Background Psychological Distress Research Articles

Evolution of psychological distress with age and its determinants in later life: evidence from 17-wave social survey data in Japan

BackgroundPsychological distress (PD) is a major risk factor for mental health among middle-aged and older adults and affects their quality of life and well-being. This study aimed to examine the evolution of PD with age and the relative importance of its determinants, issues that have been insufficiently studied.MethodsWe used longitudinal data obtained from 17-wave social surveys conducted in Japan from 2005 to 2021, to track 34,128 individuals (16,555 men and 17,573 women) born between 1946 and 1955. We defined PD as a Kessler 6 score (range: 0–24) ≥ 5 and estimated fixed-effects regression models to examine the evolution of its proportion with age. We also conducted a mediation analysis to examine the relative importance of specific mediators such as self-rated health (SRH), activities of daily living (ADL), and social participation, in the association between age and PD.ResultsRegression model results confirmed an increase in PD with age. Poor SRH, issues with ADL, and no social participation were key mediators of aging on PD, accounting for 34.2% (95% confidence interval [CI]: 21.0–47.3%), 13.7% (95% CI: 8.2–19.3%), and 10.5% (95% CI: 8.0–13.0%), respectively; consequently increasing PD between 50 and 75 years.ConclusionThe results suggest the need for policy support to encourage middle-aged and older adults to promote health and increase social participation in order to prevent depression while aging.

The psychological distress of gastrointestinal cancer patients and its association with quality of life among different genders

BackgroundPsychological distress is a prevalent unpleasant experience faced by many cancer patients. However, the psychological distress among gastrointestinal (GI) cancer patients is scarcely explored. Moreover, the association between psychological distress and quality of life in different genders has yet to be explored.AimsTo explore the psychological distress among GI cancer patients and examine its association with quality of life among different genders.MethodsThis study was a cross-sectional study. A total of 237 gastrointestinal cancer patients completed the distress thermometer and the Functional Assessment of Chronic Illness Therapy-General.ResultsThe mean score of psychological distress of the participants was 3.04 (SD = 2.90). A greater proportion of female gastrointestinal cancer patients (52.8%) had clinically relevant psychological distress compared to males (35.9%). The quality of life was negatively associated with their psychological distress (B = − 1.502, 95%CI: − 2.759 to − 0.245, p = 0.019) among gastrointestinal cancer patients. Such association was stronger among males compared to females in gastrointestinal cancer patients (Interaction term, B = − 1.713, 95%CI: − 3.123 to − 0.303, p = 0.017).ConclusionsThese findings suggest that healthcare providers should attach their attention to gastrointestinal cancer patients’ psychological distress, especially females. Longitudinal studies could adopted to track the changes in psychological distress and its association with quality of life over time among different genders. In future intervention studies, the focus of psychological interventions needs to be gender-specific.

Psychological distress and associated factors among medical students in Addis Ababa, Ethiopia: A cross-sectional study (May 2018)

BackgroundPsychological distress, posing a substantial threat to the well-being of medical students, is linked to heightened risks of academic struggles and suicidal tendencies. Despite its profound impact, comprehensive studies on the prevalence and determinants of psychological distress among medical students remain scarce, particularly in developing nations like Ethiopia. This study sought to robustly assess the prevalence of psychological distress and its determinants among medical students in Addis Ababa, Ethiopia. MethodsA rigorous institution-based cross-sectional study involving 423 medical students utilized a stratified random sampling technique. The Kessler Psychological Distress Scale (K10) served as the assessment for psychological distress. The scale has been validated for use in Ethiopia and demonstrates a sensitivity of 84.2 % and specificity of 77.8 %. Scores above 20 on the K10 were considered as indicative of psychological distress, while scores falling within the ranges of 10–19 were likely to indicate wellness. Logistic regression was used to investigate the association between dependent and independent variables. Odds ratios (OR) with corresponding 95 % confidence intervals (95 % CI) were meticulously calculated to discern the strength of associations. ResultsOut of the 423 participants, 390 were included in the current study, resulting in a response rate of 92.2 %. A formidable prevalence of psychological distress was exposed, registering at 42.82 % (95 % CI 37.97, 47.82 %). Strikingly, female students exhibited a disproportionately higher prevalence (62.03 %) compared to their male counterparts (37.93 %). Factors such as test anxiety, suicidal attempts, and suboptimal time management were pivotal contributors to escalated rates of psychological distress. Multivariable analysis underscored the significance of certain determinants, revealing that high GPA scores were protective [AOR 0.25, 95 % CI 0.13, 0.49], while inadequate social support [AOR 5.7, 95 % CI 2.96, 11.24], a history of suicidal attempts [AOR 5.62, 95 % CI 1.34, 23.4], and problematic test anxiety [AOR 5.02, 95 % CI 2.67, 9.42] were associated with heightened vulnerability. ConclusionThis study unveils a pervasive and concerning landscape of psychological distress among medical students in Addis Ababa, with a stark gender disparity. Interventions targeting test anxiety, fortifying social support structures, and providing accessible mental health resources are essential to mitigate these challenges and enhance the resilience and well-being of medical students, thereby reducing or preventing psychological distress.

