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The reported equivocal evidence of the effectiveness of disability simulation programs in reducing ableist attitudes toward people with disabilities has led to a persistent debate about the suggested discontinuation of such simulation programs to avoid further reinforcement of ableism. The present research conducted a meta-analysis on 12 empirical studies evaluating the impact of mobility disability simulation programs on attitudes toward people with disabilities and environmental accessibility to better inform future research and practice. A citation search using keywords related to “disability” and “simulation” in the title and/or abstract in 11 major online databases (i.e., Cochrane, EBSCOhost, EMBASE, Google Scholar, IEEE Xplore, JSTOR, LearnTechLib, ProQuest, PsycINFO, Scopus, and Web of Science) was conducted to retrieve relevant empirical articles that are published within the earliest dates of each database and June 2021 for the meta-analysis. Meta-analysis using a random effects model revealed that participation in the simulation programs resulted in large effect sizes in increasing fear and anxiety [Cohen’s d = -1.51, 95% CI (-2.98, -.05), n = 2] but small effect sizes in improving conceptions of social inclusion at postsimulation [Cohen’s d = .24, 95% CI (.01, .47), n = 5] while reducing stereotypes toward people with disabilities at follow-up [Cohen’s d = .57, 95% CI (.10, 1.03), n = 3]. Inconclusive changes in the behavioral tendency of inclusion-promoting actions and stereotypes at postsimulation were found. The three exploratory moderators (i.e., the program duration, the presence of facilitators with disabilities, and the debriefing arrangement) were not statistically significantly associated with between-subgroup differences in the program’s effectiveness in reducing stereotypes toward people with disabilities. The findings informed a series of recommended reforms in the program message framing, formats of the simulation, scope and referents of outcome measures, incorporation of environmental perspectives and behavioral measures, and methodological quality of the program evaluation study.

High prevalence of anxiety symptoms has been reported globally in the university students. Cognitive behavioral therapy (CBT) is the recognized treatment for anxiety and is traditionally conducted face-to-face (f-CBT). The efficacy of internet-based CBT (i-CBT) for anxiety has been extensively studied, yet evidence on its cost-effectiveness is scarce. We aimed to evaluate the cost-effectiveness of guided low-intensity i-CBT for university students with mild anxiety symptoms from the societal perspective of Hong Kong. A 5-year Markov model was designed to compare outcomes of guided i-CBT and f-CBT in a hypothetical cohort of university students with mild anxiety symptoms. Model inputs of cost and healthcare resources associated with anxiety were retrospectively collected from a cohort of university students with anxiety symptoms. Clinical and utility model inputs were retrieved from published literature. Model outcome measures were anxiety-related total cost (including direct medical and indirect costs) and quality-adjusted life-year (QALY). Sensitivity analyses were performed to examine the robustness of base-case results. In base-case analysis, i-CBT gained higher QALYs (2.9956 versus 2.9917) at lower total cost (US$6,101 versus US$6,246) than f-CBT. In one-way sensitivity analysis, the QALY gained by i-CBT was sensitive to the relative patient acceptance and adherence to CBT. In probabilistic sensitivity analysis, i-CBT was cost-effective in 90.9% of the time at the willingness-to-pay threshold of 138,210 per QALY (3× GDP per capita in Hong Kong). The probability of i-CBT to be cost-effective was 99.9% at a willingness-to-pay threshold of zero. Guided i-CBT appears to be cost-saving and effective for management of university students with mild symptoms of anxiety from the societal perspective of Hong Kong. The cost-effectiveness of i-CBT is highly subject to the individual acceptance and adherence of CBT delivered by the internet platform.

Background Subthreshold depression is common in primary care and is associated with significant healthcare burden. There is emerging evidence for the benefits of Exercise can reduce depressive symptoms among people with diagnosed depression, but there is limited evidence for subthreshold depression in primary care setting. This study aims to examine the efficacy of a 12-week online instructor-led exercise intervention in reducing depressive symptoms among people with subthreshold depression in primary care, when compared to usual care control. Methods This 1:1 randomised controlled trial will enrol 260 participants with subthreshold depression randomizing into 2 groups (online exercise intervention versus usual care control). The intervention consists of twice-weekly 1-h exercise online classes over 12 weeks, which will be led by certified instructors. Data will be collected at baseline (T0), immediate post intervention (T1), 3-month post intervention (T2) and 9-month post intervention (T3). The primary outcome is depressive symptoms measured by the Chinese version of Beck Depression Inventory-II (BDI-II) at T1. Secondary outcomes include anxiety symptoms, quality of life, physical activity levels, feasibility and acceptability, medication use and health service utilization, and cost assessment. Intention-to-treat analysis will be performed. Discussion The proposed study will assess the efficacy of online exercise intervention in improving subthreshold depressive symptoms in primary care. The findings will inform clinicians and policy makers concerning prevention of depression in primary care, and may lead to changes in the respective current guidelines and public policies. Trial Registration This trial has been registered in the Chinese Clinical Trial Registry, with the registration number: ChiCTR2400087923. The date of registration is 2024–08-07.

