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Background: Improving the professional competency of nursing students during the internship is critical. This study aimed to compare the professional competency and anxiety of nursing students trained based on two internship models. Methods: This is a two-group posttest-only quasi-experimental design study. One hundred nursing students who passed internship models A (a previous internship model) and B (an intervention with more educator support and a more planned and programmed process) were randomly enrolled in this study. Internship model groups A and B were conducted for the students in semesters 7 and 8. The outcomes assessed in both groups were "The Competency Inventory for Registered Nurses" and Spielberger "State-Trait Anxiety Inventory". T-test and MANOVA were used to analyze the data. Results: The mean scores of competency were 134.56 (SD = 43.23) and 160.19 (SD = 35.81) for the nursing students in the internship model groups A and B, respectively. The mean scores of nursing students' anxiety were 92.14 (SD = 15.36) and 80.44 (SD = 18.16) in the internship model groups A and B, respectively. MANOVA test showed a significant difference between the groups regarding professional competency (F = 10.34, p = 0.002) and anxiety (F = 11.31, p = 0.001). Conclusions: The internship model group B could improve the professional competency of nursing students to a great extent and they experienced mild anxiety; it is suggested that this intervention should be done for nursing students. Conducting more studies to evaluate the effect of this model on the nursing students' competency and anxiety after graduation and as a novice nurse is suggested. [ABSTRACT FROM AUTHOR]

Suicidal thoughts in adolescents are common. The COVID-19 pandemic may have further led to an increase. This cross-sectional random sample "online" survey study was conducted in 2021 on 703 adolescents in Iran using the Beck Scale for Suicidal Ideation. Univariate, bivariate, and multinomial regression analysis, and Odds Ratio (OR) were reported. The prevalence of suicidal ideation in this sample was 28% and with higher rates in female participants (p = 0.01). It was more prevalent in 16 to 21 years old participants than adolescents with age of 16 and lower. Participants who were academically successful had less suicidal thoughts. Considering the high rate of suicidal ideation among adolescents, it is an emergency that requires effective intervention. [ABSTRACT FROM AUTHOR]

Background: Nursing students are faced with a variety of challenges that demand effective cognitive and emotional resources. The physical and psychological well-being of the students plays a key part in the public health of the community. Despite the special lifestyle of nursing students, few studies have addressed chronic pain in this population. Accordingly, the present study aims to identify the predictors of chronic pain among nursing students. Methods: This cross-sectional study was conducted on 1,719 nursing students aged 18–42 years, between February and November 2019. Sampling was carried out in several stages. Data were collected using seven instruments, namely a demographics survey, the characteristics of chronic pain form, Spielberger State-Trait Anxiety Inventory (STAI), the Patient Health Questionnaire-9 (PHQ-9), the Bar-on Emotional Quotient Inventory, Academic Satisfaction Scale, and Procidano and Heller Social Support Scale. Descriptive statistics, multinomial logistic regression, and regression models were used to describe the characteristics of the pain and its predictive factors. Results: The average age of the participants was 22.4 ± 2.96 years. The results of univariate analysis showed that gender (P = 0.506), mother's education (P = 0.056, P = 0.278, P = 0.278), father's education (P = 0.817, P = 0.597, P = 0.41), place of residence (P = 0.215), depression (P = 0.501), grade point average (P = 0.488), academic satisfaction (P = 0.183) and chronic pain weren't significantly correlated with chronic pain in nursing students. The results of the multiple logistic regression models showed that chronic pain was positively correlated with age, social support, state anxiety, and trait anxiety (OR = 1.07, 95% CI: 1.02–1.12; OR = 0.95, 95% CI: 0.93–0.97; OR = 1.03, 95% CI: 1.02–1.05; and OR = 1.97, 95% CI: 0.95–1.99; respectively). Conclusion: The prevalence of chronic pain was relatively high in these students. In addition, age, social support, and anxiety could be important factors in the development or persistence of chronic pain in nursing students. The results also provided basic and essential information about the contributing factors in this area. However, consideration of factors such as referral for treatment, home medications for pain relief, and outcomes of chronic pain are suggested in future longitudinal studies. [ABSTRACT FROM AUTHOR]

Background: Resilience is a psychological trait and a protective factor that plays a vital role in coping with Chronic Pain (CP). Despite its importance, research has yet to fully clarify the concept and components of resilience in patients with CP. Accordingly, the present study aims to explain the components of resilience in patients with CP. Materials and Methods: The current qualitative study used a conventional content analysis methodology. The research population included all patients with CP who were referred to clinics affiliated with Shiraz University of Medical Sciences (south of Iran) from August 2021 to August 2022. Participants were selected using the purposive sampling method. In depth semi-structured interviews were conducted with 20 participants to collect information. Data analysis was conducted using MAXQDA 2020 software in conjunction with data collection efforts. Results: Generally, in the current study, 30 sub sub-categories, 11 sub-categories, and five main categories were extracted as components of resilience in patients with CP. The main categories of resilience against CP included the following: 1. emotional self regulation, 2. psychological flexibility, 3. self care, 4. appeal to religion--spirituality, and 5. internal resources and individual competencies. Conclusions: The present study highlights the different physical, mental, and religious-spiritual strategies that may contribute to resilience against pain. The resilience components identified in this study provide a foundation for healthcare professionals, particularly nurses, to design and implement diverse pain management strategies that enhance adjustment to CP conditions. [ABSTRACT FROM AUTHOR]

Introduction: Cancer is one of the leading causes of mortality in the world which imposes numerous psychological burdens on the patients. Psycho-spiritual interventions such as meaning-based therapies may help decrease these challenges. This systematic review and meta-analysis aim to investigate the effects of meaning-based psychotherapy on post-traumatic growth and death anxiety of patients with cancer. Methods: PubMed, Scopus, Proquest, Web of Science, and Google Scholar were searched until 30 September 2023. The Cochrane Collaboration’s tool was used to assess the quality of the included studies. A random-effect model was preferred, and statistical analysis was performed by STATA software version 17. Results: A total of 17 studies were included in the systematic review. Eleven articles examined the impact of meaning-based interventions on death anxiety and six articles examined post-traumatic growth in cancer patients. Ten studies with a total of 555 participants were included for analysis of the effect of logotherapy versus routine care on death anxiety. Analysis showed a significant decrease effect of logotherapy versus routine care on death anxiety (SMD, − 4.05 (− 6.20, − 1.90); I2, 98.38%). Three studies with a total of 364 participants were included for analysis of the effect of logotherapy versus routine care on post-traumatic growth in patients with cancer. Analysis showed a positive but non-significant effect of logotherapy versus routine care on post-traumatic growth (SMD, 2.05 (− 0.91, 5.01); I2, 99.08%). Conclusion: The qualitative analysis showed the positive impact of meaning-based psychotherapy interventions on death anxiety and post-traumatic growth in cancer patients, but the results of the meta-analysis on post-traumatic growth were not statistically significant. The review shows the need for more clinical trial studies in larger and more diverse samples in terms of cancer types and cultural background. [ABSTRACT FROM AUTHOR]

