Differences In Levels Of Distress Research Articles

Abstract C020: Racial differences in distress levels among Black and White hormone receptor–positive breast cancer survivors over a 3-year period

Abstract Purpose: The purpose of this study was to determine longitudinal racial variations in distress levels among Black and White women with hormone receptor-positive (HR+) breast cancer. Methods: This is a secondary data analysis from the Women’s Hormonal Initiation and Persistence (WHIP) Study, an observational study of HR+ breast cancer survivors. Data regarding patient demographics (e.g., race, age, education, income) were collected via surveys. Clinicopathologic factors (e.g., stage, type of surgery, chemotherapy, and radiation) and medication type (tamoxifen vs. aromatase inhibitors) were extracted from medical records. The National Comprehensive Cancer Network’s Distress Thermometer was used to capture distress following AET initiation at 4 timepoints (baseline, year 1, year 2 and year 3). Mixed linear effects models were used to identify differences in distress by race over the 3-year period. An unadjusted model included race and time as covariates, whereas the adjusted model controlled for demographics, clinicopathologic factors and medication type. Results: The total sample was comprised of 572 women (410 White and 162 Black). For the unadjusted model, the race by time interaction was not statistically significant (F3, 1002.53= 2.2895, p = 0.077). However, the race by time interaction was statistically significant in the adjusted model (F3, 670.99 = 2.68, p = 0.04576), such that Black survivors experienced increased distress over time compared to White survivors. Age was the only statistically significant covariate as older women had lower distress compared to their younger counterparts (p= 0.01) Conclusion. Black and White HR+ breast cancer survivors had different distress levels over a 3-year period. Over time Black survivors’ distress remained high compared to their White counterparts. It is important to consider these differences, given that Black women have higher breast cancer related morbidity and mortality. Future work should focus on the development of culturally appropriate interventions for distress management in HR+ Black breast cancer survivors. Citation Format: Fariha Tariq, Teletia Taylor, Robert A. Perera, Vanessa B. Sheppard. Racial differences in distress levels among Black and White hormone receptor–positive breast cancer survivors over a 3-year period [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C020.

Abstract P6-05-33: Distress Reduction and Physical Activity Enhancement by Mobile Support Group in Breast Cancer Survivors: a randomized controlled study

Abstract Purpose Improving physical activity (PA) and reducing mental distress are important issues in the treatment of cancer survivors. This study aimed to investigate the effect of a mobile app-based community on enhancing PA and decreasing distress in breast cancer survivors. Methods We conducted a single-center, prospective, non-blinded, randomized controlled study. Subjects who got breast cancer surgery were allocated to a control group or a app-based community group (intervention) where members were able to share their daily physical activities. Daily walk steps and weekly distress scores using app-based Distress Thermometer (DT) questionnaires were collected from participants for 24 weeks. To examine the differences in levels of distress and weekly step counts for 6 months, we used a t-test method and multivariable regression modeling. Results From Jan 2019 to Apr 2020, a total of 202 participants were enrolled in this study. The intervention group showed a significant increase in weekly steps by 4,496 for 6 months (p < 0.001). The participants in the intervention group showed a significantly lower rate of above mild distress (DT≥3, beta[B] = -0.731, p < 0.001) and above moderate distress (DT≥5, B = -0.558, p < 0.001) compared to those in the control group for 6 months. Conclusions The mobile app-based community is an effective and less resource-intensive tool to increase PA and decrease distress in breast cancer survivors. Citation Format: Il-Yong Chung, Miyeon Jung, Sae Byul Lee, Jong Won Lee, Sei Hyun Ahn, Haekwon Chung. Distress Reduction and Physical Activity Enhancement by Mobile Support Group in Breast Cancer Survivors: a randomized controlled study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-33.