Background The global coronavirus disease 2019 (COVID-19) has caused many negative effects on physical and mental health of patients who have survived COVID-19. Apart from some long-lasting physical sequelae, those COVID-19 survivors are also suffering stigma and discrimination at different levels around the world. The current study aims to assess the role resilience played in stigma and mental disorders among COVID-19 survivors. Methods The cross-sectional study was carried out among former COVID-19 patients in Jianghan District (Wuhan, China) from June 10 to July 25, 2021. The demographic questions, the Impact of Events Scale-Revised, the Generalized Anxiety Disorder Questionnaire, the Patient Health Questionnaire, the Resilience Style Questionnaire and the Short Version of COVID-19 Stigma Scale of 12 items were used to collect relevant information of the participants. Descriptive analyses, Pearson correlation analysis and Structural Equation Modeling were used to make data description and analysis. Results A total of 1541 out of 1601 COVID-19 survivors (887 females and 654 males) were included in the analysis. Perceived stigma of those COVID-19 survivors correlates significantly with anxiety (r = 0.335, P  < 0.001), depression (r = 0.325, P  < 0.001) and post-traumatic stress disorder (PTSD) (r = 0.384, P  < 0.001). It has a direct effect on COVID-19 survivors’ anxiety (β = 0.326, P  < 0.001), depression (β = 0.314, P  < 0.001), PTSD (β = 0.385, P  < 0.001) and their resilience (β = − 0.114, P  < 0.01). Resilience partially mediated the association between perceived stigma and anxiety (β = 0.020, P  < 0.01), depression (β = 0.020, P  < 0.01), and PTSD (β = 0.014, P  < 0.01) among COVID-19 survivors. Conclusion Stigma has a significant negative impact on mental health, while resilience plays a mediator role in the relationship between stigma and mental health among COVID-19 survivors. Based on our study, we suggested that when designing psychological interventions for COVID-19 survivors, consideration should be taken into account to reduce stigma and improve resilience.

Background: Caregivers of people with chronic conditions are more likely than non-caregivers to have depression and emotional problems. Few studies have examined the effectiveness of mindfulness-based stress reduction (MBSR) in improving their mental well-being. Methods: Caregivers of persons with chronic conditions who scored 7 or above in the Caregiver Strain Index were randomly assigned to the 8-week MBSR group (n = 70) or the self-help control group (n = 71). Validated instruments were used to assess the changes in depressive and anxiety symptoms, quality of life, self-efficacy, self-compassion and mindfulness. Assessments were conducted at baseline, post-intervention and at the 3-month follow-up. Results: Compared to the participants in the control group, participants in the MBSR group had a significantly greater decrease in depressive symptoms at post-intervention and at 3 months post-intervention (p < 0.01). The improvement in state anxiety symptoms was significantly greater among participants in the MBSR group than those of the control group at post-intervention (p = 0.007), although this difference was not statistically significant at 3 months post-intervention (p = 0.084). There was also a statistically significant larger increase in self-efficacy (controlling negative thoughts; p = 0.041) and mindfulness (p = 0.001) among participants in the MBSR group at the 3-month follow-up compared to the participants in the control group. No statistically significant group effects (MBSR vs. control) were found in perceived stress, quality of life or self-compassion. Conclusions: MBSR appears to be a feasible and acceptable intervention to improve mental health among family caregivers with significant care burden, although further studies that include an active control group are needed to make the findings more conclusive.