Background: Pain is a major clinical problem across all ages with serious social and economic consequences and a great negative impact on quality of life. Brain entrainment using binaural beats is a non-pharmaceutical intervention that is claimed to have analgesic effects in acute and chronic pain. We aimed to systematically review the available randomized clinical trials on the efficacy of binaural auditory beats in reducing adults' pain perception in acute and chronic pain. A systematic search in electronic databases including Medline (via PubMed), Web of Science, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), and Embase was performed. The search was completed through Google Scholar and a manual search of the reference lists of all included studies. Randomized clinical trials with full text available in English that investigated the effect of binaural auditory beats on pain perception in acute and chronic pain in adults were included. The risk of bias was assessed by the revised Cochrane risk-of-bias (RoB 2) tool. Furthermore, The GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach was used to assess the quality of the evidence. Sixteen studies (three on chronic pain and thirteen on acute pain perception) fulfilled the eligibility criteria. Because of substantial heterogeneity of the studies, a meta-analysis was inappropriate and this review focused on the narrative interpretation of the results. The risk of bias in most studies was high and the quality of evidence was low to very low. Although the effects of binaural beats on pain perception seem to be influenced by the etiology of pain or medical procedures, our review identifies alpha or a combination of tones in the range of delta to alpha as a potential non-pharmacological intervention in reducing acute pain. However, drawing a conclusion regarding the efficacy of binaural beats for chronic pain requires more high-quality studies. Registration: The protocol of this review was registered in PROSPERO (No. CRD42023425091). [ABSTRACT FROM AUTHOR]

Major depressive disorder is one of the most common psychiatric disorders in the world. It is essential to study and use effective, available, and affordable psychotherapy methods along with drug therapy to manage the symptoms of this disease. Therefore, the current study aimed to determine the effect of mobile phone-based logotherapy on depression, suicidal ideation, and hopelessness in patients with major depressive disorder by using a mixed-methods approach. In the first phase of this mixed-methods study, 70 patients completed the quantitative phase (control group = 35, intervention group = 35). The intervention group received an 8-week mobile-based logotherapy program via WhatsApp (one 180-min module per week) combined with sertraline, while the control group received just sertraline plus education about pharmacotherapy. Data was collected before, immediately after the intervention, and 3 months later using the Beck depression inventory short form items (BDI-13), the Beck hopelessness scale (BHS), and the Beck scale for suicide ideation (BSSI). Then, a qualitative study on the intervention group was conducted to explain the findings of the quantitative phase. The repeated measure MANOVA revealed a significant interaction effect of time and group on the set of dependent variables (F(6,63) = 25.218, P < 0.001). Qualitative analysis confirmed the efficacy of sertraline plus mobile-based logotherapy on depression, suicidal ideation, and hopelessness in the intervention group. Three key themes extracted from the participants' experiences of mobile-based logotherapy were "efficient instruction", "user-friendly intervention" and "constructive change". Mobile-based logotherapy through WhatsApp was an effective psychotherapy method for decreasing depression, hopelessness, and suicidal ideation in patients with major depressive disorder. It is suggested that educational, institutional, and technological infrastructure for providing and using mobile-based logotheapy for patients with major depressive disorder be considered in the mental health care system. [ABSTRACT FROM AUTHOR]

Major depressive disorder is one of the most common psychiatric disorders in the world. It is essential to study and use effective, available, and affordable psychotherapy methods along with drug therapy to manage the symptoms of this disease. Therefore, the current study aimed to determine the effect of mobile phone-based logotherapy on depression, suicidal ideation, and hopelessness in patients with major depressive disorder by using a mixed-methods approach. In the first phase of this mixed-methods study, 70 patients completed the quantitative phase (control group = 35, intervention group = 35). The intervention group received an 8-week mobile-based logotherapy program via WhatsApp (one 180-min module per week) combined with sertraline, while the control group received just sertraline plus education about pharmacotherapy. Data was collected before, immediately after the intervention, and 3 months later using the Beck depression inventory short form items (BDI-13), the Beck hopelessness scale (BHS), and the Beck scale for suicide ideation (BSSI). Then, a qualitative study on the intervention group was conducted to explain the findings of the quantitative phase. The repeated measure MANOVA revealed a significant interaction effect of time and group on the set of dependent variables (F(6,63) = 25.218, P < 0.001). Qualitative analysis confirmed the efficacy of sertraline plus mobile-based logotherapy on depression, suicidal ideation, and hopelessness in the intervention group. Three key themes extracted from the participants' experiences of mobile-based logotherapy were "efficient instruction", "user-friendly intervention" and "constructive change". Mobile-based logotherapy through WhatsApp was an effective psychotherapy method for decreasing depression, hopelessness, and suicidal ideation in patients with major depressive disorder. It is suggested that educational, institutional, and technological infrastructure for providing and using mobile-based logotheapy for patients with major depressive disorder be considered in the mental health care system. [ABSTRACT FROM AUTHOR]

