Background
Depression is the largest contributing factor to global disability, and the translation and validation of depression screening instruments is vital toward understanding the prevalence of depression symptoms around the world. The aim of this study was to translate a widely used depression screening instrument, the Patient Health Questionnaire (PHQ), for use with Tibetan populations, and to explore the prevalence of depression symptoms in a population of Tibetan-speaking Buddhist monastic science scholars.
Methods
A total of 384 monastics (363 monks, 21 nuns) completed the Tibetan PHQ-9. We computed measures of internal consistency and conducted factor analysis to evaluate scale performance, and describe the prevalence of depression symptoms among the monastic population and subgroups.
Results
The Tibetan PHQ-9 had acceptable reliability and demonstrated a single-factor structure. While having low energy was the most commonly endorsed symptom, monastics did not have overall higher rates of other somatic symptoms. Over 10% of the monastics scored in the moderately severe to severe range, using standard diagnostic criteria cut-offs. First year monks had the highest mean score, and there was not a significant difference between monks and nuns.
Conclusion
These preliminary findings indicate that the Tibetan PHQ-9 is a reliable instrument for exploring and assessing depression symptoms and that it will be useful toward examining how symptoms are experience, interpreted, and communicated among Buddhist monastics.
Healthcare personnel experienced unprecedented stressors and risk factors for burnout, anxiety, and depression during the COVID-19 pandemic. This may have been particularly true for spiritual health clinicians (SHCs), also referred to as healthcare chaplains. We administered a daily pulse survey that allowed SHCs to self-report burnout, depression, and well-being, administered every weekday for the first year of the pandemic. We used a series of linear regression models to evaluate whether burnout, depression, and well-being were associated with local COVID-19 rates in the chaplains’ hospital system (COVID-19 admissions, hospital deaths from COVID-19, and COVID-19 ICU census). We also compared SHC weekly rates with national averages acquired by the U.S. Census Bureau’s Household Pulse Survey (HPS) data during the same timeframe. Of the 840 daily entries from 32 SHCs, 90.0% indicated no symptoms of burnout and 97.1% were below the cutoff for depression. There was no statistically significant relationship between any of the COVID-19 predictors and burnout, depression, or well-being. Mean national PHQ-2 scores were consistently higher than our sample’s biweekly means. Understanding why SHCs were largely protected against burnout and depression may help in addressing the epidemic of burnout among healthcare providers and for preparedness for future healthcare crises.
Background: Depression is the largest source of global medical disability, highlighting the importance of translating and validating depression screening instruments to improve our understanding of differences in the prevalence of depression in divergent cultures around the world. The aim of this study was to translate and evaluate a widely used depression screening and diagnostic instrument, the Patient Health Questionnaire-9 (PHQ-9), for use with Tibetan populations. A secondary aim was to use the Tibetan-PHQ-9 (T-PHQ-9) to estimate the prevalence of depression symptoms in a population of Tibetan-speaking Buddhist monastic scholars engaging in a 6-year science curriculum in India, the Emory Tibet Science Initiative (ETSI).
Methods: Three-hundred-eighty-four monastics (363 monks, 21 nuns) completed the T-PHQ-9. We computed measures of internal consistency and conducted factor analysis to evaluate scale performance. Following this, we evaluated the prevalence of depressive symptoms among the monastic population. We also conducted cognitive interviews with six monastics to explore their thought processes when completing the instrument and when thinking about depression symptoms.
Results: The T-PHQ-9 had acceptable reliability and demonstrated a single-factor structure. While having low energy was the most commonly endorsed symptom, monastics did not have overall higher endorsement rates of other somatic symptoms when compared with endorsement rates of emotional symptoms. Over 10% of the monastics scored in the moderately severe to severe range and met criteria for major depressive disorder using standard diagnostic criteria cut-offs. First year monks had the highest mean score, and there was not a significant difference between monks and nuns. Cognitive interviews revealed some variation in the cognitive processes used to complete the instrument, particularly with symptoms related to energy and concentration.
Conclusion: These preliminary findings indicate that the Tibetan PHQ-9 is a reliable instrument for assessing depressive symptoms, as evidenced by its ability to inform how symptoms are experienced, interpreted, and communicated among Buddhist monastics. Results from the cognitive interviews may be important for further refining the instrument.
We are at a historic point in which scientists and Tibetan monastics are working together to investigate ancient questions of mind and matter, and to serve the best interests of humanity. To facilitate this collaboration, His Holiness the Dalai Lama supported the development of the Emory University-Tibet Science Initiative (ETSI), which reflects the first major change in the Tibetan monastic curriculum in six centuries. Over the course of a 6-year long curriculum, Tibetan monastics living in India have the opportunity to study science with experts in various disciplines. In 2019, ETSI graduated its first cohort of monastic students from a 6-year “implementation phase,” and now has entered the “sustainability phase.” A goal of the sustainability phase is to broaden the scope of ETSI and begin training monastics through research. The present paper provides an overview of a 3-year Research Training Program being developed for the sustainability phase. We first overview a pilot program that informed feasibility and potential structure for a broader Research Training Program at the monasteries and monastic universities in India. Next, we discuss the conceptual framework for the Research Training Program and four learning objectives that we hope to attain. We then discuss the specifics of the course design for the proposed 3-year research training curriculum, through which our goal is to transition from a more guided training experience to a less guided experience. Finally, we discuss challenges and opportunities that we expect to encounter in developing and implementing the program.