Fear of giving birth alone: Experiences of psychological distress, symptoms of anxiety and depression, and coping- strategies of childbearing women during COVID-19

BackgroundPsychological distress during pregnancy is a well-documented risk factor for adverse maternal outcomes. Distress related to the COVID-19 pandemic may further increase the vulnerability of pregnant women to negative mental health outcomes. AimTo explore the mental health experiences of pregnant women, focusing on mental health outcomes, challenges related to the pandemic, coping strategies, and factors buffering mental health factors during the restricted COVID-19 lockdown period. MethodsA mixed-methods survey study was conducted, examining symptoms of anxiety, depression, and burnout among 21 pregnant women. Qualitative data were gathered through open-ended questions about participants’ experiences of challenges, coping strategies and buffering factors amid the pandemic. Symptoms of anxiety, depression and burnout were calculated, and qualitative data was thematically analyzed. ResultsApproximately one-third (24 %) of the respondents reported clinically significant levels of depression, 19 % reported clinically significant levels of anxiety, and 43 % reported experiencing burnout. All participants reported distress and emotional burden, including fear, worry, stress and anxiety related to the pandemic. Specific concerns such as fear of giving birth alone, fear of the consequences due to lockdown restrictions, insufficient information, disruption of prenatal healthcare services, and fear of miscarriage were prevalent among the participants. Social support, financial stability, stable relationships, adherence to daily routines, reduced stress and social demands, a calmer daily life, physical activity, and less work-related stress including working from home, emerges as buffering factors that aided women in coping with pandemic-related distress. ConclusionHealthcare providers should prioritize stability, predictability, and minimizing disruptions to prenatal care. Broad-based screening is crucial to identify women at risk of depression, anxiety, and burnout. Recommendations for clinical pathways aimed at pregnant women are discussed.

Physical activity habits prevent psychological distress in female academic students: The multiple mediating role of physical and psychosocial parameters

BackgroundPsychological distress is recognised as the most common mental health difficulty in emerging adult (18-to-24-year-old) female academic students. This study aimed to test a novel model positing physical activity habits as a protective factor for psychological distress through the mediating role of physical and psychological parameters. Adherence to the Mediterranean diet and self-reported physical health status were included as physical parameters. Self-reported psychological health status and time spent on leisure activities were the psychological parameters considered. MethodData were collected between April and May 2021. Correlation analyses and a multiple mediation model were computed on 411 online questionnaires filled out by 18-to-24-year-old female students from the University of blind (Italy). ResultsThe multiple indirect effects were significant (β = −0.088; p < 0.001). This means that physical activity habits reduce psychological distress through high adherence to the Mediterranean diet, a good self-assessment of one's physical and psychological health status, and more time spent on leisure activities outdoors, with friends, and with family members. ConclusionsResults show that academic policies should be adopted so as to design physical activity programmes that may improve the students’ healthy behaviours and social interactions, which, in turn, mitigate the detrimental effects of psychological distress.

Social support, family resilience and psychological resilience among maintenance hemodialysis patients: a longitudinal study

