Distress In Survivors Research Articles

Awareness and use of support services following mass violence incidents

Mass violence incidents (MVIs) result in significant psychological distress for survivors and the broader community. Support services (mental health services, support groups, religious support) can buffer negative effects of MVIs and facilitate recovery. However, the extent to which community members are aware of and use support services post-MVIs is unknown. A probability sample of 5991 adults (Meanage = 45.6, SD = 17.6), mostly female (53%) and White (71%), were recruited from six communities that had experienced an MVI. Participants answered questions on their awareness and use of support services after the MVI and completed measures assessing predisposing, enabling, and need factors that may influence service use. Approximately 20% of participants reported they were aware of mental health services, 20% reported awareness of support groups, and 16% reported awareness of religious support. Younger participants with higher income (predisposing factors), high social support (enabling factor), and direct MVI exposure and psychological distress (need factors) were more likely to report awareness of support services. Of those aware of services, approximately 21% reported using support services. Those with direct MVI exposure and psychological distress were more likely to use each type of service. Otherwise, use of mental health services, support groups, and religious support varied across predisposing factors (race, age, income). Overall, findings suggest there is limited awareness of support services post-MVI, despite the well-documented mental health burden after these incidents. This suggests the need for improved communication about available services after MVIs.

Effects of cardiac radiation on sleep and psychological distress in adult survivors of pediatric Hodgkin lymphoma without breathing sleep disorders.

10068 Background: Adult survivors of childhood Hodgkin lymphoma (HL) are at higher risk for excessive sleepiness, fatigue, and other morbidities that affect long-term quality of life (QoL). The relationship between radiation dose to the heart delivered during treatment and self-reported sleep quality, fatigue, QoL, and psychological distress in survivors of HL has not been explored. This study examines clusters of cardiac dosimetry and sleep quality and associated symptoms of insomnia, fatigue, QoL, and psychological distress in a subset of adult survivors of pediatric HL without breathing sleep disorders. Methods: Survivors completed standardized surveys of sleep quality (Pittsburg Sleep Quality Index, PSQI), insomnia (Insomnia Severity Index), fatigue (FACIT-F), QoL (SF36 short survey), and psychological distress (BS18). Two consecutive nights of in-home polysomnography were completed with at least 4 hours of recorded sleep in one night. Analyses were conducted on 95 survivors (mean[SD] age=36[7.2] years, 55 female) who demonstrated at least average sleep efficiency (>85%) and demonstrated no evidence of sleep apnea (Apnea-Hypopnea Index <5, or AHI >5 and <15 with no daytime sleepiness as defined by the American Society of Sleep Medicine). Radiation dose to the heart was estimated using dose reconstruction methods for therapeutic radiation exposure developed by the MD Anderson Cancer Center. Radiation/Sleep clusters were found using a silhouette analysis and K-means algorithm. Linear regression associations between clusters and outcomes were adjusted by age and body mass index. Statistical analyses were computed in the statsmodels toolbox for Python3. Results: Sleep and radiation were not correlated (ρ=0.03, p=0.67). Considering good sleep as PSQI<5, three main Radiation/Sleep clusters were found indicating a low-radiation/middling-sleep group (22%; RT = 251[250.7] cGy, PSQI = 7[2.7]), a high- radiation/better-sleep group (46%; RT = 2012[406.8] cGy, PSQI = 4[1.5]), and a high- radiation/worst-sleep group (32%; RT = 2072[472.3] cGy, PSQI = 11[2.5]). Survivors in high-radiation/worst-sleep group demonstrated worse fatigue ( β=-12.3, p=0.001) and insomnia ( β=9.52, p<0.001). This group was associated with poor Mental Health ( β=-2.1, p<0.001) but not Physical Health QoL ( β=-0.4, p=0.154). This latter group also indicated more psychological distress (depression β=11.6, p=0.001, somatization β=11.8, p<0.001), but not anxiety ( β=4.6, p=0.241). Conclusions: Our results highlight the burden of symptoms associated with higher radiation dosimetry in the heart including poor sleep quality, insomnia, fatigue, and increased psychological distress. Understanding the mechanisms of sleep quality and fatigue in HL survivors is warranted as some survivors demonstrate poor sleep quality and fatigue due to factors other than clinical sleep disorders.

