiratory system in the evaluation and treatment mayoptimize the effects of rehabilitation.Trial registration number: ClinicalTrials.gov: NCT04098731.

Background

While previous literature has continuously demonstrated the negative effects of cancer and its treatment on fertility and sexuality, evidence-based interventions to alleviate fertility-related distress and sexual dysfunction are lacking. This study protocol describes the internal pilot study and randomized controlled trial of an internet-delivered psychoeducational intervention: Fex-Can 2.0. The primary objective is to determine efficacy of Fex-Can 2.0 in terms of reduction of fertility-related distress and sexual dysfunction at end of the 12-week intervention. The internal pilot study will assess feasibility of the study, determined according to pre-specified progression criteria and individual interviews.

Methods

The study has a randomized controlled design, with an internal pilot phase. The intervention group will receive Fex-Can 2.0, consisting of psychoeducational- and behavior change content. The control group will be allocated to standard care. Primary outcomes are fertility-related distress (RCAC) and sexual function and satisfaction (PROMIS SexFS Brief Sexual Profile). Secondary outcomes include body image (BIS), emotional distress (HADS), health-related quality of life (EORTC QLQ-C30), need satisfaction and frustration scale (NSFS), fertility- and sex-related knowledge, and self-efficacy related to fertility and sex life. Outcomes will be assessed at baseline, directly after the intervention, and 12 weeks later. During the internal pilot, data on trial recruitment, data collection, drop out, and adherence will be collected to assess feasibility. Semi-structured interviews will be conducted to further assess acceptability of Fex-Can 2.0.

Conclusions

This randomized controlled trial aims to evaluate whether Fex-Can 2.0 is superior to standard care, in terms of reducing fertility-related distress and sexual dysfunction in young adults diagnosed with cancer. If proven efficacious, the Fex-Can 2.0 intervention may be a valuable resource in health care, with the potential to significantly improve the care of young adults experiencing fertility-related distress and/or sexual dysfunction following cancer.

Trial registration

ClinicalTrials.gov ISRCTN18040643

Objective

Psychological inflexibility (PIF), the inability to adapt to changing circumstances and engage in behaviors that are consistent with one's values, has been associated with distress and impaired quality of life. To date only a paucity of studies have examined the role of PIF in people with cardiovascular disease. Hence, the current study will examine the association between PIF and depression, anxiety, and health-related quality of life in a large, prospective, Dutch, cardiac sample.

Methods

A total of N = 302 cardiac patients were recruited at the Elisabeth-TweeSteden Hospital in The Netherlands. Data were collected at baseline, 3- and 6-months follow-up using online questionnaires. Pearson's correlation and Linear Mixed Models (LMM) analysis was performed to answer the research question.

Results

The mean age of the sample was 64 ± 10 and N = 111(37 %) were females. Results showed that at baseline, PIF correlated positively with depression (r = 0.58) and anxiety (r = 0.64) symptoms, and negatively with both health-related quality of life subscales (MCS r = −0.56; PCS r = −0.27). After adjusting for covariate, LMM showed that, over time, PIF was positively associated with depression (B = 0.32;p < .001), anxiety (B = 0.32;p < .001), and negatively with Mental (B = -0.81; p < .001) and Physical Component Scale (B = -0.45; p < .001).

Conclusions

This is the first prospective study to examine the association between PIF and mental health in cardiac patients. Results showed that PIF was positively associated with depression and anxiety symptoms and negatively with health-related quality of life. Intervention studies are needed to examine whether decreasing PIF associates with a decrease in distress and increase in health-related quality of life.

Introduction

Although poor mental health among young people has been increasing in the past decades, many young people are reluctant to use traditional mental healthcare. To cater to the needs of young people, various youth-friendly treatment options have been developed. These include the youth-friendly health service (YFHS) standards put forth by the WHO in 2012 and the integrated youth services (IYS) for mental health developed in certain countries globally. However, no synthesis of the effect of these services on youth mental health has been conducted. The aim of the proposed study is to conduct a systematic review of the effect of mental health treatments conducted within YFHS and IYS clinics. The primary research question is what effect mental health interventions given at ‘youth-friendly’ clinics for treating mental health, such as IYS and YFHS, have on the mental health and quality of life (QoL) of young people?

Methods and analysis

A preliminary search for other reviews on the topic was conducted during the first half of 2024, after which a protocol of the present study was registered in PROSPERO. In May 2024, a search was carried out in the PubMed, PsycINFO, CINAHL and Web of Science databases, which gave references for 12 738 papers to be screened for inclusion in the review, and a follow-up search was carried out in April 2025, yielding a further 2182 references. For inclusion, studies must have participants between 12 and 25 years of age; interventions be given at clinics designed to be ‘youth-friendly’ or given at an IYS; control condition, if any, consisting of standard care or waiting list; outcomes must be mental health symptomology or QoL. To be included, studies must be published from 2012 and onwards. Screening of titles and abstracts in the initial search was carried out independently by two reviewers. Screening of studies found in the follow-up search and in the reference lists of included articles will be carried out in the same way. Data analysis of the initial search was conducted in the latter half of 2024, while final data analysis including the results from the follow-up search is ongoing. The Cochrane risk of bias assessment tools will be used to assess bias of included articles, and certainty of the evidence will be evaluated according to the GRADE methodology. A meta-analysis of the results will be performed if a sufficient amount of homogenous data is found; otherwise, a synthesis without meta-analysis will be conducted.

Ethics and dissemination

The proposed review may form a valuable synthesis of the state of the art of treatment options catering to young people. Investigating the effectiveness of YFHS or IYS in treating young people’s mental health may inform future directions for development and research. The present study does not need ethical approval, since only previously published, ethically approved data are used in the current study. The findings of the study will be disseminated through submissions to peer-reviewed journals and international conferences, as well as disseminated within the Swedish YFHS community.

PROSPERO registration details

ID nr CRD42024528687.