Background: Since clinical experience is challenging, identifying the factors influencing the learning process and acquiring clinical competence in mental departments is essential. Limited studies have investigated students' concerns regarding attending this clinical setting and how they are mentally and academically prepared. Aim/question: Explaining the various aspects of nursing students' preparation to attend the mental clinical environment. Methods: This qualitative study was conducted on bachelorette nursing students and college professors using in-depth, semi-structured interviews. Inductive content analysis was used for data analysis, and Lincoln and Guba's criteria were used for the rigor of the data. Results: The participants' viewpoints regarding how to prepare nursing students to enter mental clinical settings can be summarized in 4 categories: "understanding the students' concerns" "understanding the students' expectations" "the necessity of the students' mental preparation" and "preparing the scientific materials needed to attend in a mental ward". Conclusion: Nursing students have fears and worries about entering mental departments and have expectations of themselves and their instructors. To help students deal with these concerns, psychological and educational preparations should be provided, among which the role of new educational technologies can be mentioned. [ABSTRACT FROM AUTHOR]

Background: The evaluation of spiritual requirements in patients can facilitate the delivery of spiritual care as an essential element of holistic healthcare. The objective of this research was to develop and evaluate the psychometric properties of a questionnaire on patients' spiritual needs in medical-surgical hospital settings. Methods: This research utilized an exploratory sequential design, involving the creation of a pool of items through both inductive and deductive methods. The questionnaire's psychometric properties were then assessed using various techniques, such as face and content validity, item analysis, construct validity, internal consistency, stability, confirmatory factor analysis, and the Gradual Response Model of Samejima. The data analysis was conducted using MPLUS software, version 5.1. Results: The study's results showed that a four-factor structure (interpersonal connectedness, relationship with God, transcendence, and peaceful environment) with 43 items was successfully extracted through exploratory factor analysis. The confirmatory factor analysis supported the findings of the exploratory factor analysis. The Cronbach's alpha coefficients for the scale and factors ranged between 0.83 and 0.95. Furthermore, the interclass correlation coefficients for the scale and factors were between 0.89 and 0.96. Conclusions: The questionnaire designed in this study is a reliable and valid instrument that can be utilized by healthcare, educational, and research institutions to evaluate the spiritual needs of patients in medical-surgical hospital settings. [ABSTRACT FROM AUTHOR]

Objectives: There is a considerable debate regarding the possible dependence between depression and suicidal ideation treatments. The present study used a novel mediation approach in a randomized comparison of pharmacotherapy and combined therapy to explore whether depressive symptoms mediate the association between treatment and suicidal ideation and whether it depends on the treatment condition. Design: This study is a randomized, controlled, parallel group (1:1), clinical trial using a novel mediation approach for longitudinal data. Latent difference score modelling was utilized to investigate whether changes in depressive symptoms drive subsequent changes in suicide ideation. Method: Participants were 94 depressive suicidal outpatients who were assessed regarding depressive symptoms and suicidal ideation over the course of an experiment (0–2‐7 months). Direct and indirect associations between (change in) depressive symptoms and (change in) suicidal ideation were explored using Pearson's correlations and latent difference score model. Results: The results showed that depression treatment affects not only suicidal ideation directly but also its influence on suicidal ideation occurs via improvement in depressive symptoms. It was found a more significant effect of combining pharmacotherapy and PPT (in comparison with the pharmacotherapy alone) on the early and late improvements of suicidal ideation (Δ 0–2 and Δ 2–7) via the early improvement of depressive symptoms (Δ 0–2). Conclusions: The findings indicate that changes in depressive symptoms preceded changes in suicidal ideation. Our results highlighted that improving depressive symptoms could be a primary target in treating patients with depression experiencing suicidal thoughts. [ABSTRACT FROM AUTHOR]

Background: This study aimed to determine the prevalence of chronic pain and its contributing factors among teenagers aged 12-21 years in Shiraz, Iran. Methods: This cross-sectional study was conducted on adolescents aged 12-21 years. Demographic variables of the adolescents and their parents as well as the pain characteristics were assessed. Descriptive statistics, multinomial logistic regression, and regression models were used to describe the characteristics of the pain and its predictive factors. Results: The prevalence of chronic pain was 23.7%. The results revealed no significant difference between the male and female participants regarding the pain characteristics, except for the home medications used for pain relief. The results of a chi-square test showed that the mother's pain, education, and occupation, and the father's education were associated significantly with chronic pain in adolescents (P < 0.05). Multinomial logistic regression also showed the mother's history of pain played a significant role in the incidence of adolescents' chronic pain. Conclusions: The prevalence of chronic pain was relatively high in these adolescents. The results also provided basic and essential information about the contributing factors in this area. However, consideration of factors such as anxiety, depression, school problems, sleep, and physical activity are suggested in future longitudinal studies. [ABSTRACT FROM AUTHOR]

Background: Psycho-educational interventions might play a crucial role in the management of diseases. This study was conducted to determine the effect of psycho-educational interventions via social networks on self-efficacy and anxiety among Coronavirus Disease 2019 (COVID-19) patients in home quarantine. Materials and Methods: This randomized clinical trial was conducted on 72 COVID-19 patients, in Shiraz, Iran, in 2020. The patients were randomly assigned to an intervention and control group. Patients in the intervention group underwent psycho-educational interventions daily for 14 days. The data were collected using the Strategies Used by People to Promote Health (SUPPH) questionnaire and the State-Trait Anxiety Inventory (STAI) before and 2 weeks after the intervention. Results: After the intervention, the mean score of SUPPH was mean = 120.75 (16.56) and mean(SD) 111.27 (14.40) in the intervention and control groups, respectively. Moreover, after the intervention, the mean score of state and trait anxiety were 34.69 (10.75) and 38.31 (8.44) in the intervention group, and mean(SD) 45.75 (13.01) and 43.50 (8.44) in the control group, respectively. After the intervention, a difference was observed between the groups concerning the mean score of SUPPH (t 70 = 2.58; p = 0.01), state anxiety (F 1 = 16.52; p < 0.001), and trait anxiety (t 70 = −2.49; p = 0.01). Conclusions: Considering the effectiveness of psycho-educational interventions in self-efficacy and anxiety, healthcare providers are recommended to use these interventions in COVID-19 patients. [ABSTRACT FROM AUTHOR]