Introduction:
Chronic pain creates economic burden and exerts profound individual and societal harm. Mobile application (app)-delivered mindfulness meditation may be an important approach to self-management of chronic pain.
Objectives:
We examined the feasibility, acceptability, and impact of app-delivered mindfulness meditation on pain cognition and daily functioning among patients reporting chronic pain.
Methods:
We used a longitudinal, randomized, and wait-list–controlled design (NCT03495726) to evaluate changes in self-reported pain severity, pain catastrophizing, and social and physical functioning among participants randomized to 6 weeks of app-delivered mindfulness meditation, compared with participants randomized to a wait-list control group.
Results:
Although most participants randomized to the mindfulness group used the app at least once, fewer than half adhered to the instructed program. Participants who did not use the app scored higher on the helplessness component of pain catastrophizing at the start of the study and were less likely to have completed 4 years of college. Participants who reported feeling pressured to enroll in the study were also less likely to adhere to the intervention. Compared with participants randomized to wait-list, those in the mindfulness group reported significant improvements in social functioning, even after controlling for pain severity. Participants randomized to the mindfulness intervention also reported significant improvements in helplessness. App usage was not significantly correlated with changes in social functioning or helplessness scores.
Conclusions:
These results suggest that app-delivered mindfulness meditation is beneficial to patients with chronic pain. Identifying characteristics of patients who were adherent highlights important considerations for clinical settings.
This study investigates paternal brain function with the hope of better understanding the neural basis for variation in caregiving involvement among men. The neuropeptides oxytocin (OT) and vasopressin (AVP) are implicated in paternal caregiving in humans and other species. In a double-blind, placebo-controlled, within-subject pharmaco-functional MRI experiment, we randomized 30 fathers of 1–2 year old children to receive either 24 IU intranasal OT before one scan and placebo before the other scan (n = 15) or 20 IU intranasal AVP before one scan and placebo before the other scan (n = 15). Brain function was measured with fMRI as the fathers viewed pictures of their children, unknown children and unknown adults, and as they listened to unknown infant cry stimuli. Intranasal OT, but not AVP, significantly increased the BOLD fMRI response to viewing pictures of own children within the caudate nucleus, a target of midbrain dopamine projections, as well as the dorsal anterior cingulate (dACC) and visual cortex, suggesting that intranasal oxytocin augments activation in brain regions involved in reward, empathy and attention in human fathers. OT effects also varied as a function of order of administration such that when OT was given before placebo, it increased activation within several reward-related structures (substantia nigra, ventral tegmental area, putamen) more than when it was given after placebo. Neither OT nor AVP had significant main effects on the neural response to cries. Our findings suggest that the hormonal changes associated with the transition to fatherhood are likely to facilitate increased approach motivation and empathy for children, and call for future research that evaluates the potential of OT to normalize deficits in paternal motivation, as might be found among men suffering from post-partum depression.
Multiple lines of research indicate that fathers often treat boys and girls differently in ways that impact child outcomes. The complex picture that has emerged, however, is obscured by methodological challenges inherent to the study of parental caregiving, and no studies to date have examined the possibility that gender differences in observed real-world paternal behavior are related to differential paternal brain responses to male and female children. Here we compare fathers of daughters and fathers of sons in terms of naturalistically observed everyday caregiving behavior and neural responses to child picture stimuli. Compared with fathers of sons, fathers of daughters were more attentively engaged with their daughters, sang more to their daughters, used more analytical language and language related to sadness and the body with their daughters, and had a stronger neural response to their daughter's happy facial expressions in areas of the brain important for reward and emotion regulation (medial and lateral orbitofrontal cortex [OFC]). In contrast, fathers of sons engaged in more rough and tumble play (RTP), used more achievement language with their sons, and had a stronger neural response to their son's neutral facial expressions in the medial OFC (mOFC). Whereas the mOFC response to happy faces was negatively related to RTP, the mOFC response to neutral faces was positively related to RTP, specifically for fathers of boys. These results indicate that real-world paternal behavior and brain function differ as a function of child gender.
