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d
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d
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su
b
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q
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n
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K
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w
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s
:
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x
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Dep
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s
s
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Me
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ta
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al
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last
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c
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1.
I
NT
RO
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ac
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[
1
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2
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I
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im
p
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n
tatio
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[
3
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.
I
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Evaluation Warning : The document was created with Spire.PDF for Python.
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I
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b
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Hea
lth
Sci
,
Vo
l.
15
,
No
.
2
,
J
u
n
e
20
26
:
3
3
7
-
3
4
5
338
ev
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s
u
g
g
ests
th
at
co
m
m
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s
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p
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p
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r
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[
4
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[
5
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6
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p
d
is
c
u
s
s
i
o
n
s
is
s
e
en
as
f
ac
il
ita
ti
n
g
c
o
m
m
u
n
i
ca
ti
o
n
b
ec
au
s
e
it
u
s
es
la
n
g
u
ag
e
t
h
a
t
is
m
o
r
e
u
n
d
e
r
s
ta
n
d
a
b
l
e
to
a
d
o
les
ce
n
ts
a
n
d
r
e
d
u
c
es
t
h
e
b
a
r
r
ie
r
o
f
em
b
ar
r
ass
m
e
n
t
i
n
e
x
p
r
ess
i
n
g
t
h
o
u
g
h
ts
a
n
d
f
e
eli
n
g
s
.
T
h
is
a
p
p
r
o
a
c
h
h
as
als
o
b
ee
n
r
e
p
o
r
t
ed
t
o
b
e
ef
f
e
cti
v
e
i
n
in
cr
ea
s
in
g
h
ea
lt
h
k
n
o
wl
ed
g
e
an
d
b
e
h
a
v
i
o
r
[
7
]
.
Desp
ite
th
e
g
r
o
win
g
b
o
d
y
o
f
ev
id
en
ce
s
u
p
p
o
r
tin
g
m
en
tal
h
ea
lth
f
ir
s
t
a
id
(
MH
FA)
as
a
n
ef
f
ec
tiv
e
s
tr
ateg
y
f
o
r
im
p
r
o
v
i
n
g
m
e
n
tal
h
ea
lth
liter
ac
y
,
r
ed
u
cin
g
s
tig
m
a,
an
d
en
h
a
n
cin
g
c
o
n
f
i
d
en
ce
in
h
el
p
in
g
in
d
iv
id
u
als
with
m
e
n
tal
h
ea
lt
h
s
y
m
p
to
m
s
[
8
]
,
[
9
]
,
s
ig
n
if
ic
an
t
g
ap
s
r
em
ai
n
in
u
n
d
e
r
s
tan
d
in
g
its
ap
p
licatio
n
with
in
ad
o
lescen
t
p
o
p
u
l
atio
n
s
,
p
ar
ticu
lar
l
y
wh
en
co
m
b
in
ed
with
em
p
ath
y
-
b
ased
p
ee
r
s
u
p
p
o
r
t
m
ec
h
an
is
m
s
.
W
h
ile
ex
is
tin
g
liter
atu
r
e
d
em
o
n
s
tr
ates
th
at
p
ee
r
co
u
n
s
elin
g
f
ac
ilit
ates
co
m
m
u
n
icatio
n
am
o
n
g
ad
o
lescen
ts
b
y
u
s
in
g
r
elata
b
le
lan
g
u
ag
e
an
d
r
ed
u
cin
g
b
ar
r
ier
s
s
u
ch
as
em
b
ar
r
ass
m
en
t,
an
d
th
at
MH
FA
tr
ain
in
g
im
p
r
o
v
es
k
n
o
wled
g
e
an
d
h
elp
in
g
in
ten
ti
o
n
s
ac
r
o
s
s
v
ar
io
u
s
co
m
m
u
n
iti
es [
1
0
]
,
[
1
1
]
,
T
h
is
g
ap
is
p
ar
ticu
lar
ly
cr
itical
g
iv
en
th
e
r
ec
o
g
n
itio
n
o
f
th
e
g
lo
b
al
"y
o
u
th
m
en
tal
h
ea
lth
c
r
is
is
"
an
d
th
e
im
p
o
r
tan
ce
o
f
cu
ltu
r
ally
ad
ap
te
d
,
s
ch
o
o
l
-
b
as
ed
in
ter
v
en
tio
n
s
.
T
h
er
ef
o
r
e,
th
is
s
tu
d
y
a
d
d
r
ess
es
th
e
f
o
llo
win
g
r
esear
ch
q
u
esti
o
n
s
:
i
)
W
h
at
is
th
e
ef
f
ec
tiv
en
ess
o
f
an
em
p
ath
y
-
b
ased
MH
FA
in
t
er
v
en
tio
n
u
s
in
g
th
e
SUFA
m
o
d
el
in
r
ed
u
cin
g
an
x
i
ety
lev
els
am
o
n
g
ad
o
lescen
ts
?
ii
)
W
h
at
is
th
e
ef
f
ec
tiv
en
ess
o
f
th
is
in
ter
v
e
n
tio
n
in
r
ed
u
cin
g
d
e
p
r
ess
io
n
lev
els am
o
n
g
a
d
o
lescen
ts
?
2.
M
E
T
H
O
D
2
.
1
.
Desig
n
T
h
is
s
tu
d
y
u
s
ed
a
q
u
asi
-
ex
p
er
i
m
en
tal
o
n
e
-
g
r
o
u
p
p
r
etest
–
p
o
s
ttes
t
d
esig
n
to
ev
alu
ate
t
h
e
ef
f
e
ctiv
en
ess
o
f
an
em
p
at
h
y
-
b
ased
MH
FA
in
ter
v
en
tio
n
im
p
lem
e
n
ted
th
r
o
u
g
h
s
tr
u
ctu
r
ed
S
UFA
m
en
to
r
in
g
b
y
p
ee
r
co
u
n
s
elo
r
s
in
r
ed
u
cin
g
an
x
iet
y
an
d
d
e
p
r
ess
io
n
lev
els
in
ad
o
lescen
ts
.
I
n
th
is
d
esig
n
,
m
ea
s
u
r
em
en
ts
wer
e
tak
e
n
b
ef
o
r
e
t
h
e
in
ter
v
e
n
tio
n
(
p
r
e
-
te
s
t)
an
d
af
ter
th
e
in
ter
v
en
ti
o
n
(
p
o
s
t
-
test
)
in
th
e
s
am
e
g
r
o
u
p
.
2
.
2
.
L
o
ca
t
io
n a
nd
t
im
e
T
h
is
r
esear
ch
was
co
n
d
u
cted
in
a
s
ch
o
o
l
s
ettin
g
,
c
o
v
er
in
g
J
u
n
io
r
Hig
h
Sch
o
o
l
a
n
d
S
en
io
r
Hig
h
Sch
o
o
l
lev
els,
with
th
e
in
ter
v
en
tio
n
a
p
p
lied
t
o
th
e
in
ter
v
e
n
tio
n
g
r
o
u
p
f
o
r
2
wee
k
s
.
T
h
e
d
ata
co
llectio
n
tim
e
s
er
ies
was
ar
r
an
g
ed
s
eq
u
e
n
tially
in
f
o
u
r
m
ai
n
p
h
ases
.
First
,
th
e
p
ee
r
c
o
u
n
s
elo
r
tr
ain
in
g
p
h
ase
was
co
n
d
u
cted
to
en
s
u
r
e
th
e
r
ea
d
in
ess
o
f
th
e
in
ter
v
en
tio
n
im
p
lem
en
ter
s
an
d
th
e
u
n
if
o
r
m
ity
o
f
m
en
to
r
in
g
p
r
o
ce
d
u
r
es.
Seco
n
d
,
th
e
s
cr
ee
n
in
g
p
h
ase
was
ca
r
r
ie
d
o
u
t
as
an
in
itial
m
ea
s
u
r
em
e
n
t
(
b
aselin
e/p
r
e
-
test
)
to
o
b
tain
an
o
v
er
v
iew
o
f
th
e
p
ar
ticip
an
ts
'
co
n
d
itio
n
s
b
ef
o
r
e
th
e
p
r
o
g
r
am
was
ad
m
in
is
ter
ed
.
T
h
ir
d
,
th
e
SUFA
m
en
to
r
i
n
g
p
h
ase
last
ed
f
o
r
2
wee
k
s
ac
co
r
d
in
g
to
th
e
p
lan
n
ed
in
ter
v
en
tio
n
d
u
r
atio
n
,
wit
h
an
e
m
p
h
asis
o
n
th
e
co
n
s
is
ten
t
im
p
lem
en
tatio
n
o
f
m
en
to
r
in
g
ac
tiv
ities
in
th
e
s
ch
o
o
l
en
v
i
r
o
n
m
e
n
t.
Fo
u
r
t
h
,
th
e
ev
alu
atio
n
p
h
ase
was
ca
r
r
ied
o
u
t
th
r
o
u
g
h
a
f
in
al
m
ea
s
u
r
em
en
t
(
p
o
s
t
-
test
)
to
ass
es
s
ch
an
g
es
an
d
o
u
tco
m
es
af
ter
th
e
in
ter
v
en
tio
n
a
n
d
to
allo
w
f
o
r
d
ir
ec
t
co
m
p
ar
is
o
n
b
etwe
en
co
n
d
itio
n
s
b
ef
o
r
e
an
d
af
ter
t
h
e
p
r
o
g
r
am
.
2
.
3
.
P
a
rt
i
cipa
nts a
nd
s
a
m
ple c
ha
ra
ct
er
is
t
ics
T
h
e
s
tu
d
y
in
v
o
l
v
ed
1
0
0
s
tu
d
en
ts
wh
o
ac
ted
as
p
ee
r
co
u
n
s
elo
r
s
.
E
ac
h
p
ee
r
co
u
n
s
elo
r
co
n
d
u
cte
d
m
en
tal
h
ea
lth
s
cr
ee
n
in
g
s
o
n
ad
o
lescen
ts
an
d
p
r
o
v
id
e
d
o
n
e
-
on
-
o
n
e
s
u
p
p
o
r
t
(
o
n
e
c
o
u
n
s
elo
r
ass
is
tin
g
o
n
e
ad
o
lescen
t)
u
s
in
g
MH
FA
wit
h
th
e
SUFA
f
r
am
ewo
r
k
.
