Tag: anxiety

Medical clowns boost sleep quality and reduce hospital stay for children, study finds

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In a recent study published in Scientific Reports, a group of researchers evaluated the impact of medical clown interventions on sleep quality and hospital stay duration in pediatric patients.

Study: Medical clowns improve sleep and shorten hospitalization duration in hospitalized children. Image Credit: AnnaStills/Shutterstock.com

Background

Sleep is crucial for recovery, yet hospital environments often disrupt it, particularly affecting pediatric patients. Hospitalized children experience late bedtimes, frequent awakenings, and reduced sleep time, intensifying their anxiety and discomfort.

Medical clowns, a non-pharmacologic intervention, have demonstrated potential in reducing stress and anxiety, enhancing overall well-being and cooperation in pediatric care, yet further research is essential to conclusively establish their effectiveness in improving sleep quality and overall recovery outcomes in hospitalized children.

About the study

This single-center, prospective observational study, conducted at The Lady Davis Carmel Medical Center in Israel from July 2019 to January 2022, involved pediatric patients aged 2-18 years, predicted to stay for at least two nights. Patients were recruited based on admission order and matched 1:1 for age and clinical condition with controls. Exclusions included children under 2 or over 18, those with sleep disorders, on sleep-altering medication, chronic conditions, a fear of clowns, or expected one-day hospitalizations. Participants were excluded if discharged or transferred within one night or if they removed the Actigraph sleep-monitoring device prematurely.

The study group received standard medical care and a session with a medical clown at bedtime, using relaxation techniques like music or guided imagination for 15–30 minutes. The control group, matched by medical condition, age, and if possible, gender, received standard care without clown intervention. Both groups wore Actigraph devices to measure sleep and were accompanied by a primary caregiver who completed a three-part questionnaire about the child’s sleep at home, during hospitalization, and, for the clown group, the perceived effect of the clown on sleep.

Data from Actigraph devices were compared with parents’ questionnaires, and each study participant’s data was compared with their control group counterparts. An independent unpaired two-tailed t-test was used for statistical analysis, with a paired t-test for within-group comparisons across two hospital days. A p-value of less than 0.05 indicated statistical significance. Ethical approval was granted by the Carmel Medical Center IRB, with informed consent obtained from all participant caregivers.

Study results

In the present study, 57 children were initially recruited, but 15 were dropped for not completing the required two-night protocol, leaving 42 participants divided into a clown group (n = 21) and a control group (n = 21). Children were matched by age and clinical characteristics, averaging around 10.8 years, with a nearly equal gender distribution. Medical conditions varied, including acute appendicitis and abdominal pain, among others.

The sleep habits of both groups were initially similar. However, the study revealed significant differences in sleep patterns post-intervention. The clown group, exposed to a medical clown intervention before bedtime, showed a delayed wake-up time by approximately 27 minutes compared to the control group. This group also experienced longer time in bed and total sleep time as assessed by both objective measures and parental estimates.

Interestingly, the total wake time during the night was slightly shorter in the clown group. The mean sleeping period was longer in the clown group by 72 minutes, though this did not reach statistical significance. Sleep efficiency was marginally higher in the clown group. The mean number of awakenings during the night was lower in the clown group, but this also did not reach statistical significance.

A notable finding was within the clown group itself. When comparing the two nights for each child in this group, the night following the clown intervention showed a significant increase in total sleep time by 54 minutes, reduced total wake time, and improved sleep efficiency by 4.3%. These changes were mainly attributed to a reduction in the wake period after sleep onset.

Beyond sleep parameters, the study also observed general characteristics of the children’s hospital stay. A remarkable outcome was that the length of hospitalization was significantly shorter in the clown group compared to the control group, with an average reduction of nearly a full day.

Conclusions

The study found significant improvements in sleep parameters for the clown group, including later wake-up times, reduced wakefulness during the night, and increased sleep efficiency. This improvement was particularly notable when comparing nights with and without the clown intervention within the same group. Moreover, the study discovered a substantial reduction in hospital stay duration for children who interacted with the clowns. These findings suggest that medical clowns not only improve sleep quality but also potentially expedite overall recovery.

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January 31, 2024
Does visual impairment influence mental disorders?

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A recent Scientific Reports study investigated whether visual impairment (VI) affects mental disorders in the older population.

Study: The association between visual impairment and mental disorders. Image Credit: ThomsonD/Shutterstock.com

Background

In 2020, about 1.1 billion people were living with some form of VI, which is a very common preventable disorder. Lifestyle changes and population aging are expected to increase this number in the coming years, and most of the burden is likely to fall on low- and middle-income countries (LMICs).

Besides the economic costs, VI adversely affects various aspects of a person’s daily life. The elderly individuals are more vulnerable as they often have many co-existing problems.

Prior research in Western and high-income countries has investigated the relationship between VI and mental health disorders, such as anxiety, depression, cognitive impairment, and suicide.

VI’s psychological problems have received less attention as this is conceptualized as a physical problem. In Iran, no prior studies have analyzed VI’s psychological angle, and the current study is the first to fill this gap.

