Dimensions Of Distress Research Articles

Carrying an unintended pregnancy to term and long-term maternal psychological distress: Findings from the Dutch prospective Amsterdam Born Children and their Development study.

Given the estimated high rate of unintended pregnancies, it is important to investigate long-term effects on psychological distress in women carrying an unintended pregnancy to term. However, research into associations between unintended pregnancies carried to term and psychological distress postpartum is mixed, and especially, evidence on long-term associations is scarce. To examine whether carrying an unintended pregnancy to term is associated with maternal psychological distress later in life, up to 12 years postpartum. This study is based on the population-based birth cohort study 'Amsterdam Born Children and their Development' study, which included pregnant people in 2003 (n = 7784) and followed them up until 12 years postpartum. Unintended pregnancy was measured as a multidimensional construct, based on self-reported data around 16 weeks gestation on pregnancy mistiming, unwantedness and unhappiness. Symptoms of maternal psychological distress were assessed around 3 months, 5 years and 12 years postpartum using multiple questionnaires measuring symptoms of depression, anxiety and stress. Multiple structural equation modelling models were analysed, examining the associations between dimensions of unintended pregnancy and maternal psychological distress per time point, while controlling for important co-occurring risks. Pregnancy mistiming and unhappiness were significant predictors of more maternal psychological distress around 3 months postpartum. Around 5 years postpartum, only pregnancy mistiming was positively associated with maternal psychological distress. Dimensions of unintended pregnancy were no longer associated with maternal psychological distress around 12 years postpartum. Strikingly, antenatal psychological distress was a much stronger predictor of maternal psychological distress than pregnancy intention dimensions. Those who carried a more unintended pregnancy to term reported more symptoms of psychological distress at 3 months and 5 years postpartum. People carrying an unintended pregnancy to term may benefit from extra support, not because of the pregnancy intentions per se, but because they may be related to antenatal psychological distress.

The Impacts of Alexithymia and Sexual Distress on Sexual Functioning Among Portuguese Women

Introduction: Recognizing own’s emotions seems to have an important role regarding not only our overall well-being, but also our sexual functioning. Aims: The aim of this study is to analyze the association or impact of alexithymia on female sexual functioning. Methods: 459 Portuguese women, with a mean age of 34.57 years (SD = 10.27), ranging from 18 to 65 years, completed the Toronto Alexithymia Scale (TAS-20), the Female Sexual Distress Scale – Revised (FSDS-R) and, additionally, completed the Female Sexual Function Index (FSFI), indicating if and when a sexual relationship occurred in the last month. Results: The results showed that higher levels of alexithymia were associated with worse sexual functioning and higher levels of sexual distress. Higher levels of sexual distress were associated with worse sexual functioning. It was possible to establish a significant linear regression model between dimensions of alexithymia (difficulties in identifying feelings and difficulties in describing feelings) and sexual distress in sexual functioning; the variables together explained about 45.2% of sexual functioning in these women. Conclusions: The results emphasize the relevance of alexithymia’s dimensions in sexual functioning concerning women with or without sexual dysfunction, since they present themselves as significant predictors. Professionals working in women's sexual health should take this into account for more effective assessment and intervention in matters concerning sexual health.

Effectiveness of Narrative Photography in Increasing Nursing Students' Empathy: A Pretest-Posttest Study

Narrative photography is a method that can enhance nursing students' empathy when caring for individuals with HIV. This quasiexperimental pre-test-posttest study included 28 first-year nursing students from a public university in Barcelona, Spain. Empathy was assessed using the Spanish validated version of the Interpersonal Reactivity Index. Empathy scores were higher in the intervention group (p = .01). Women scored higher on empathy and also on the fantasy, empathic concern, and personal distress dimensions. A significant relationship was found between the perspective taking dimension and students choosing nursing as their first option at university. Having no experience in the health field was associated with higher scores on the empathic concern dimension (p = .027). Narrative photography is an effective learning method to promote nursing students' empathy when caring for individuals with HIV. [J Nurs Educ. 2022;61(12):701-705.].