I
n
t
h
e
o
p
er
atio
n
al
f
r
am
ew
o
r
k
o
f
th
is
s
tu
d
y
,
t
h
er
e
ar
e
two
en
titi
es:
i
)
Peer
co
u
n
s
elo
r
s
(
n
=
1
0
0
)
as
in
te
r
v
en
tio
n
im
p
lem
en
te
r
s
,
wh
o
h
av
e
r
ec
eiv
ed
tr
ain
in
g
.
ii
)
Ad
o
lescen
ts
wh
o
ar
e
ac
co
m
p
an
ied
as
in
ter
v
en
tio
n
r
ec
ip
ien
ts
(
lo
g
ically
,
a
1
:1
d
esig
n
,
th
e
n
u
m
b
er
o
f
in
ter
v
en
tio
n
r
ec
ip
ien
ts
is
eq
u
al
to
th
e
n
u
m
b
er
o
f
c
o
u
n
s
ello
r
s
.
Pre
-
p
o
s
t
an
aly
s
is
o
f
a
n
x
i
ety
an
d
d
ep
r
ess
io
n
s
y
m
p
to
m
s
r
ef
er
s
to
th
e
s
cr
ee
n
i
n
g
/
ass
ess
m
en
t r
esu
lts
o
f
th
e
ac
co
m
p
an
y
in
g
a
d
o
lescen
ts
.
I
m
p
o
r
ta
n
t
m
eth
o
d
o
lo
g
ical
n
o
te:
T
h
e
o
u
tc
o
m
e
d
ata
(
m
ea
n
s
co
r
es
an
d
c
h
an
g
es
in
m
ild
/m
o
d
er
ate
ca
teg
o
r
ies)
in
d
icate
th
at
th
e
u
n
it
o
f
an
aly
s
is
was
th
e
a
d
o
lescen
t
r
ec
ip
ien
ts
o
f
t
h
e
in
ter
v
e
n
tio
n
.
B
ec
au
s
e
th
e
in
ter
v
en
tio
n
was
co
n
d
u
cted
1
:1
b
y
1
0
0
p
ee
r
co
u
n
s
elo
r
s
,
th
is
s
tu
d
y
im
p
licitly
in
v
o
lv
ed
u
p
to
1
0
0
r
ec
ip
ie
n
ts
(
o
n
e
p
er
co
u
n
s
elo
r
)
,
u
n
less
th
er
e
was
d
r
o
p
o
u
t.
Dr
o
p
o
u
t
in
f
o
r
m
atio
n
is
n
o
t
in
clu
d
ed
,
s
o
th
e
m
eth
o
d
s
tatem
en
t
is
b
ased
o
n
av
ailab
le
d
ata.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
I
mp
a
ct
o
f
a
n
emp
a
th
y
-
b
a
s
ed
men
ta
l h
ea
lth
fir
s
t
a
id
in
terven
tio
n
u
s
in
g
t
h
e
S
UF
A
…
(
S
u
la
s
tr
i
)
339
2
.
4
.
Dro
p
-
o
ut
re
s
po
nd
ent
cr
it
er
ia
Par
t
ici
p
an
ts
we
r
e
class
if
i
e
d
as
d
r
o
p
o
u
ts
a
n
d
e
x
cl
u
d
e
d
f
r
o
m
th
e
f
i
n
a
l
a
n
a
ly
s
is
if
th
e
y
m
et
an
y
o
f
th
e
f
o
ll
o
wi
n
g
c
r
it
er
ia:
i
)
i
n
co
m
p
l
ete
i
n
t
er
v
en
ti
o
n
e
x
p
o
s
u
r
e,
ii
)
d
i
d
n
o
t
p
ar
tici
p
ate
in
th
e
p
o
s
t
-
tes
t
ass
ess
m
e
n
t
,
iii
)
t
h
e
em
er
g
e
n
ce
o
f
a
c
r
is
is
d
u
r
in
g
t
h
e
i
n
t
er
v
e
n
t
io
n
p
e
r
i
o
d
n
ec
ess
itat
in
g
p
a
r
ti
ci
p
at
io
n
g
u
ar
an
t
ee
s
f
o
r
t
h
e
s
a
f
et
y
o
f
t
h
e
p
a
r
ti
ci
p
a
n
ts
;
iv
)
v
o
l
u
n
ta
r
y
s
el
f
-
wit
h
d
r
awa
l
at
th
e
p
ar
tic
i
p
a
n
t'
s
o
w
n
r
eq
u
es
t,
a
n
d
v
)
lo
s
t
to
f
o
l
lo
w
-
u
p
.
2
.
5
.
I
nclus
io
n a
nd
ex
clus
io
n
cr
it
er
ia
T
h
e
i
n
c
l
u
s
i
o
n
c
r
it
e
r
i
a
f
o
r
i
n
te
r
v
e
n
t
i
o
n
r
e
c
i
p
i
e
n
ts
i
n
c
l
u
d
e
d
a
d
o
l
e
s
c
e
n
ts
wi
t
h
J
H
S/
S
HS
l
e
v
el
s
t
a
t
u
s
w
h
o
p
a
r
t
i
c
i
p
a
t
e
d
i
n
m
e
n
t
a
l
h
ea
l
t
h
s
c
r
e
e
n
i
n
g
,
s
h
o
w
e
d
i
n
d
i
ca
t
i
o
n
s
o
f
a
n
x
i
e
t
y
a
n
d
/
o
r
d
e
p
r
e
s
s
i
o
n
s
y
m
p
t
o
m
s
b
a
s
e
d
o
n
i
n
i
t
i
al
s
c
r
e
e
n
i
n
g
u
s
i
n
g
t
h
e
M
in
i
M
I
N
D
H
E
AR
Y
o
u
t
h
S
c
al
e
V
.
1
i
n
t
h
e
c
a
t
e
g
o
r
y
o
f
a
t
l
e
a
s
t
"
m
o
d
e
r
a
t
e
"
(
o
r
a
c
c
o
r
d
i
n
g
t
o
t
h
e
o
p
e
r
a
ti
o
n
a
l
c
u
t
-
o
f
f
s
e
t
b
y
t
h
e
s
c
h
o
o
l
)
,
a
n
d
e
x
p
r
e
s
s
e
d
w
i
ll
i
n
g
n
e
s
s
t
o
p
a
r
t
i
c
i
p
at
e
i
n
S
UF
A
m
e
n
t
o
r
i
n
g
f
o
r
t
w
o
w
e
e
k
s
.
T
h
e
e
x
c
l
u
s
i
o
n
c
r
it
e
r
i
a
i
n
cl
u
d
e
d
a
d
o
l
e
s
c
e
n
t
s
w
h
o
w
e
r
e
i
n
c
r
i
s
i
s
o
r
h
i
g
h
-
r
i
s
k
c
o
n
d
i
t
i
o
n
s
r
e
q
u
i
r
i
n
g
i
m
m
e
d
i
a
t
e
r
e
f
e
r
r
a
l
,
f
o
r
e
x
a
m
p
l
e
,
i
n
d
i
c
a
t
i
o
n
s
o
f
s
e
v
e
r
e
s
u
i
c
i
d
a
l
i
d
ea
t
i
o
n
o
r
p
s
y
c
h
o
t
i
c
s
y
m
p
t
o
m
s
,
b
e
c
a
u
s
e
,
a
c
c
o
r
d
i
n
g
t
o
t
h
e
p
r
i
n
c
i
p
l
e
s
o
f
MH
FA
p
r
a
c
t
i
c
e
,
s
u
c
h
c
a
s
es
a
r
e
n
o
t
h
a
n
d
l
e
d
a
s
p
u
r
e
p
e
e
r
m
e
n
t
o
r
i
n
g
b
u
t
a
r
e
d
i
v
e
r
t
e
d
t
h
r
o
u
g
h
t
h
e
c
l
i
n
i
ca
l
r
e
f
e
r
r
a
l
s
y
s
t
e
m
.
I
n
a
d
d
i
t
i
o
n
,
p
a
r
t
i
c
i
p
a
n
ts
w
h
o
d
i
d
n
o
t
c
o
m
p
l
e
t
e
t
h
e
tw
o
-
w
e
e
k
m
e
n
t
o
r
i
n
g
s
e
r
i
es
o
r
d
i
d
n
o
t
c
o
m
p
l
e
t
e
t
h
e
p
o
s
t
-
t
e
s
t
w
e
r
e
e
x
c
l
u
d
e
d
f
r
o
m
t
h
e
i
n
t
e
r
v
e
n
t
i
o
n
e
v
a
l
u
a
t
i
o
n
a
n
a
l
y
s
is
b
e
c
a
u
s
e
t
h
e
y
d
i
d
n
o
t
m
e
et
t
h
e
co
m
p
l
e
t
e
n
e
s
s
o
f
i
n
t
e
r
v
e
n
ti
o
n
e
x
p
o
s
u
r
e
a
n
d
o
u
t
c
o
m
e
m
e
a
s
u
r
e
m
e
n
t
.
2
.
6
.
I
nte
rv
ent
io
n:
e
m
pa
t
hy
-
ba
s
ed
M
H
F
A
wit
h
SUFA
m
o
del
T
h
e
i
n
ter
v
e
n
tio
n
test
ed
in
th
is
s
tu
d
y
was
em
p
ath
y
-
b
ased
M
HFA,
o
p
er
atio
n
alize
d
th
r
o
u
g
h
th
e
SUFA
Mo
d
el
as
a
s
tr
u
ctu
r
ed
s
eq
u
en
ce
o
f
m
en
t
o
r
in
g
f
o
r
ea
r
ly
n
o
n
-
clin
ical
s
u
p
p
o
r
t
f
o
r
ad
o
lesc
en
ts
,
en
co
m
p
ass
in
g
ea
r
ly
d
etec
tio
n
,
s
tr
en
g
th
en
in
g
s
o
cial
s
u
p
p
o
r
t,
a
n
d
p
r
o
f
ess
io
n
al
r
ef
er
r
als
wh
en
n
ee
d
e
d
.
I
n
th
e
Awa
r
e
s
tag
e,
p
ee
r
co
u
n
s
elo
r
s
id
en
tify
ea
r
l
y
s
ig
n
s
o
f
p
s
y
ch
o
lo
g
ical
p
r
o
b
lem
s
(
eg
,
with
d
r
awa
l,
em
o
tio
n
al
ch
an
g
es,
o
r
im
p
air
ed
s
o
cial/ac
ad
em
ic
f
u
n
c
tio
n
in
g
)
as a
f
o
r
m
o
f
liter
ac
y
a
n
d
in
itial scr
ee
n
in
g
.