Background: Compassion is considered a fundamental human capacity instrumental to the creation of medicine and for patient-centered practice and innovations in healthcare. However, instead of nurturing and cultivating institutional compassion, many healthcare providers cite the health system itself as a direct barrier to standard care. The trend of compassion depletion begins with medical students and is often attributed to the culture of undergraduate medical training, where students experience an increased risk of depression, substance use, and suicidality. Objectives: This qualitative study aims to develop a more comprehensive understanding of compassion as it relates to undergraduate medical education. We used focus groups with key stakeholders in medical education to characterize beliefs about the nature of compassion and to identify perceived barriers and facilitators to compassion within their daily responsibilities as educators and students. Methods: Researchers conducted a series of virtual (Zoom) focus groups with stakeholders: Students (N = 14), Small Group Advisors (N = 11), and Medical Curriculum Leaders (N = 4). Transcripts were thematically analyzed using MAXQDA software. Results: Study participants described compassion as being more than empathy, demanding action, and capable of being cultivated. Stakeholders identified self-care, life experiences, and role models as facilitators. The consistently identified barriers to compassion were time constraints, culture, and burnout. Both medical students and those training them agreed on a general definition of compassion and that there are ways to cultivate more of it in their daily professional lives. They also agreed that undergraduate medical education – and the healthcare culture at large – does not deliberately foster compassion and may be directly contributing to its degradation by the content and pedagogies emphasized, the high rates of burnout and futility, and the overwhelming time constraints. Discussion: Intentional instruction in and cultivation of compassion during undergraduate medical education could provide a critical first step for undergirding the professional culture of healthcare with more resilience and warm-hearted concern. Our finding that medical students and those training them agree about what compassion is and that there are specific and actionable ways to cultivate more of it in their professional lives highlights key changes that will promote a more compassionate training environment conducive to the experience and expression of compassion.
Despite the well-documented importance of paternal caregiving for positive child development, little is known about the neural changes that accompany the transition to fatherhood in humans, or about how changes in hormone levels affect paternal brain function. We compared fathers of children aged 1-2 with non-fathers in terms of hormone levels (oxytocin and testosterone), neural responses to child picture stimuli, and neural responses to visual sexual stimuli. Compared to non-fathers, fathers had significantly higher levels of plasma oxytocin and lower levels of plasma testosterone. In response to child picture stimuli, fathers showed stronger activation than non-fathers within regions important for face emotion processing (caudal middle frontal gyrus [MFG]), mentalizing (temporo-parietal junction [TPJ]) and reward processing (medial orbitofrontal cortex [mOFC]). On the other hand, non-fathers had significantly stronger neural responses to sexually provocative images in regions important for reward and approach-related motivation (dorsal caudate and nucleus accumbens). Testosterone levels were negatively correlated with responses to child stimuli in the MFG. Surprisingly, neither testosterone nor oxytocin levels predicted neural responses to sexual stimuli. Our results suggest that the decline in testosterone that accompanies the transition to fatherhood may be important for augmenting empathy toward children.
Crying is the principal means by which newborn infants shape parental behavior to meet their needs. While this mechanism can be highly effective, infant crying can also be an aversive stimulus that leads to parental frustration and even abuse. Fathers have recently become more involved in direct caregiving activities in modern, developed nations, and fathers are more likely than mothers to physically abuse infants. In this study, we attempt to explain variation in the neural response to infant crying among human fathers, with the hope of identifying factors that are associated with a more or less sensitive response. We imaged brain function in 39 first-time fathers of newborn infants as they listened to both their own and a standardized unknown infant cry stimulus, as well as auditory control stimuli, and evaluated whether these neural responses were correlated with measured characteristics of fathers and infants that were hypothesized to modulate these responses. Fathers also provided subjective ratings of each cry stimulus on multiple dimensions. Fathers showed widespread activation to both own and unknown infant cries in neural systems involved in empathy and approach motivation. There was no significant difference in the neural response to the own vs. unknown infant cry, and many fathers were unable to distinguish between the two cries. Comparison of these results with previous studies in mothers revealed a high degree of similarity between first-time fathers and first-time mothers in the pattern of neural activation to newborn infant cries. Further comparisons suggested that younger infant age was associated with stronger paternal neural responses, perhaps due to hormonal or novelty effects. In our sample, older fathers found infant cries less aversive and had an attenuated response to infant crying in both the dorsal anterior cingulate cortex (dACC) and the anterior insula, suggesting that compared with younger fathers, older fathers may be better able to avoid the distress associated with empathic over-arousal in response to infant cries. A principal components analysis revealed that fathers with more negative emotional reactions to the unknown infant cry showed decreased activation in the thalamus and caudate nucleus, regions expected to promote positive parental behaviors, as well as increased activation in the hypothalamus and dorsal ACC, again suggesting that empathic over-arousal might result in negative emotional reactions to infant crying. In sum, our findings suggest that infant age, paternal age and paternal emotional reactions to infant crying all modulate the neural response of fathers to infant crying. By identifying neural correlates of variation in paternal subjective reactions to infant crying, these findings help lay the groundwork for evaluating the effectiveness of interventions designed to increase paternal sensitivity and compassion.