BackgroundPsychological distress is common in maintenance hemodialysis patients, and high psychological resilience can promote psychological well-being. The current research focuses on psychological resilience protective factors such as family resilience and social support. However, the trajectories of psychological resilience, family resilience, and social support over time and their longitudinal relationships in maintenance hemodialysis patients have not been fully explored yet. Therefore, this study aims to explore the longitudinal relationship between these factors.MethodsPatients who received regular hemodialysis treatment for more than three months at dialysis centers of three tertiary hospitals in Zhejiang, China, were recruited from September to December 2020. A total of 252 patients who met the inclusion and exclusion criteria completed three follow-up surveys, including social support, family resilience, and psychological resilience assessments. A repeated measures ANOVA was used to explore differences in their respective scores at different time points. The cross-lagged analysis was performed in AMOS using the maximum likelihood method to examine the the reciprocal predictive relationships between these factors.ResultsSocial support and psychological resilience remained relatively stable over time, whereas family resilience indicated a little increasing trend. According to the cross-lagged analysis, higher T1 social support predicted higher family resilience at T2 [β = 0.123, 95% CI (0.026–0.244)]. Further, the effects of T2 social support to T3 family resilience [β = 0.194, 95%CI (0.039–0.335)] and psychological resilience [β = 0.205, 95%CI (0.049–0.354)] were significant. Finally, the effects of T2 family resilience to T3 social support [β = 0.122, 95%CI (0.010–0.225)] and psychological resilience [β = 0.244, 95%CI (0.119–0.359)] were also significant.ConclusionsThe study showed that the directionality of the relationship appears to be from social support or family resilience to patients’ psychological resilience but not vice versa. This finding reminds healthcare professionals to emphasize the vital role of social and family resources in providing appropriate support and interventions for maintenance hemodialysis patients to promote psychological resilience and mental health development.

Psychological Distress and the Risk of Adverse Cardiovascular Outcomes in Patients With Coronary Heart Disease

BackgroundPsychological distress is a recognized risk factor in patients with coronary heart disease (CHD), but its clinical significance is unclear. ObjectivesThe purpose of this study was to determine if an index of psychological distress is independently associated with adverse outcomes and significantly contributes to risk prediction. MethodsPooled analysis of 2 prospective cohort studies of patients with stable CHD (N = 891). A psychological distress score was constructed using measures of depression, anxiety, anger, perceived stress, and post-traumatic stress disorder, measured at baseline. The study endpoint included cardiovascular death or first or recurrent nonfatal myocardial infarction or hospitalization for heart failure at 5.9 years. ResultsIn both cohorts, first and recurrent events occurred more often among those in the highest tertile of distress score than those in the lowest tertile. After combining the 2 cohorts, compared with the lowest tertile, the hazards ratio for having a distress score in the highest tertile was 2.27 (95% CI: 1.69-3.06), and for the middle tertile, it was 1.52 (95% CI: 1.10-2.08). Adjustment for demographics and clinical risk factors only slightly weakened the associations. When the distress score was added to a traditional clinical risk model, C-statistic, net reclassification index, and integrative discrimination index all significantly improved. ConclusionsAmong patients with CHD, a composite measure of psychological distress was significantly associated with an increased risk of adverse events and significantly improved risk prediction.

Psychological distress in pregnancy and postpartum: a cross-sectional study of Babol pregnancy mental health registry

BackgroundPsychological distress (PD) is a significant issue during pregnancy and postpartum, adversely affecting both children and mothers. This study aims to determine PD's prevalence and risk factors in a large Iranian population sample during pregnancy and postpartum.MethodsA cross-sectional study was conducted using data from the Babol Pregnancy Mental Health Registry (located in the north of Iran) between June 2020 and March 2021. A total of 2305 women were included, with 1639 during pregnancy and 666 during postpartum. Psychological distress was assessed using the Brief Symptoms Inventory (BSI-18), and data were analyzed using independent t-tests and multiple logistic regressions.ResultsThe prevalence of psychological distress, defined by a cut-off score of BSI ≥ 13, was 19% during pregnancy and 15% during postpartum. Multivariate logistic analysis revealed that high-risk pregnancy was the leading risk factor for psychological distress during the antenatal period (β = 1.776, P < 0.001), as well as its three subscales: somatization (β = 1.355, P = 0.019), anxiety symptoms (β = 2.249, P < 0.001), and depressive symptoms (β = 1.381, P = 0.028). Additionally, women with a gestational age < 20 weeks had a higher risk of psychological distress (β = 1.344, P = 0.038) and the somatization subscale (β = 1.641, P < 0.001). During the postpartum period, women residing in urban areas were at higher risk of psychological distress (β = 1.949, P = 0.012), as well as two subscales: anxiety symptoms (β = 1.998, P = 0.012) and depressive symptoms (β = 1.949, P = 0.020).ConclusionThe high prevalence of psychological distress emphasizes detecting and treating PD during pregnancy and postpartum, particularly in women with high-risk pregnancies. This study suggests that obstetricians and midwives should implement programs to identify women experiencing psychological distress during early pregnancy through postpartum visits.