T
h
e
Ad
d
r
ess
s
tag
e
is
ca
r
r
ied
o
u
t
b
y
o
p
en
in
g
a
s
af
e
co
n
v
er
s
atio
n
th
r
o
u
g
h
ac
tiv
e
lis
ten
in
g
an
d
n
o
n
-
ju
d
g
m
en
tal
r
esp
o
n
s
es
to
r
ed
u
ce
s
tig
m
a
b
ar
r
ier
s
.
Nex
t,
in
Facilitatio
n
,
co
u
n
s
elo
r
s
p
r
o
v
id
e
em
o
ti
o
n
al
an
d
p
r
ac
tical
s
u
p
p
o
r
t
s
u
c
h
as
v
alid
ati
o
n
o
f
f
ee
lin
g
s
,
co
p
in
g
p
lan
n
i
n
g
,
a
n
d
ass
is
tan
c
e
in
d
ea
lin
g
with
s
o
cial/d
ig
ital
s
tr
es
s
o
r
s
(
in
clu
d
in
g
f
r
ien
d
s
h
ip
co
n
f
licts
o
r
c
y
b
er
b
u
lly
in
g
)
.
I
n
th
e
d
i
r
ec
t
s
tag
e,
co
u
n
s
elo
r
s
ass
ess
th
e
lim
its
o
f
p
ee
r
s
u
p
p
o
r
t
a
u
th
o
r
it
y
an
d
d
ir
ec
t
ac
ce
s
s
to
ap
p
r
o
p
r
iat
e
ass
is
tan
ce
(
g
u
id
an
ce
tea
ch
er
s
,
h
ea
lth
s
er
v
ices,
p
ar
en
ts
/g
u
ar
d
ian
s
,
o
r
p
r
o
f
ess
io
n
als)
,
esp
ec
ially
wh
en
s
y
m
p
to
m
s
p
er
s
is
t
o
r
wo
r
s
en
.
T
h
e
in
ter
v
en
tio
n
is
im
p
le
m
en
ted
b
y
s
tu
d
en
ts
wh
o
h
av
e
b
ee
n
tr
ain
e
d
,
with
a
d
u
r
atio
n
o
f
two
wee
k
s
.
T
h
e
f
r
eq
u
en
c
y
o
f
s
ess
io
n
s
was
n
o
t
av
ailab
le
,
s
o
th
e
d
o
s
ag
e
was tr
an
s
p
ar
en
tly
r
ep
o
r
ted
as “
two
wee
k
s
o
f
s
tr
u
ctu
r
ed
m
en
to
r
i
n
g
.
”
2
.
7
.
Resea
rc
h
i
ns
t
rum
ent
s
T
h
e
p
r
im
ar
y
in
s
tr
u
m
e
n
t
o
f
th
i
s
s
tu
d
y
was
th
e
Min
i
MI
NDHE
AR
Yo
u
th
Scale
V.
1
,
w
h
ich
was
u
s
ed
to
ass
ess
an
d
s
cr
ee
n
f
o
r
s
y
m
p
to
m
s
o
f
an
x
iet
y
a
n
d
d
ep
r
ess
io
n
in
ad
o
lescen
ts
.
Me
asu
r
em
en
ts
wer
e
co
n
d
u
cted
at
two
tim
es:
p
r
e
-
test
(
b
aselin
e
b
ef
o
r
e
SUFA
s
u
p
p
o
r
t)
an
d
p
o
s
t
-
test
(
af
ter
2
wee
k
s
o
f
s
u
p
p
o
r
t)
,
allo
win
g
f
o
r
co
m
p
ar
is
o
n
o
f
c
h
an
g
es
i
n
s
co
r
es
b
ef
o
r
e
an
d
af
ter
th
e
in
te
r
v
en
tio
n
.
An
x
iety
an
d
d
ep
r
ess
io
n
v
ar
iab
les
wer
e
r
ep
o
r
ted
i
n
two
f
o
r
m
s
:
i
)
m
ea
n
p
r
e
-
p
o
s
t
s
co
r
es
p
r
esen
te
d
an
d
ii
)
s
ev
er
it
y
ca
teg
o
r
y
g
r
o
u
p
in
g
s
,
n
am
el
y
m
ild
/n
o
n
e
v
er
s
u
s
m
o
d
er
ate
f
o
r
ea
ch
co
n
s
tr
u
ct.
I
n
r
ep
o
r
tin
g
,
th
er
e
is
an
im
p
o
r
tan
t
n
o
te
r
eg
a
r
d
in
g
th
e
co
n
s
is
ten
cy
o
f
n
am
in
g
:
th
e
l
ab
el
“An
x
iety
Pre
-
Po
s
t”
ap
p
ea
r
in
g
in
th
e
d
ep
r
ess
io
n
s
ec
ti
o
n
ap
p
ea
r
s
to
b
e
a
m
is
lab
elin
g
,
as b
ased
o
n
t
h
e
n
ar
r
ativ
e
o
f
t
h
e
r
esu
lts
,
th
at
s
ec
tio
n
s
u
b
s
tan
tiv
ely
r
e
p
r
esen
ts
d
ep
r
ess
io
n
.
2
.
8
.
Da
t
a
c
o
llect
io
n pro
ce
du
re
s
T
h
e
d
ata
co
llectio
n
p
r
o
ce
d
u
r
e
was
ca
r
r
ied
o
u
t
th
r
o
u
g
h
two
m
ain
s
tag
es:
p
r
ep
ar
atio
n
an
d
im
p
lem
en
tat
io
n
.
I
n
th
e
p
r
ep
ar
atio
n
s
tag
e,
th
e
r
esear
ch
er
f
ir
s
t c
o
o
r
d
in
ated
with
th
e
s
ch
o
o
l t
o
o
b
tain
p
er
m
is
s
io
n
to
ca
r
r
y
o
u
t
th
e
ac
tiv
ity
,
th
en
r
ec
r
u
ited
p
ee
r
co
u
n
s
elo
r
s
f
r
o
m
s
tu
d
en
ts
(
n
=
1
0
0
)
.
Nex
t,
th
e
p
ee
r
co
u
n
s
elo
r
s
p
ar
ticip
ated
in
tr
ain
in
g
co
v
er
i
n
g
th
e
p
r
in
cip
l
es
o
f
MH
FA,
em
p
ath
etic
co
m
m
u
n
icatio
n
tech
n
iq
u
es,
s
cr
ee
n
in
g
s
k
ills
u
s
in
g
th
e
Min
i
MI
N
DHE
AR
Yo
u
th
Scale
V.
1
,
m
en
to
r
in
g
eth
ics
(
in
clu
d
in
g
co
n
f
id
en
tiality
,
r
o
l
e
b
o
u
n
d
ar
ies,
an
d
r
ef
er
r
al
m
ec
h
an
is
m
s
)
,
an
d
th
e
im
p
lem
en
tatio
n
o
f
th
e
SUFA
p
r
o
ce
s
s
.
I
n
t
h
e
im
p
lem
en
ta
tio
n
s
tag
e,
p
ee
r
co
u
n
s
elo
r
s
co
n
d
u
cted
an
in
itial
s
cr
ee
n
in
g
(
p
r
e
-
test
)
o
n
th
e
ad
o
lescen
t
p
ar
tn
er
s
u
s
in
g
th
e
Min
i
MI
NDHE
AR
Yo
u
th
Scale
V.
1
to
o
b
tain
b
aselin
e
an
x
ie
ty
an
d
d
ep
r
ess
io
n
s
co
r
es.
Af
ter
th
at,
s
tr
u
ctu
r
ed
m
en
to
r
in
g
f
o
r
two
wee
k
s
wa
s
ca
r
r
ied
o
u
t
b
ased
o
n
th
e
SUFA
s
tag
es
(
r
ec
o
g
n
is
e
–
s
p
ea
k
–
f
ac
ilit
ate
–
d
ir
ec
t
)
.
Af
ter
two
wee
k
s
,
a
f
in
al
ev
alu
atio
n
(
p
o
s
t
-
test
)
was
co
n
d
u
cted
th
r
o
u
g
h
r
e
-
m
ea
s
u
r
em
e
n
t
u
s
in
g
th
e
s
am
e
in
s
tr
u
m
en
t to
ass
ess
ch
an
g
es in
s
co
r
es.
2
.
9
.
Resea
rc
h
v
a
ria
bles
a
nd
o
pera
t
io
na
l def
ini
t
io
ns
T
h
e
in
d
e
p
en
d
e
n
t
v
ar
iab
le
i
n
t
h
is
s
tu
d
y
is
th
e
in
ter
v
e
n
tio
n
MH
FA
e
m
p
ath
y
-
b
ased
,
ac
co
m
p
an
ied
b
y
s
tr
u
ctu
r
ed
SUFA
m
en
to
r
in
g
b
y
p
ee
r
c
o
u
n
s
elo
r
s
f
o
r
2
wee
k
s
,
wh
ich
is
o
p
er
atio
n
ally
d
e
f
in
ed
as
th
e
p
r
o
v
is
io
n
o
f
an
ea
r
ly
m
en
tal
h
ea
lth
ass
is
tan
ce
p
r
o
g
r
am
th
at
em
p
h
asize
s
e
m
p
ath
ic
s
k
ills
(
e.
g
.
,
ac
tiv
e
l
is
ten
in
g
,
em
o
tio
n
al
v
alid
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n
,
n
o
n
-
j
u
d
g
m
e
n
tal
s
u
p
p
o
r
tiv
e
co
m
m
u
n
icatio
n
)
an
d
is
im
p
lem
en
ted
t
h
r
o
u
g
h
a
s
er
ies
o
f
s
ch
ed
u
led
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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:
2
2
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I
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t J Pu
b
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Hea
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l.
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2
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J
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20
26
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3
3
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340
m
en
to
r
in
g
s
ess
io
n
s
b
y
p
ee
r
co
u
n
s
elo
r
s
with
a
SUFA
f
lo
w
(
as
a
s
tan
d
ar
d
ized
m
en
to
r
in
g
p
r
o
to
co
l
to
en
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u
r
e
u
n
if
o
r
m
ity
o
f
s
tep
s
,
f
r
e
q
u
en
c
y
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d
g
o
als o
f
ea
ch
s
ess
io
n
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wi
th
in
a
two
-
wee
k
in
ter
v
en
tio
n
p
er
io
d
.