Psychological distress among parents of children with autism spectrum disorders: A randomized control trial of cognitive behavioural therapy

High psychological distress that ranges from stress reactions to anxiety and depression are prevalent among parents and caregivers of children with Autism Spectrum Disorder (ASD) and undermine positive parenting and health outcomes. The current study sought to investigate cognitive-behavioral therapy (CBT) in curtailing psychological distress in a sample of those parenting children with autism. We conducted the study in Enugu state, Nigeria, with 97 parents of children with ASD. Participants were randomly allocated into CBT (N = 48) and waitlist comparison (WLC) (N = 49) groups. The CBT group participated in a 120 min CBT program weekly for 12 weeks. Data were collected using Demographic Questionnaire; Depression, Anxiety, and Stress Scale-21 items (DASS-21) and Satisfaction with therapy and therapist scale- revised (STTS-R). Three data sets were collected at baseline, post-test, and follow-up. Descriptive statistics, Repeated measures Multivariate Analysis of Variance (MANOVA), and t-test statistics were used to analyze the data. Raincloud plots were also used to illustrate results. Results revealed that all dimensions of psychological distress (DASS-depressive symptoms, DASS-anxiety, and DASS-stress) reduced significantly at post-CBT intervention and follow-up assessments in the CBT group, compared to the WLC. Multivariate analysis showed that the global psychological distress score was responsive to CBT intervention. We concluded that stress, anxiety, and depression among those parenting children with autism could be lessened with CBT.

Downstream consequences of moral distress in COVID-19 frontline healthcare workers: Longitudinal associations with moral injury-related guilt

ObjectiveTo examine the longitudinal associations between dimensions of COVID-19 pandemic-related moral distress (MD) and moral injury (MI)-related guilt in a large sample of frontline COVID-19 healthcare workers (FHCWs).Methods: Data from a diverse occupational cohort of 786 COVID-19 FHCWs were collected during the initial peak of the COVID-19 pandemic in New York City and again 7 months later. Baseline MD and MI-related guilt at follow-up were assessed in three domains: family-, work-, and infection-related. Social support was evaluated as a potential moderator of associations between MD and MI-related guilt. ResultsA total of 66.8% of FHCWs reported moderate-or-greater levels of MI-related guilt, the most prevalent of which were family (59.9%) or work-related (29.4%). MD was robustly predictive of guilt in a domain-specific manner. Further, among FHCWs with high levels of work-related MD, those with greater perceptions of supervisor support were less likely to develop work-related guilt 7 months later. DiscussionMD was found to be highly prevalent in FHCWs during the initial wave of the COVID-19 pandemic and was linked to the development of MI-related guilt over time. Prevention and early intervention efforts to mitigate MD and bolster supervisor support may help reduce risk for MI-related guilt in this population.

Childhood abuse, left-behind status and mental health among lesbian, gay, and bisexual young adults in China

BackgroundLesbian, gay, and bisexual (LGB) young adults are at increased risk of mental distress in China. To better carry out psychological intervention, it is essential to understand unique patterns of mental distress and their association with childhood abuse/neglect, including experiencing being left behind by migrating parents. ObjectiveIn a sample of Chinese LGB young adults, we examined: (1) associations between childhood abuse and left-behind status and mental distress; (2) latent profiles of mental distress; and (3) associations between childhood abuse and left-behind status and latent profiles of mental distress. Participants and settingA sample of 630 Chinese LGB young adults aged 18–30 years was recruited to complete an online survey. MethodsParticipants provided demographic information and completed validated measures of childhood abuse experience and mental distress. Latent profile analysis (LPA) was used to identify patterns of mental distress, and logistic regression analysis was used to examine the relationships among these variables. ResultsResults showed that all forms of childhood abuse and left-behind status were associated with all dimensions of adulthood mental distress. The LPA suggested a 3-group solution as optimal (no mental distress, mild mental distress, and moderate/severe mental distress). Participants who experienced any forms of childhood abuse were more likely to be members of both the mild mental distress and moderate/severe mental distress groups (all p's < 0.001). Also, participants who had left-behind status were more likely to be in the moderate/severe mental distress group (AOR = 1.61, p < .05). ConclusionsOur findings highlight the need for interventions aimed at addressing childhood abuse/neglect among Chinese LGB young adults, as these experiences increase the risk for mental health issues in adulthood.