Background: Pain, as a psychological experience, is caused by complex interactions among sensory‐discriminative, motivational‐affective, and cognitive‐evaluative dimensions. The psychosocial approach is one of the important approaches in managing musculoskeletal pain in patients. Therefore, this study aimed to determine and compare the effects of psychosocial skills training on pain intensity in patients with acute and chronic musculoskeletal pain. Methods: In this quasi‐experimental study, 64 patients with acute and chronic musculoskeletal pain were selected using convenience sampling. Both groups received psychosocial training in pain management in groups of 8–10 people over six 1‐h sessions. The data were collected at baseline, after the intervention, and 3 months later using a numerical rating scale (NRS). Then, the data were entered into the SPSS 22 software and were analysed using descriptive and inferential statistics. Results: In this study, the mean age of the participants was 50.10 ± 10.63 years and 60.9% of them were female. Based on the results, time had a significant effect on pain intensity (p < 0.001), but the effect of group on pain intensity was not statistically significant (p = 0.07). The group × time effect on pain intensity was also statistically significant (p < 0.001). Conclusion: Psychosocial training had a positive impact on the reduction of pain among the patients with acute and chronic musculoskeletal pain. Additionally, the training was more effective in patients with acute pain due to early training. These findings can help healthcare providers in the field of musculoskeletal pain management, especially in patients with acute pain. [ABSTRACT FROM AUTHOR]

Objectives. Most research studying the relationship between job stress and chronic pain has relied on physiological responses. This study aims to determine psychosocial mechanisms by which job stress can influence chronic pain in workers. Methods. This cross-sectional study was carried out among 793 workers in gas and oil platforms or petroleum refinery plants in southern Iran. Structural equation modelling was applied to evaluate direct, indirect and total effects of job stress on chronic pain in the presence of mediating variables (work–family conflict and depression). Results. Job stress (B = 0.024, β = 0.477), 95% confidence interval (CI) [0.016, 0.032], work–family conflict (B = 0.031, β = 0.446), 95% CI [0.023, 0.038], depression (B = 0.046, β = 0.224), 95% CI [0.028, 0.064] and work experience (B = 0.083, β = 0.380), 95% CI [0.065, 0.101] had significant direct effects on chronic pain. Indirect paths from job stress to chronic pain via depression (B = 0.002, β = 0.042), 95% CI [0.001, 0.003] and work–family conflict (B = 0.004, β = 0.085), 95% CI [0.003, 0.006] were significant. Conclusions. Given that depression and work–family conflict mediate the effects of job stress on pain, stress management programmes for workers might include various strategies to reduce negative thoughts as well as cognitive biases and minimize role conflicts between work and private life. [ABSTRACT FROM AUTHOR]

Background: Chronic pain (CP) among adolescents has received less attention than adultsandthere is limited qualitative studies about it in Iran. This study explored the experience of CP among adolescents.Methods: This exploratory qualitative study was conducted in April-October 2019. Participants were 14 adolescent students purposively recruited from schools in Shiraz, Iran. Semi-structured interviews were conducted for data collection and data analysis was done through conventional content analysis.Findings: Adolescents' experiences of CP came into nine subcategories and three main categories, namely perceived suffering, attempt to overcome pain, and attempt to find sources of support.Conclusion: Adolescents with CP experience physical and mental suffering and attempt to manage their pain and its associated suffering through different physical and psychological strategies and using different sources of support such as family, peers, healthcare providers, and school staff. [ABSTRACT FROM AUTHOR]

Copyright of Investigacion & Educacion en Enfermeria is the property of Universidad de Antioquia, Facultad de Enfermeria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives Feeling of loneliness and aggression are common problems in the elderly living in nursing homes that can have serious psychological and physical consequences for them. Due to the growing number of the elderly population, it is essential to use practical strategies for reducing their isolation and aggression. This study aims to assess the effect of combining adapted physical and artistic activities on feeling of loneliness and aggression in the elderly living in nursing homes. Methods & Materials In this quasi-experimental study, 68 older residents of a nursing home in Shiraz, Iran with feeling of loneliness and aggression and without acute psychological and physical problems participated, who were selected using a convenience sampling method and then assigned into two groups of control and intervention by block randomization method. The control group received routine care, while the intervention group participated in 16 sessions of adapted physical and artistic activities. Data were collected using the UCLA Loneliness Scale and Buss-Perry Aggression Questionnaire before and immediately after the intervention. Data were analyzed using descriptive (Mean±SD, and frequency) and inferential statistics (Chi-square test, Mann-Whitney U test, and Wilcoxon test) in SPSS software, version 22. Results The participants' mean age was 70.93±7.99 years in total, and 69.1% were women. The scores of loneliness and aggression significantly reduced after the intervention in the intervention group (P<0.001). The scores of loneliness (P<0.001) and aggression (P=0.001) in the intervention group were significantly lower than in the control group. Conclusion Feeling of loneliness and the level of aggression in the elderly living in nursing homes can be reduced significantly by combining adapted physical and artistic activities. This practical and costeffective intervention can be used to reduce feeling of loneliness and aggression in the elderly living in nursing homes. [ABSTRACT FROM AUTHOR]

The present study was examined the effect of a combined treatment (sertraline and positive psychotherapy) compared to the pharmacotherapy (sertraline) alone on hopelessness and suicidal ideation of patients with major depressive disorder (MDD). Patients were 100 depressed outpatients treated with either combined treatment (n = 50) or pharmacotherapy alone (n = 50). Measures were taken multiple times over the course of treatment (at baseline, 2, and 7 months later). The results of the repeated measures ANOVAs showed that pharmacotherapy alone and combined treatment had beneficial effects with a superior effect of combined treatment on hopelessness and suicidal ideation. Our results suggest that pharmacotherapy alone may not be sufficient to protect patients with MDD from suicidal ideation, especially in the early phase of the treatment with sertraline. The present results suggest that combination of pharmacotherapy and psychotherapy could be an effective option for treating major depressive disorder in both the short and long term. [ABSTRACT FROM AUTHOR]

