Raimo Lappalainen

Depression and occupational burnout are prevalent and interrelated forms of psychological distress in working-age populations (Tóth‐Király et al., 2021). While depression reflects broader emotional...

This study aimed to evaluate the feasibility and acceptability of a sport-specific acceptance and commitment therapy group intervention enhancing athletes’ mental well-being. Acceptance and commitment therapy is a cognitive-behavioral approach including psychological flexibility skills training to promote mental well-being in sport. In addition, we examined new skills acquired by the athletes and individual differences in their experiences. A total of 43 athletes who completed the intervention were surveyed at the end of the intervention using semistructured questionnaires and a thematic analysis. Overall, 93% of athletes found the intervention useful or very useful, and all of the athletes recommended the intervention to other athletes. The thematic analysis revealed the themes of increased acceptance and present-moment skills, self-awareness, and value-based actions. The results indicate that the intervention is feasible and accepted by athletes. All athletes, regardless of gender, age, or sport, found the intervention useful.

Purpose: Persistent physical symptoms (PPS) can significantly impair work ability and daily functioning, exacerbated by comorbid illness worry (IW). This randomized controlled trial (RCT) examined the effectiveness of guided internet-based treatment on work ability and daily functioning of working-aged individuals with PPS associated with indoor environment (IE) and/or chronic fatigue (CF) with disability. The intervention was based on acceptance and commitment therapy (ACT) combined with individual case formulation, compared to treatment as usual (TAU). IW’s role in moderating effects was explored. Methods: In this RCT (Clinicaltrials.gov NCT04532827), 103 individuals with PPS linked to IE, CF or both were assigned to a video-based case conceptualization and 10-week internet-based ACT with TAU (iACT + TAU; n = 50) or TAU alone ( n = 53). Self-reported work ability and daily functioning were assessed from pre-intervention to 9-month follow-up, examining the potential moderating effect of baseline IW. Analyses used linear mixed models and Type III ANOVA. Results: Of the 103 participants, 62% completed the 9-month follow-up. Baseline demographics showed no significant differences between treatment groups. Significant positive interaction (treatment group and time) effects for work ability were found in the iACT + TAU group at post-measurement ( β = 0.41, p = 0.041), 3-month ( β = 0.58, p = 0.004), and 9-month ( β = 0.47, p = 0.022) follow-ups. Daily functioning improved significantly at 3-month ( β = 0.57, p = 0.007), particularly in the work domain ( β = 0.67, p = 0.003). IW and PPS group did not moderate outcomes. Conclusion: Internet-based ACT with individual case formulation was associated with improved work ability for individuals with PPS associated with IE and CF, providing preliminary support for further examination as a potential frontline treatment.

Background: Mental health problems and adverse health behaviors are enriched in individuals with obesity and need to be considered in weight loss interventions. Regarding weight loss, hybrid interventions combining digital and in-person elements have proven superior to eHealth-only interventions. However, it remains unclear whether minimal group or individual enhancement could bring additional benefits to the mental health and health behavior domains in individuals with obesity. Objective: This study aimed to explore whether minimal group or individual enhancements could offer additional benefits to an eHealth intervention in relation to mental health, perceived work ability, and health behavior in a sample of occupational health patients with obesity. In addition, the study sought to examine the overall effects of the health behavior–focused intervention across these domains. Methods: This study was a randomized controlled trial with a 12-month intervention (March 2021-2022), with selected variables followed for another 12 months without additional support. Recruited from occupational health care, 111 working-age adults with BMI 30‐40 kg/m² were randomized to one of the 3 treatment arms, such as eHealth, eHealth+Group, or eHealth+Individual. All treatment arms received a web-administered, coach-assisted eHealth program based on acceptance and commitment therapy, and, in addition, the eHealth+Group and eHealth+Individual arms received 3 remotely facilitated group or individual meetings. The overall intervention effects were evaluated quasi-experimentally by combining the 3 treatment arms into a single eHealth arm. Participants were assessed for depression (the Beck Depression Index 21 [BDI-21]), burnout (Bergen Burnout Inventory 18 [BBI-15]), perceived work ability, eating behavior (ecSatter 2.0, Three Factor Eating Questionnaire [TFEQ], and Binge Eating Scale [BES]), and physical activity (Baecke Habitual Physical Activity Questionnaire, BHPAQ). Results: We observed inconsistent fluctuations between the treatment arms in depression and burnout scores, indicating a lack of meaningful intervention effects despite statistical significance. Therefore, none of the treatment arms showed superiority over another. Across all participants, depression showed an estimated mean decrease of 2.5 BDI-21 points, with older participants experiencing a greater reduction in depressive symptoms. Furthermore, binge eating tendency decreased by 4.9 BES points during the 12-month intervention. We also observed increases in eating competence, controlled restraint, and physical activity. However, the 24-month measurements showed an adverse effect on eating competence, especially on attitudes toward eating and food, during the follow-up period without further support. Conclusions: Minimal enhancement through either group or individual video-conference meetings did not provide additional benefits in the mental health or eating habit domains compared with the eHealth intervention alone. Nevertheless, our results indicate that eHealth interventions for weight loss have the potential to reduce depression symptoms and binge-eating tendencies, while also improving eating competence and physical activity across the study population. Continued support may be necessary to sustain positive changes.