Feasibility of a brief, in-patient coping and sleep intervention to reduce potentially preventable readmission of cardiac patients to hospital

BackgroundPsychological distress is prevalent amongst hospital in-patient and may predispose patients to potentially preventable readmissions after discharge. A particularly vulnerable group are patients with cardiac disorders. This study tested the feasibility of a brief cognitive behavioural therapy consisting of an in-hospital coping session and a post-discharge healthy sleep session. MethodsStandardised questionnaire were used to assess sleep, coping/distress and wellbeing at baseline (pre-intervention) and one-month post-discharge (post-intervention). Treatment fidelity and acceptability were assessed at follow-up. Participants included 72 inpatients admitted with a cardiac disorder or reported to have a cardiac problem whilst in hospital from a single Australian public hospital. ResultsMost (83 %) participants found the intervention helpful/very helpful. At baseline prior to admission, almost half of participants (46 %) reported poor wellbeing, 19 % high levels of distress and poor coping, and 47 % sleeping less than 7 h per night. Following the intervention, 45 % of participants with poor wellbeing at baseline had reliable change in wellbeing at follow-up. Conversely, only 22 % of patients with high levels of coping/distress at baseline demonstrated improved coping/distress at follow-up suggesting smaller gains. On average a large 43 min gain in sleep duration was observed post-treatment in patients with poor sleep at baseline. Fourteen percent of participants were readmitted to hospital within 34-days of discharge. ConclusionsThe coping and sleep intervention was well received with positive outcomes in patients especially those reporting high levels of distress for sleep and to lesser extent coping and wellbeing. Future studies to assess the efficacy of the brief intervention at reducing hospital readmissions are needed.

Psychological outcomes of the systematic interventions based on the stress-induced situation, affective, bodily, and cognitive reactions framework for patients with lung cancer: A randomized clinical trial

BackgroundPsychological distress is a multi-factorial unpleasant experience of a psychological, social, spiritual, and/or physical nature that may interfere with one's ability to cope effectively with cancer, physical symptoms and treatment. Psychological distress is common and affects the prognosis of cancer patients. Lung cancer accounted for 11.4 % of all new cancer cases and 18 % of all cancer mortality for 36 cancers in 185 countries. The prevalence of distress among Chinese lung cancer patients ranged from 10.1 % to 61.29 %. However, the existing intervention studies on the psychological distress in lung cancer patients are limited and intervention results may be different. ObjectivesTo explore the psychological outcomes of a nurse-led systematic intervention program based on the stress-induced situation, affective, bodily, and cognitive reactions framework for patients with lung cancer undergoing operation at anxiety and depression. DesignA randomized clinical trial. SettingThoracic surgery ward in a tertiary hospital in China. ParticipantsLung cancer patients undergoing surgery. MethodsThis is a 12-month longitudinal randomized controlled study in a tertiary hospital in China. A total of 240 lung cancer patients were randomly divided into either the control group or the intervention group. The nurse-led systematic intervention contents include psychological education, intervention measures based on the stress-induced situation, affective, bodily, and cognitive reactions framework, issuance of daily lifestyle cards, and regular follow-ups. The Hospital Anxiety and Depression Scale, Functional Assessment of Chronic Illness Therapy—Fatigue Scale, and Satisfaction with Life Scale were used for the baseline assessment within 48 h upon admission. The same assessment was performed respectively at 1, 3, 6 and 12 months after the intervention started. The effects of the systematic interventions on depression, anxiety, fatigue, and life satisfaction were tested by a linear mixed effects model. ResultsOverall time-by-group interaction effects were significantly different with regard to anxiety, depression, and fatigue after controlling for the covariates, while a significant time-by-group interaction effect was not found for life satisfaction. Changes for anxiety and depression scores at 6 and 12 months after initiation of the intervention were significantly greater in the intervention group compared with those in the control group (t = 3.046, p = 0.002, t = 3.190, p = 0.001; t = 3.735, p = 0.000, t = 2.979, p = 0.002), whereas scores for fatigue were significantly higher in the intervention group at 6 and 12 months (t = −3.096, p = 0.002, t = −2.784, p = 0.005). ConclusionThe systematic intervention program based on the stress-induced situation, affective, bodily, and cognitive reactions framework may effectively relieve anxiety, depression, and fatigue in lung cancer patients undergoing surgery. RegistrationThis study was registered on December 22, 2019 with the registration number ChiCTR1900028487, and the date of first recruitment was Jan 5, 2020.