E
x
p
o
s
u
r
e
t
o
th
e
in
ter
v
en
tio
n
is
co
n
s
id
er
ed
“im
p
lem
en
ted
”
if
th
e
p
ar
ticip
a
n
t
r
ec
eiv
es
all
co
r
e
co
m
p
o
n
en
ts
ac
co
r
d
in
g
to
th
e
estab
lis
h
ed
s
ch
ed
u
le.
Dep
en
d
en
t
v
ar
ia
b
les
in
clu
d
e
i
)
A
n
x
iety
s
co
r
es
(
an
x
iety
)
b
ased
o
n
th
e
Min
i
MI
NDHE
AR
Yo
u
th
Scale
V
.
1
w
h
ich
is
o
p
er
atio
n
alize
d
as
a
n
u
m
er
ical
v
alu
e
(
av
er
ag
e
)
o
f
th
e
m
ea
s
u
r
em
en
t
r
esu
lts
b
ef
o
r
e
th
e
in
ter
v
en
tio
n
(
p
r
e)
an
d
af
ter
th
e
in
ter
v
e
n
tio
n
(
p
o
s
t)
,
s
o
th
at
ch
an
g
es
in
p
r
e
-
p
o
s
t
s
co
r
es
r
ep
r
esen
t c
h
an
g
es in
an
x
iety
l
ev
els
;
ii
)
D
ep
r
ess
io
n
s
co
r
es (
d
ep
r
ess
io
n
)
b
ased
o
n
th
e
Min
i M
I
NDHE
AR
Yo
u
th
Scale
V.
1
wh
ich
is
o
p
er
atio
n
alize
d
s
im
ilar
ly
as
p
r
e
an
d
p
o
s
t
n
u
m
er
ic
(
m
ea
n
)
v
alu
es
,
with
th
e
p
r
e
–
p
o
s
t
d
if
f
er
en
ce
d
escr
ib
in
g
ch
a
n
g
es
in
d
ep
r
ess
io
n
lev
els
,
an
d
iii
)
C
ateg
o
r
ies
o
f
an
x
iety
an
d
d
e
p
r
ess
io
n
s
y
m
p
to
m
lev
els
wh
ich
ar
e
o
p
er
atio
n
ali
ze
d
as
p
r
e
–
p
o
s
t
ca
teg
o
r
ical
d
ata
with
th
e
g
r
o
u
p
in
g
o
f
“
m
ild
/n
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n
e”
v
er
s
u
s
“m
o
d
er
ate”
b
ased
o
n
t
h
e
Min
i
MI
NDHE
AR
Yo
u
th
Scale
V.
1
cu
t
-
o
f
f
p
o
in
t.
2
.
1
0
.
Da
t
a
a
na
ly
s
is
Data
an
aly
s
is
was
co
n
d
u
cte
d
t
h
r
o
u
g
h
two
m
ain
s
tag
es:
d
escr
ip
tiv
e
an
d
in
f
er
en
tial
a
n
aly
s
is
,
with
th
e
s
tatis
t
ical
s
ig
n
if
ican
ce
th
r
esh
o
ld
s
et
at
α
=
0
.
0
5
.
I
n
th
e
d
esc
r
ip
tiv
e
an
aly
s
is
,
r
esp
o
n
d
en
t
c
h
ar
ac
ter
is
tics
wer
e
p
r
esen
ted
in
th
e
f
o
r
m
o
f
f
r
e
q
u
en
cy
d
is
tr
ib
u
tio
n
s
an
d
p
er
ce
n
tag
es
f
o
r
k
ey
d
e
m
o
g
r
ap
h
ic
v
ar
iab
les
,
in
clu
d
in
g
g
en
d
er
,
ag
e
g
r
o
u
p
,
an
d
ed
u
ca
tio
n
lev
el.
A
d
escr
ip
tio
n
o
f
c
h
an
g
es
in
an
x
iety
an
d
d
ep
r
ess
io
n
s
y
m
p
to
m
s
was
r
ep
o
r
ted
u
s
in
g
th
e
m
ea
n
p
r
e
-
t
est
an
d
p
o
s
t
-
test
s
co
r
es
an
d
th
e
m
ag
n
itu
d
e
o
f
th
e
d
if
f
e
r
en
ce
in
m
ea
n
r
ed
u
ctio
n
(
Δ
m
ea
n
)
as
an
in
d
icato
r
o
f
s
h
if
ts
in
s
y
m
p
to
m
lev
els
af
te
r
th
e
in
ter
v
e
n
tio
n
.
T
o
co
m
p
le
m
en
t
th
e
ca
teg
o
r
y
-
b
ased
clin
ical
in
ter
p
r
etatio
n
,
t
h
e
d
is
tr
ib
u
tio
n
o
f
s
y
m
p
to
m
l
ev
els
b
ef
o
r
e
an
d
af
ter
t
h
e
in
t
er
v
en
tio
n
was
also
p
r
esen
ted
b
y
g
r
o
u
p
i
n
g
r
esp
o
n
d
en
ts
in
to
two
ca
teg
o
r
ies,
n
am
ely
"m
ild
/n
o
n
e"
v
er
s
u
s
"m
o
d
er
ate"
.
I
n
th
e
in
f
er
en
tial
an
aly
s
is
,
ch
a
n
g
es
i
n
s
y
m
p
to
m
ca
teg
o
r
ies
in
r
ep
e
ated
p
r
e
-
p
o
s
t
m
ea
s
u
r
em
e
n
ts
(
t
wo
ca
teg
o
r
ies)
wer
e
an
aly
ze
d
u
s
in
g
th
e
p
air
e
d
p
r
o
p
o
r
tio
n
d
i
f
f
er
en
ce
test
f
o
r
ca
te
g
o
r
ical
d
ata,
n
am
ely
th
e
Mc
Ne
m
ar
test
.
2
.
1
1
.
L
im
it
a
t
io
n
T
h
is
s
tu
d
y
h
as
m
eth
o
d
o
lo
g
ica
l
lim
itatio
n
s
.
T
h
e
s
tu
d
y
u
s
ed
a
q
u
asi
-
ex
p
er
im
e
n
tal
o
n
e
-
g
r
o
u
p
p
r
etest
-
p
o
s
ttes
t
d
esig
n
with
o
u
t
a
co
n
tr
o
l
g
r
o
u
p
.
I
n
ad
d
itio
n
,
t
h
e
in
ter
v
e
n
tio
n
d
u
r
atio
n
o
f
o
n
l
y
two
wee
k
s
was
r
elativ
ely
s
h
o
r
t c
o
m
p
ar
ed
to
s
im
ilar
in
ter
v
en
tio
n
s
.
3.
RE
SU
L
T
S
Fig
u
r
e
1
illu
s
tr
ates
th
at
th
e
S
UFA
m
o
d
el
ca
n
b
e
p
o
s
itio
n
ed
as
a
p
ee
r
-
b
ased
in
ter
v
en
tio
n
f
r
am
ewo
r
k
f
o
r
ea
r
ly
s
u
p
p
o
r
t
o
f
ad
o
lesc
en
t
m
en
tal
h
ea
lth
,
em
p
h
asizi
n
g
ea
r
ly
d
etec
tio
n
,
s
u
p
p
o
r
tiv
e
co
m
m
u
n
icatio
n
,
em
o
tio
n
al
-
p
r
ac
tical
s
u
p
p
o
r
t,
a
n
d
p
r
o
f
ess
io
n
al
r
e
f
er
r
al
w
h
en
n
ee
d
ed
.
I
ts
r
ele
v
an
ce
is
s
u
p
p
o
r
ted
b
y
ev
id
en
ce
th
at
an
x
iety
/d
e
p
r
ess
io
n
ar
e
r
elate
d
to
ad
o
lescen
t
s
o
cial
d
y
n
am
ics
(
e.
g
.
,
f
r
ien
d
s
h
ip
q
u
ality
)
,
p
s
y
ch
o
s
o
cial
f
ac
to
r
s
s
u
ch
as
lo
n
elin
es
s
,
an
d
ex
p
o
s
u
r
e
to
d
ig
ital
s
tr
ess
o
r
s
(
e.
g
.
,
cy
b
e
r
b
u
lly
in
g
)
,
wh
ich
im
p
ac
t
m
en
tal
h
ea
lth
.
R
ec
o
g
n
itio
n
r
e
q
u
ir
es
s
en
s
itiv
ity
to
ch
an
g
es
in
s
o
cial
-
em
o
tio
n
al
f
u
n
ctio
n
in
g
(
with
d
r
awa
l,
wo
r
s
en
in
g
r
elatio
n
s
h
ip
s
)
an
d
ca
n
b
e
s
tr
en
g
th
en
e
d
th
r
o
u
g
h
p
s
y
ch
o
e
d
u
c
atio
n
/m
en
tal
h
ea
lth
liter
ac
y
to
im
p
r
o
v
e
th
e
ab
ilit
y
to
r
ec
o
g
n
ize
s
ig
n
s
.
It
f
o
cu
s
es
o
n
o
p
en
i
n
g
s
af
e
co
n
v
er
s
atio
n
s
,
ac
tiv
e
lis
ten
in
g
,
an
d
n
o
n
-
ju
d
g
m
en
tal
r
esp
o
n
s
es,
in
lin
e
with
f
in
d
in
g
s
th
at
p
ee
r
em
o
tio
n
al
s
u
p
p
o
r
t
is
co
r
r
el
ated
with
p
s
y
ch
o
lo
g
ical
well
-
b
ein
g
.
Facilitatio
n
o
p
er
atio
n
alizin
g
s
o
cial
s
u
p
p
o
r
t
th
r
o
u
g
h
e
m
p
ath
y
,
v
alid
atio
n
,
an
d
p
r
ac
tical
ass
is
tan
ce
(
in
clu
d
in
g
s
tr
ateg
ies
f
o
r
d
ea
lin
g
with
cy
b
er
b
u
lly
in
g
)
.
Dir
ec
tly
af
f
ir
m
in
g
th
e
b
o
u
n
d
a
r
ies
o
f
p
ee
r
s
u
p
p
o
r
t
b
y
co
n
n
e
ctin
g
in
d
iv
id
u
als
to
co
u
n
s
elo
r
s
/p
r
o
f
ess
io
n
al
s
er
v
ices a
n
d
s
ch
o
o
l r
eso
u
r
ce
s
in
a
ti
m
ely
m
an
n
e
r
.
