Acute Psychological Distress Research Articles

Lawyer as Emotional Laborer

Prevailing norms of legal practice teach lawyers to detach their independent moral judgments from their professional performance-to advocate zealously for their clients while remaining morally unaccountable agents of those clients' causes. Although these norms have been subjected to prominent critiques by legal ethicists, this Article analyzes them instead through the lens of "emotional labor," a sociological theory positing that workers required to induce or suppress feeling in order to sustain the outward countenance mandated by organizational rules face substantial psychological risks. By subordinating their personal feelings and values to displays of zealous advocacy on behalf of others, lawyers, too, may face acute psychological distress and professional dissatisfaction; ironically, legal practice norms may place the heftiest psychological burden on those lawyers most oriented toward justice. This Article explores several potential antidotes to the deleterious effects of emotional labor on legal practitioners, including: (1) deep acting, or the process by which a person attempts to experience the emotions that she is expected to display (effectively, the antithesis of detachment); (2) self-selection into (or out of) the legal profession based on certain personality traits, or self-selection into certain work environments based on one's personal values; and (3) a shift in the standard conception of the lawyer's role toward greater moral autonomy for lawyers. Empirical researchers are called upon to generate data suggesting how best to alleviate lawyers' emotional labor without entirely eliminating the potential usefulness of emotional labor as a check on unethical conduct in legal practice.

Predictors of Subjective Well-being among Individuals with Multiple Sclerosis

Neuropsychological and psychosocial predictors of subjective well-being (SWB) were examined among 74 persons with multiple sclerosis (MS). The multidimensional construct of SWB was assessed by self-report measures of acute psychological distress, global life satisfaction, and health-related quality of life (HRQoL). Objective disease-related indices were obtained from medical records and neuropsychological testing. Unawareness of deficit, a frequent aspect of executive function impairments in MS, was measured as the discrepancy between patient self-report of functional abilities and a caregiver's report of the patient's abilities. Results indicate that a substantial proportion of patients experienced diminished SWB and that disease characteristics such as duration and severity have differential relationships to SWB outcomes. Multiple regression analyses indicated that, in the context of a combined predictive model, social support and unawareness of deficit provided unique information in predicting all three aspects of SWB, beyond that accounted for by disease characteristics. Both social support and unawareness of deficit were associated with positive well-being outcomes. Neuropsychological impairment was adversely related to life satisfaction and HRQoL, but it did not add unique information to the prediction of these outcomes. The findings present a unique view of SWB among individuals with MS in the absence of acute exacerbation of the illness.

Prenatal diagnosis of congenital malformations and parental psychological distress-a prospective longitudinal cohort study

To test whether postnatal psychological distress in parents of babies with congenital malformations is reduced by prenatal diagnosis. A prospective observational longitudinal cohort study was conducted at two Norwegian hospitals. We included 293 parents of babies with congenital malformations (prenatal detection rate: 36.5%) referred for neonatal surgery and 249 parents of healthy babies (comparison group). Parental psychological responses were assessed on three postnatal occasions by psychometric instruments (GHQ-28, STAI-X1, and IES). Significantly increased psychological distress (GHQ-28) was reported by parents who received prenatal diagnosis as compared to postnatal diagnosis; acutely 28.9 versus 24.4, P = 0.006 (comparison group: 19.6); at 6 weeks 26.8 versus 21.5, P < 0.001 (comparison group: 17.7); and at 6 months 22.6 versus 18.7, P = 0.015 (comparison group: 16.6). Mothers consistently reported higher levels of distress than fathers. Multiple linear regression analysis showed that prenatal diagnosis and being a mother significantly predicted severity of acute psychological distress. At 6 weeks and 6 months, mortality and associated anomalies were significant independent predictors of psychological distress. Controlling for other covariates, we found that prenatal diagnosis of congenital malformations was a significant independent predictor of acute parental psychological distress after birth.

