Clinical Levels Of Psychological Distress Research Articles

Diversity of adaptation profiles in youth victims of child sexual abuse.

Child sexual abuse (CSA) is associated with long-term negative consequences in adolescents, but some survivors display resilience. The purpose of this study was to delineate profiles of adaptation in adolescent victims of CSA and to examine their associations with individual and environmental-systemic protective factors. As part of a population-based survey, 8,230 high school students were questioned about CSA and completed measures assessing a host of protective factors and indicators of positive adaptation across 5 domains: self-perception, academic success, mental health, health risk behaviors and romantic relationships. Using a latent class analysis, a best fitting model of 4 classes was identified. This model included a reference group of nonsexually abused teenagers and 3 classes characterizing survivors of CSA: Resilient profile (33% of youth), Externalized profile (34% of youth) and Internalized profile (33% of youth). Sexually abused youth assigned to the Resilient profile were similar to nonsexually abused youth in terms of self-esteem, academic performance, absence of clinical levels of psychological distress and dating violence. Despite experiencing CSA of comparable severity, youth in the Resilient profile reported more optimism and were less likely to rely on avoidant or emotional strategies to cope with difficulties and more likely to report high maternal and paternal support. Findings highlight the utility of a person-oriented approach to enhance our understanding of the diversity of adaptation profiles in youth victims of CSA. Results also underscore the importance of tailoring intervention efforts to efficiently tackle the diverse needs of teen victims of CSA. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Factor structure of the parental reflective functioning questionnaire and association with maternal postpartum depression and comorbid symptoms of psychopathology.

Parental reflective functioning (PRF) refers to the parent’s capacity to envision mental states in the infant and in themselves as a parent, and to link such underlying mental process with behavior, which is important for parenting sensitivity and child socio-emotional development. Current findings have linked maternal postpartum depression to impaired reflective skills, imposing a risk on the developing mother–infant relationship, but findings are mixed, and studies have generally used extensive methods for investigating PRF. The present study examined the factor structure and measurement invariance of the Danish version of the 18-item self-report Parental Reflective Functioning Questionnaire (PRFQ) in a sample of mothers with and without diagnosed postpartum depression. Moreover, the association between PRF and maternal postpartum depression in mothers with and without comorbid symptoms of personality disorder and/or clinical levels of psychological distress was investigated. Participants included 423 mothers of infants aged 1–11 months. Confirmatory factor analysis supported a three-factor structure of the PRFQ; however, item loadings suggested that a 15-item version was a more accurate measure of PRF in mothers of infants. Multi-group factor analysis of the 15-item PRFQ infant version indicated measurement invariance among mothers with and without diagnosed postpartum depression. Multinomial logistic regression showed that impaired PRF was associated with maternal psychopathology, although only for mothers with postpartum depression combined with other symptoms of psychopathology. These results provide new evidence for the assessment of maternal self-reported reflective skills as measured by a modified infant version of the PRFQ, as well as a more nuanced understanding of how variance in symptomatology is associated with impaired PRF in mothers in the postpartum period in differing ways.

The link between infertility-related distress and psychological distress in couples awaiting fertility treatment: a dyadic approach

While there is broad evidence to suggest that individual stress increases, and that high couple relationship quality reduces the risk for psychological distress, our understanding of these associations in couples dealing with infertility remains limited. In this cross-sectional study, we used dyadic data-analysis (Actor-Partner Interdependence Model; APIM) to examine the effects of infertility-related distress (experienced as an individual risk factor) and couple relationship quality (experienced as a couple-based resource), on psychological distress in a sample of 116 infertile couples. 59% of women and 23% of men reported clinical levels of psychological distress, 71% of women and 45% of men reported infertility-related distress, and 3% of participants reported low couple relationship quality. Infertility-related distress predicted psychological distress at the individual level (‘actor effects’) while men’s infertility-related distress predicted women’s psychological distress (partner effect’). Women without medically assisted reproduction (MAR) treatment exposure reported significantly higher couple relationship quality than women with MAR exposure, and men without treatment exposure reported significantly lower infertility-related distress than men with exposure. The level of psychological distress depended on whether both or neither of the partners, or only one partner reported infertility-related distress. Couple relationship quality was not associated with distress, which may imply that dyadic dimensions other than overall satisfaction could be relevant in supporting couples facing infertility.