Abstract PO3-28-02: BODY-IMAGE DISTRESS IN BREAST CANCER SURVIVORS AND THEIR EVALUATION OF MEDICAL TATTOOING FOLLOWING SURGERY

Abstract A review of the literature reveals a high incidence of body-image distress among breast cancer survivors who have undergone surgery, which is a natural response to the significant changes in their appearance. Reconstructive surgery, utilizing implants or flaps, may be employed to restore breast size and shape. Medical tattooing can recreate the nipple-areola complex and decorative appliques can conceal scars and skin color variations. Both reconstructive surgery and medical tattoos are associated with patient-reported satisfaction, yet further research is necessary to understand their combined impact on body-image distress. To investigate this, a survey was distributed among national breast cancer support groups and advocacy organizations, yielding 207 responses from individuals meeting the study's criteria. The participants were categorized into two groups: those who received post-surgical medical tattoos (n = 61) and those who did not (n = 146). The study also examined how participants evaluated the cosmetic and decision satisfaction of patients who made various surgical and cosmetic intervention choices. This was accomplished by having participants rate images of patients who had received three types of intervention: mastectomy and reconstruction only, mastectomy and medical tattooing only, and mastectomy, reconstruction, and medical tattooing. Using linear regression and multilevel modeling that controlled for demographic and clinical factors associated with body-image distress, the findings demonstrated that participants with medical tattoos reported significantly lower levels of body-image distress, depressive symptoms, and perceived stress compared to those without medical tattoos. Furthermore, participants rated images of patients who underwent both reconstruction and medical tattooing post-mastectomy as having significantly higher cosmetic and decision satisfaction ratings than images of patients who received reconstruction or medical tattooing alone. This research expands on our understanding of body-image distress in survivors as a multidimensional construct and may serve to indicate potential means for intervention. Enhancing our understanding of how breast cancer treatment and surgery affects survivors' body-image distress may aid healthcare professionals in offering additional psychoeducation and recommendations. Furthermore, presenting information about medical tattooing as a complementary cosmetic option early in the treatment process allows patients the opportunity to consider it within the context of their overall treatment plan. Table. Linear regression results using BIBCQ as the outcome variable and medical tattoo group as the predictor variable with covariates included. Note. PHQ9 = Patient Health Questionnaire-9. PSS = Perceived Stress Scale. Citation Format: Miranda Proctor, Jeffrey Cassisi. BODY-IMAGE DISTRESS IN BREAST CANCER SURVIVORS AND THEIR EVALUATION OF MEDICAL TATTOOING FOLLOWING SURGERY [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO3-28-02.

Abstract B021: Trends in psychological distress among adult survivors of childhood, adolescent and young adult cancers: Analysis of 2008-2018 National Health Interview Survey data

Abstract Background: Cancer survivors diagnosed at childhood, adolescent and young adults age face psychological distress in the form of depression, anxiety, and panic attacks. In addition, psychological distress has been found to have an impact on the medical expenditures of cancer survivors. Previous studies have examined psychological distress in survivors of childhood, and young adult cancers (AYA) and found them to be high, whether this increasing or decreasing over the years is unknown. The aim of our study was to examine trends in psychological distress among survivors of childhood AYA cancers. Methods: We analyzed the 2008-2018 National Health Interview Survey (NHIS) data, a cross-sectional household interview survey of the US civilian, non-institutionalized population that uses a multistage area probability design. We identified individuals (n=6,175) who were diagnosed with cancer between 0 to 39 years of age. Psychological distress was assessed using the validated Kessler 6-item scale. Using a 30-day reference period, respondents’ rate how often they felt nervous, hopeless, restless or fidgety, so sad that nothing could cheer them up, that everything was an effort, and worthless. Response options include ‘never’, ‘a little of the time’, ‘some of the time’, ‘most of the time’, and ‘all of the time’. Responses were scored and added to produce a range of 0–24. We defined mild distress as a score of less <5, moderate distress as a score between 5-13 and severe distress as a score of >13. Joinpoint regression estimated yearly increases/decreases in psychological distress using annual percent changes. Results: Overall, the proportion of childhood and AYA cancer survivors with moderate distress decreased slightly between 2008 and 2014 but increased from 2014-2018 by 5% per year, though not statistically significant. However, the proportion of childhood and AYA cancer survivors with mild and severe distress remained relatively stable throughout the study period. The proportion of females and males with moderate distress increased by an average of 5% and 6% annually from 2014-2018 respectively, however, the increase was not statistically significant. The proportion of childhood and AYA cancer survivors who were married with moderate distress increased by 8% from 2014-2018 whereas survivors who were never married with severe distress decreased by 29% in the same time range. Conclusion: There is an increase in the number of survivors with moderate psychological distress while mild psychological distress has declined from 2014-15 onwards. Severe distress has remained relatively stable in all the years. Citation Format: Pranali G. Patel, Chaitali S Dagli, Nosayaba Osazuwa-Peters, Mrudula Nair, Dina K. Abouelella, Oluwole A. Babatunde, Shreya P. Ramkumar, Eric Adjei Boakye. Trends in psychological distress among adult survivors of childhood, adolescent and young adult cancers: Analysis of 2008-2018 National Health Interview Survey data [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 B021.