Psychological consequences of prenatal diagnosis in a case of familial Angelman Syndrome

Angelman Syndrome (AS), characterized by mental retardation, absence of speech, seizures and motor dysfunction, is caused by genetic defects leading to loss of expression of the maternal copy of the chromosome 15q11-13 imprinted region. Most cases are sporadic, being caused by de novo deletion of maternal chromosome 15q11-13 (75%) or by paternal uniparental disomy (3-4%). Familial cases can occur, due to mutations in the UBE3A gene or in the imprinting center. We describe the case of a pregnant woman having two nephews with AS caused by a UBE3A mutation; lack of communication within the family led the woman to be completely unaware of the risk of disease recurrence until 15 weeks of gestation. UBE3A genetic testing revealed she carried the familial mutation 892-893delCT. Prenatal diagnosis was performed on amniotic fluid and demonstrated that the fetus had inherited the mutation. The unexpected diagnosis and the subsequent termination of the pregnancy caused the woman to undergo acute psychological distress showing relevant psychopathological symptoms. Nevertheless, at 2-year follow-up, adverse consequences were minimized, and the couple was planning a new pregnancy. Factors affecting the psychological outcome of abortion and the role of psychological support in reducing the risk of long-term unfavorable consequences are discussed.

Cognitive-behavioural therapy modestly reduces post-traumatic stress symptoms resulting from physical injury

Bisson JI, Shepherd JP, Joy D, et al . Early cognitive-behavioural therapy for post-traumatic stress symptoms after physical injury: Randomised controlled trial. Br J Psychiatry 2004;184:63–9. [OpenUrl][1][Abstract/FREE Full Text][2] Q...

Comparative levels of psychological distress, stress symptoms, depression and anxiety after childbirth—a prospective population-based study of mothers and fathers

Objective To compare maternal and paternal psychological responses following birth of a healthy baby; and to explore predictors of parental psychological distress. Design A prospective, longitudinal, population-based cohort study. Setting A Norwegian district general hospital. Population One hundred and twenty-seven mothers and 122 fathers were included. Methods Eligible consenting parents were enrolled. The assessments, which were performed zero to four days after birth, at six weeks and at six months, included General Health Questionnaire-28 (GHQ-28), State Anxiety Inventory and Impact of Event Scale. The response rates at the three occasions were 97%, 85% and 71%. Main outcome measures Symptoms of intrusion, avoidance, arousal and psychological distress including anxiety, depression, social dysfunction and somatisation. Results Clinically important psychological distress was reported by 37% of the mothers and 13% of the fathers a few days after childbirth ( P < 0.001). Severe intrusive stress symptoms were reported by 9% and 2% of mothers and fathers, respectively ( P = 0.002). Level of intrusive stress was the outcome that differed most clearly between mothers and fathers at all three points of time. Being a single parent, multiparity and a previous traumatic birth were significant independent predictors of acute maternal psychological distress. After six weeks and six months, the level of psychological distress including symptoms of depression fell to levels found in the general population. Conclusions Childbirth does not seem to trigger long term psychological distress in most parents. Clinically important psychological distress occurred more frequently in mothers than in fathers. Acute maternal psychological distress was predicted by being a single parent, being multiparous, and having a previous traumatic birth.

An investigation of the psychological effects of the September 11, 2001, attacks on New York City: developing and implementing research in the acute postdisaster period.

The September 11, 2001, attack on New York City was the largest human-made disaster in United States history. In the first few days after the attack, it became clear that the scope of the attacks (including loss of life, property damage, and financial strain) was unprecedented and that the attacks could result in substantial psychological sequelae in the city population. Researchers at the Center for Urban Epidemiologic Studies at the New York Academy of Medicine designed and implemented an assessment of the mental health of New Yorkers 5-8 weeks after the attacks. To implement this research in the immediate postdisaster period, researchers at the center had to develop, in a compressed time interval, new academic collaborations, links with potential funders, and unique safeguards for study respondents who may have been suffering from acute psychological distress. Results of the assessment contributed to a New York state mental health needs assessment that secured Federal Emergency Management Agency funding for mental health programs in New York City. This experience suggests that mechanisms should be in place for rapid implementation of mental health assessments after disasters.

Risk factors for preoperative anxiety in adults.