Background Newly diagnosed HIV-positive men who have sex with men (MSM) are an important subgroup in HIV intervention. How newly diagnosed HIV-positive MSM look at HIV/AIDS is consequential and is potentially associated with their risk behaviors and mental health problems. Illness representation has been used to define patients’ beliefs and expectations on an illness, and the revised Illness Perception Questionnaire (IPQ-R) has been developed to measure illness representations. This study aims to examine the psychometric properties of the IPQ-R among newly diagnosed HIV-positive MSM and to investigate their views towards HIV/AIDS. Method A total of 225 newly diagnosed HIV-positive MSM completed the Chinese version of IPQ-R. Both confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) were applied to examine the factor structure of IPQ-R. Results CFA showed a poor goodness of fit to the original factor structure of IPQ-R. EFA of the IPQ-R revealed 7 factors, including Emotional Response, Treatment Control, Timeline-acute/chronic, Illness Coherence, Consequence, Personal Control and Helplessness. Cronbach’s alpha showed acceptable internal consistency for the derived factors, except the Personal Control (0.61) and Helplessness (0.55). Person correlation coefficients demonstrated that the derived factors of IPQ-R had significant associations with the outcome variables (depression and posttraumatic growth). The scores of the Emotional Response, Consequence, Treatment Control, Personal Control, Timeline-acute/chronic and Illness Coherence were above the midpoint, and the score of the Helplessness was below the midpoint. Conclusion Both similarities and differences were found when the IPQ-R is applied to newly diagnosed HIV-positive MSM. The IPQ-R can be used with some refinements in future studies. Newly diagnosed HIV-positive MSM have a relatively high level of negative perceptions towards HIV/AIDS in both cognitive and emotional aspects.

PurposeCancer-related self-stigma (the internalized sense of shame about having cancer) has been found to associate with poorer quality of life (QoL) among cancer survivors. However, culturally salient illness beliefs (e.g., cancer is contagious; cancer is a result of karma; and cancer brings shame to the family) may make Chinese cancer survivors vulnerable to self-stigmatization. This study examined the association between self-stigma and QoL among Chinese American breast cancer survivors (BCS). To understand the potential mechanism, the mediating role of self-perceived burden to caregivers between self-stigma and QoL was also examined.MethodsChinese American BCS (n = 136) were recruited through community-based cancer associations. Participants’ self-stigma, self-perceived burden, and QoL were measured in a questionnaire package.ResultsStructural equation modeling results supported the proposed mediation model in predicting physical QoL (χ2(100) = 123.041, CFI = 0.982, TLI = 0.975, RMSEA = 0.041) and emotional QoL (χ2(84) = 137.277, CFI = 0.958, TLI = 0.940, RMSEA = 0.069), with satisfactory model fit indices. Both the indirect effects from self-stigma to QoL via self-perceived burden (physical: β = − 0.13; 95% CI = − 0.22, − 0.07 and emotional: β = − 0.11; 95% CI = − 0.22, − 0.04) and the direct effects from self-stigma to poorer QoL were significant (physical: β = − 0.22; 95% CI = −0.34, −0.10 and emotional: β = − 0.39; 95% CI = − 0.54, − 0.23), suggesting a partial mediation effect of self-perceived burden between self-stigma and QoL.ConclusionsSelf-stigma could reduce physical and emotional QoL through increasing self-perceived burden. Interventions aiming to reduce Chinese American BCS’ self-stigma and perceptions of burdensomeness may facilitate improvement in QoL, which in turn promotes better cancer survivorship.

Background Mindfulness-based interventions (MBIs) have shown promise in reducing stress among family caregivers (FCs) of people with dementia (PWD). However, the long-term stress-relieving effects of traditional MBIs are often limited by challenges in maintaining regular practice, leading to issues with adherence and attrition. To address these limitations, this study protocol aims to test a novel closed-loop mindfulness-based program, integrated with a mobile application (Mind & Care App), to facilitate sustained mindfulness practice by providing quantifiable practice feedback and adaptive practice durations based on attentional capacity. Methods This is a three-arm randomized controlled trial involving 189 FCs of PWD. Participants will be randomly assigned to one of three groups: (1) the closed-loop mindfulness-based program, (2) a traditional mindfulness program, or (3) a control group receiving brief education on dementia care. The closed-loop mindfulness program will consist of three weekly face-to-face training sessions (90 minutes each) and daily guided self-practice using the Mind & Care App over an 8-week period. Evaluations will occur at baseline, post-intervention, and at a 6-month follow-up. The primary outcome will be perceived stress, while secondary outcomes will include depressive symptoms, peace of mind, caregiving burden, dyadic relationship quality, dispositional mindfulness, heart rate variability, and the care recipients’ neuropsychiatric symptoms. A process evaluation will examine whether dispositional mindfulness mediates the relationship between mobile app usage and stress reduction. A cost-effectiveness analysis will evaluate between-group differences in intervention costs relative to work productivity and activity impairment with caregiving activities. Focus group interviews will be conducted to explore the strengths, limitations, and therapeutic components of the intervention from the perspective of FCs. Discussion This study will contribute to the understanding of how integrating quantifiable feedback and adaptive practice durations into mindfulness programs can enhance long-term mindfulness practice. By empowering FCs of PWD with mindfulness skills to manage the long-term challenges of caregiving, this intervention can improve caregiver well-being and caregiving outcomes. Trial registration ClinicalTrials.gov, NCT06880822. Registered on March 2025.