Non-pharmacological interventions to manage psychological distress in patients living with cancer: a systematic review

BackgroundPsychological distress is common in patients with cancer; interfering with physical and psychological wellbeing, and hindering management of physical symptoms. Our aim was to systematically review published evidence on non-pharmacological interventions for cancer-related psychological distress, at all stages of the disease.MethodsWe followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The review was registered on PROSPERO (CRD42022311729). Searches were made using eight online databases to identify studies meeting our inclusion criteria.Data were collected on outcome measures, modes of delivery, resources and evidence of efficacy. A meta-analysis was planned if data allowed. Quality was assessed using the Mixed Methods Appraisal Tool (MMAT).ResultsFifty-nine studies with 17,628 participants were included. One third of studies included mindfulness, talking or group therapies. Half of all studies reported statistically significant improvements in distress. Statistically significant intervention effects on distress were most prevalent for mindfulness techniques. Four of these mindfulness studies had moderate effect sizes (d = -0.71[95% CI: -1.04, -0.37] p < 0.001) (d = -0.60 [95% CI: -3.44, -0.89] p < 0.001) (d = -0.77 [CI: -0.146, -1.954] p < 0.01) (d = -0.69 [CI: -0.18, -1.19] p = 0.008) and one had a large effect size (d = -1.03 [95% CI: -1.51, -0.54] p < 0.001). Heterogeneity of studies precluded meta-analysis. Study quality was variable and some had a high risk of bias.ConclusionsThe majority of studies using a mindfulness intervention in this review are efficacious at alleviating distress. Mindfulness—including brief, self-administered interventions—merits further investigation, using adequately powered, high-quality studies.Systematic review registrationThis systematic review is registered on PROSPERO, number CRD42022311729.

The Effects of the Compassionate Mind Training for Caregivers on Professional Quality of Life and Mental Health: Outcomes from a Cluster Randomized Trial in Residential Youth Care Settings

BackgroundPsychological distress is highly noticeable among caregivers working in residential youth care (RYC). Maintaining and enhancing caregivers’ professional mental health and quality of life is crucial to achieve effective outcomes in RYC. Nevertheless, trainings to protect caregivers’ mental health are scarce. Considering the buffering effect over negative psychological outcomes, compassion training could be beneficial in RYC.ObjectiveThis study is part of a Cluster Randomized Trial examining the effects of the Compassionate Mind Training for Caregivers (CMT-Care Homes), looking at professional quality of life and mental health of caregivers working in RYC.MethodThe sample was composed of 127 professional caregivers from 12 Portuguese residential care homes (RCH). RCHs were randomly allocated at experimental (N = 6) and control group (N = 6). Participants were assessed at baseline, post-treatment, and 3 and 6-month follow-ups, answering to the Professional Quality of Life Scale and the Depression, Anxiety and Stress Scale. Program effects were tested using a two-factor mixed MANCOVA, with self-critical attitude and education degree as covariates.ResultsMANCOVA showed a significant Time × Group interaction effects (F = 1.890, p = .014; ηp2\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$${\\eta }_{p}^{2}$$\\end{document} = .050), with CMT-Care Homes participants presenting lower scores on burnout, anxiety, and depression at 3 and 6-months follow-ups, when compared with controls. Participants that received CMT-Care Homes considered the program useful to deal with pandemic threats and with youth during lockdowns.ConclusionThis study shows the benefits of the CMT-Care Homes in helping professional caregivers reducing burnout, anxiety and depression, and dealing with pandemic challenges in RYC.Trial registration: This cluster randomized trial was registered at ClinicalTrials.gov (TRN: NCT04512092) on 6th August 2020.

Differences in the presentation of COVID-19-related psychosocial stress and general psychological distress and the relation between the number of care days and these symptoms among Japanese ward staff working exclusively with COVID-19 and support staff