Background: Although there is a growing body of evidence linking parenting styles to health outcomes, little emphasis has been dedicated to how parenting styles affect chronic pain in adolescents. Given the high prevalence of chronic pain in adolescents and taking into consideration the complexity of chronic pain and the factors affecting it, further research is needed to better understand the processes through which parenting styles affect adolescents' pain. The purpose of the present study was to explore the mediating role of maladaptive schemas in the association between different parenting styles and chronic pain. Method: 1302 adolescents aged 12 to 21 in Shiraz, Iran, were randomly selected to participate in this study. To identify adolescents with chronic pain, screening questions based on the 11th revision of the International Classification of Diseases were used. Buri's Parental Authority Questionnaire (PAQ), and Young's Schema Questionnaire-Short Form (YSQ-SF) were used to assess the parenting styles and maladaptive cognitive schemas, respectively. The structural equation modeling approach was carried out to evaluate the direct, indirect, and total effects of different parenting styles on chronic pain. Results: The results in the SEM models revealed that disconnection/ rejection (β = − 0.043, 95%CI = − 0.07 to − 0.02), impaired autonomy/ performance (β = − 0.01, 95%CI = − 0.02 to -0.003), over-vigilance/inhibition (β = − 0.007, 95%CI = − 0.01 to − 0.008), and impaired limits schemas (β = − 0.004, 95%CI = − 0.006 to − 0.002) significantly mediated the protective effects of the authoritative parenting style on chronic pain. It was also found that the mediating effects of disconnection/ rejection (β = 0.01, 95%CI = 0.01 to 0.02), and over-vigilance/ inhibition (β = 0.002, 95%CI = 0.001 to 0.02) existed in the relationship between the authoritarian style and chronic pain. The permissive style may also affect chronic pain through disconnection/ rejection (β = 0.004, 95%CI = 0.001 to 0.01), other-directedness (β = 0.01, 95%CI = 0.005 to 0.015), and impaired limits schemas (β = 0.05, 95%CI = 0.04 to 0.06). Discussion: The findings of the present study showed that maladaptive cognitive schemas play a mediating role in the relationship between parenting styles and chronic pain in adolescents. It seems that the interventions that target the effective communication between the parents and the adolescents can be considered as an important part in the chronic pain management in adolescents. [ABSTRACT FROM AUTHOR]

Introduction: Previous studies into Low Back Pain (LBP) assessed the effects of physical interventions or face-to-face (FTF) education mostly in western cultures. The present study aimed to compare the effects of multimedia and FTF pain management education (PME) on pain intensity and pain catastrophizing among participants with chronic LBP. Methods: This double-blind randomized controlled clinical trial was conducted on ninety participants with chronic LBP randomly allocated to either multimedia, FTF, or control groups. Participants in the multimedia group received PME through watching seven educational CDs at home and their counterparts in the FTF group received the same educations in seven weekly FTF educational sessions. Pain intensity (using a numerical rating scale) and pain catastrophizing (using the Pain Catastrophizing Scale) were assessed before, immediately after, and one month after the study intervention. The effects of the interventions were assessed using the repeated-measures multivariate analysis of variance (MANOVA). Effect size and minimal detectable change (MDC) were reported for both variables. The regression model used in the present study was Generalized Estimating Equations (GEE). Findings: The findings of MANOVA showed the significant effects of time on pain intensity and pain catastrophizing (P<0.001). The Tukey's test showed that before and immediately after the intervention, the mean scores of pain intensity and pain catastrophizing in the FTF and PME groups were significantly different from the control group (P<0.001 and P = 0.001, respectively). MDC did not show clinically significant changes in the mean score of pain intensity and GEE revealed significant difference among the groups. Conclusion: The findings suggested that multimedia PME is as effective as FTF education in reducing pain intensity and pain catastrophizing among participants with LBP. Future studies into the effects of education on LBP are recommended to consider longitudinal designs, a reliable cutoff score for pain catastrophizing, and participants' physical ability. IRCT registration code: IRCT20180313039074N1. [ABSTRACT FROM AUTHOR]

Copyright of Investigacion & Educacion en Enfermeria is the property of Universidad de Antioquia, Facultad de Enfermeria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Investigacion & Educacion en Enfermeria is the property of Universidad de Antioquia, Facultad de Enfermeria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Investigacion & Educacion en Enfermeria is the property of Universidad de Antioquia, Facultad de Enfermeria and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The quality of care that older adult patients receive during hospitalization is directly associated with the perception, knowledge, and skills of the healthcare team. This qualitative study was conducted to explore the concept of age discrimination perceived by hospitalized older adult patients. Methods: The present exploratory qualitative study was conducted using conventional content analysis. The purposive sampling method was used to recruit participants and the sampling continued until data saturation. A total of 21 individuals comprising of 12 hospitalized older adult patients, 5 family caregivers, 3 nurses, and a physician were enrolled in the study. Data were collected through 21 face-to-face, semi-structured, in-depth interviews. Data were analyzed using the qualitative content analysis method as described by Elo and Kyngäs. Results: The analysis of the interview data resulted in 4 main categories, namely injustice perceptions, interactional injustice, procedural injustice, and organizational injustice. Conclusion: The findings of the study indicated that older adult patients perceive the occurrence of age discrimination by healthcare teams and inequalities in the provided care in hospitals. It is therefore important to address ageism and subsequent inequalities through short- and long-term policies and plans, as well as standardization and transformation of the present condition of hospitals to become an age-friendly environment. [ABSTRACT FROM AUTHOR]

Background: Although the context of parenting has been incorporated into psychosocial pain research, very little attention has been paid to how parenting styles influence chronic pain in adolescents. The present study aimed to investigate the mediating role of self-esteem, emotional intelligence, and psychological distress in the association between parenting styles and chronic pain. Method: Seven hundred and thirty nine adolescents and their parents participated in this study. To identify adolescents with chronic pain, screening questions based on the 11th revision of the International Classification of Diseases were used. Baumrind parenting style questionnaire was used to assess the parenting style (permissive, authoritarian, and authoritative parenting styles). The structural equation modelling (SEM) was carried out in M-Plus version 6 to evaluate the direct, indirect, and total effects of different parenting styles on chronic pain. Results: The results in the SEM models revealed that only the indirect paths from authoritative and authoritarian parenting styles to pain through emotional intelligence (βauthoritative = − 0.003, 95% CI = − 0.008 to − 0.003; βauthoritarian = 0.001, 95% CI = 0.001 to 0.003) and psychological distress (βauthoritative = − 0.010, 95% CI = − 0.021 to − 0.004; βauthoritarian = 0.008, 95% CI = 0.004 to 0.016) were significant. Indirect paths from permissive style to pain and the mediating role of self-esteem were not significant. Discussion: Emotional intelligence and psychological distress significantly mediated the effects of authoritative and authoritarian parenting styles on chronic pain. The current results support the notion that interventions targeting effective parent–adolescent communication may be an important part of chronic pain management in adolescents. Moreover, the results provide rationale for targeting emotional intelligence and psychological distress in adolescents by explicitly teaching effective communication skills, expressing opinions and minds, and emotion regulation strategies. [ABSTRACT FROM AUTHOR]