About this study

Given the absence of evidence and the urgent need for information for healthcare planning, this study explored the relationship between mental disorders and VI using the general health questionnaire (GHQ) to understand the psychological aspects of quality of life.

It comprises 28 questions on physical symptoms, anxiety and insomnia, social dysfunction, and depression, which are scored on a 4-point Likert scale.

The sample consisted of 3,200 subjects, aged 60 years and above, from the Tehran geriatric eye study (TGES).

Presenting visual acuity (PVA), as per the World Health Organization (WHO) guideline, was used to define VI. It was further categorized into blindness and low vision.

Individuals with cognitive problems were excluded from the current study. Furthermore, diabetes was defined based on the HbA1c test, and to get a sense of economic variables, data on 13 household assets were collected. Through self-reporting, alcohol consumption and smoking data were obtained.

Key findings

Consistent with existing reports, a significant association was noted between VI and depression in the present study. Estimates indicated that depression or anxiety was experienced by about one-third of people with VI.

This association was present even after confounders and background variables were accounted for. Previous research has documented similar findings, i.e., adults with self-reported VI were more likely to develop depression in the future.

It is unclear whether the severity of VI is linked to depression. Some studies have documented that the more severe the VI, the more the chances of developing depression, while others have not found such a link.

The bidirectional nature of the relationship between VI and depression has also been highlighted in previous studies, which have been mainly cross-sectional.

The depression coefficient in people with VI was lowered in the present study by controlling for confounders, such as age, income, and health status.

This suggests the need to study the full set of factors governing the relationship between VI and depression so that the magnitude of the association can be pinned down accurately.

Here, increased anxiety in the presence of VI was also noted, and many researchers have not studied this association. One study documented anxiety in patients diagnosed with glaucoma, i.e., not severe VI.

However, it must be acknowledged that anxiety can be the result of the worry of having to live with a disability. Anxiety levels were also lower in blind people than those with VI, which could be due to the lower participation of blind people in social activities.

Moreover, anxiety levels have been shown to decrease with advancing age. Finally, this study also documented that individuals with VI were less prone to engage in physical activities.

Conclusions

In sum, VI was seen to be associated with an increase in depression, anxiety, and physical symptoms. However, most of the psychological disorders studied here could be due to confounding factors and not VI.

The temporal sequence between mental disorders and VI could not be determined here. One possibility is that VI patients potentially develop more functional problems, which subsequently leads to more mental health problems.

Given that the tool used to measure the study outcomes was not similar to the ones used in previous studies, the findings reported here should be compared to those in other reports with caution.

Further, due to the cross-sectional study design, the temporal sequence between mental disorders and VI could not be determined here. Other factors affecting VI, such as cataracts and refractive errors, were not accounted for.

The study’s main strengths were the large sample size and careful examination by a trained and expert team.

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January 31, 2024
Maternal happiness during pregnancy linked to child’s brain development
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In a recent study published in the journal Nature Mental Health, researchers explored the relationship between maternal mental health and children’s brain development. Their results contribute to the medical understanding of the importance of the intrauterine environment and suggest that in addition to positive outcomes for the mother, emotional well-being during pregnancy can be an important protective factor for brain development in children.

Study: Maternal positive mental health during pregnancy impacts the hippocampus and functional brain networks in children. Image Credit: Prostock-studio / Shutterstock

Background

Research suggests that depression, anxiety, and stress during pregnancy can have enduring adverse effects on the child’s brain development. Maternal anxiety and depression have been found to affect gray matter density in the medial temporal and prefrontal cortex as well as hippocampal growth.

Maternal health factors can also modify the cortico-limbic system, which helps regulate stress responses and emotional states. These widespread effects have been observed to be more prominent in female children between birth and early childhood. These findings highlight the need to address prenatal mental health to promote brain development in children.

However, emotional well-being is not merely the absence of mental illness but also includes the experience of positive emotions and mental affect. While the effect of positive maternal emotions on parenting behavior, mother-infant bonding, long-term mental health, and child development has been studied, its impacts on brain development have not been explored.

About the study

The study followed a longitudinal prospective birth cohort design to investigate the relationship between maternal well-being and brain development in 7.5-year-old children using magnetic resonance imaging (MRI). This age was chosen because it is a key neurodevelopmental period when significant cognitive processes and brain changes occur.

Participants in the study included pregnant Asian (Malay, Indian, or Chinese) women in their first trimester who were recruited while they antenatal care at an ultrasound scan clinic in Singapore. For the MRI, children were included if they had a gestational age of more than 30 weeks and a birth weight of more than 2 kg to avoid the confounding effects of birth complications.

The authors hypothesized that positive emotions during pregnancy would be associated with significant differences in brain structures, such as the amygdala and hippocampus as well as functional networks, such as the default mode and visual networks. The mental health of the mothers was assessed using the Beck Depression Inventory, the Edinburgh Postnatal Depression Scale, and the State-Trait Anxiety Inventory.