Fig
u
r
e
1
.
An
x
iety
/
d
ep
r
ess
io
n
in
ter
v
en
tio
n
m
ec
h
an
is
m
(
SUF
A
m
o
d
el)
B
ased
o
n
T
ab
le
1
,
th
e
d
is
tr
ib
u
tio
n
o
f
r
esp
o
n
d
en
t
ch
ar
ac
ter
is
tics
s
h
o
ws
th
at
th
e
m
ajo
r
ity
o
f
p
ar
ticip
an
ts
wer
e
f
e
m
ale
(
6
7
%)
co
m
p
ar
ed
to
m
ale
(
3
3
%).
I
n
ter
m
s
o
f
a
g
e,
r
esp
o
n
d
e
n
ts
wer
e
m
o
r
e
lik
ely
to
b
e
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
I
mp
a
ct
o
f
a
n
emp
a
th
y
-
b
a
s
ed
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ta
l h
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lth
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s
t
a
id
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terven
tio
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s
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h
e
S
UF
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(
S
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la
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tr
i
)
341
in
late
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ce
(
6
4
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th
an
ea
r
ly
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o
lescen
ce
(
4
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in
d
icatin
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le
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o
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ated
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ase.
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ter
m
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o
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o
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r
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en
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o
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ig
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el
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r
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te
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o
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h
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g
h
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ch
o
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l (
4
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%).
T
ab
le
1
.
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esp
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t c
h
ar
ac
ter
is
tics
C
h
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r
a
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e
r
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s
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c
s
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a
t
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o
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F
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e
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P
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r
c
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(
%)
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e
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7
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a
n
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.
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46
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s
64
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8
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u
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a
t
i
o
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n
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o
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ased
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ased
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3
.
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ased
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4.
DIS
CU
SS
I
O
N
Stag
e
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x
p
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it,
e
m
p
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asize
g
r
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s
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war
m
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ter
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s
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s
itiv
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x
p
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f
cir
cu
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s
tan
ce
s
,
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d
ac
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ten
in
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to
b
u
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a
s
en
s
e
o
f
r
elatio
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al
s
af
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.
T
h
e
liter
atu
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s
u
g
g
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th
at
th
e
q
u
ality
o
f
f
r
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s
h
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d
p
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s
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p
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t
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p
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tan
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f
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J
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g
m
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d
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t
r
esp
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attac
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m
en
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an
d
lim
it
ac
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s
s
to
e
ar
ly
h
elp
[
1
2
]
.
Ab
o
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t
o
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e
i
n
s
ev
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teen
ag
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s
ex
p
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s
s
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ch
as
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an
d
an
x
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[
1
3
]
,
s
o
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p
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tiv
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m
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p
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to
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en
[
1
4
]
.
T
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f
ac
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s
tag
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teg
r
ates
i)
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em
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ag
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m
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an
d
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ity
)
,
ii)
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(
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p
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t,
in
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p
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[
1
5
]
.
I
n
m
o
d
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p
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s
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p
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b
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h
ar
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ex
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r
ien
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s
with
o
u
t f
ea
r
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f
ju
d
g
m
en
t [
1
5
]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
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I
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Sci
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Vo
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No
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2
,
J
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20
26
:
3
3
7
-
3
4
5
342
Stag
e
“Dir
ec
t”
em
p
h
asizes
th
at
p
ee
r
s
u
p
p
o
r
t
is
lim
ited
.
T
h
er
e
f
o
r
e,
i
n
d
iv
id
u
als
n
ee
d
to
b
e
s
tr
u
ctu
r
ed
ly
co
n
n
ec
ted
to
co
m
p
eten
t
s
o
u
r
ce
s
o
f
s
u
p
p
o
r
t
(
e
.
g
.
,
s
ch
o
o
l
co
u
n
s
elo
r
s
an
d
m
en
tal
h
ea
lth
s
er
v
ices)
wh
en
s
y
m
p
to
m
s
p
er
s
is
t
o
r
ar
e
s
ev
er
e
to
en
s
u
r
e
ap
p
r
o
p
r
iate
t
r
ea
tm
en
t
[
1
6
]
.
T
h
e
n
ee
d
f
o
r
r
e
f
er
r
al
in
th
e
s
ch
o
o
l
co
n
tex
t
is
s
u
p
p
o
r
ted
b
y
s
ch
o
o
l
-
b
ased
s
cr
ee
n
in
g
f
in
d
in
g
s
th
a
t
in
d
icate
a
s
ig
n
if
ican
t
p
r
o
p
o
r
tio
n
o
f
ad
o
lescen
ts
with
s
tr
ess
,
an
x
iety
,
an
d
d
ep
r
ess
iv
e
s
y
m
p
to
m
s
,
r
eq
u
i
r
in
g
ac
ce
s
s
to
m
en
tal
h
ea
lth
in
f
o
r
m
atio
n
an
d
clea
r
r
ef
er
r
al
p
at
h
way
s
[
1
6
]
.
I
n
ad
d
itio
n
to
r
ef
e
r
r
als,
th
e
“Dir
ec
t”
s
tag
e
in
clu
d
es
s
tr
en
g
th
en
in
g
e
m
o
ti
o
n
al
r
e
g
u
latio
n
th
r
o
u
g
h
p
o
s
itiv
e
s
ch
o
o
l
-
b
ased
ac
tiv
ities
an
d
p
s
y
ch
o
ed
u
ca
tio
n
.
Var
io
u
s
p
s
y
ch
o
ed
u
ca
tio
n
al
in
ter
v
en
tio
n
s
an
d
s
k
ills
-
b
ased
th
er
ap
ies
im
p
lem
en
ted
in
s
ch
o
o
ls
h
av
e
b
ee
n
p
r
o
v
en
to
r
ed
u
ce
an
x
iety
in
s
tu
d
en
ts
[
1
7]
-
[
1
9
]
.
Use
o
f
ed
u
ca
tio
n
al
m
ed
ia
b
ased
on
v
id
eo
also
s
h
o
ws
p
o
ten
tial
to
in
f
lu
en
ce
an
x
iety
an
d
u
n
d
er
s
tan
d
in
g
,
m
ak
in
g
it
wo
r
th
y
o
f
in
teg
r
atio
n
as
a
co
m
p
o
n
en
t
o
f
in
itial
s
u
p
p
o
r
t
b
ef
o
r
e
o
r
alo
n
g
s
id
e
r
ef
er
r
a
l
[
2
0
]
.
I
n
d
is
tr
ess
in
f
lu
en
ce
d
b
y
s
tr
o
n
g
s
o
cial
d
e
ter
m
in
an
ts
,
s
tr
en
g
t
h
en
in
g
s
o
ci
al
s
u
p
p
o
r
t
t
h
r
o
u
g
h
s
ch
o
o
l
p
r
o
g
r
am
s
s
till
n
ee
d
s
t
o
b
e
co
m
b
i
n
ed
with
p
r
o
f
ess
io
n
a
l r
ef
er
r
als to
en
s
u
r
e
co
n
tin
u
ity
o
f
s
er
v
ices [
2
1
]
,
[
2
2
]
.
T
a
b
le
1
s
h
o
ws
th
at
t
h
e
d
is
t
r
i
b
u
tio
n
o
f
r
es
p
o
n
d
en
ts
is
d
o
m
i
n
at
ed
b
y
f
e
m
a
les
(
6
7
%
)
c
o
m
p
ar
e
d
t
o
m
a
les
(
3
3
%
)
.
I
n
te
r
m
s
o
f
ag
e,
m
o
r
e
r
esp
o
n
d
e
n
ts
we
r
e
i
n
l
ate
a
d
o
l
es
ce
n
ce
(
5
8
.
1
8
%
)
t
h
a
n
e
ar
ly
ad
o
lesc
en
ce
(
4
1
.
8
2
%
)
.
T
a
b
le
2
s
h
o
ws
a
d
ec
r
e
ase
i
n
m
ea
n
s
y
m
p
t
o
m
s
f
r
o
m
p
r
e
-
te
s
t
t
o
p
o
s
t
-
test
f
o
r
b
o
th
an
x
i
et
y
(
4
.
9
2
t
o
3
.
5
0
;
a
d
e
cr
ea
s
e
o
f
1
.
4
2
)
an
d
d
e
p
r
ess
i
o
n
(
5
.
0
5
t
o
3
.
2
1
;
a
d
e
c
r
ea
s
e
o
f
1
.
8
4
)
.
C
o
n
c
e
p
t
u
al
ly
,
t
h
e
p
a
tt
er
n
o
f
“d
ec
r
e
ase
i
n
p
o
s
t
-
in
te
r
v
e
n
ti
o
n
s
co
r
es
c
o
m
p
a
r
e
d
to
p
r
e
-
in
te
r
v
e
n
ti
o
n
”
is
a
f
i
n
d
i
n
g
o
f
t
e
n
u
s
e
d
as
a
n
i
n
d
i
ca
t
o
r
o
f
t
h
e
ef
f
e
cti
v
e
n
ess
o
f
p
s
y
ch
o
s
o
c
ial
/
p
s
y
c
h
o
th
e
r
a
p
y
p
r
o
g
r
am
s
i
n
v
a
r
i
o
u
s
p
o
p
u
l
ati
o
n
c
o
n
t
ex
ts
.
F
o
r
e
x
a
m
p
le
,
p
r
et
est
–
p
o
s
ttes
t
s
tu
d
i
es
e
v
a
lu
ati
n
g
a
n
i
n
te
r
v
e
n
t
io
n
a
ls
o
r
e
p
o
r
t
a
d
ec
r
e
ase
i
n
p
o
s
t
-
i
n
t
er
v
e
n
t
io
n
a
n
x
i
et
y
s
c
o
r
es
c
o
m
p
a
r
ed
to
p
r
e
-
i
n
t
er
v
en
ti
o
n
[
2
3
]
.