Smartphone-assisted guided self-help cognitive behavioral therapy for young people with distressing voices (SmartVoices): study protocol for a randomized controlled trial

BackgroundThe long-standing view that auditory verbal hallucinations (AVH) or hearing voices is a sign of schizophrenia has been challenged by research demonstrating that they lie on a continuum ranging from normal to pathological experience related to distress and need for care. Hearing voices is more prevalent in adolescence than in later life, and hearing voices during adolescence indicates a risk for severe psychopathology, functional impairments, and suicide later in life. While there is increasing evidence for the efficacy of cognitive behavioral therapy for voices (CBTv) in adults with schizophrenia, research on psychological treatments for youth with distressing voices has been scarce. The aim of the current study is to examine the efficacy of CBTv, delivered using smartphone-based Ecological Momentary Assessment Intervention (EMI) in a transdiagnostic sample of youth.MethodsThis is a superiority randomized controlled trial comparing 8 weeks of CBTv-based EMI in addition to treatment as usual (TAU) versus TAU only. TAU covers both no treatment and any form of psychiatric/psychological treatment. In the EMI condition, participants will be prompted twice a day to complete an EMA survey, and receive one intervention proposal per assessment. One-hundred fifty-four youth aged 14–25 years with distressing voices will be recruited from psychiatric clinics, local private practices, internet forums, and advertisements in print and social media. Before and after the intervention phase, participants will undergo a 9-day EMA. Single-blinded assessments will be conducted at baseline (T0) and at 3-month (T1) and 6-month (T2) follow-up. The primary outcome is the distress dimension of the Auditory Hallucinations subscale of the Psychotic Symptom Rating Scales at T1. Secondary outcomes include perceived hostile intention, power, and dominance of voices, passive, aggressive, and assertive relating to voices, and negative core beliefs about the self.DiscussionAdolescence provides a crucial window of opportunity for early intervention for hearing voices. However, youth are notoriously reluctant help-seekers. This study offers a low-intensity psychological intervention for youth with distressing voices beyond diagnostic boundaries that, using a mobile technology approach, may match the treatment preferences of the generation of “digital natives.”Trial registrationGerman Clinical Trials Register DRKS00026243. Registered on 2 September 2021

The impact of COVID-19 pandemic on the psychological well-being among health care workers: A 6-month cohort longitudinal survey study.

IntroductionHealth care workers (HCW) have been identified as a risk group to suffer psychological burden derived from Coronavirus Disease 19 (COVID-19) pandemic. In addition, possible gender differences in the emotional reactions derived from COVID-19 pandemic have been suggested in this population. The aims of the study were to explore the impact of COVID-19 as well as possible gender differences on mental health status and suicidality in a cohort of HCW.Materials and methodsOne thousand four hundred and thirty-two HCW responded to an online survey including sociodemographic, clinical, and psychometric tests in May 2020 while 251 HCW answered in November 2020. Mental health status was measured by General Health Questionnaire 28 (GHQ-28) in both time periods.ResultsHCW informed of a worsening in somatic symptomatology over the follow up period. Gender differences were found in all GHQ-28 dimensions as well in the total score of the questionnaire. Post hoc analyses displayed significant interaction between the time and gender in somatic and anxiety dimensions as well as in GHQ-28 total score. Stress produced by COVID-19 spreading and the feeling of being overwhelmed at work resulted the main predictors of psychological distress although each domain is characterized by a specific set of predictors.ConclusionsSomatic reactions represent the most sensitive dimension over the follow-up period. Moreover, women are characterized by a greater psychological distress at the beginning, although these differences tend to disappear over time. Finally, a complex network of factors predicted different dimensions of psychological distress, showing the complexity of prevention in high-risk populations facing major disasters.

Maasai women hearing voices: Implications for global mental health.

There is a sparse literature on women who hear voices globally, even though there are documented gendered dimensions of distress in the context of globalization and climate change and research indicates that trauma and psychosocial stress may be related to an increased prevalence of voice-hearing or auditory verbal hallucinations (AVHs). There is also a gap in the cultural phenomenology of voice-hearing in general, as well as idioms of distress for non-western peoples. This article presents results of a mixed methods study that: 1) estimated community prevalence of voice-hearing among Maasai women in northern Tanzania; 2) examined any demographic correlates and two specific hypothesized correlates (i.e., psychological stress and potentially traumatic events); and 3) engaged women in semi-structured interviews about their everyday lives and the phenomenological experience of voice-hearing. The prevalence of voice-hearing (39.4%) in this nonclinical sample (n = 71) was quite high compared to other studies in sub-Saharan Africa. Most women also reported high psychosocial stress and traumatic life events. They also talked about gendered conditions of social adversity in a context of rapid social, economic, and climate change. Women who reported hearing voices had a statistically significantly higher level of psychological distress, met criteria for severe psychological distress, and reported more potentially traumatic life events. In a logistic regression model, psychosocial stress predicted voice-hearing. The presence of distressing voices may offer a straightforward way to quickly identify people in the community experiencing the most extreme levels of psychosocial stress and traumatic events-a potentially simple but effective screening tool for health workers on the ground.