Protocol for a Phase Two, Parallel Three-Armed Non-inferiority Randomized Controlled Trial of Acceptance and Commitment Therapy (ACT-Adjust) Comparing Face-to-Face and Video Conferencing Delivery to Individuals With Traumatic Brain Injury Experiencing Psychological Distress.

Background: People with traumatic brain injury (TBI) face a range of mental health challenges during the adjustment process post-injury, but access to treatment can be difficult, particularly for those who live in regional and remote regions. eHealth provides the potential to improve access to evidence-based psychological therapy for people with a severe TBI. The aim of the current study is to assess the efficacy of a psychological intervention delivered via video consulting to reduce psychological distress in people with TBI.Methods: This paper outlines the protocol for a multi-center, three-arm, parallel, non-inferiority randomized controlled trial (RCT) of an evidence-based manualized psychological intervention, ACT-Adjust. ACT-Adjust provides nine sessions for adults with a moderate to severe TBI experiencing clinical levels of psychological distress. Fifty-six participants referred from Brain Injury Rehabilitation Units across New South Wales (NSW) and the NSW icare scheme will be randomly allocated to three conditions; (1) video consulting (VC), (2) face-to-face (FtF) and, (3) a waitlist control (WL).Discussion: This is the first RCT to evaluate the efficacy of a psychological therapy (ACT-Adjust) delivered via video consulting for individuals with a moderate to severe TBI.Trial Registration: www.anzctr.org.au, Australian New Zealand Clinical Trials Registry ANZCTRN2619001602112.

Resilience Portfolios and Poly-Strengths: Identifying Strengths Associated with Wellbeing after Adversity

Objectives: This study aimed to describe the prevalence of traumas and strengths in a representative sample of Quebec youth and to test whether poly-strengths were associated with low psychological distress, after controlling for poly-traumas. Method: Using data from the Quebec Youths’ Romantic Relationships survey (QYRRS), hierarchical logistic regressions were conducted to examine the relationship between poly-strengths and low levels of psychological distress, and to identify which strengths were associated with outcomes, after accounting for demographic variables and individuals’ experiences of traumas. Results: More than a third of the sample experienced 4 traumas or more (37.0%). The average number of experienced traumas was 3.04 out of 10 measured traumas. More than half of the sample had at least 5 strengths, the average number of strengths being 3.95 (out of 8). Two third (67.6%) of the sample did not suffer from psychological distress. Among poly-victims, half of the participants (49.6%) showed clinical symptoms of distress. Poly-strengths were uniquely associated with low of clinical distress. After accounting for demographics and poly-traumas, poly-strengths explained 24.2% of the variance of low levels of psychological distress. Self-esteem, optimism, parental support and attachment, number of sources of support, social support (seeking secure base), and capacity to adapt (resiliency) were uniquely associated with low levels of distress. Conclusion and Implications: The combination of strengths decreases the likelihood of experiencing clinical levels of psychological distress, which can contribute to healthy functioning in context of adversities. Findings highlight the importance of promoting multiple and diverse strengths among youth.

Intolerance of uncertainty in parents of childhood cancer survivors: A clinical profile analysis

Purpose: This research aimed to investigate the psychological adjustment related to the risk factor of intolerance of uncertainty in parents of childhood cancer survivors.Design: Participants were mothers (N = 45) and fathers (N = 16) of a childhood cancer survivor (from 4 until 6 years of cancer remission). Parents completed measures of intolerance of uncertainty and its associated factors (positive beliefs about worry, cognitive avoidance, rumination, and problem solving), measures of psychological distress (anxiety, depression somatization, and worries), and performed two Stroop tasks. Findings: A substantial subgroup of parents reported clinical levels of psychological distress and 64% reported a significant level of intolerance of uncertainty. Parents presented a high profile for intolerance of uncertainty (generalized anxiety disorder [GAD] profile) were those who had a high level of distress associated with ineffective psychological adjustment. Conclusion: The data are supportive of brief intervention to reduce intolerance of uncertainty. Sensitizing health care professionals to the identification of intolerance of uncertainty and its associated factors is essential for efficient intervention strategies.