An exploration of mental distress in transgender people in Ireland with reference to minority stress and dissonance theory

Introduction: Internationally mental distress is more prominent in the LGBTI community than the general population. The LGBTIreland study was set up to take stock of this in the Republic of Ireland. This paper reports on the analysis of the transgender group with reference to minority stress theory and cognitive dissonance theory. Method: An online survey was conducted addressing several aspects of mental health and distress that received responses from all groupings (n = 2,264) among which 12.3% (n = 279) identified as transgender. The survey consisted of several validated tools to measure depression, anxiety, stress (DASS-21), coping (CSES), self-esteem (RSES), alcohol and drugs misuse (AUDIT) and a variety of questions addressing demographics, experiential aspects, coping and self-related factors. Data analysis focused on predicting mental distress using DASS-general (composite of depression, anxiety and stress). Results: Transgender participants reported higher levels of mental distress, self-harm, suicidal ideation and attempts, and lower levels of self-esteem in comparison with the LGB groups, as well as the general population. Hierarchical multiple regression showed that 53% of variance in mental distress could be predicted from reduced self-esteem, the experience of harassment and not belonging in school. Furthermore, mental distress was highest among younger participants, those who were ‘not out’, those who had self-harmed and used avoidant coping. There was no significant difference in distress levels among those who had sought mental health support and those who had not. Conclusions: To understand mental distress in transgender people, the minority stress model is useful when taking into account both adverse external (environmental) and internal (cognitive/emotional) factors. The cognitive dissonance mechanism is essential in outlining the mechanism whereby gender incongruence is associated with psychological discomfort, low self-esteem and high mental distress.

Distress and Well-Being Among Psychiatric Patients in the Aftermath of the First COVID-19 Lockdown in Israel: A Longitudinal Study.

Objectives: Studies assessing the effect of the COVID-19 pandemic on psychiatric patients have mostly focused on cross-sectional evaluations of differences in levels of distress. In this study, we aimed to assess changes in distress and well-being following the COVID-19 pandemic outbreak as compared with pre-pandemic levels, as well as potential predictors of symptomatic deterioration, among psychiatric outpatients treated in a public mental health hospital in Israel. Methods: Patients evaluated for distress and well-being before the pandemic (n = 55) were re-evaluated at the end of the first lockdown in Israel. Results: Analyses revealed a significant decrease in the patients’ sense of personal growth. Increases in distress were significantly associated with fear of COVID-19 beyond patient characteristics. Conclusion: These results suggest that the pandemic has a short-term effect on patients’ well-being, and that fear of the pandemic is associated with elevations in distress.

Shift work, and burnout and distress among 7798 blue-collar workers

ObjectiveThis study aimed to investigate the association between shift work, and burnout and distress, and differences by degree of satisfaction with shift schedule and its impact on private life.MethodsPopulation 4275 non-shift factory workers and 3523 rotating 5-shift workers. Workers participated between 2009 and 2016 one to three times in the companies’ periodical occupational health checks. Burnout was measured using the distance, exhaustion and competence subscales of the Dutch Maslach Burnout Inventory and distress by the subscale of the Four-Dimensional Symptom Questionnaire (scale: 0–100). Multiple-adjusted linear mixed models were used to assess between- and within-subject associations between shift work and outcomes, and differences by age, years of shift work, and satisfaction with and impact of shift schedule.ResultsShift work was significantly associated with lower scores on burnout distance (B − 1.0, 95% − 1.8 to 0.3), and among those aged < 48 years with burnout exhaustion (range B − 1.3 to − 1.6). However, the effect sizes were small. Compared to non-shift workers, shift workers dissatisfied with their schedule and those experiencing a high impact on private life had significantly higher burnout (range B 1.7–6.3) and distress levels (range B 4.9–6.1). In contrast, satisfied shift workers and those experiencing a low impact of shift schedule had lower burnout (range B − 0.2 to − 2.2) and no difference in distress levels (P ≥ 0.05). No clear pattern by years of shift work was observed.ConclusionsShift work was associated with burnout and distress in those who were dissatisfied with or who had perceived high impact on the private life of their shift schedule.

Sticking with it: Psychotherapy outcomes for adults with autism spectrum disorder in a university counseling center setting.

This study aimed to discover how individuals with autism spectrum disorders (ASD) fare in psychotherapy within a university counseling setting, compared to their neurotypical peers. Clients with ASD showed no difference in level of distress at intake compared to their neurotypical peers, and improved about the same amount from pre- to post-treatment. However, students with ASD stayed in treatment for significantly more sessions than neurotypical clients, and took significantly longer to achieve maximum improvement on Outcome Questionnaire-45 reports.