Introduction: Chronic pain negatively affects adolescents' quality of life. Therefore, it is important to seek for ways to effectively manage pain, which may, in turn, promote quality-of-life dimensions in this population. However, there are many barriers including geographical distance which prevent most adolescents from receiving an effective treatment for chronic pain. The present study aimed to investigate the effect of a smartphone-based pain management application compared with face-to-face pain management program and wait-list control on the pain intensity and quality-of-life dimensions in adolescents with chronic pain. Methods: This study used a cluster double-blinded randomized parallel-group design with school as the unit of randomization. Participants included were 192 adolescents with chronic pain. The questionnaires (pain intensity and quality of life measuring physical, emotional, social, and school dimensions) were completed at the baseline, immediately at the end of pain management program and three months after the end of the program. Results: Repeated measures ANOVAs with adjustment for clustering effect showed that there were significant main effects of time on ratings of pain intensity (p < 0.01), physical (p < 0.005), emotional (p < 0.008), social (p < 0.001), and school (p < 0.005) dimensions of quality of life. There was also a significant main effect of group on ratings of emotional (p < 0.001), social (p < 0.009), and school (p < 0.002) dimensions. The interaction of group × time for emotional (p < 0.004), social (p < 0.001), and school (p < 0.005) dimensions of quality of life was statistically significant. Discussion: The findings suggest that smartphone-based pain management program, which is a highly accessible and cost-effective intervention, may provide benefits similar to a face-to-face intervention and shows promise for being effective on emotional, social, and school dimensions of quality of life in adolescents with different types of chronic pain. The study was registered within the Iranian Registry of Clinical Trials (IRCT20180808040744N2). [ABSTRACT FROM AUTHOR]

The development, implementation, and qualitative evaluation of smartphone-based pain management applications may provide an opportunity for more optimal management of pediatric pain in the homesetting. The present mixed-method study was conducted to assess a smartphone-based pain management application regarding the feasibility, adherence, participant satisfaction, and effectiveness on pain intensity and quality of life in adolescents with chronic pain. The study was carried out in the quantitative and qualitative stages using a mixed-method approach. The quantitative stage included 128 adolescents who met the ICD-11 criteria of chronic pain. After random allocation, adolescents allocated to the intervention group received a pain management program through a smartphone-based application. No education was given to the adolescents in the control group. The adolescents were assessed regarding pain intensity and different dimensions of quality of life at pre-intervention, post-intervention, and three-month follow-up. The findings in the quantitative stage were explained by qualitative interviews. The findings of the quantitative stage showed significant improvements in the pain intensity, emotional, social, and school functioning but not in the physical functioning of the adolescents. A high level of adherence (78.12%) and satisfaction (Mean = 26.45, SD = 6.45) with thes martphone-based pain management program was found. Based on the qualitative interviews, adolescents' pain management strategies can be classified in three main categories: physical management, psychological management, and interpersonal resources. The results confirm the positive effect of a smartphone-based pain management program on the pain intensity and different dimensions of quality of life of adolescents with chronic pain. Within the context of chronic pain management, a mobile application incorporating both the psychological and physical management of pain may help adolescents with chronic pain to reduce the negative impacts of pain on their life. [ABSTRACT FROM AUTHOR]

Background: There is evidence suggesting that quarantine might have undesirable psychological impacts on the patients. Therefore, it is important to seek for ways to increase the resilience and alleviate the psychological pressure of the patients who are quarantined due to infection with COVID-19. The present study was conducted to assess an online multimedia psychoeducational intervention regarding the feasibility, adherence, patient satisfaction and effectiveness on resilience and perceived stress of patients hospitalized with confirmed COVID-19. Method: This was a pilot cluster randomized parallel-controlled trial with hospital wards as the units of randomization. Participants in this fully online trial were 50 consecutive patients who were hospitalized in 2 hospitals in Shiraz, after being diagnosed with COVID-19. Before the beginning of the intervention, four inpatient wards inside two of the hospitals were randomly assigned to either intervention or control conditions. All eligible participants in the wards allocated to the intervention condition received online multimedia psychoeducational interventions during the 2 weeks, whilst the patients in the wards allocated to the control condition were offered the opportunity to receive telephone-based psychological counseling if needed. Psychoeducational interventions mainly included cognitive–behavioural techniques, stress management techniques, mindfulness-based stress reduction and positive psychotherapy. The patients were assessed regarding resilience and perceived stress at baseline and after two weeks. Results: Of 27 patients starting multimedia psychoeducational interventions, 26 (96.29%) completed post-assessments. A high level of adherence (80.76%) and satisfaction (Mean = 29.42; SD = 4.18) with the online multimedia psychoeducational interventions was found. Compared with the control group, the patients who used online multimedia psychoeducational interventions reported greater resilience (Meanintervention = 81.74; Meancontrol = 72.86; adjusted t (46) = 2.10; p = 0.04; CI: 0.39 to 17.38; dppc2 = 0.83) and fewer perceived stress (Meanintervention = 22.15; Meancontrol = 29.45; adjusted t (46) = 2.66; p = 0.01; CI: − 12.81 to − 1.78; dppc2 = − 0.77) after 2 weeks. Discussion: The findings of the present study provided a successful first attempt at implementing feasible online multimedia psychoeducational interventions to promote resilience and mitigate stress among the patients who were hospitalized due to infection with COVID-19. The present results could help mental health professionals to determine which psychological techniques should be emphasized to promote patients' resilience in the context of COVID-19 disease. Trial registration: Iranian Registry of Clinical Trials, IRCT20201001048893N1. Retrospectively registered, 29 Jan 2021. [ABSTRACT FROM AUTHOR]