Barriers to psychosocial oncology service utilization in patients newly diagnosed with head and neck cancer.

While patients with head and neck cancer (HNC) are known to experience higher levels of anxiety and depression, they do not always use psychosocial oncology (PSO) services when available. This study aimed to investigate barriers to PSO service utilization in this patient population, with the goal of appropriately targeting outreach interventions. A conceptual model based on the Behavioral Model of Health Services Use was tested in 84 patients newly diagnosed with a first occurrence of HNC followed longitudinally over 1year, including variables collected through self-administered questionnaires, Structured Clinical Interviews for DSM (SCID-I), and medical chart reviews. Within the first-year post-diagnosis, 42.9% of HNC patients experienced clinical levels of psychological distress, with only 50% of these consulting PSO services (29% total). A logistic regression indicated that PSO utilization was increased when patients presented with advanced cancer (P=0.04) and a SCID-I diagnosis of major depressive disorder, anxiety disorder, or substance use disorder (P=0.02), while there was an inverse relationship with self-stigma of seeking help (P=0.03); these variables together successfully predicted 76.3% of overall PSO utilization, including 90.6% of non-users. Future outreach interventions in patients with HNC could address stigma in an attempt to enhance PSO integration into routine clinical care.

Treatment Adherence and Psychological Wellbeing in Maternal Carers of Children with Phenylketonuria (PKU).

Phenylketonuria (PKU), a rare metabolic disorder, causes cognitive impairment unless treated with a strict, protein-restricted diet, but few studies have examined the relationship between treatment compliance and parental wellbeing. In the present study, 46 primary caregivers of children with PKU completed measures of psychological distress, parenting stress (related to caring for a child with an illness), resilience, perceived social support and child dependency. Treatment adherence was assessed using the proportion of blood phenylalanine concentrations within target range in the preceding year. Results indicated that 59% of caregivers showed clinical levels of psychological distress, which was predicted by their parenting stress and resilience. Whilst the proportion of blood phenylalanine concentrations in range was not associated with parental distress, it was predicted by child age and caregiver's perceived support from family. Despite experiencing high levels of distress, the results indicated that caregivers' ability to adhere to treatment was not affected. Interventions to reduce parenting stress and boost caregiver resilience may have a positive effect on parental wellbeing. Additionally, interventions to promote treatment adherence benefit parents of older children, with a focus on promoting support from family members. Further research with larger sample sizes and longitudinal designs is needed to further establish causal mechanisms.

Psychological Distress in Elite Adolescent Soccer Players Following Deselection

Elite adolescent soccer players may represent one athletic population that is vulnerable to developing psychological distress following deselection. This study examined the proportion of players experiencing clinical levels of psychological distress following selection procedures and whether player status (i.e., deselected vs. retained) had a significant effect on psychological distress. Data was collected from 91 players who completed the General Health Questionnaire -12 at three time points: 7–14 days before selection procedures, 7 days after and 21 days after. Although outcomes were heterogeneous, a sizable proportion of deselected players were found to experience clinical levels of psychological distress. A factorial ANOVA (p < .001) found that deselected players experienced higher levels of psychological distress than retained players at postselection time points. The research provides evidence that some deselected players are “at risk” of developing clinical levels of psychological distress. Clinical implications and recommendations for future research are discussed.

Commentary: "Mental Distress in Patients with Cerebral Visual Injury Assessed with the German Brief Symptom Inventory".