BackgroundPsychological distress has been frequently observed in frontline healthcare workers under stress during the coronavirus disease 2019 (COVID-19) epidemic; however, it is unclear if there are differences in the stress and symptoms experienced by staff members who work exclusively in a COVID-19 ward and support staff temporarily deployed to a COVID-19 ward. The present study investigated psychosocial stress specific to the care for patients with COVID-19 and psychological distress among ward staff working exclusively with COVID-19 and temporary support staff.MethodsThe participants were full-time nurses and doctors working in COVID-19 wards or the ICU who provided face-to-face care to patients with COVID-19 during the COVID-19 outbreak in February of 2021. The data of 67 staff members (21 exclusively working with Covid-19 patients (group A) and 46 in the temporary support group (group B)) was available for study. Psychosocial stress specific to healthcare professionals during this COVID-19 outbreak (Tokyo Metropolitan Distress Scale for Pandemic [TMDP]) and general psychological distress (K6) were assessed.ResultsThe K6 score was significantly lower in group B than in group A (p = .006), but no significant difference was found in the total score of TMDP or its subscales. Positive correlations were found between TMDP and K6 for group B (p = .011), as was the number of days of care on TMDP-social (rs = .456, p = .001).ConclusionEven though support staff members experienced lower psychological distress than staff working exclusively with COVID-19, COVID-19-related psychosocial stress specific to HCWs was comparable. The support staff also presented psychological distress associated with psychosocial stress specific to healthcare professionals during this COVID-19 outbreak, and the COVID-19-related social stress was enhanced as the number of working days increased. Our results show that all staff, not only those working exclusively with COVID-19 patients but also other support staff should be provided with care focusing on COVID-19-related psychosocial occupational stress.

Health care providers’ perspectives on providing end-of-life psychiatric care in cardiology and oncology hospitals: a cross-sectional questionnaire survey

BackgroundPsychological distress is a major concern for patients with end-stage heart failure (HF). However, psychiatric care for patients with HF is not as organized as that for patients with cancer. Therefore, the aim of this study was to elucidate and compare the barriers faced by health care providers of cardiology and oncology hospitals in providing end-of-life psychiatric care to patients with HF and cancer, respectively.MethodsWe conducted a cross-sectional questionnaire survey among the health care providers of Japan. Questionnaires were mailed to physicians and nurses of 427 cardiology and 347 oncology hospitals in March 2018 to assess health care providers’ perspectives. First, we compared the scores of the Palliative Care Difficulties Scale and the original scale of end-of-life psychiatric care difficulties between health care providers of cardiology and oncology hospitals. Second, we asked the health care providers to describe the barriers to providing end-of-life psychiatric care with an open-ended question and then compared the freely-provided descriptions using content analysis.ResultsA total of 213 cardiology and 224 oncology health care providers responded to the questionnaire. No significant differences were found between health care providers of cardiology and oncology hospitals in the frequency of experiencing barriers to providing end-of-life psychiatric care (59.8% and 62.2%, respectively). A content analysis identified the following eight barriers: “patients’ personal problems,” “family members’ problems,” “professionals’ personal problems,” “communication problems between professionals and patients,” “problems specific to end-of-life care,” “problems specific to psychiatric care,” “problems of institution or system,” and “problems specific to non-cancer patients.” The “problems specific to noncancer patients” was described more frequently by health care providers in cardiology hospitals than that in oncology hospitals. However, there were no significant differences in other items between the two.ConclusionAlthough health care providers of both cardiology and oncology hospitals faced barriers to providing end-of-life psychiatric care, those of cardiology hospitals particularly faced challenges pertaining to non-cancer patients, such as unpredictability of prognosis or insufficiency of guideline development. A system of psychiatric care, specifically for patients with HF, should be established.

Exploring HIV status as a mediator in the relationship of psychological distress with socio-demographic and health related factors in South Africa: findings from the 2012 nationally representative population-based household survey