Abstract C17: Racial/ethnic variation in psychological distress following an abnormal Pap test

Abstract Introduction: While racial/ethnic disparities in cervical cancer incidence are mostly attributed to screening test utilization, lower rates of adherence to diagnostic and clinical follow-up after an abnormal Pap test may contribute to the higher cervical cancer mortality among racial/ethnic minorities. Psychological distress is a known contributor to non-adherence to diagnostic and therapeutic follow-up. The objective of this analysis is to explore racial/ethnic differences in distress following an abnormal Pap. Methods: Data were collected as part of a clinical trial to evaluate emerging optical technologies for the diagnosis of cervical dysplasia. Participants were non-pregnant women, age ≥18 years, with a recent abnormal Pap test and were recruited at one of the participating colposcopy clinics. Participants answered questionnaires before and after their colposcopy procedure. Distress regarding the abnormal Pap was assessed using the Cervical Dysplasia Distress Questionnaire (CDDQ). The CDDQ measures multiple domains of distress, including those related to the colposcopy procedure (i.e., Tension and Discomfort, Embarrassment), as well as those related to having a positive screening test for cervical cancer (i.e., Health Consequences, Sexual/Reproductive Consequences). Additional items assessed participants' fear of cancer. Subscale scores range from 1 to 4, with higher scores indicating higher levels of distress. Linear regression models were built to assess the differences in distress scores among Hispanic, non-Hispanic black, and non-Hispanic white women after controlling for age and education (Model 1) and age, education, trait anxiety and depression (Model 2). Trait anxiety and depression were respectively measured using the State-Trait Anxiety Inventory for Adults and the Center for Epidemiologic Studies Depression (CESD) scale. Results: Eighty-five Hispanic, 55 non-Hispanic black, and 86 non-Hispanic white women were included in these analyses. After controlling for age and education, there were statistically significant differences by race/ethnicity in distress scores, particularly for the domains of health consequences (p=0.02) and cancer worry (p = 0.014). In both domains, scores were highest among Hispanic women, compared to non-Hispanic black and non-Hispanic white women (mean health consequences scores = 2.45, 2.02, and 2.16, respectively; mean cancer worry scores = 2.02, 1.62, and 1.75, respectively). Furthermore, these racial/ethnic differences in domain-specific distress remained statistically significant after controlling for differences in underlying depression and trait anxiety. Discussion: Our results suggest that there are racial/ethnic differences in levels of distress following an abnormal Pap test, particularly related to concerns over health consequences and fear of cancer. Distress scores in these domains were significantly greater among Hispanic women compared to non-Hispanic blacks and non-Hispanic whites. Hispanic women may be more likely to perceive that their abnormal Pap test will have long-term health consequences and develop into cancer. Clinical and ancillary health professionals who communicate Pap test results to Hispanic patients should reinforce messages to address unrealistic fears about disease and alleviate distress. Citation Format: Jane R. Montealegre, Michael E. Scheurer, Eileen H. Shinn, Thelma Carrillo, Zuber Mulla, Michele Follen, Karen Basen-Engquist. Racial/ethnic variation in psychological distress following an abnormal Pap test. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C17.

A Prospective Comparison Between Cyclopentolate Spray and Drops in Pediatric Outpatients

To determine whether children tolerate cyclopentolate 1% spray better than drops and to assess the adequacy of cycloplegia achieved by spray for objective refraction. The effects of cyclopentolate 1% drops and spray on distress levels were assessed prospectively using a guardian questionnaire in consecutive patients 10 years of age or younger. Distress was graded at various points during the appointment using a Likert scale of 1 to 10 (1 = no distress, 10 = severe distress). The adequacy of cycloplegia in children receiving cyclopentolate spray and the waiting times were assessed via a Likert questionnaire completed by the examining physician. The guardians of 72 and 77 children who received cyclopentolate 1% drops or spray, respectively, completed the questionnaire. The children were divided in three age groups: 1 to 4 years, 5 to 7 years, and 8 to 10 years. Children 7 years or younger were significantly less distressed by administration of cyclopentolate 1% spray (P < .005). There was no statistical difference in distress levels in children older than 7 years (P = .9719). Thirteen of the 77 children who received cyclopentolate 1% spray did not have adequate cycloplegia to allow objective refraction. The results demonstrate cyclopentolate 1% spray is less distressing at the time of administration than cyclopentolate 1% drops for children 7 years or younger. However, the cycloplegia achieved is not adequate in a high percentage of children.