Measuring moral distress in nurses during a pandemic: Development and validation of the COVID-MDS.

The COVID‐19 pandemic created novel patient care circumstances that may have increased nurses' moral distress, including COVID‐19 transmission risk and end‐of‐life care without family present. Well‐established moral distress instruments do not capture these novel aspects of pandemic nursing care. The purpose of this study was to develop and evaluate the psychometric properties of the COVID‐19 Moral Distress Scale (COVID‐MDS), which was designed to provide a short MDS that includes both general and COVID‐19‐specific content. Researcher‐developed COVID‐19 items were evaluated for content validity by six nurse ethicist experts. This study comprised a pilot phase and a validation phase. The pilot sample comprised 329 respondents from inpatient practice settings and the emergency department in two academic medical centers. Exploratory factor analysis (EFA) was conducted with the pilot data. The EFA results were tested in a confirmatory factor analysis (CFA) using the validation data. The validation sample comprised 5042 nurses in 107 hospitals throughout the United States. Construct validity was evaluated through CFA and known groups comparisons. Reliability was assessed by the omega coefficient from the CFA and Cronbach's alpha. A two‐factor CFA model had good model fit and strong loadings, providing evidence of a COVID‐19‐specific dimension of moral distress. Reliability for both the general and COVID‐19‐specific moral distress subscales was satisfactory. Known groups comparisons identified statistically significant correlations as theorized. The COVID‐MDS is a valid and reliable short tool for measuring moral distress in nurses including both broad systemic sources and COVID‐19 specific sources.

A Study on Psychological Distress and Stress Resilience of MSW students in Delhi NCR

Aim: To find out the level of psychological distress and stress resilience and the relationship between psychological distress, stress resilience and background characteristics of MSW students in Delhi-NCR. Method: The sample size is 297 (male-123 and female-174) by adopting non-probability purposive method. A survey among the Master of social work students (first year and second year) of four Universities in Delhi-NCR was carried out. Result: The result shows overall medium level of psychological distress and stress resilience.&#x0D; Conclusion: The dimensions of psychological distress and stress resilience are influenced by the background characteristics of the respondents. It shows that there is a need for the appropriate interventions particularly amongst the 1st Yearr MSW students and include components for effective stress management and stress resilience by introducing changes in curriculum.

Perceived Social Support and Psychological Distress among Healthcare Professionals during COVID-19

The Coronavirus disease (COVID-19) has brought an array of problems affecting people everywhere. Healthcare professionals were under immense work and emotional pressure since the advent of COVID-19 outbreak which exposed them to physical and psychological vulnerabilities. Current study was designed to investigate social support and psychological distress defined as depression, anxiety and stress in healthcare professionals serving during COVID-19. Sample comprised 321 healthcare professionals including male (n=57%) and female (n= 42%) professionals from various healthcare facilities. Majority of the participants had poor social support. Depression mean score (11.86, SD= 5.81) was in mild severity range, whereas mean score of anxiety (11.81, SD=5.76) indicated moderate severity. Mean score on stress (14.01, SD= 7.37) was towards the high side of the normal range. Data revealed gender differences in terms of mean scores on depression, anxiety, stress (p&lt;0.05) and social support (p&gt;0.05). Female healthcare professionals scored significantly lower (p&lt;0.05) on all components of psychological distress namely depression, anxiety and stress than males. Those with high scores on any of the three dimensions of psychological distress also showed to have poor social support. Healthcare professionals noted to have experienced mild to moderate levels of psychological distress and showed differences in level of psychological distress based on relative exposure to patients, perceived social support and gender.

Dimensions of emotional distress among Brazilian workers in a COVID-19 reference hospital: A factor analytical study.