Visual disorders are associated with a substantial economic and personal burden (Rein, 2013). The recent paper by Gall et al. (2015) examined the influence of visual disorder on one aspect of this burden, mental health. Their study involved 122 participants (mean age = 58.1 ± 15.6 years, 72 males, 61% either married or in a relationship) who had visual field defects associated with cerebral visual injury due to either optic neuropathies or postchiasmatic lesions following ischemic or hemorrhagic stroke. About one-quarter of the participants also had additional impairments, such as hearing loss (n = 19), tactile paresthesia (n = 7), and loss of sense of smell (n = 5). Their paper highlights the importance of clarifying the mental health challenges associated with eye diseases, such as macular degeneration and diabetic retinopathy (Mathew et al., 2011). Conceivably, it would not be at all surprising if many people become highly distressed and depressive after receiving such a diagnosis. Concern and anticipation about one’s future health, social relationships, work status, and financial security would naturally increase, given expected increased difficulties with daily living and resultant deterioration in quality of life that such diseases can produce (Gall et al., 2015). Gall et al. (2015) argue that the mental health impacts of cerebral visual injury, a result of optic neuropathies or lesions following ischemic or hemorrhagic stroke, is under investigated, and so requires clarification. To assess mental health, the investigators employed the brief symptom inventory (BSI), a well-validated psychometric tool that assesses domains, such as depressive mood, anxiety, hostility, and interpersonal sensitivity (Franke, 2015). Participants who were listed on a clinical database were invited to complete the BSI in addition to socio-demographic information. Cross-sectional mental health data on levels of psychological distress in the participants were compared to community norms for the BSI. Their findings indicated that cerebral visual injury is associated with elevated rates of mental health problems and concerns. For instance, they found over 25% of their sample reported clinical levels of psychological distress. While the cross-sectional nature of their study does not allow the conclusion of causal relationship, the most likely explanation is that the visual disorder leads to physical, social, behavioral, and personal anxieties and apprehensions, with the eventual possibility of leading to mental disorders like major depressive disorder. Similar dynamics have been shown to be associated with a number of physical disorders and diseases. For example, adults with a fluency disorder (chronic stuttering), a neurologically inherited disorder of communication, have been shown to be higher at risk of social anxiety disorder and elevated psychological distress including depressive mood and anxiety (Blumgart et al., 2010; Tran et al., 2011). Furthermore, Gall et al. (2015) also found that participants with multisensory impairment (that is, visual impairment as well as impairment of other senses, such as smell and hearing) had significantly elevated levels of mental distress compared to those with visual impairment alone. This again is not surprising, and is not dissimilar to what we see with other physical disorders, like for instance, in people sustaining an acute spinal cord injury as well as a co-morbid traumatic brain injury (Craig et al., 2013, 2015). Gall et al. (2015) also suggested that quality of life will improve should mental health problems be addressed. This is certainly a positive way forward when dealing with impairment that is difficult to treat or perhaps not reversible. Arguably, assisting the person with the impairment to be more resilient by teaching skills designed to improve the way they cope and adjust with their disorder and impairment will prove to be a very attractive strategy. While the research findings of Gall et al. (2015) may seem evident, their data showing a strong connection between mental distress and a disorder like cerebral visual injury is highly important for directing future research in the area.

Disentangling self-stigma: Are mental illness and help-seeking self-stigmas different?

Two established but disparate lines of research exist: studies examining the self-stigma associated with mental illness and studies examining the self-stigma associated with seeking psychological help. Whereas some researchers have implicitly treated these 2 constructs as synonymous, others have made the argument that they are theoretically and empirically distinct. To help clarify this debate, we examined in the present investigation the overlap and uniqueness of the self-stigmas associated with mental illness and with seeking psychological help. Data were collected from a sample of college undergraduates experiencing clinical levels of psychological distress (N = 217) and a second sample of community members with a self-reported history of mental illness (N = 324). Confirmatory factor analyses provide strong evidence for the factorial independence of the 2 types of self-stigma. Additionally, results of regression analyses in both samples suggest that the 2 self-stigmas uniquely predict variations in stigma-related constructs (i.e., shame, self-blame, and social inadequacy) and attitudes and intentions to seek help. Implications for researchers and clinicians interested in understanding stigma and enhancing mental health service utilization are discussed.