Elevated peri‐transplant distress in caregivers of allogeneic blood or marrow transplant patients

A full-time 24/7 caregiver is required for 100 days or longer following an allogeneic blood or marrow transplant during which time caregivers have multiple demands. Although distress in caregivers is documented, generalization is limited by small sample sizes, restricted range of assessments, and lack of information as to which caregivers may be more vulnerable to distress. The purpose of this study was to describe the peri-transplant psychological status of a sample of caregivers of allogeneic transplant patients. We assessed caregiver mood, stress, burden, and sleep using valid self-report measures in 109 caregivers of allogeneic transplant patients prior to stem cell transplantation. Caregivers' scores were compared with norms or established cutoff scores for behavioral measures. Additionally, demographic characteristics such as age and sex were tested as predictors of distress. Caregivers showed significant levels of anxiety, stress, intrusion and avoidance behaviors, and poor sleep at the start of transplant compared with established norms. Younger caregivers were more distressed than older caregivers. There were no differences in levels of distress between male and female caregivers. The peri-transplant period is a time of heightened anxiety and distress for caregivers of allogeneic transplant patients. This study indicates that caregivers would benefit from support programs in the peri-transplant period. Recommendations for types of support that may be helpful to caregivers are provided, but additional research is needed to validate that these programs would help caregivers providing care to patients receiving an allogeneic transplant in the peri-transplant period.

Do cancer and treatment type affect distress?

We examined differences in distress levels and Distress Thermometer (DT) cutoff scores between different cancer types. The effect of socio-demographic and illness-related variables on distress was also examined. One thousand three hundred fifty patients (response = 51%) completed questions on socio-demographic and illness-related variables, the Dutch version of the DT and Problem List, and the Hospital Anxiety and Depression Scale. Receiver operating characteristics analyses were performed to determine cancer specific cutoff scores. Univariate and multivariate effects of socio-demographic and illness-related variables (including cancer type) on distress were examined. Prostate cancer patients reported significantly lower DT scores (M = 2.5 ± 2.5) and the cutoff score was lower (≥ 4) than in patients with most other cancer types (M varied between 3.4 and 5.1; cutoff ≥ 5). Multivariate analyses (F = 10.86, p < .001, R(2) = 0.08) showed an independent significant effect of four variables on distress: intensive treatment (β = .10, any (combination of) treatment but surgery only and 'wait and see'); a non-prostate cancer type (β = -.17); the interaction between gender and age (β = -.12, highest distress in younger women as compared with older women and younger and older men); and the interaction between cancer type and treatment intensity (β = .08, lowest scores in prostate cancer patients receiving non-intensive treatment as compared with their counterparts). Distress and cutoff score in prostate cancer patients were lower than in patients with other cancer types. Additionally, younger women and patients receiving treatment other than surgery only or 'wait and see' are at risk for higher distress. These results can help identify patients possibly in need of referral to professional psychosocial and/or allied health care.