Background: Taking into account the differences in job requirements and conditions, it is expected that workers in some occupations are more susceptible to pain than others. Objective: To examine the prevalence of chronic pain among workers of several petrochemical and petroleum refinery plants. We also examined the predictive role of psycho-familial variables (depression, work-family conflict and job stress) in causing chronic pain when controlling for demographic and occupational factors. Methods: This cross-sectional study was carried out among 674 workers. Those with chronic pain were identified by affirmative answers to screening questions based on the ICD-11 criteria. Results: There were 162 (24.0%; 95% CI 20.8% to 27.3%) workers meeting the ICD-11 criteria for chronic pain. Headache was the most frequently reported pain (29.9%). We found a significantly (p=0.03) higher prevalence of pain among the middle age than in other age groups. Chronic pain more frequently affected divorced/widowed workers (p<0.001), and those with more work experience (p=0.04). Workers with chronic pain reported significantly higher levels of depression (p<0.001), job stress (p=0.007), and work-family conflict (p<0.001). After controlling for demographic and occupational factors, depression (p<0.001) and work-family conflict (p=0.003) were found to be independent predictors of chronic pain among studied workers. Conclusion: Workers who experience higher levels of depression, work-family conflict and job stress might be more prone to chronic pain. The majority of these factors are modifiable, and the problem may thus be solved by establishing appropriate screening programs, and availability of proper services and education. [ABSTRACT FROM AUTHOR]

Purpose: Reduction in pain following multidisciplinary treatment is most often associated with a reduction in disability. To further elaborate the relationship between pain intensity and disability, the present study investigated three main questions: first, whether multidisciplinary treatment leads to a significant improvement in pain, disability and psychological variables (depression, pain acceptance and catastrophizing). Second, it was examined whether pain reduction may account for significant changes in the psychological variables (pre- to follow-up change scores). Finally, it was analyzed whether the psychological changes mediate the association between reduction in pain and in disability after controlling for age, sex and pain history. Patients and methods: Patients suffering from chronic musculoskeletal pain (n=279) attended a German inpatient multidisciplinary program lasting 15 consecutive days on average, with self-report data collected at pretreatment, posttreatment and three-month follow-up. Results: Repeated measures ANOVAs showed a significant improvement in pain intensity, disability, pain acceptance, catastrophizing and depression at posttreatment and follow-up. Univariate regression analyses revealed that changes in pain intensity accounted for significant changes in depression, pain catastrophizing and pain acceptance (pre- to follow-up change scores). The results of Multiple Mediation Procedure showed that pain reduction did affect reduction in disability through improvement of depression, catastrophizing and acceptance. Conclusion: Our findings support a cognitive-behavioral model of pain that posits an important role for pain-related cognitive and emotional processes in long-term outcomes following multidisciplinary pain treatment, in particular for the modulation of disability due to pain. The results add evidence to the notion that pain-related cognitions are dynamic features varying over time dependent on the internal situation. Perspective: The current findings are relevant to the management of patients with musculoskeletal pain. The results support the notion that, in contrast with the view of enduring personality traits, pain-related cognitions and emotions reflect a situational response that varies over time. [ABSTRACT FROM AUTHOR]

Introduction: Nurses are exposed to various injuries in the upper and lower extremities. Aim: To evaluate features of chronic pain in the upper and lower extremities and factors associated with the intensity of chronic pain among nurses. Materials and Methods: This cross-sectional study recruited nurses with chronic pain using census sampling (n=414). Data were collected using a structured self-administered questionnaire. Data analysis was performed by using descriptive and inferential statistics. Results: The findings of this study shows that 414 subjects displayed chronic pain in their upper or lower extremities; 277 subjects (66.9%) reported chronic pain in the upper extremity and 137 subjects (33.1%) intheir lower extremity. The quality of pain, pain frequency, and pain-related disabilities were statistically different between nurses with upper limb pain and lower limb pain (p<0.05). The intensity of pain was not statistically different between the two groups of nurses with chronic pain in either upper or lower extremities (p>0.05). Results also showed that pain intensity was significantly associated with age, time spent in a new work position, evening shift work, and levels of pain frequency (p<0.05). Conclusion: Nurses usually complain of chronic pain in different parts of their bodies. The characteristics of pain are different in upper and lower body extremities. However, there was no significant difference in pain intensity between upper and lower limbs. Thus, implementing the preventive intervention based on the characteristics of chronic pain would help in improving the quality of nursing care. [ABSTRACT FROM AUTHOR]

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Purpose: Evidence of the effectiveness of multidisciplinary treatment with a focus on neuropathic pain is still rare. The present study investigated whether multidisciplinary treatment leads to improvement of neuropathic pain in outcome (pain intensity and disability) and psychological (depression, pain acceptance, and catastrophizing) variables at posttreatment and 3-month follow-up. We examined whether and to what extent psychological changes can predict long-term outcome at 3-month follow-up, when other variables are controlled for (baseline characteristics and changes in pain parameters).Patients and methods: Patients suffering from a chronic neuropathic pain condition (n=141) attended an inpatient multidisciplinary program lasting about 15 continuous days with self-report data collected at pretreatment, posttreatment, and 3-month follow-up. Results: Repeated-measures ANOVAs showed a significant improvement of pain intensity, disability, pain acceptance, catastrophizing, and depression at posttreatment. These improvements remained stable over the 3-month follow-up for all variables except for depression. The inclusion of psychological changes in multiple regression analyses greatly increased the variance in outcome, explained by baseline characteristics and changes in pain parameters.Conclusion: The results could help clinicians to determine which variables should be emphasized during inpatient treatment and during the follow-up period, in order to maintain the gains after an inpatient multidisciplinary treatment for neuropathic pain.Perspective: The present study demonstrates the beneficial effects of an inpatient multidisciplinary program for neuropathic pain and further question the resistant nature of neuropathic pain to treatment. The results add evidence to the relevance of cognitive-behavioral models of pain positing an important role for pain-related thoughts and emotions in long-term outcome following multidisciplinary pain treatment. [ABSTRACT FROM AUTHOR]