A
r
a
n
d
o
m
i
ze
d
co
n
t
r
o
ll
ed
t
r
i
al
s
tu
d
y
o
f
a
m
i
n
d
f
u
l
n
ess
/
r
ela
x
a
ti
o
n
-
b
as
ed
p
r
o
g
r
am
a
ls
o
f
o
u
n
d
l
o
w
er
p
o
s
t
-
t
est
an
x
i
et
y
s
co
r
es
,
b
o
t
h
c
o
m
p
a
r
e
d
t
o
b
ase
lin
e
a
n
d
a
c
o
m
p
a
r
is
o
n
g
r
o
u
p
[
2
4
]
,
a
n
d
ch
il
d
b
ir
th
ed
u
c
ati
o
n
p
r
o
g
r
a
m
s
als
o
s
h
o
w
ed
a
d
ec
r
e
ase
i
n
a
n
x
iet
y
f
r
o
m
p
r
et
est
to
p
o
s
ttes
t
af
te
r
t
h
e
in
te
r
v
e
n
ti
o
n
[
2
5
]
.
T
h
e
r
ed
u
ctio
n
in
m
ea
n
d
ep
r
ess
io
n
in
T
ab
le
2
is
also
co
n
s
is
ten
t
with
ev
id
en
ce
th
at
ce
r
tain
p
s
y
ch
o
lo
g
ical
in
ter
v
e
n
tio
n
s
ca
n
r
ed
u
ce
d
ep
r
ess
iv
e
s
y
m
p
to
m
s
.
Me
ta
-
an
aly
s
es
o
f
s
elf
-
co
m
p
ass
io
n
in
ter
v
en
tio
n
s
r
e
p
o
r
t
ef
f
ec
ts
o
n
r
ed
u
cin
g
d
ep
r
ess
iv
e
an
d
an
x
iety
s
y
m
p
to
m
s
[
2
6
]
.
Min
d
f
u
ln
ess
in
ter
v
en
tio
n
s
(
in
clu
d
in
g
d
ig
ital
f
o
r
m
s
)
in
s
y
s
tem
atic
r
ev
iews/me
ta
-
an
aly
s
es
h
av
e
also
b
ee
n
r
ep
o
r
ted
to
b
e
ef
f
ec
tiv
e
in
allev
iatin
g
d
ep
r
ess
io
n
[
2
4
]
.
I
n
ad
d
itio
n
,
g
r
atitu
d
e
-
b
ased
in
ter
v
en
tio
n
s
we
r
e
r
e
p
o
r
ted
to
h
av
e
s
m
all
b
u
t
s
tatis
t
ically
s
ig
n
if
ican
t e
f
f
ec
ts
o
n
d
ep
r
ess
iv
e
s
y
m
p
to
m
s
as we
ll a
s
an
x
iety
at
p
o
s
t
-
test
an
d
f
o
llo
w
-
u
p
[
2
7
].
T
ab
le
3
s
h
o
ws
a
s
h
if
t
in
th
e
d
is
tr
ib
u
tio
n
o
f
s
y
m
p
to
m
lev
els
to
war
d
m
ild
er
ca
teg
o
r
ies
af
ter
th
e
in
ter
v
en
tio
n
.
Fo
r
an
x
iety
,
th
e
“m
ild
/n
o
n
e”
ca
teg
o
r
y
in
c
r
ea
s
ed
(
1
3
to
5
6
r
esp
o
n
d
en
ts
)
,
a
n
d
th
e
“m
o
d
er
ate”
ca
teg
o
r
y
d
ec
r
ea
s
ed
(
8
7
t
o
4
4
)
,
with
p
=
0
.
0
0
3
.
Fo
r
d
e
p
r
ess
io
n
(
s
h
o
w
n
as
“A
n
x
iety
Pre
-
Po
s
t”
in
th
e
tab
le)
,
th
e
“m
ild
/n
o
n
e”
ca
teg
o
r
y
in
c
r
ea
s
ed
(
1
3
to
6
1
)
,
a
n
d
t
h
e
“m
o
d
er
at
e”
ca
teg
o
r
y
d
ec
r
ea
s
ed
(
4
4
t
o
3
9
)
,
with
p
=
0
.
0
0
1
.
Me
th
o
d
o
lo
g
ically
,
th
is
p
atter
n
o
f
“sh
if
tin
g
ca
teg
o
r
ies
to
w
ar
d
m
ild
e
r
lev
els”
alig
n
s
with
t
h
e
n
ar
r
ativ
e
th
at
in
ter
v
en
tio
n
s
ca
n
n
o
t
o
n
l
y
r
e
d
u
ce
m
ea
n
s
co
r
es
b
u
t
also
alter
r
is
k
p
r
o
f
iles
at
th
e
in
d
i
v
id
u
al/g
r
o
u
p
lev
el.
T
h
e
f
in
d
in
g
o
f
im
p
r
o
v
em
e
n
t
in
a
n
x
iety
s
y
m
p
to
m
s
f
r
o
m
p
r
e
-
t
o
p
o
s
t
-
an
x
iety
is
also
co
n
s
is
ten
t
with
s
tu
d
ies
o
f
ex
p
o
s
u
r
e
th
er
a
p
y
in
c
h
il
d
r
en
an
d
a
d
o
lescen
ts
th
at
r
ep
o
r
t
d
e
cr
ea
s
ed
an
x
iety
s
y
m
p
to
m
s
af
t
er
th
er
a
p
y
[
2
8
]
,
as
well
as with
m
in
d
f
u
ln
ess
/r
elax
atio
n
in
ter
v
en
tio
n
s
th
at
s
h
o
we
d
lo
wer
p
o
s
t
-
in
ter
v
en
tio
n
an
x
i
ety
s
co
r
es [
2
4
]
.
T
h
e
s
tatis
tical
s
ig
n
if
ican
ce
(
p
-
v
alu
e)
in
T
ab
le
3
s
tr
en
g
th
e
n
s
th
e
in
ter
p
r
etatio
n
th
at
th
e
ch
a
n
g
es
in
th
e
d
is
tr
ib
u
tio
n
o
f
p
r
e
-
p
o
s
t c
ateg
o
r
ies we
r
e
n
o
t simp
ly
r
an
d
o
m
f
lu
ctu
atio
n
s
in
th
is
s
am
p
le.
Alth
o
u
g
h
th
e
av
ailab
le
r
ef
er
en
ce
s
d
o
n
o
t
ad
d
r
ess
s
p
ec
if
ic
ca
teg
o
r
y
test
in
g
in
th
e
c
o
n
tex
t
o
f
ad
o
lescen
t
MH
FA,
R
C
T
ev
id
en
ce
o
n
m
in
d
f
u
ln
ess
/r
elax
atio
n
an
d
ch
ild
b
ir
th
ed
u
ca
tio
n
p
r
o
g
r
am
s
d
em
o
n
s
tr
ates
s
tati
s
tically
s
ig
n
if
ican
t
d
if
f
er
en
ce
s
in
an
x
iety
f
r
o
m
p
r
e
to
p
o
s
t
[
2
4
]
.
I
n
ad
d
itio
n
,
m
eta
-
a
n
aly
s
es
o
f
s
elf
-
co
m
p
ass
io
n
an
d
g
r
atitu
d
e
in
ter
v
en
tio
n
s
also
in
d
icate
th
at
ch
an
g
es
in
s
y
m
p
to
m
s
(
d
ep
r
ess
io
n
an
d
/o
r
an
x
iety
)
ca
n
ap
p
ea
r
co
n
s
is
ten
tly
at
p
o
s
t
-
test
ac
r
o
s
s
s
tu
d
ies,
alth
o
u
g
h
th
e
m
ag
n
itu
d
e
o
f
th
e
ef
f
ec
t
v
a
r
ies
[
2
6
]
,
[
2
7
]
.
T
h
u
s
,
th
e
s
tatis
tical
s
ig
n
if
i
ca
n
ce
in
T
ab
le
3
is
co
n
s
is
ten
t
with
th
e
in
ter
v
en
ti
o
n
liter
atu
r
e
s
h
o
win
g
s
tatis
tic
ally
d
etec
tab
le
ch
an
g
es
in
s
y
m
p
to
m
s
,
wh
ile
also
u
n
d
er
s
co
r
i
n
g
th
at
v
ar
iab
ilit
y
i
n
ef
f
ec
ts
is
co
m
m
o
n
in
u
n
iv
er
s
al/p
r
ev
en
tio
n
in
ter
v
en
tio
n
s
[
2
9
]
.
T
a
b
le
3
is
als
o
r
el
ev
an
t
t
o
r
ea
d
wi
th
in
th
e
f
r
a
m
e
wo
r
k
o
f
“p
e
er
-
le
d
”
m
en
to
r
i
n
g
.
I
n
a
s
u
r
v
e
y
d
u
r
i
n
g
t
h
e
p
a
n
d
e
m
ic
,
a
n
e
x
a
m
p
l
e
o
f
a
p
e
e
r
-
le
d
m
en
tal
h
e
alt
h
p
r
e
v
e
n
ti
o
n
p
r
o
g
r
a
m
f
o
r
m
e
d
i
ca
l
s
tu
d
en
ts
was
r
ep
o
r
te
d
i
n
t
h
e
co
n
t
ex
t
o
f
a
b
u
r
n
o
u
t
a
n
d
s
t
r
es
s
p
r
ev
e
n
ti
o
n
s
e
m
i
n
a
r
,
i
ll
u
s
t
r
at
i
n
g
th
at
p
e
er
-
b
as
ed
ap
p
r
o
ac
h
es
a
r
e
u
s
ed
i
n
m
e
n
t
al
h
e
alt
h
p
r
e
v
e
n
ti
o
n
p
r
ac
tic
e
an
d
ar
e
ass
o
cia
te
d
w
it
h
p
s
y
c
h
o
lo
g
ic
al
o
u
t
co
m
es
i
n
p
a
r
ti
ci
p
a
n
ts
[
2
9
]
.
F
u
r
th
e
r
m
o
r
e
,
th
e
d
e
v
el
o
p
m
e
n
t o
f
t
r
ai
n
i
n
g
t
h
at
“
d
r
aws
i
n
s
p
ir
ati
o
n
f
r
o
m
M
HFA
”
w
it
h
a
tte
n
t
io
n
to
a
n
x
ie
t
y
a
n
d
d
e
p
r
ess
i
o
n
w
as
also
d
is
c
u
s
s
e
d
in
a
s
tu
d
y
o
f
c
r
o
s
s
-
s
er
v
i
ce
p
r
o
g
r
am
ac
ce
p
t
ab
il
ity
,
w
h
i
c
h
c
o
n
f
ir
m
e
d
th
e
r
e
le
v
an
ce
o
f
M
HFA
as
a
tr
a
in
in
g
f
r
am
ew
o
r
k
f
o
r
th
e
ea
r
l
y
d
e
tec
ti
o
n
/t
r
e
atm
e
n
t
o
f
an
x
i
et
y
an
d
d
e
p
r
ess
i
o
n
.