Background: Acceptance and commitment therapy provides a psychobehavioral framework feasible for digital and hybrid weight loss interventions. In face-to-face studies, group-based interventions yield more favorable outcomes than individual interventions, but the effect of the intervention form has not been studied in combination with eHealth. Objective: This study investigated whether a minimal, 3-session group or individual enhancement could provide additional benefits compared to an eHealth-only intervention when assessing weight, body composition, and laboratory metrics in a sample of occupational health patients with obesity. Methods: This study was a randomized controlled trial with a 12-month intervention, followed by a 12-month follow-up period without additional support (March 2021 to March 2023). Recruited from occupational health care for Finnish municipal employees, 111 working-age adults with a BMI of 30-40 kg/m2 were randomized to 1 of the 3 treatment arms: eHealth, eHealth+group, or eHealth+individual. All treatment arms received a web-administrated, coach-assisted eHealth program based on acceptance and commitment therapy, and additionally, the eHealth+group and eHealth+individual arms received 3 remotely facilitated group or individual meetings with their designated coach. The participants were assessed for weight, body composition, blood pressure, and laboratory measurements at 0-, 6-, 12-, and 24-month time points. Applying estimated means to decrease bias caused by dropouts, generalized estimating equations were used to study the differences between the 3 groups over time. Results: There were no between-group differences in primary measurements of weight change or categorical weight change. Secondary outcomes also did not show changes attributable to the intervention arm. Across the entire sample, the total weight loss was 1.5% during the intervention, with 18% (20/111) of the participants attaining a ≥5% weight loss. Sustained at follow-up, waist circumference decreased, and high-density lipoprotein cholesterol increased slightly. The participants completed, on average, 58.6% of the eHealth program. Conclusions: There were no differences in weight or other somatic health variables between the eHealth arm and intervention combining eHealth with minimal group or individual enhancement. Despite a modest overall weight loss, the intervention shows promise in improving body composition and metabolic health. Moving forward, further research is needed to determine if there is a threshold where face-to-face meetings provide additional benefits in hybrid interventions. Moreover, there is a need to explore for whom and under what conditions eHealth and hybrid models may be most effective. Trial Registration: ClinicalTrials.gov NCT04785586; https://clinicaltrials.gov/study/NCT04785586

Persistent physical symptoms (PPS) can significantly impair health-related quality of life (HRQoL) and are often accompanied by psychiatric comorbidity. Psychological flexibility (PF), characterized by the ability to adapt functionally and congruently to diverse situations based on personal values, may play a crucial role in determining HRQoL. This study aims to examine the associations between symptoms of depression, anxiety or insomnia or PF and HRQoL among individuals with PPS associated with (i) the indoor environment (IE), (ii) chronic fatigue, or (iii) both. We utilized the baseline data (n = 103) from a randomized controlled trial focused on improving the HRQoL of individuals (mean age 46.1, SD 7.8, 86% women) experiencing PPS associated with IE or chronic fatigue. Self-report questionnaires were administered to evaluate symptoms of depression, anxiety, insomnia, and dimensions of PF, including acceptance, cognitive fusion, and thought suppression. The primary outcome was HRQoL, assessed using a 15D questionnaire. The association between symptoms, PF dimensions, and HRQoL was examined using Pearson’s correlation and ANCOVA. Symptoms of depression, anxiety, and insomnia were negatively associated with HRQoL (p <.001) across all participants. Among individuals with PPS associated with IE, higher PF was significantly associated with higher HRQoL. No association was found between PF and HRQoL in those with chronic fatigue-associated PPS or both conditions. PF associated with positive outcomes in HRQoL in individuals with PPS associated with the indoor environment, but not in those with chronic fatigue. Further research on the differences between these groups is warranted to enhance treatment targeting. Clinicaltrials.gov NCT04532827 (registered 26.08.2020).

We conducted the first validation of the Depression Anxiety Stress Scales (DASS-21) in Finnish. DASS-21 is a short public domain questionnaire, which presents a way to quickly and effectively screen for mental ill health. We recruited two large samples, one aged 24-45 (N = 3,101 [2,488 women]), and the other aged 60-82 (N = 5,462 [4,473 women]), all employees of the city of Helsinki at inclusion (2017 and 2000-2002). DASS-21 measured depression, anxiety, stress, and general distress reliably among Finnish-speaking adults. It appeared invariant with age and gender as evinced by invariance analyses, latent mean comparisons, and an examination of psychometric properties for the subscales and individual items. The subscales negatively correlated with the Emotional Well-being subscale of the RAND-36, as expected. A comparison of five structural models using confirmatory factor analyses and a robust estimation method (weighted-least-squares method) showed a good fit for a one-factor solution. We discuss the use and interpretation of the DASS-21 as both a measure of specific affective symptoms and unidimensional general distress. We provide future researchers and clinicians with norms and estimates of measurement error among Finnish-speaking adults.