Patients who undergo surgery experience acute psychological distress in the preoperative period. The objective of this study was to identify and quantify the effect of risk factors for preoperative anxiety in adults. A cross-sectional study was performed with 592 inpatients scheduled for elective surgery. Age ranged from 18 to 60 years (ASA physical status I-III). Demographic information was collected using a structured questionnaire. The measuring instruments were a visual analog scale, the State-Trait Anxiety Inventory; the Montgomery-Asberg Depression Rating Scale, the WHO Self-Reporting Questionnaire-20, and the future self-perception questionnaire. Multivariate conditional regression modeling was used to control confounding factors and to determine independent predictors of preoperative anxiety, taking into account the hierarchical relationship between risk factors. High preoperative anxiety was associated with history of cancer (odds ratio (OR)=2.26) and smoking (OR=7.47), psychiatric disorders (OR=5.93), negative future perception (OR= 2.30), moderate to intense depressive symptoms (3.22), high trait-anxiety (3.83), moderate to intense pain (2.12), medium surgery (OR=1.52), female gender (OR=2.0), ASA category III (OR=3.41), up to 12 years of education (OR=1.36), and more than 12 years of education (OR=1.68). Previous surgery (OR= 0.61) was associated with lower risk for preoperative state-anxiety. History of cancer and smoking, psychiatric disorders, negative future perception, moderate to intense depressive symptoms, high trait-anxiety, moderate to intense pain, medium surgery, female gender, ASA category III, up to 12 years of education and more than 12 years of education constituted independent risk factors for preoperative state-anxiety. Previous surgery reduced the risk for preoperative anxiety.

A mediational model relating affect intensity, emotion inhibition, and psychological distress

A growing empirical literature suggests that attempts to suppress, inhibit, or avoid private experience (e.g., thoughts, feelings) can be problematic. The purpose of this study was to examine a model in which inhibition of thoughts and emotion was predicted to mediate the relationship between the trait of negative affect intensity and acute psychological distress. Two studies evaluated the model using structural equation modeling procedures: one in a clinical sample and the other in a nonclinical sample. Support for the model was found in both studies, indicating its generalizability. These results provide further evidence for the notion that avoiding or inhibiting cognitive and emotional experience may be a particularly problematic coping style, which is more likely to be engaged in by emotionally intense individuals who are vulnerable to psychological distress.

Premature Ejaculation: A Psychophysiological Approach for Assessment and Management

This article distinguishes several subtypes of biogenic and psychogenic premature ejaculation (PE) according to their etiologic features: the physiological PE types of (a) neurologic constitution, (b) acute physical illness, (c) physical injury, and (d) pharmacologic side effect; and the psychological PE types of (a) psychological constitution, (b) acute psychological distress, (c) relationship distress, and (d) psychosexual skills deficit. Attention is given to assessment and differential diagnosis, and to specific treatment of the types of PE, such as the pharmacologic management of difficult neurologic cases. Effective psychosexual treatment combines multiple strategies such as physiological relaxation, pubococcygeal muscle training, cognitive and behavioral pacing strategies, and the involvement of the partner in the therapy. Treatment should determine the specific type of PE and comprehensively address its particular features in order to improve long-term treatment effectiveness.

Type D personality: A potential risk factor refined

Objective. Acute and chronic psychological distress have been associated with coronary heart disease (CHD) but little is known about the determinants of distress as a coronary risk factor. Broad and stable personality traits may have much explanatory power; this article selectively focuses on negative affectivity (NA; tendency to experience negative emotions) and social inhibition (SI; tendency to inhibit self-expression in social interaction) in the context of CHD. Methods. The first part of this article reviews research on NA and SI in patients with CHD. The second part presents new findings on NA and SI in 734 patients with hypertension. Results. Accumulating evidence suggests that the combination of high NA and high SI designates a personality subtype (“distressed” type or type D) of coronary patients who are at risk for clustering of psychosocial risk factors and incidence of long-term cardiac events. Type D and its contributing low-order traits (dysphoria/tension and reticence/withdrawal) could also be reliably assessed in a community-based sample of patients with hypertension. This finding was replicated in men and women, and in Dutch- and French-speaking subjects. Type D hypertensives reported more depressive affect than their non type D counterparts. Conclusions. There is an urgent need to adopt a personality approach in the identification of patients at risk for cardiac events. NA and SI are broad and stable personality traits that may be of special interest not only in CHD, but in other chronic medical conditions as well.