Prevalence and Correlates of Depression with Atypical Symptoms in Hong Kong

Previous studies of atypical depression have been conducted in Western communities. There has been no community-based epidemiological study of atypical depression that covers the entire spectrum of bipolar disorders. The aim of the present study was to examine the 12 month prevalence of atypical depression and the differences in demographic and clinical profiles between depressed patients with and without atypical symptoms in the Chinese adult population of Hong Kong. A random sample of 3016 Chinese adults completed a telephone-based structured interview that examined their 12 month prevalence of major depressive episode. Atypical depression was defined as major depressive episode with hypersomnia and increased weight or appetite. Major depressive episode with and without atypical symptoms were compared on sociodemographic variables, number of depressive and manic/hypomanic symptoms, proportion of having lifetime mania/hypomania, suicidality, family psychiatric history, help-seeking behaviour, level of distress and role impairment. The 12 month prevalence of atypical depression was 1.3%. Compared to non-atypical depression, atypical depression was associated with female gender, soft (subthreshold) bipolar II disorder, family psychiatric history, higher suicidality, more help-seeking from psychiatrists, and more depressive and manic/hypomanic symptoms. There was no difference in levels of distress or impairment. Although limited by the lack of detailed information on comorbidity, bipolar family history, and age of onset, the findings support the hypothesis that atypical depression among Chinese people in Hong Kong exhibited prevalence and correlates similar to those found in Western epidemiological and clinical studies. Further research is warranted to examine its association with hypomania and how atypical depression may occupy a nosological position between typical unipolar depression and bipolar spectrum disorders.

Complementary and Alternative Medicine: Believe it or not?

Complementary and Alternative Medicine: Believe it or not?

A methodological note on modeling the effects of race: the case of psychological distress

AbstractPsychological distress is an important indicator of the mental well‐being of the population. Findings regarding racial differences in distress are inconclusive but may represent an important pathway through which disparities exist across a number of physical health outcomes. We used data from the 1994 Minority Health Survey, a nationally representative multiracial/ethnic sample of adults in US households, to examine racial/ethnic differences in psychological distress (n = 3623). Our primary study aim was to examine differences between additive and multiplicative models in assessing the influence of income and gender on the race/distress relationship. We hypothesized that additive models do not sufficiently account for potential interactions of race with income and gender, and may therefore mask important differences in distress between racial groups. The results suggest that our hypotheses were supported. After adjusting for income, there were no statistically significant differences in distress levels between racial groups. However, significant differences emerge when multiplicative models are used demonstrating the complexities of the intersection of race, income and gender in predicting psychological distress. Black men and women of higher income status represent a particularly vulnerable group, whereas Hispanic men are especially hardy. We discuss the implications of our findings for future work on racial health disparities. Copyright © 2008 John Wiley &amp; Sons, Ltd.

Psychological distress among immigrants from high- and low-income countries: Findings from the Oslo Health Study

This study compared psychological distress between immigrants from high- and low-income countries living in Oslo, and investigated whether pre- or post-migration factors could explain any such differences in distress levels. A cross-sectional survey with self-administered questionnaires was conducted between 2000 and 2001 among 812 immigrants from high-income countries and 1434 immigrants from low-income countries living in Oslo. The Hopkins Symptom Checklist (HSCL)-10 was used to measure psychological distress. The prevalence rates of psychological distress among immigrants from high- and low-income countries were 10.3% and 24.3%, respectively (P=0.001). Unadjusted odds ratio (OR) of distress among the latter group was 2.38 with 95% confidence interval (CI) 1.73–3.29. The first adjustment (socio-demographic variables) hardly attenuated the difference reported (adjusted OR =2.25, 95% CI 1.58–3.21), the second adjustment (socio-demographic and pre-migration variables) reduced the difference (adjusted OR =1.86, 95% CI 1.28–2.69) while the last adjustment (socio-demographic and pre- and post-migration variables) attenuated the difference below the level of significance (adjusted OR =1.33, 95% CI 0.88–2.01). This means that both pre-migration and post-migration factors were associated with the higher level of distress among immigrants from low-income countries, the post-migration factors in the host country probably being the most important.

Warm or Cold Contrast Medium in the Micturating Cystourethrogram (MCUG): Which is Best?

AIM: The purpose of this study was to determine what difference using room temperature (“cold”) or body temperature (“warm”) contrast medium had on the outcome of MCUG examinations in infants under 1 year of age. MATERIALS AND METHODS: One hundred infants (50 males and 50 females) referred for an MCUG were identified. Individuals with known bladder neuropathy were excluded. Each was randomized to receive either warm or cold contrast medium. The screening time, volume of contrast instilled, number of attempts at voiding, patient distress, completeness of bladder emptying and incidence of reflux were measured and the results between the two groups compared. RESULTS: No difference was found between the two groups with regards to screening time, volume of contrast instilled or number of attempts at voiding. There was a statistically significant ( p<0.05, chi square) difference in distress levels, with more children crying during instillation of cold contrast medium than warm. Bladder emptying was more often to completion when using cold contrast medium (32 compared with 16%), and vesicoureteric reflux (VUR) was more commonly demonstrated when using warm contrast medium (16 compared with 6%), although these values did not reach statistical significance. CONCLUSION: Warm contrast medium causes significantly less distress than cold contrast medium, but does not prolong screening time or increase the volume of contrast required.