Using experience sampling methodology (ESM) to improve our understanding of day-to-day intrusion frequency and related distress in survivors of trauma

Background and objectivesCognitive models of posttraumatic stress disorder (PTSD) suggest that appraisals of traumatic sequelae and subsequent distress drive the development and maintenance of PTSD. Posttraumatic research has relied heavily on macro-longitudinal designs, with weeks or months between assessments of trauma-related cognitions and symptoms. The present study uses experience sampling methodology (ESM) better understand the day-to-day experiences of trauma exposed individuals. MethodsOne-hundred trauma exposed adults reported their posttraumatic symptoms, interpretations, and behaviours four times a day over a 10-day ESM period. ResultsAs anticipated, within-person fluctuations in negative appraisals of intrusions and maladaptive coping strategies (e.g., thought suppression) were significantly positively associated with intrusion frequency and related distress. In all cases, the associations for negative appraisals and maladaptive coping were stronger with intrusion related distress than intrusion frequency. LimitationsThe observed contemporaneous associations only demonstrate that variables reliably fluctuated together and cannot indicate causality. ConclusionsThe findings demonstrate that day-to-day fluctuations in trauma related perceptions and sequelae are significant and should be explored alongside broader individual differences to advance our understanding of the development, maintenance, and treatment of PTSD.

Community-based advocacy in “cold case” sexual assault prosecutions: A qualitative exploration of survivors’ and advocates’ experiences

Sexual assault survivors who report to the criminal legal system often need the assistance of victim advocates to navigate this complex and often retraumatizing system. In recent years, victim advocates have been called upon to assist more survivors in “cold case” sexual assault prosecutions. The term “cold case” refers to a criminal incident that is reopened years after it was initially reported, often because new evidence has become available. In this study, we interviewed sexual assault survivors and community-based victim advocates about their experiences working together in cold cases. These cases were reopened because victims’ sexual assault kits (SAKs; also known as “rape kits”) had not been submitted by the police for forensic DNA testing in a timely way. When these SAKs were finally tested, the biological evidence produced new investigatory leads, and prosecutors wanted to move forward with criminal charges against the offenders. Re-opening these legal cases caused significant emotional distress for survivors, but most did not want mental health counseling during their legal re-engagement. Instead, survivors wanted their advocates to provide emotional support while focusing on their tangible needs so that they had sufficient life stability to re-engage in the prosecution process. Survivors also needed extensive legal advocacy from their advocates throughout their hearings and trials. These results underscore the need for cold case protocols that train practitioners about the long-term impacts of trauma and the importance of centering survivors’ individual needs.

Perceived negative consequences of cancer and psychological distress in survivors: the moderating role of social support.

Many cancer survivors experience psychological distress at some point during their care. The degree to which individuals perceive negative consequences of cancer has been associated with psychological distress, including anxiety and depression. Identifying psychosocial factors that buffer the effects of illness perceptions on distress may provide a target for intervention to improve the psychological health of cancer survivors. As such, the present study aimed to examine whether social support moderates the relationship between perceived negative consequences of cancer and psychological distress. The current longitudinal study of 413 cancer survivors (64% female, 58% breast cancer, Mage = 59.68, SD = 11.41) examined social support as a potential moderator of the relationship, hypothesizing that greater overall perceived social support would buffer the relationship between perceived negative consequences of cancer and subsequent symptoms of anxiety and depression. Perceived negative consequences of cancer predicted anxiety and depression over time (p < .05), but social support had a buffering effect on the perceived negative consequences of cancer-anxiety relationship (β = - .20, p < .001) as well as the perceived negative consequences of cancer-depression relationship (β = - .11, p < .05). Results suggest that social support is a protective factor over time against the pathway of illness perceptions leading to psychological distress among cancer survivors. Interventions that improve social support in cancer survivors may attenuate psychological distress and help support these individuals in their survivorship journey.