T
h
e
r
e
f
o
r
e,
t
h
e
s
h
i
f
t
i
n
s
y
m
p
t
o
m
c
ate
g
o
r
ies
i
n
T
a
b
le
3
c
an
b
e
p
l
ac
e
d
wit
h
i
n
t
h
e
e
v
i
d
e
n
c
e
la
n
d
s
c
a
p
e
t
h
a
t
p
r
o
g
r
am
s
t
h
a
t
a
r
e
s
t
r
u
ct
u
r
e
d
,
o
r
ie
n
t
ed
t
o
w
ar
d
ea
r
l
y
s
u
p
p
o
r
t
,
a
n
d
m
ay
in
cl
u
d
e
t
r
ai
n
i
n
g
/
m
e
n
t
o
r
in
g
c
o
m
p
o
n
e
n
ts
(
i
n
c
lu
d
i
n
g
p
ee
r
s
u
p
p
o
r
t)
h
a
v
e
th
e
p
o
te
n
ti
al
t
o
r
es
u
l
t
in
i
m
p
r
o
v
e
m
e
n
ts
i
n
a
n
x
iet
y
a
n
d
d
e
p
r
es
s
io
n
in
d
i
ca
t
o
r
s
[
3
0
]
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
I
mp
a
ct
o
f
a
n
emp
a
th
y
-
b
a
s
ed
men
ta
l h
ea
lth
fir
s
t
a
id
in
terven
tio
n
u
s
in
g
t
h
e
S
UF
A
…
(
S
u
la
s
tr
i
)
343
5.
CO
NCLU
SI
O
N
T
h
is
s
tu
d
y
d
e
m
o
n
s
tr
ates
th
at
th
e
SUFA
Mo
d
el,
im
p
lem
e
n
ted
th
r
o
u
g
h
p
ee
r
c
o
u
n
s
elo
r
-
d
eliv
er
ed
MH
FA
in
ter
v
en
tio
n
,
s
ig
n
if
ic
an
tly
r
ed
u
ce
s
an
x
iety
a
n
d
d
ep
r
ess
io
n
s
y
m
p
to
m
s
am
o
n
g
ad
o
lescen
ts
.
T
h
e
f
in
d
in
g
s
r
ev
ea
l
m
ed
iu
m
-
lar
g
e
ef
f
ec
ts
f
o
r
an
x
iety
(
C
o
h
en
'
s
d
≈
0
.
7
1
)
an
d
lar
g
e
ef
f
ec
ts
f
o
r
d
ep
r
ess
io
n
(
C
o
h
en
'
s
d
≈
0
.
9
2
)
,
with
s
tatis
tically
s
i
g
n
if
ican
t
s
y
m
p
t
o
m
r
ed
u
ctio
n
s
(
p
<
0
.
0
5
)
.
T
h
ese
r
esu
lts
co
n
f
ir
m
th
at
s
tr
u
ctu
r
e
d
,
em
p
ath
y
-
b
ased
p
ee
r
i
n
ter
v
en
tio
n
s
ef
f
ec
tiv
ely
ad
d
r
ess
ad
o
lescen
t
m
en
tal
h
ea
lth
co
n
c
er
n
s
th
r
o
u
g
h
ea
r
l
y
d
et
ec
tio
n
,
s
u
p
p
o
r
tiv
e
c
o
m
m
u
n
icatio
n
,
an
d
a
p
p
r
o
p
r
iate
p
r
o
f
ess
io
n
al
r
ef
er
r
al
p
at
h
way
s
.
T
h
e
m
ag
n
itu
d
e
o
f
th
ese
ef
f
ec
t
s
izes
alig
n
s
with
estab
lis
h
ed
b
en
ch
m
a
r
k
s
in
p
s
y
ch
o
lo
g
ical
in
ter
v
en
ti
o
n
r
esear
c
h
,
s
u
g
g
esti
n
g
clin
ical
m
ea
n
in
g
f
u
ln
ess
b
ey
o
n
d
s
tatis
t
ical
s
ig
n
if
ica
n
ce
.
Fo
r
s
ca
lin
g
a
n
d
p
o
licy
in
teg
r
atio
n
,
s
ev
e
r
al
s
tr
ateg
ic
a
p
p
r
o
ac
h
es
ar
e
r
ec
o
m
m
en
d
e
d
.
E
d
u
ca
tio
n
al
in
s
titu
tio
n
s
s
h
o
u
ld
d
ev
elo
p
s
tan
d
ar
d
ized
,
r
ep
licab
le
tr
ain
in
g
cu
r
r
icu
la
f
o
r
p
ee
r
co
u
n
s
elo
r
s
,
co
m
p
lem
en
ted
b
y
d
ig
ital
p
latf
o
r
m
s
to
ex
ten
d
i
n
ter
v
en
tio
n
r
ea
c
h
,
p
ar
ticu
lar
l
y
ad
d
r
ess
in
g
c
y
b
er
b
u
lly
in
g
-
r
elate
d
s
tr
ess
o
r
s
an
d
tr
ain
-
th
e
-
tr
ain
er
p
r
o
g
r
am
s
en
s
u
r
in
g
s
u
s
tain
ab
le
im
p
lem
e
n
ta
tio
n
ca
p
ac
ity
.
At
t
h
e
p
o
licy
l
ev
el,
g
o
v
er
n
m
en
ts
s
h
o
u
ld
in
c
o
r
p
o
r
ate
p
ee
r
-
b
ased
m
en
tal
h
ea
lth
s
u
p
p
o
r
t
in
to
n
atio
n
al
s
ch
o
o
l
h
ea
lth
p
o
licies,
allo
ca
te
d
e
d
icate
d
f
u
n
d
in
g
with
in
ed
u
ca
ti
o
n
al
b
u
d
g
ets,
estab
lis
h
clea
r
r
ef
er
r
al
p
r
o
to
co
ls
lin
k
in
g
p
ee
r
s
y
s
tem
s
with
p
r
o
f
ess
io
n
al
s
er
v
ices,
m
an
d
ate
f
o
u
n
d
atio
n
al
m
en
tal
h
ea
lth
liter
ac
y
e
d
u
ca
tio
n
,
an
d
d
ev
elo
p
m
o
n
ito
r
i
n
g
f
r
a
m
ewo
r
k
s
to
ev
alu
ate
in
ter
v
en
tio
n
f
id
elity
an
d
o
u
tco
m
es
at
s
ca
le.
T
h
ese
in
teg
r
ated
ap
p
r
o
ac
h
es
ca
n
f
ac
ilit
ate
s
y
s
tem
atic
ad
o
p
tio
n
wh
ile
m
ain
tain
in
g
in
ter
v
en
tio
n
q
u
ality
an
d
ef
f
ec
tiv
en
ess
.
ACK
NO
WL
E
DG
M
E
N
T
S
T
h
e
au
th
o
r
s
wo
u
ld
lik
e
to
ex
p
r
ess
th
eir
g
r
atitu
d
e
t
o
th
e
s
ch
o
o
ls
(
ju
n
i
o
r
h
ig
h
s
ch
o
o
ls
/s
en
io
r
h
ig
h
s
ch
o
o
ls
)
f
o
r
p
r
o
v
id
in
g
p
er
m
is
s
io
n
,
s
u
p
p
o
r
tin
g
f
ac
ilit
ies,
an
d
co
o
r
d
in
atin
g
th
e
r
esear
c
h
im
p
lem
en
tatio
n
th
r
o
u
g
h
o
u
t
th
e
tr
ain
in
g
,
s
cr
ee
n
in
g
,
SUFA
m
en
to
r
in
g
,
an
d
ev
alu
atio
n
p
h
ases
.
T
h
ey
also
ap
p
r
ec
iate
th
e
p
ee
r
co
u
n
s
elo
r
s
(
n
=
1
0
0
)
a
n
d
th
e
ad
o
lescen
t
p
ar
ticip
a
n
ts
f
o
r
t
h
eir
p
ar
ticip
atio
n
,
d
is
cip
lin
e,
an
d
co
m
m
itm
en
t
i
n
f
o
llo
win
g
t
h
e
p
r
etest
–
p
o
s
ttes
t
p
r
o
ce
d
u
r
es
o
v
er
th
e
two
wee
k
s
.
Fin
ally
,
th
ey
wo
u
l
d
lik
e
to
th
an
k
all
p
a
r
ties
wh
o
ass
is
ted
in
th
e
d
ata
co
lle
ctio
n
p
r
o
ce
s
s
,
m
ain
tain
ed
r
esear
ch
eth
ics
(
co
n
f
id
en
tiality
a
n
d
r
ef
er
e
n
ce
s
)
,
an
d
en
s
u
r
ed
th
e
s
m
o
o
th
im
p
lem
e
n
tatio
n
o
f
th
e
MH
FA
-
b
ased
in
t
er
v
en
tio
n
.
F
UNDING
I
NF
O
R
M
A
T
I
O
N
T
h
is
r
esear
ch
was
f
u
n
d
e
d
b
y
t
h
e
Min
is
tr
y
o
f
Hea
lth
,
th
r
o
u
g
h
th
e
DI
PA
f
u
n
d
s
o
f
th
e
T
an
j
u
n
g
Ka
r
an
g
Min
is
tr
y
o
f
Hea
lth
Po
ly
tech
n
i
c
with
th
e
n
u
m
b
er
HK.
1
1
2
.
3
.
0
2
/DI
PA/2
0
2
5
.
AUTHO
R
CO
NT
RI
B
UT
I
O
NS ST
A
T
E
M
E
N
T
T
h
is
jo
u
r
n
al
u
s
es
th
e
C
o
n
tr
ib
u
to
r
R
o
les
T
ax
o
n
o
m
y
(
C
R
ed
iT)
to
r
ec
o
g
n
ize
in
d
iv
id
u
al
au
th
o
r
co
n
tr
ib
u
tio
n
s
,
r
ed
u
ce
au
th
o
r
s
h
ip
d
is
p
u
tes,
an
d
f
ac
ilit
ate
co
llab
o
r
atio
n
.