BackgroundPsychological distress as measured by mental disorders like depression and anxiety is more prevalent in people living with HIV (PLHIV) than in the general population. However, the relationship between mental disorders and HIV is complex and bidirectional. Improved understanding of the relationship between mental disorders and HIV is important for designing interventions for this group. This paper explores the interrelationships of psychological distress with HIV and associated socio-demographic and health-related factors.MethodsThis secondary data analysis used the 2012 South African population-based household survey on HIV collected using a cross-sectional multi-stage stratified cluster sampling design. Generalized structural equation modelling (G-SEM) path analysis was used to explore the direct and indirect relationships of socio-demographic, health and HIV-related factors with psychological distress as measured by Kessler 10 scale using HIV status as a moderator variable.ResultsA total of 20,083 participants were included in the study, 21.7% reported psychological distress, of whom (32.6%) were HIV positive. In the final path model with HIV status as a moderator, psychological distress was significantly more likely among age group 25–49 years (AOR: 1.4 [95% CI 1.3–1.6]), age 50 years and older, (AOR: 1.4 [95% CI 1.2–1.6]), females (AOR: 1.6 [95% CI 1.4–1.8]), high risk drinkers (AOR: 1.9 [1.6–2.2]) hazardous drinkers (AOR: 4.4 [95% CI 3.1–6.3]), ever tested for HIV (AOR: 1.2 [95% CI 1.1–1.3]). Psychological distress was significantly less likely among the married [AOR: 0.8 (0.7–0.9)], other race groups [AOR: 0.5 (0.5–0.6)], those with secondary level education (AOR: 0.9 [95% CI 0.8–0.9]), and tertiary level education (AOR: 0.7 [95% CI 0.6–0.9]), those from rural informal [AOR: 0.8 (0.7–0.9)], and rural formal [AOR: 0.8 (0.7–0.9)] areas and those who rated their health as excellent/good [AOR: 0.4 (0.4–0.5)].ConclusionThe findings highlight the importance of designing tailored interventions targeted at psychological distress among PLHIV especially the elderly, females, those with no education and / or low education attainment and those residing in informal urban areas.

Psychological distress in adolescents: prevalence and its relation to high-risk behaviors among secondary school students in Mbarara Municipality, Uganda

BackgroundPsychological distress among adolescents negatively affects their academic performance, relationships with family and friends, and ability to participate fully in the community. Stressful life events in low-income countries and risk-taking behavior of adolescents have raised concerns regarding the impact of psychological distress among adolescents. Therefore, the present study estimated the prevalence of psychological distress and examined the high-risk behaviors associated with psychological distress among Ugandan adolescents.MethodsA community based cross-sectional study was conducted among secondary school students in Mbarara Municipality, Uganda. Multistage cluster sampling was used to recruit 921 adolescents from 12 schools. Psychological distress was assessed using the 10-item Kessler Psychological Distress Scale (K10). Logistic regression was used with p-value estimating regression coefficient and 95% confidence interval for odds ratio and adjusted odds ratio (AOR).ResultsThe prevalence of psychological distress using the K10 was 57%. Logistic regression analyses showed that risky sexual behavior [AOR = 1.52; 95% confidence interval (CI) 1.02–2.28], substance use (AOR = 2.06; 95% CI 1.49–2.84) were associated with psychological distress. Students in mixed schools (comprising both sexes) (AOR = 1.94; 95% CI 1.19–3.15) and adolescents with chronic illness (AOR = 1.68; 95% CI 1.18–2.38) were more likely to report psychological distress.ConclusionThe prevalence of psychological distress among school-going adolescents is high. Risky sexual behavior, substance use as well as chronic illness were associated with psychological distress. In addition, the type of school was significantly associated with psychological distress. The findings suggest the need for policy makers and stakeholders in health and education sectors to institute measures that will address mental health issues among adolescents.

Psychological distress among people living with chronic medical illness and the general population, Northwest Ethiopia: A comparative cross-sectional study.

Psychological distress is often linked to and negatively affects the outcomes of chronic medical conditions; however, data on psychological distress and its predictors among individuals with chronic medical illnesses are scarce in developing countries like Ethiopia. The main objective of this study was to assess the magnitude and predictors of psychological distress among people living with chronic medical illness and the general population. A comparative cross-sectional study was conducted in Mecha demographic research center, Northwest Ethiopia. The participants were selected from the general population and outpatient departments. Kessler-10 (K-10) was used to assess psychological distress. The magnitude of psychological distress among people living with chronic medical illness and those from the general population was 62.0% and 35.1%, respectively. The odds of psychological distress in people living with chronic medical illness was three times more than the one in the general population. Divorced marital status, family history of chronic medical illness, and low social support were statistically significantly associated with psychological distress in both groups. The magnitude of psychological distress was significantly higher among people living with chronic medical illness. Routine screening of such cases for psychological distress during their visits for their medical illness helps take appropriate therapeutic interventions.