Background: Chronic pain in adolescents is prevalent, disabling, and costly. So, providing methods to improve the multidisciplinary management of adolescents' pain is important. Objective: This study aimed to determine the effect of a mobile-based educational application on the severity of chronic pain in adolescents. Material and Methods: This study used a double-blind randomized parallel-group design. 192 adolescents with chronic pain were assigned to three conditions equally (Face-to-face educational program, mobile-based educational program, and Wait-list control condition). Participants in the group of mobile-based educational program completed four modules in the area of pain, stress and anger management and communication skills (1 module per week) via their mobile application. The participants completed pain intensity questionnaire at the baseline, immediately after the mobile-based educational program, and three months after the program. The data were analyzed by SPSS 22 software. Results: There were significant main effects of time on ratings of pain intensity (P<0.01). The main effects of group on ratings of pain intensity (P<0.10) and pain diagnosis on ratings of pain intensity (P<0.84) weren't significant. There were not significant interactions of group × time (P<0.09) and pain diagnosis × time (P<0.69) for pain intensity. Conclusion: Over time, pain intensity decreased, but there were no differences in pain intensity across treatment groups. It seems that adolescents with chronic pain who do not have access to pain care may benefit from remote pain management programs delivered by mobile application. [ABSTRACT FROM AUTHOR]

Background: The development, implementation and qualitative evaluation of smartphone-based pain management applications may provide an opportunity for more optimal management of pediatric pain. Objective: To assess a smartphone-based pain management application regarding the feasibility, adherence, participant satisfaction and effectiveness on pain intensity and quality of life in adolescents with chronic pain. Material and Methods: The study was carried out in the quantitative and qualitative stages using a mixed method approach. The quantitative stage included 128 adolescents who had chronic pain. The intervention group received a pain management program through a smartphone-based application. The adolescents were assessed regarding pain intensity and different dimensions of quality of life at three phases. The findings in the quantitative stage were explained by qualitative interviews. Results: The findings of the quantitative stage showed significant improvements in pain intensity, emotional, social and school functioning, but not in physical functioning of the adolescents. A high level of adherence (78.12%) and satisfaction (26.45±6.45) with the smartphone-based pain management program was found. Based on the qualitative interviews, adolescents' pain management strategies can be categorized in three main categories: physical management, psychological management, and interpersonal resources. Conclusion: The results confirm the positive effect of a smartphone-based pain management program on the pain intensity and different dimensions of quality of life of adolescents with chronic pain. A mobile application incorporating both the psychological and physical management of pain may be able to help adolescents with chronic pain to reduce the negative impacts of pain on their life. [ABSTRACT FROM AUTHOR]

Background: Low back pain (LBP) is a very common problem among different age groups. Objective: The present study aimed to compare the effects of multimedia and FTF pain management education (PME) on pain intensity and pain catastrophizing (PC) among patients with chronic LBP. Material and Methods: This single-blind randomized controlled clinical trial was conducted on ninety patients with chronic LBP selected from three healthcare centers affiliated to FUMS. Participants were randomly allocated to a multimedia, an FTF, and a control group. Participants in the multimedia PME group received PME through watching seven educational CDs and their counterparts in the FTF PME group received the same educations in seven weekly FTF educational sessions. Data were collected before, immediately after, and one month after the study intervention. To analyze treatment effects, MANOVA with Tukey post hoc test was performed. Effect size was reported where appropriate. Clinical outcomes (Minimal Detectable Change (MDC)) for pain intensity also reported. Results: The results indicated that the two interventions exerted significant statistical effects on decreasing the participants' pain intensity and catastrophizing compared to the control group. The findings indicated non-significant main effect of time and non-significant difference between groups for mean differences of immediately and one month after intervention for intensity and PC scores. The MDC for pain intensity also showed no significant clinical difference. Conclusion: Both multimedia and FTF PME are effective in significantly reducing pain intensity and PC among patients with chronic LBP. Therefore, PME through multimedia and FTF is recommended for chronic LBP management. [ABSTRACT FROM AUTHOR]

Background: A large number of population-based studies of chronic pain have considered neuropathic sensory symptoms to be associated with a high level of pain intensity and negative affectivity. The present study examines the question of whether this association previously found in non-selected samples of chronic pain patients can also be found in chronic pain patients with underlying pathology of neuropathic sensory symptoms. Methods: Neuropathic sensory symptoms in 306 patients with chronic pain diagnosed as typical neuropathic pain, radiculopathy, fibromyalgia, or nociceptive back pain were assessed using the Pain DETECT Questionnaire. Two separate cluster analyses were performed to identify subgroups of patients with different levels of self-reported neuropathic sensory symptoms and, furthermore, to identify subgroups of patients with distinct patterns of neuropathic sensory symptoms (adjusted for individual response bias regarding specific symptoms). Results: ANOVA (analysis of variance) results in typical neuropathic pain, radiculopathy, and fibromyalgia showed no significant differences between the three levels of neuropathic sensory symptoms regarding pain intensity, pain chronicity, pain catastrophizing, pain acceptance, and depressive symptoms. However, in nociceptive back pain patients, significant differences were found for all variables except pain chronicity. When controlling for the response bias of patients in ratings of symptoms, none of the patterns of neuropathic sensory symptoms were associated with pain and psychological factors. Conclusion: Neuropathic sensory symptoms are not closely associated with higher levels of pain intensity and cognitive-emotional evaluations in chronic pain patients with underlying pathology of neuropathic sensory symptoms. The findings are discussed in term of differential response bias in patients with versus without verified neuropathic sensory symptoms by clinical examination, medical tests, or underlying pathology of disease. Our results lend support to the importance of using adjusted scores, thereby eliminating the response bias, when investigating self-reported neuropathic symptoms by patients. [ABSTRACT FROM AUTHOR]

Background: This study explored the effectiveness of family psycho-education in reducing patients' symptoms and on family caregiver burden. Methods: Seventy Iranian outpatients with a diagnosis of schizophrenia disorder and their caregivers were randomly allocated to the experimental (n = 35) or control groups (n = 35). Patients in the experimental group received antipsychotic drug treatment and a psycho-educational program was arranged for their caregivers. The psycho-educational program consisted of ten 90-min sessions held during five weeks (two session in each week). Each caregiver attended 10 sessions (in five weeks) At baseline, immediately after intervention, and one month later. Validated tools were used to assess patients' clinical status and caregiver burden. Results: Compared with the control group, the case group showed significantly reduced symptom severity and caregiver burden both immediately after intervention and one month later. Conclusions: These results suggest that even need based short-term psycho-educational intervention for family members of Iranian patients with schizophrenic disorder may improve the outcomes of patients and their families. Trial registration: IRCT Number:138809122812 N1 [ABSTRACT FROM AUTHOR]