Objectives Mindfulness-based interventions have been widely applied to various populations with demonstrated effects in reducing physical and psychological distress. However, it is equally important to investigate whether, and how, mindfulness might enhance people’s psychological well-being. One important dimension of well-being is meaning in life. We systematically analyzed the correlational relationship between mindfulness and meaning in life and whether randomized controlled trials of mindfulness-based interventions could enhance meaning in life. Methods A comprehensive literature search identified 22 studies (25 samples, N = 7895) for the meta-analysis of the relationship between mindfulness and meaning in life, and 9 studies (11 samples, N = 912) for the meta-analysis of the effects of randomized controlled trials (RCTs) of mindfulness-based interventions on meaning in life. Results Cross-sectional correlation between mindfulness and meaning was estimated to be .37, a moderate effect size. RCTs of mindfulness-based interventions had a moderate effect size on meaning (Hedge’s g = 0.53). Our systematic review indicated that the effect of mindfulness on meaning was mediated by decentering, authentic self-awareness, and attention to positive experience. Conclusions Overall, these findings showed the promise of applying mindfulness-based interventions to enhance meaning in life. However, more empirical studies with an active control group are required to establish the effects of mindfulness-based interventions above and beyond placebo effect.

Background: Public stigma in mental health often brings various adverse effects on people with mental illness. Researchers have been developing different interventions in combating public stigma. Objective: This study investigates the effects of immersive virtual reality (IVR) in reducing the public stigma of mental illness using a single-blinded randomized control trial. Methods: A pre-post experimental design with a 1-week follow-up was conducted. Participants (N=206) were recruited through the mass mail system of The Chinese University of Hong Kong and randomized into 3 conditions: immersive animation, text, and control. In the immersive animation condition (n=72), participants experienced the simulation of daily life and the stigma experienced as an animated story protagonist with mixed anxiety and depressive disorder with IVR. In the text condition (n=65), participants experienced an identical story to the immersive animation condition with first-person audio narration using the same virtual reality headset. In the control condition (n=69), participants watched a video about planets with IVR. All participants received interventions with a researcher-assisted Oculus Go virtual reality headset. Participants’ public stigma was measured through self-administered online questionnaires and compared across conditions and at different time points using repeated measures analysis of variance. Simple and sequential mediation analyses on the relationship of condition (immersive animation vs text) and follow-up public stigma with possible mediators, including sense of embodiment and story transportation, were conducted using PROCESS. Results: Public stigma did not differ significantly across conditions at pre-experiment (P>.99). In the immersive animation and text conditions, public stigma was significantly reduced at postexperiment and at the 1-week follow-up compared to pre-experiment (all with P<.001). Public stigma in the control condition at postexperiment and follow-up remained unchanged compared with pre-experiment (P=.69). Immersive animation had significantly lower public stigma than the control at postexperiment (P=.003) and follow-up (P=.02). Text also had lower public stigma than the control at postexperiment (P=.007) and follow-up (P=.03). However, immersive animation did not significantly differ from text in public stigma at postexperiment and follow-up (both P>.99). In simple mediation models, both sense of embodiment (95% CI –0.22 to 0.46) and story transportation (95% CI –0.18 to 0.00) were not significant mediators. In the sequential mediation model, both sense of embodiment and story transportation were significant sequential mediators. Sense of embodiment was positively associated with story transportation (P<.001), while story transportation was negatively associated with public stigma (P<.001). The indirect effect of the sequential mediation model was significant (95% CI –0.38 to –0.11). Conclusions: This study provides novel findings and a rigorous comparison in understanding the effects of IVR on public stigma. The findings showed that IVR and text with audio narration performed similarly and significantly in stigma reduction. Sense of embodiment and story transportation were found to be sequentially associated with public stigma reduction. Trial Registration: Centre for Clinical Research and Biostatistics Clinical Trial Registry CUHK_Ccrb00638; https://www2.ccrb.cuhk.edu.hk/registry/public/632