Assessing the utility of the willingness/prototype model in predicting help-seeking decisions.

Prior research on professional psychological help-seeking behavior has operated on the assumption that the decision to seek help is based on intentional and reasoned processes. However, research on the dual-process prototype/willingness model (PWM; Gerrard, Gibbons, Houlihan, Stock, & Pomery, 2008) suggests health-related decisions may also involve social reaction processes that influence one's spontaneous willingness (rather than planned intention) to seek help, given conducive circumstances. The present study used structural equation modeling to evaluate the ability of these 2 information-processing pathways (i.e., the reasoned pathway and the social reaction pathway) to predict help-seeking decisions among 182 college students currently experiencing clinical levels of psychological distress. Results indicated that when both pathways were modeled simultaneously, only the social reaction pathway independently accounted for significant variance in help-seeking decisions. These findings argue for the utility of the PWM framework in the context of professional psychological help seeking and hold implications for future counseling psychology research, prevention, and practice.

Interpersonal victimization patterns and psychopathology among Latino women: Results from the SALAS study.

Research on the victimization of Latino women and the subsequent psychological impact has been limited by focusing on individual forms of victimization, primarily partner violence or sexual assault. Another deficiency includes mainly using convenience and/or geographically restricted samples, which impacts the generalizability of the results. To overcome these research limitations, the Sexual Assault Among Latinas (SALAS) study aimed to evaluate the broader scope of victimization among Latino women. The study surveyed a national sample of 2,000 Latino women using random digit dial methodology. Women were asked about various forms of victimization in childhood and adulthood including physical assaults, sexual assaults, stalking, threats, and witnessed violence, as well as psychological symptomatology including depression, anxiety, anger, and dissociation. This analysis found that victimized women were more likely to experience some form of polyvictimization and/or revictimization throughout their lives, with only 36% of victimized women experiencing one form of victimization in childhood or adulthood alone. Furthermore, multiple victimization experiences significantly increased the proportion of women who experienced psychological distress symptoms in the clinical range. For almost all evaluated symptoms, the multiple forms of victimization or varying victimization patterns significantly predicted clinical levels of psychological distress over any specific form or single incident of victimization. The results suggest that victimized Latino women experience multiple forms of victimization and that the evaluation of a broader spectrum of victimization better accounts for pathological symptomatology. Clinical implications for Latino women and future research directions are discussed.

Using electronic surveying to assess psychological distress within the UK student population: a multi-site pilot investigation

This paper describes the level of psychological distress within university students participating in an evaluation of a web-based intervention for alcohol misuse. Data was collected from 1129 student from four UK universities. Psychological distress was assessed using an online version of the CORE-10. Results showed that 29% of students reported clinical levels of psychological distress. Eight percent of students had moderate-to-severe or severe levels of distress. The items tapping depression and anxiety suggest that, when compared to depression scores, levels of anxiety are heightened. These findings are discussed in light of the evidence which suggests that traditional modes of support delivery may not be sufficient for all students. The possibility that web-based therapeutic interventions could be utilized within this highly computer literate population is explored.

Clinical Interpretation of Quality-of-Life Outcomes: An Investigation of Data from the Randomized Trial of Gemcitabine Plus Paclitaxel Compared with Paclitaxel Alone for Advanced Breast Cancer

Quality-of-Life (QL) data are increasingly relevant to trial results, but are often difficult to interpret and apply clinically; methods to address this problem are needed. Exploratory analyses were conducted using QL data from a recent phase III trial comparing front line gemcitabine plus paclitaxel (GT) versus paclitaxel (T) alone in patients with advanced breast cancer. The most troublesome symptom and toxicity items were identified. For each QL domain, associations and change over time were analyzed using clinically relevant data. The impact of tumor response and duration of therapy on QL outcomes was assessed using pooled data from both treatment arms. Baseline QL data were available from 336 patients, out of 266 patients enrolled on the GT arm and 263 patients enrolled on the T arm. The prevalence of disease-related symptoms was low; 7 of the 10 most troublesome items were psychological. Clinical levels of psychological distress were significantly associated with global QL and reduced significantly over time in both arms. Improved QL was significantly associated with reduced functional impairment, tumor response and completing more cycles of therapy. In this patient population, QL may be closely associated with the clinical efficacy of chemotherapy, functional status and psychological well-being, rather than outcomes such as symptom palliation and toxicity.