BACKGROUNDThe coronavirus disease 2019 (COVID-19) pandemic is an unprecedented challenge for public health and has caused the loss of millions of lives worldwide. Hospital workers play a key role in averting the collapse of the health system, but the mental health of many has deteriorated during the pandemic. Few studies have been devoted to identifying the needs of workers on frontline duty.AIMTo investigate dimensions of common emotional symptoms and associated predictors among Brazilian workers in a COVID-19 reference hospital.METHODSThis is an observational study of the mental health of professionals in a COVID-19 hospital in the city of São Paulo. We invited all hospital employees to respond to an online survey between July and August 2020, during the first peak of the pandemic. Data of 1000 participants who completed the survey were analyzed (83.9% were women and 34.3% were aged 30 to 40). Hospital workers self-reported the presence of symptoms of depression, anxiety, trauma-related stress, and burnout through the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, the Impact of Event Scale-Revised and the Mini-Z Burnout Assessment respectively. Responses were assembled and subjected to exploratory factor analysis to reveal workers’ core emotional distress. Multiple linear regression models were subsequently carried out to estimate the likelihood of dimensions of distress using questions on personal motivation, threatening events, and institutional support.RESULTSAround one in three participants in our sample scored above the threshold of depression, anxiety, post-traumatic stress disorder, and burnout. The factor analysis revealed a three-factor structure that explained 58% of the total data variance. Core distressing emotional domains were avoidance and re-experience, depression-anxiety, and sleep changes. Regression analysis revealed that institutional support was a significant protective factor for each of these dimensions (β range = -0.41 to -0.20, P < 0.001). However, participants’ personal motivation to work in healthcare service was not associated with these emotional domains. Moreover, the likelihood of presenting the avoidance and re-experience dimension was associated with having a family member or close friend be hospitalized or die due to COVID-19 and having faced an ethical conflict.CONCLUSIONDistressing emotional domains among hospital workers were avoidance and re-experience, depression and anxiety, and sleep changes. Improving working conditions through institutional support could protect hospital workers' mental health during devastating public health crises.

Identifying Symptom Clusters in Cancer Patients Receiving Chemotherapy using Symptom Occurrence and Distress Dimensions.

The current study explored symptom clusters in a heterogenous sample that includes all age groups, and all types of cancer being treated with chemotherapy. A cross-sectional survey design was used. The sample comprise 393 cancer patients with a mean age of 52.1 years (SD 13.9). The most prevalent symptoms were tiredness (78.9%), lack of energy (71.8%), and irritability (66.9%) and the most distressing symptom was lack of appetite. Four clusters of the symptom experience: chemotherapy-related, psychological, fatigue and pain, and gastrointestinal symptoms, regardless of the dimension used, were identified. The content and number of symptoms within each cluster using the distress dimension were slightly different from the occurrence dimension. The findings call for an early comprehensive assessment and treatment of symptoms for patients undergoing chemotherapy. Also, healthcare providers especially nurses need to thoroughly assess and manage these symptoms to ease patients' experience, enhance their compliance and improve their quality of life.

The Ever-Changing Present &amp; Uncertain Future: Clinician Distress During the COVID-19 Pandemic: A Dimensional Analysis (GP754)

Outcomes1. Illustrate the dimensions of clinician distress by narratively describing the phenomenon in caring for patients with COVID-192. Describe the clinical, research, and ethical implications of clinician distress on patients, families, and cliniciansImportanceDuring the COVID-19 pandemic, healthcare clinicians have experienced unprecedented physical and psychological distress. Many expressed emotions in the social media, yet little research has been conducted on the emotional experience of these clinicians.ObjectiveWe aimed to understand the range of emotions expressed by clinicians through various media outlets.MethodsA qualitative dimensional analysis was used with the goal of breaking down the concept of clinician distress into its smallest parts, including “attributes, interconnections, context, process, and implications” and then reconstructing the concept with a new and clearer understanding. Search strategy centered around data written in the clinician's voice through published editorials, commentaries, and opinion pieces from January 1, 2020 through July 22, 2020. Total records of the combined searches resulted in 545 editorials; after deduplication and full text review, 10 journal editorials and 24 newspaper editorials were included in analysis.ResultsA narrative of clinician distress during the COVID-19 pandemic among American clinicians emerged, grounded by the perspective of a clinician's perceptions of clinical care in the context of an ever-changing present and uncertain future, where a clinician recognizes within themselves one of the following conditions: an emotional response or a conflict in tandem with a significant role change resulting in a process of the inability to feel and act according to one's values due to the COVID-19 pandemic, leading to the ultimate consequence of clinician distress.ImpactThis study adds to the concept of clinician distress: expanding the understanding of clinician distress during a global pandemic through published work written by clinicians themselves, including the emotional aspects of caring for patients, developing a new framework for understanding clinician distress by analyzing clinicians’ own written words, and exploring real-time distress through a novel qualitative method to better understand the clinicians’ experiences.