One year follow-up of women opting for presymptomatic testing for BRCA1 and BRCA2: emotional impact of the test outcome and decisions on risk management (surveillance or prophylactic surgery).

Genetic testing enables women at risk for hereditary breast and/or ovarian cancer to find out whether they have inherited the gene mutation (BRCA1/BRCA2), and if so, to opt for frequent surveillance and/or prophylactic surgery (bilateral mastectomy and/or oophorectomy). Here, a follow-up is described for 63 healthy women at 50% risk of being a BRCA1/BRCA2 mutation carrier who underwent genetic testing. The course of distress and problems regarding body image and sexuality up to 1 year after disclosure of the test-outcome were described separately for mutation carriers undergoing mastectomy (n = 14), for mutation carriers opting for surveillance (n = 12) and for non-mutation carriers (n = 37). Furthermore, we analyzed whether women opting for prophylactic mastectomy differed from those opting for close surveillance with respect to biographical characteristics, experiences with cancer in relatives and personality. Women opting for prophylactic mastectomy had significantly higher distress levels than mutation carriers who opted for surveillance, and the non-mutation carriers. This difference in levels of distress was highest at pre- and post-test and had almost disappeared at 1-year follow-up. Besides, mutation carriers opting for prophylactic mastectomy were more often in their thirties, more often had young children and had a longer awareness of the genetic nature of cancer in the family than those opting for regular surveillance. Adverse effects were observed in women who underwent prophylactic mastectomy (mostly in combination with immediate breast reconstruction) regarding the perception of how their breast region looked like and felt, the intimate relationship and physical wellbeing whereas women opting for prophylactic mastectomy reported more distress than the other women in the study, their distress levels had significantly decreased 6 months or longer after surgery, possibly due to the significant risk reduction of developing breast cancer. This might explain, why most women who underwent prophylactic mastectomy were satisfied with this decision, despite a perceived negative impact on body image, the intimate relationship and physical wellbeing.

Personality and psychopathology profiles of veterans' wives: measuring distress using the MMPI-2.

The present study compared personality and psychopathology profiles of veterans' wives against married women in the MMPI-2 restandardization sample. Differences in levels of distress and pathology were analyzed using the validity, clinical, and content scales of the MMPI-2. As expected, veterans' wives, when compared to restandardization wives, reported higher levels of psychopathology and distress, with symptoms such as depression, social maladjustment, and other negative, internal symptomatic behaviors. Findings are discussed in terms of the need for additional research examining this "at-risk" population.

Evidence of Physician Adaptability During the Medical Training Period

The present study explores some of the adaptations made during the medical training period comparing men and women on a number of demographic and psychological variables. Medical students and house officers were also compared on these variables. The results showed few significant sex or group differences. The house officers reported more depression and anger in response to pressure than the medical students. When sex role identification (as measured by the PAQ) was analyzed, there were significant differences in distress levels (anxiety, depression and anger/hostility). In all cases, those in the androgynous group reported the least distress, suggesting that personality traits of instrumentality and expressiveness may be important moderators of the responses made to the stresses of training and that a wider range of responses may permit more flexible adaptations.

Distinction between male and female invested partners in sexual disorders

Using the SCL-90, a self-administered symptom inventory, the authors evaluated 48 sexually asymptomatic male and female partners (invested partners) of sexually dysfunctional men and women. They found that the male invested partners showed significantly more psychological symptoms than the female invested partners but about the same symptom distress levels as sexually dysfunctional men. The authors hypothesize that the reason for this gender-specific difference in distress levels of invested partners is society's definition of the male's role as the responsibe partner regarding satisfaction in sexual relationships.