Factors Linked to Distress in Mothers of Children Disclosing Sexual Abuse

The aim of the present study is to investigate the variability in clinical level of psychological distress experienced by mothers of sexually abused children by exploring the role of (a) abuse-related variables (length, severity, and identity of perpetrator), (b) a history of childhood sexual abuse and partner violence experienced in the past year, and (c) mothers' coping and feelings of empowerment. Data were collected through self-report measures completed by 149 French-speaking mothers of girls aged 4 to 12 years disclosing sexual abuse. Results revealed that more than half of the mothers reported clinical levels of psychological distress and experienced child sexual abuse, and 1 of 4 mothers experienced physical partner violence. Logistic regression analysis revealed that mother's sexual abuse and partner violence as well as avoidance coping and empowerment contributed to scores reaching clinical levels of psychological distress. In addition, mothers of child victims of intrafamilial sexual abuse are more likely to report clinical levels of distress. Results underscore the importance of evaluating for trauma history and taking coping strategies and empowerment into account in treatment interventions.

Implementation of a feedback system in a managed care environment: What are patients teaching us?

Lessons about patient treatment response from a large-scale outcomes management project are summarized. More than 7,000 clinicians contributed outcome data. Overall, the data demonstrated that patients who have clinical levels of psychological distress and impairment showed a relatively rapid response to treatment. Furthermore, although it appears that the duration and intensity of treatment vary widely from case to case, clinicians and patients make sound judgments as to how much and what kind of treatment is appropriate. Results supported the conclusion that the most effective method to manage costs is to ensure that each patient receive effective care. There are large and stable differences in the effectiveness of clinicians, and outcomes can be improved by referring patients to effective clinicians. The data also suggested that patients who had a poor initial response to treatment eventually had positive outcomes, provided that they remained engaged in treatment. This finding suggests that outcomes can be improved by identifying at-risk patients and proactively keeping them engaged in treatment.

Living with severe anxiety disorders: relatives' distress and reactions to patient behaviours

Psychological distress and complaints of relatives living with agoraphobic and obsessive compulsive patients were examined. Nineteen per cent of relatives reported clinical levels of psychological distress. Relatives' complaints about patients were focused on four primary areas of patient behaviour: chronic sick role/family burden, anxiety symptoms, interpersonal problems, and problems in their relationship with the patient. The focus of complaints and relatives' self- report of psychological distress were not correlated with each other or with socioeconomic status, various measures of patients' initial symptom severity, or relatives' criticism or hostility as measured by the Camberwell Family Interview (CFI). However, relatives' distress was significantly correlated with a measure of patients' initial overall functioning and marginally correlated with relatives' emotional over-involvement as measured by the CFI. Copyright © 2000 John Wiley & Sons, Ltd.

The Experience and Psychological Impact of Early Miscarriage

Interviews were conducted with 27 women in the year following a first trimester miscarriage to investigate their reactions to the experience and the events surrounding it. Some aspects of medical care were reported as unsatisfactory. Little consultation was evident concerning decisions about viewing or disposing of remains following miscarriage. A range of negative emotions were experienced at the time of miscarriage. most dissipating with time. However, clinical levels of psychological distress, as measured by the General Health Questionnaire. were evident in 44% of the group some months after the event. Distress was not associated with length of pregnancy, lime since miscarriage, demographic or pregnancy-related factors. Instead, aspects of medical management, such as patient category (private care vs other) and ability to discuss miscarriage at follow-up, were significantly related to levels of psychological distress. Early miscarriage is clearly an event of considerable significance for the women conc...