Effects of the Heart to Heart Card Game for Patients with Advanced Cancer Receiving Home-Based Palliative Care: A Clinical Randomized Controlled Trial.

The Heart to Heart Card Game improves psychological health outcomes in hospitalized patients with advanced cancer, but effectiveness studies for patients at home are rare. This randomized controlled study was conducted to determine the effectiveness of the Heart to Heart Card Game on patients with advanced cancer receiving home-based palliative care. Sixty-six participants were randomly assigned to the intervention group (n = 34) and control group (n = 32). The quality of life, dignity, and psychological distress were considered as outcomes, which were assessed pre-intervention and six weeks after the intervention. There was a statistical difference in the quality of life (global health statues) between the intervention group and the control group after intervention (z = 2.017, p < 0.05). A significant difference was found in the quality of life (emotional, social function), dignity (symptom distress dimension), and psychological distress in the intervention group through intragroup comparison before and after the intervention. This randomized trial showed that the Heart to Heart Card Game likely alleviates barriers to end-of-life conversations and helps patients with advanced cancer maintain a more stable mental state. This trial has been registered at the Chinese Clinical Trial Registry (registration number: ChiCTR2100049933).

Changes in the network structure of mental health after a multicomponent positive psychology intervention in adolescents: A moderated network analysis.

The effectiveness of multicomponent positive psychology interventions (MPPIs) on adolescents' mental health has been studied with the use of standard procedures throughout the scientific literature. However, little is known about the potential mechanisms underlying the network structure of mental health following the dual‐factor model after an MPPI. We relied on network analysis to explore the reorganization of the connections between mental health indicators after a school‐based MPPI. Adolescents from two high schools in Spain were randomly allocated to the 6‐week intervention group (n = 85) or to the control group (n = 135). Network analysis showed that the relations between the two differentiated network dimensions of mental health (i.e. well‐being and psychological distress) changed after the intervention. Unlike control participants, emotional well‐being was negatively associated with depression and stress, while psychological well‐being was positively related to stress after the intervention. The present study supports the viability of the network approach in analyzing the connections between mental health indicators as defined by the dual‐factor model and the contribution of MPPIs to change the complex pattern of relations between the dimensions of well‐being and psychological distress.

Heterogeneity of pain-related psychological distress in patients seeking care for shoulder pathology.

Psychological distress is associated with disability and quality of life for patients with shoulder pain. However, uncertainty around heterogeneity of psychological distress has limited the adoption of shoulder care models that address psychological characteristics. In a cohort of patients with shoulder pain, our study sought to (1) describe the prevalence of various subtypes of psychological distress; (2) evaluate associations between psychological distress and self-reported shoulder pain, disability, and function; and (3) determine differences in psychological distress profiles between patients receiving nonoperative vs. operative treatment. The sample included 277 patients who were evaluated in clinic by a shoulder surgeon and completed the Optimal Screening for Prediction of Referral and Outcome Yellow Flag Assessment Tool (OSPRO-YF) from 2019 to 2021. This tool categorizes maladaptive and adaptive psychological traits, and the number of yellow flags (YFs) ranges from 0 to 11, with higher YF counts indicating higher pain-related psychological distress. Operative and nonoperative cohorts were compared using χ2 test and Student t test. Linear regression was used to evaluate the association between pain, disability, and YFs, whereas Poisson regression evaluated the association between operative treatment and psychological distress. K-means cluster analysis was performed to propose potential psychological distress phenotypes. Two hundred fifty-one patients (91%) had at least 1 YF on the OSPRO-YF tool, with a mean number of 6 ± 3.5 YFs. YFs in unhelpful coping (85%) and helpful coping domains (78%) were most prevalent. The number of YFs was significantly associated with baseline shoulder pain (P < .001), Single Assessment Numeric Evaluation (P < .001), and American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (P < .001) scores. Comparing operative and nonoperative cohorts, the operative cohort had a significantly higher mean number of YFs (6.5 vs. 5.6, P = .035), presence of any YF (94.3% vs. 85.7%, P = .015), and presence of YFs within the unhelpful coping domain (91.8% vs. 75.6%, P < .001). Three phenotypes were described, corresponding to low, moderate, and severe psychological distress (P < .001), with females (P = .037) and smokers (P = .018) associated with higher psychological distress phenotypes. YFs, particularly within the unhelpful coping and helpful coping domains, were highly prevalent in a cohort of patients presenting to a shoulder surgeon's clinic. Additionally, operative patients were found to have a significantly higher rate of YFs across multiple dimensions of psychological distress. These findings stress the importance of routine attentiveness to multiple dimensions of pain-related psychological distress in shoulder populations, which can provide an opportunity to reinforce healthy interpretation of pain while minimizing distress in appropriately identified patients.