Spiritual Administration: Gender and Discernment in the Carmelite Reform

In 1562, Teresa de Jesus founded the first of seventeen reformed (discalced) Carmelite convents and drafted the first of a series of monastic constitutions designed to promote certain ideals-above all, the opportunity for nuns to practice mental prayer, through which they might act as agents of spiritual renewal for a church in crisis. This article analyzes Teresa's innovations in governance; among them, a crucial role for prioresses in spiritual guidance and in discernment-a charism generally restricted to priests. Within ten years of Teresa's death in 1582, the Constitutions were revised in ways that seriously curtailed the provisions designed to protect the discalced feminine magisterium. Despite conditions which could induce acute psychological distress, the Carmelite reform did for a brief time allow some nuns enhanced opportunities for self-actualization as spiritual teachers and healers.

Posttraumatic stress reactions after injury.

Many individuals experience psychological distress after injury. It is unclear whether poor psychological outcome reflects pretrauma variables. In a prospective, cross-sectional study, 152 accident and emergency department patients with physical injuries and an acute stress reaction completed trauma and psychometric questionnaires, including the Impact of Event Scale and the Hospital Anxiety and Depression Scale. Although levels of pretrauma social, occupational, and familial functioning were high, and the modal Abbreviated Injury Scale score was 1, there were high levels of psychological distress at 3 weeks. Mean Hospital Anxiety and Depression Scale anxiety and depression scores were 11.8 (SD, 4.4) and 8.7 (SD, 4.4), respectively. The mean total Impact of Event Scale score was 46.0 (SD, 16.1). Stepwise linear regression analysis found unemployment and previous history of trauma to be associated with increased symptoms of traumatic stress. Trauma patients with high levels of pretrauma functioning may develop acute psychological distress. Unemployment and previous trauma increase risk. Psychological wellbeing should be considered in routine injury assessments.

Role Playing in the History of Economic Thought

Active learning has been widely recognized as central in a student's mastery of a subject (Angelo and Cross 1993; Pascarella and Terenzini 1991). One type of active learning is role playing, which has been used effectively in a variety of fields. For example, Bhawuk (1990) discusses it as a technique to foster cross-cultural awareness; Smokowski (1992) describes its use in psychodrama; and McCaughey (1991) describes its role in exploring acute psychological distress. Role playing is also widely used in studying economics and evaluating social policy options (Williams 1992; Hester 1991; and King and LaRoe 1991). It has also been part of a number of experiments reported in this journal (Leuthold 1993; DeYoung 1993; Bell 1993; Fels 1993). Most closely related to the topic of this article is the example used by Brooks (1985) in a history of psychology course. In each case, role playing is a part of the course experience for students, usually intertwined with other, more traditional academic experiences. In no case was it the exclusive technique used in the delivery of course material. In this article, I describe a history of economic thought (HET) course built entirely on a role-playing model. This course places unusual demands on students and faculty but has led to a remarkable student engagement with the subject matter.

Symptom Overreporting in Combat Veterans Evaluated for PTSD: Differentiation on the Basis of Compensation Seeking Status

We examined the role of compensation-seeking status on response patterns to self-report inventories of acute psychopathology and psychological distress in a group of 165 combat veterans evaluated for posttraumatic stress disorder (PTSD) at a Department of Veteran Affairs (VA) Medical Center. Veterans completed the Minnesota Multiphasic Personality Inventory-Revised, Beck Depression Inventory, Mississippi Scale for Combat-Related PTSD, a fixed-response format version of the Dissociative Experiences Scale, and Impact of Events Scale as pan of a standard assessment battery. Results showed that compensation-seeking veterans endorsed dramatically higher levels of psychopathology across measures and produced sharply elevated fake-bad validity indices as compared to non-compensation-seeking veterans. Differences between the two groups on most scales and indices exceeded effect sizes of 1.0, even when effects of income, global assessment of functioning, and clinician-rated severity of PTSD were controlled for. It is suggested that the availability of VA disability compensation for combat-related PTSD impedes accurate initial assessment of veterans presenting for treatment and may impair estimation of long-term therapeutic outcome in this population.