Clinically relevant effects of Mindfulness-Based Stress Reduction in individuals with asthma

BackgroundPsychological distress and comorbid psychopathology contribute to exacerbation risk in patients with asthma. Thus, interventions designed to reduce stress and improve emotion regulation, such as Mindfulness-Based Stress Reduction (MBSR), may augment standard care. Few studies have addressed this question and a paucity of data exists to determine the ability of MBSR to impact clinical outcomes in asthma. MethodsThis randomized controlled trial investigated effects of MBSR training on asthma control and airway inflammation, in relation to psychological symptoms, in adults with asthma. Participants were randomized to an 8-week MBSR training (n = 35) or wait-list control group (n = 34). Clinically relevant asthma assessments, including Asthma Control Questionnaire and inflammatory biomarkers, were collected at baseline and six approximately-monthly follow-ups. Self-reported mindfulness, distress, depression, and anxiety symptoms were assessed at baseline, post-intervention, and study completion. Chronic stress level was determined at baseline only. ResultsAsthma control improved significantly in individuals randomized to MBSR, relative to wait-list controls (p = .01; effect size d = 0.76), which was maintained at 4mo post-intervention. 32% of MBSR participants achieved a clinically significant improvement, based on the ACQ6 Minimally Important Difference, relative to 12% of wait-list participants. Moreover, MBSR-related improvement in asthma control was associated with a reduction in distress (p = .043) and the intervention was most efficacious for those with the highest baseline depressive symptoms (p = .023). Importantly, MBSR also reduced levels of exhaled nitric oxide, a biomarker of airway inflammation, relative to wait-list controls (p < .05). ConclusionSupporting and extending extant evidence of mind-body relationships in asthma and the benefits of stress reduction for these patients, this is, to the best of our knowledge, the first RCT to demonstrate that training in MBSR improves clinically relevant asthma outcomes. MBSR may thus be a valuable addition to optimal asthma management, particularly for those with comorbid psychopathology. Clinical trial registrationNCT02157766.

The moderating role of resilience in the relationship between state and trait anxiety and post-traumatic growth of medical freshmen

BackgroundPsychological distress such as anxiety of medical students especially during the first-year has been widely acknowledged. However, many students could exhibit post-traumatic growth when experiencing anxiety. Previous study demonstrated that anxiety might have impacts on post-traumatic growth, but how anxiety affects post-traumatic growth is still undefined. This study sought to examine whether resilience has a moderating role between state and trait anxiety and post-traumatic growth when medical freshmen are experiencing stressful events. MethodsA total of 295 medical freshmen were administered the Post Traumatic Growth Inventory, the State-Trait Anxiety Inventory and the Connor-Davidson Resilience Scale. ResultsPost-traumatic growth was negatively correlated with state anxiety and trait anxiety, with a correlation coefficient of −0.474 and −0.462 (p < 0.01), and positively correlated with resilience, with a correlation coefficient of 0.635 (p < 0.01). Resilience acted as a moderator for the indirect effect of state and trait anxiety on post-traumatic growth. ConclusionsThese findings demonstrated resilience could be of extreme importance for developing post-traumatic growth, and therapeutic interventions tailored to the medical freshmen to promote their resilience to adapt to life in college.

Psychological Distress Among Infertility Patients: A Network Analysis.

BackgroundPsychological distress is common among infertility patients. Total scale scores are often used to represent the severity of anxiety, depression, or stress, which ignores important differences between specific symptoms, and relationships between symptoms. This study aimed to identify patterns of psychological distress experienced by infertility patients and to identify the most central symptoms of anxiety, depression, and stress.MethodFrom June to September 2016, 740 infertility patients were included in this cross-sectional study. Infertility patients were asked to complete the Generalized Anxiety Disorder-7, Patients Health Questionnaire-9 (PHQ-9), and Fertility Problem Inventory. Network analysis was used to examine the patterns of psychological distress in infertility patients and to test the most central symptoms of anxiety, depression, and stress.ResultsRestlessness was the most central symptom in infertility patients. “Feelings of guilt” had the highest strength among PHQ-9 symptoms. “Relationship concern stress” and “sexual concern stress” had the strongest connections in the network. Stability estimation indicated that the order of node strength centrality was more stable than the order of closeness and betweenness (the CS-coefficients were 0.75, 0.13, and 0.67, respectively). In addition, network structure and global strength were invariant across gender.LimitationsThe cross-sectional design did not permit identification of causal relationships. Patients in this study were recruited from one reproductive hospital; especially, most patients had low socioeconomic status, which limits generalizability of the findings.ConclusionThis study reinforces the need to better understand the underlying causes of psychological distress in infertile patients. A more detailed investigation of the relationship between these symptoms could provide information for psychosocial interventions aimed beyond “alleviating psychological distress.” We should consider the individual psychological symptom pattern and its potential causes in infertility patients instead of assuming a consistent psychological distress structure.