Additionally, the survey included questions on socioeconomic status, relationships with friends and family, life stress, and other topics related to prenatal health and well-being. This information was used to construct an overall socio-environmental adversity factor and scores for four risk domains – personal, interpersonal, socioeconomic, and life stress.

Findings

The sample of participants who underwent the structural MRI included 381 children, of whom 369 also underwent the functional MRI procedure. After controlling for the overall socio-environmental adversity factor and the child’s age during the MRI, researchers found that more positive maternal emotions during the prenatal period were associated with a larger bilateral hippocampal volume in female children but not males. However, maternal positive emotions were not seen to be associated with cortical thickness or volumes of the thalamus, amygdala, lateral ventricles, or basal ganglia.

In terms of functional networks, more maternal positive emotions were associated with higher functional connectivity between the right frontoparietal and visual association networks, salience and thalamo-hippocampal networks, and posterior default mode and attention networks. Notably, these results were significant after controlling for child sex and age as well as postnatal parenting stress and other risk factors. These outcomes were not, however, associated with anxiety or depressive symptoms during pregnancy.

Conclusions

These findings indicate that there may be a neural basis through which positive emotions during pregnancy are transmitted from the mother to her offspring during the early development of the brain. Of the significantly associated outcomes, only the change in the bilateral hippocampi differed between male and female children. This research implies that ensuring mothers’ mental health could lead to sustained benefits for offspring in terms of neural development.

While the study has several strengths and offers novel insights, the authors acknowledged some limitations. While brain development was assessed through neuroimaging, data on maternal mood and well-being were collected through subjective reports and may, therefore, be subject to biases related to recall and social desirability. Self-reports of positive emotions may not be an adequate proxy for psychological well-being, a complex and multifaceted issue. The study participants were all Asian, leading to a lack of generalizability to other populations.

Future studies can build on these findings by including individuals of other races and factoring in positive emotions during other stages (such as during the postnatal period). This work adds to a growing body of literature showing the transgenerational nature of mental health outcomes and the importance of ensuring that mothers and children are not just healthy but happy, too.
Journal reference:

Maternal positive mental health during pregnancy impacts the hippocampus and functional brain networks in children. Qui, A., Shen, C., López-Vicente, M., Szekely, E., Chong, Y., White, T., Wazana, A. Nature Mental Health (2024). DOI: 10.1038/s44220-024-00202-8, https://www.nature.com/articles/s44220-024-00202-8
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January 31, 2024
How to hack your stress and turn it into a positive force in your life

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Many of us have felt more than a little stressed over the past couple of years. For me, exhibit A is my teeth. A recent trip to the dentist confirmed that months of pandemic-induced jaw-clenching, product of the usual deadline stress amplified by the demands of two young children, had left four of them broken.

Crumbling teeth are small fry. Last year, the American Psychological Association found that two-thirds of people in the US reported feeling more stressed in the pandemic, and predicted “a mental health crisis that could yield serious health and social consequences for years to come”. Increased risk of diabetes, depression and cardiovascular disease and more are all associated with high stress levels. It’s enough to make you feel stressed just thinking about it.

Perhaps we just need to think about stress differently, though. That, at least, is the startling conclusion of researchers studying the mind-body connection. There are natural benefits to being stressed, they say, and if we change our “stress mindset”, we might be able to turn things around and make stress a positive influence on our lives. Fortunately, there are some simple hacks that will allow us to do this, and they bring with them the promise of better physical health, clearer thinking, increased mental toughness and greater productivity.

There is no denying that too much stress can harm both body and mind. It has been linked to all six of the main causes of death in the West: cancer, heart disease, liver disease, accidents, lung disease and suicide. It can weaken the immune system, leaving us more prone to infection and reducing…

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December 1, 2021
Don’t stress: The scientific secrets of people who keep cool heads

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YOU know that person. The one who uses a delayed train as an excuse to get stuck into a good book. The one who can make a joke 10 seconds after breaking their ankle. The one who loves giving presentations and never falters under pressure. They seem to float through life unfazed by the stress that can overwhelm the rest of us. What’s their secret?

Are they blessed with stress-resistant genes? Did their upbringing make them exceptionally resilient? Have they learned specific ways of coping with life’s challenges? Or do they just know how to avoid stress altogether? To answer these questions, researchers have been examining how humans and animals react and adapt to adversity, identifying those who are particularly resilient to stress and teasing apart the factors that contribute to this ability. It is a journey that has taken them from orphanages in Romania and interrogation chambers in North Carolina to fire stations in Indianapolis and humour classes in Austria.

This work is helping the military recruit candidates for high-stress jobs. It has also led to the first human trial of a “stress vaccine”, with the potential to inoculate us against its devastating effects, from post-traumatic stress disorder (PTSD) to depression. But there is a bigger pay-off to understanding the secret of stress-free living. Knowing why some people handle stress better than others, and the things we might all do to improve our resilience, won’t just help all of us manage life’s daily struggles better, it might also teach us how to use stress to our advantage.

One thing is for certain: whether you are running late for…

Article amended on 27 February 2020

We clarified when people suffered negative effects of stress.

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February 19, 2020