Na
m
e
o
f
Aut
ho
r
C
M
So
Va
Fo
I
R
D
O
E
Vi
Su
P
Fu
Su
last
r
i
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
Sit
i Fato
n
ah
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
Yu
n
iast
in
i
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
Gir
i U
d
an
i
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
Allan
Har
r
is
✓
✓
✓
✓
✓
✓
✓
✓
✓
✓
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✓
C
:
C
o
n
c
e
p
t
u
a
l
i
z
a
t
i
o
n
M
:
M
e
t
h
o
d
o
l
o
g
y
So
:
So
f
t
w
a
r
e
Va
:
Va
l
i
d
a
t
i
o
n
Fo
:
Fo
r
mal
a
n
a
l
y
s
i
s
I
:
I
n
v
e
s
t
i
g
a
t
i
o
n
R
:
R
e
so
u
r
c
e
s
D
:
D
a
t
a
C
u
r
a
t
i
o
n
O
:
W
r
i
t
i
n
g
-
O
r
i
g
i
n
a
l
D
r
a
f
t
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:
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r
i
t
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-
R
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v
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e
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&
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d
i
t
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n
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su
a
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p
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v
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r
o
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t
a
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mi
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t
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Fu
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CO
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I
C
T
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N
T
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R
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S
T
ST
A
T
E
M
E
NT
Au
th
o
r
s
s
tate
n
o
co
n
f
lict o
f
in
t
er
est.
E
T
H
I
CAL AP
P
RO
V
AL
T
h
is
r
esear
ch
h
as
r
ec
eiv
e
d
et
h
ical
ap
p
r
o
v
al
f
r
o
m
th
e
Ma
tar
am
Min
is
tr
y
o
f
Hea
lth
Po
ly
te
ch
n
ic
with
th
e
n
u
m
b
er
: 4
4
6
/KE
PK
-
T
J
K/V/2
0
2
5
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
15
,
No
.
2
,
J
u
n
e
20
26
:
3
3
7
-
3
4
5
344
DATA AV
AI
L
AB
I
L
I
T
Y
T
h
e
d
ata
th
at
s
u
p
p
o
r
t
th
e
f
in
d
in
g
s
o
f
th
is
s
tu
d
y
a
r
e
av
aila
b
le
f
r
o
m
t
h
e
co
r
r
esp
o
n
d
i
n
g
a
u
th
o
r
,
[
S
]
,
u
p
o
n
r
ea
s
o
n
ab
le
r
eq
u
est.
RE
F
E
R
E
NC
E
S
[
1
]
A
.
S
c
h
i
c
k
,
C
.
H
e
n
n
,
T.
S
.
S
e
n
d
,
S
.
M
a
l
t
e
se
,
M
.
D
e
u
s
c
h
l
e
,
a
n
d
U
.
R
e
i
n
i
n
g
h
a
u
s,
“
I
n
i
t
i
a
l
e
f
f
e
c
t
s o
f
m
e
n
t
a
l
h
e
a
l
t
h
f
i
r
st
a
i
d
t
r
a
i
n
i
n
g
o
n
men
t
a
l
h
e
a
l
t
h
l
i
t
e
r
a
c
y
,
s
o
c
i
a
l
d
i
st
a
n
c
e
,
st
i
g
ma
,
me
n
t
a
l
h
e
a
l
t
h
,
a
n
d
q
u
a
l
i
t
y
o
f
l
i
f
e
i
n
t
h
e
G
e
r
m
a
n
a
d
u
l
t
p
o
p
u
l
a
t
i
o
n
–
F
i
n
d
i
n
g
s
f
r
o
m
a
p
i
l
o
t
s
t
u
d
y
,
”
E
u
ro
p
e
a
n
Ps
y
c
h
i
a
t
ry
,
v
o
l
.
6
8
,
n
o
.
1
,
p
.
e
1
6
4
,
O
c
t
.
2
0
2
5
,
d
o
i
:
1
0
.
1
1
9
2
/
j
.
e
u
r
p
sy
.
2
0
2
5
.
1
0
1
1
4
.
[
2
]
S
.
R
u
sse
l
l
,
V
.
K
e
l
l
y
,
R
.
P
o
l
ma
n
,
a
n
d
M
.
W
a
r
r
e
n
-
Jame
s,
“
T
h
e
e
f
f
e
c
t
i
v
e
n
e
ss
o
f
o
n
l
i
n
e
m
e
n
t
a
l
h
e
a
l
t
h
f
i
r
st
a
i
d
t
r
a
i
n
i
n
g
i
n
c
o
mm
u
n
i
t
y
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a
s
se
s
t
e
a
c
h
in
g
,
m
e
n
t
o
ri
n
g
stu
d
e
n
ts,
a
n
d
e
n
g
a
g
i
n
g
in
re
se
a
rc
h
a
ime
d
a
t
a
d
d
re
ss
in
g
c
o
n
tem
p
o
ra
r
y
c
h
a
ll
e
n
g
e
s
in
n
u
rsin
g
.
As
a
d
e
d
ica
ted
e
d
u
c
a
to
r,
sh
e
stri
v
e
s
t
o
e
q
u
i
p
f
u
t
u
re
n
u
rse
s
with
t
h
e
k
n
o
wle
d
g
e
a
n
d
sk
il
ls
n
e
c
e
ss
a
ry
t
o
e
x
c
e
l
i
n
th
e
ir
p
r
o
fe
ss
io
n
.
S
h
e
c
a
n
b
e
c
o
n
ta
c
ted
a
t
e
m
a
il
:
y
u
n
ias
ti
n
i
3
6
5
@g
m
a
il
.
c
o
m
.
G
iri
Uda
n
i
is
a
n
a
c
a
d
e
m
ic
a
t
th
e
De
p
a
rtme
n
t
o
f
Nu
rsi
n
g
,
M
i
n
istr
y
o
f
He
a
lt
h
P
o
ly
tec
h
n
ic
(P
o
lt
e
k
k
e
s
Ke
m
e
n
k
e
s)
Tan
ju
n
g
k
a
ra
n
g
,
Ba
n
d
a
r
Lam
p
u
n
g
,
Lam
p
u
n
g
P
r
o
v
i
n
c
e
,
In
d
o
n
e
sia
.
I
n
h
is
c
a
p
a
c
it
y
a
t
t
h
e
i
n
stit
u
t
io
n
,
h
e
p
lay
s
a
ro
le
in
th
e
d
e
v
e
lo
p
m
e
n
t
a
n
d
imp
lem
e
n
tati
o
n
o
f
v
o
c
a
t
io
n
a
l
h
i
g
h
e
r
e
d
u
c
a
ti
o
n
a
c
ti
v
it
ies
in
t
h
e
fiel
d
o
f
n
u
rs
in
g
,
a
s
we
ll
a
s
su
p
p
o
rti
n
g
t
h
e
imp
lem
e
n
tatio
n
o
f
t
h
e
Tri
Dh
a
rm
a
P
e
rg
u
r
u
a
n
Ti
n
g
g
i
(e
d
u
c
a
ti
o
n
,
re
se
a
rc
h
,
a
n
d
c
o
m
m
u
n
i
ty
se
rv
ice
)
in
a
c
c
o
rd
a
n
c
e
wit
h
th
e
i
n
stit
u
ti
o
n
'
s
m
a
n
d
a
te.
His
p
ro
fe
ss
io
n
a
l
i
n
v
o
l
v
e
m
e
n
t
f
o
c
u
se
s
o
n
stre
n
g
th
e
n
in
g
n
u
rsin
g
c
o
m
p
e
ten
c
ies
a
n
d
imp
ro
v
in
g
t
h
e
q
u
a
li
ty
o
f
h
e
a
lt
h
se
rv
ice
s
th
ro
u
g
h
a
n
e
d
u
c
a
ti
o
n
-
a
n
d
p
ra
c
ti
c
e
-
b
a
se
d
a
p
p
ro
a
c
h
.
F
o
r
a
c
a
d
e
m
ic
c
o
rre
sp
o
n
d
e
n
c
e
a
n
d
p
r
o
fe
ss
io
n
a
l
c
o
m
m
u
n
ica
ti
o
n
.
S
h
e
c
a
n
b
e
c
o
n
ta
c
ted
a
t
e
m
a
il
:
g
iri
u
d
a
n
i
6
2
@
g
m
a
il
.
c
o
m
.
Alla
n
H
a
r
r
is
is
a
n
u
rsin
g
a
c
a
d
e
m
ic
a
ffil
iate
d
with
t
h
e
De
p
a
rtme
n
t
o
f
N
u
rsin
g
,
P
o
lt
e
k
k
e
s
Ke
m
e
n
k
e
s
Ta
n
ju
n
g
k
a
ra
n
g
,
Ba
n
d
a
r
Lam
p
u
n
g
,
Lam
p
u
n
g
P
r
o
v
i
n
c
e
,
I
n
d
o
n
e
sia
.
I
n
h
i
s
c
a
p
a
c
it
y
a
s
a
lec
tu
re
r/ed
u
c
a
to
r
a
t
th
e
in
stit
u
ti
o
n
,
h
e
c
o
n
tri
b
u
tes
to
th
e
d
e
v
e
l
o
p
m
e
n
t
o
f
e
d
u
c
a
ti
o
n
a
n
d
stre
n
g
th
e
n
in
g
p
r
o
fe
ss
io
n
a
l
c
o
m
p
e
ten
c
ies
in
n
u
rsin
g
,
i
n
c
lu
d
in
g
t
h
e
imp
lem
e
n
tatio
n
o
f
e
v
id
e
n
c
e
-
b
a
se
d
p
ra
c
ti
c
e
in
th
e
c
o
n
tex
t
o
f
h
e
a
lt
h
c
a
re
.
His
p
ro
fe
ss
io
n
a
l
i
n
tere
sts
i
n
c
lu
d
e
imp
ro
v
in
g
th
e
q
u
a
li
t
y
o
f
lea
rn
i
n
g
a
n
d
stre
n
g
t
h
e
n
in
g
n
u
rsin
g
se
rv
ice
s
o
rien
te
d
to
wa
rd
s
p
a
ti
e
n
t
sa
fe
ty
a
n
d
c
o
m
m
u
n
it
y
n
e
e
d
s.
F
o
r
a
c
a
d
e
m
ic
c
o
rre
sp
o
n
d
e
n
c
e
a
n
d
p
r
o
fe
ss
io
n
a
l
c
o
m
m
u
n
ica
ti
o
n
.
He
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
a
ll
a
n
st
d
5
@g
m
a
il
.
c
o
m
.
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