Understanding acute psychological distress following natural disaster

AbstractA household probability sample of 229 adults was interviewed four to seven months after the Sierra Madre earthquake (June 28, 1991; Los Angeles County). The study predicted psychological distress from these variables: demographics, traumatic event history, low magnitude event history, earthquake related threat perceptions, and earthquake related resource loss. Based on the Conservation of Resources (COR) stress model, it was predicted that resource loss would be central in predicting psychological distress. Three major hypotheses were supported: (1) resource loss was positively associated with psychological distress; (2) resource loss predicted psychological distress when other predictors were statistically controlled; and (3) resource loss was associated with mild to moderate elevations in of psychological distress. The findings support COR stress theory. Theoretical and practical implications are discussed.

The psychological costs of screening for cancer

The benefits of cancer screening programmes accrue to those who have canceror identifiable precancerous conditions, and in whom the disease progression is slowed or halted by earlier intervention. The costs accrue to the rest of the population for whom there is no direct benefit to health. Attention has been given to the medical risks of screening procedures and to the economic costs, but there has been very little regard paid to the psychological costs. The aim of this paper is to evaluate the psychological impact of screening. Screening participants who are found to have untreatable disease, or for whom the interventions prove ineffective, have a greater proportion of their life as a cancer patient with all the associated psychological (and perhaps physical) distress, but no increase in their life expectancy. Those who receive false positive results may experience acute psychological distress produced by the prospect of a grave diagnosis before they are found to be free from serious disease. Even the procedure of screening itself, with the disturbance of the invitation, the discomfort of the tests and the wait for the diagnosis, can have a significant impact upon some patients. This paper evaluates the psychological costs which may be involved across the whole screening procedure, from the possible alarm of receiving an invitation to participate in screening, to the trauma of a cancer diagnosis for someone who had been unaware of any symptoms.

Long-Term Psychological Consequences of Infertility: A Follow-Up Study of Former Patients

ABSTRACT Objective: The acute psychological distress in infertility is well-known, but we know less about the long-term resolution of the problem. This study examined former female infertility patients' subjective experience with infertility, and the long-term psychological functioning in patients who got pregnant, adopted, or remained childless. Design: The medical records of all 361 registered patients in an infertility unit 1982 were identified, and the patients were mailed a follow-up questionnaire, including three standard psychological tests, in 1988 (response rate ca. 70%). Outcome: Most patients had experienced infertility as a traumatic life event with severe implications for their lives. The overall long-term psychological functioning of the patients was fair. There were some differences in well-being between those who did get a child and those who did not, but many other factors, such as marital status, time since investigation, and length of education also influenced the psychological outcome....

Role players: A brief, intensive training program to portray acute psychological distress

AbstractRole players can be used to help train medical personnel to deal with the victims of psychological trauma. An important aspect of this training process is to make the role player presentations as realistic as possible. A program was developed at the Uniformed Services University of the Health Sciences to teach role players how to portray one kind of psychological distress: battle fatigue. The following is a brief description of the methods that were used to train these role players. Key elements of the program were: (1) identify the psychological syndrome, (2) select role players, (3) educate the role players about the syndrome, (4) role players practice the role, (5) present the role to the medical students.

Role players: A brief, intensive training program to portray acute psychological distress

Role players can be used to help train medical personnel to deal with the victims of psychological trauma. An important aspect of this training process is to make the role player presentations as realistic as possible. A program was developed at the Uniformed Services University of the Health Sciences to teach role players how to portray one kind of psychological distress: battle fatigue. The following is a brief description of the methods that were used to train these role players. Key elements of the program were: (1) identify the psychological syndrome, (2) select role players, (3) educate the role players about the syndrome, (4) role players practice the role, (5) present the role to the medical students.