Efficacy of a Web-Based Psychoeducational Intervention for Young Adults With Fertility-Related Distress Following Cancer (Fex-Can): Randomized Controlled Trial.

BackgroundThreatened fertility following cancer diagnosis in the reproductive age may severely impact emotional and psychosocial well-being in survivorship. Effective web-based interventions for fertility-related distress have been lacking.ObjectiveThis study aims to test whether the Fertility and Sexuality following Cancer (Fex-Can) intervention is superior to standard care in reducing fertility-related distress and related psychosocial outcomes in young adults with cancer.MethodsThis randomized controlled trial evaluated a 12-week, web-based, automated self-help intervention for fertility-related distress following cancer—Fex-Can Fertility. Individuals were identified via Swedish national quality registries, and those reporting fertility-related distress 1.5 years after diagnosis were invited. A total of 100 women and 24 men (aged 19-40 years) answered self-administered surveys at baseline (T0), directly after the intervention (T1), and 3 months later (T2). The main outcome was fertility-related distress, which was measured by using the 6-dimension Reproductive Concerns After Cancer (RCAC) scale. The secondary outcomes were health-related quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire), emotional distress (Hospital Anxiety and Depression Scale), fertility-related knowledge, and fertility self-efficacy. In addition, the intervention group (IG) reported self-perceived changes in problems related to fertility after cancer (T1). 2-tailed t tests and linear mixed models, including intention-to-treat and subgroup analyses, were performed to compare the effects of the intervention with those of standard care.ResultsAlthough 62% (31/50) of the participants in the IG stated that their concerns about fertility were fewer after the intervention, there were few statistically significant group differences in the main outcome (RCAC) at T1 and T2. Compared with controls, the IG rated lower distress concerning the dimension child’s health at T2 (P=.003; effect size [ES]=0.64). This difference was maintained when adding group and time interactions (intention-to-treat: P=.003; ES=0.58). The IG also had better self-perceived cancer-related fertility knowledge at T1 (P=.05; ES=0.35) and T2 (P=.01; ES=0.42) than the control group. Subgroup analyses based on dose or adherence and baseline RCAC scores did not substantially alter these results. Overall, the use of the web-based program was low.ConclusionsThe Fex-Can intervention had small to moderate positive effects on cancer-related fertility knowledge and distress related to child’s health. The lack of group differences in other dimensions of fertility distress and related secondary outcomes contrasted with reports on self-perceived improvement after the intervention. The Fex-Can Fertility program may be a useful complement to routine psychosocial support in the clinical care of young women and men with cancer.Trial RegistrationISRCTN Registry 36621459; https://www.isrctn.com/ISRCTN36621459

HIV Symptom Clusters are Similar Using the Dimensions of Symptom Occurrence and Distress

ContextPeople living with HIV infection (PLWH) in the United States continue to experience a high symptom burden despite improvements in antiretroviral therapy. ObjectivesThe purpose of this study was to determine if the number and types of symptom clusters differed based on whether symptom occurrence rates or distress ratings were used to create the clusters. MethodsData from 2,000 patients with complete symptom occurrence rates and distress scores on the 20-item HIV Symptom Index from their first ambulatory clinic visit at one of six national HIV centers of excellence in the Center for AIDS Research Network of Integrated Clinical Systems were used in these analyses. Exploratory factor analysis was used to create the symptom clusters. ResultsThe same four symptom clusters (i.e., gastrointestinal, psychological, pain, body image) were identified using occurrence rates and distress ratings. For both dimensions of the symptom experience, the psychological, pain, and body image clusters each had the same symptoms. For the gastrointestinal cluster, four symptoms loaded on the occurrence dimension and six symptoms loaded on the distress dimension. ConclusionThe number and types of symptom clusters were relatively similar across the occurrence and distress dimensions of the symptom experience. Symptom clusters in PLWH may provide insights into the development of targeted interventions for multiple co-occurring symptoms.