Psychological distress in survivors of childhood cancer and their parents before and after a follow-up appointment: the need for screening and validation of the emotion thermometer

AbstractBackground:Childhood cancer affects patients and their parents. Childhood cancer survivors are at risk of mental health problems. Regular psychological screening is recommended. The emotion thermometer (ET) is a short, validated tool to detect psychological distress in adult patients with cancer. However, its suitability and acceptability in young cancer populations have not yet been reported. We (1) describe mental health in survivors and their parents before and after a follow-up appointment and (2) investigate the ET's usefulness for screening in young childhood cancer survivors.Methods:Survivors (15 years or older at study, ≥1 year after treatment ended) and their parents completed two electronic surveys to assess mental health (including somatization, depression, anxiety, a Global Severity Index [GSI], fear of cancer recurrence/relapse and post-traumatic stress). The first questionnaire was completed in the weeks leading up to the follow-up appointment and the second one after. We assessed survivors' opinion on acceptability of the ET.Results:Forty-five survivors (age at study: 22 years, 54% female) and 46 parents (age: 54 years, 63% female) participated. Scores forsomatization,depression, and theGSIwere lower after the appointment (p&lt;.05 for all). For parents, there was no change. A subset of survivors reported clinically relevant post-traumatic stress (Nbefore= 3 [8%], Nafter= 4 [10%]). Fear of cancer recurrence/relapse remained stable. The ET identified moderate-to-severe distress in 13 survivors (29%), showing good specificity (0.91) and sensitivity (0.91) in relation to the gold standard Symptom Checklist-90-R. Survivors found the ET to be easy to use and understand.Conclusions:Psychological distress in survivors attending follow-up care is common, and screening is imperative. The ET may be helpful for initial psychological screening.

Psychological distress in survivors of childhood cancer and their parents before and after a follow-up appointment: the need for screening and validation of the emotion thermometer

Psychological distress in survivors of childhood cancer and their parents before and after a follow-up appointment: the need for screening and validation of the emotion thermometer

Course and predictors of psychological distress among colorectal cancer survivors with ostomies: A longitudinal study.

To examined the course and predictors of psychological distress among colorectal cancer survivors with ostomies. 131 survivors were considered in this longitudinal study. Participants were measured at first month (T1), third month (T2), and sixth month (T3) post-operation. Psychological distress, peristomal skin complications and stomal complications were measured. All participants' sociodemographic data were collected one day before discharge. ANOVA with repeated measures was used to compare the course of psychological distress. Generalized Estimating Equations were used to determine the predictors. The prevalence of mild to severe psychological distress in colorectal cancer survivors undergoing colostomy at T1, T2 and T3 was 96.94%, 88.55%, and 29.77%，respectively. The difference of psychological distress in survivors with ostomies at T1, T2 and T3 was statistically significant (F=603.310, P<0.001). Higher level psychological distress was generally differentiated by no religious belief, spouse caregiver, first and third month after ostomy, permanent enterostomy, peristomal skin complications and stomal complications. Survivors generally experience psychological distress, especially at first and third month after surgery. A multidisciplinary collaborative group comprised of Wound, Ostomy, and Continence/Enterostomal Therapy nurses and doctors, as well as psychological counselors, peer educators, and other participants, should be formed to conduct continuous assessments and management of psychological distress. Permanent enterostomies at first and third month after surgery, with spouse caregiver and no religious belief, with peristomal skin complications and stomal complications were being a priority for targeted attention.

Brain correlates of depression, post-traumatic distress, and inflammatory biomarkers in COVID-19 survivors: A multimodal magnetic resonance imaging study

Psychiatric sequelae substantially contribute to the post-acute burden of disease associated with COVID-19, persisting months after clearance of the virus. Brain imaging shows white matter (WM) hypodensities/hyperintensities, and the involvement of grey matter (GM) in prefrontal, anterior cingulate (ACC) and insular cortex after COVID, but little is known about brain correlates of persistent psychopathology.With a multimodal approach, we studied whole brain voxel-based morphometry, diffusion-tensor imaging, and resting-state connectivity, to correlate MRI measures with depression and post-traumatic distress (PTSD) in 42 COVID-19 survivors without brain lesions, at 90.59 ​± ​54.66 days after COVID. Systemic immune-inflammation index (SII) measured in the emergency department, which reflects the immune response and systemic inflammation based on peripheral lymphocyte, neutrophil, and platelet counts, predicted worse self-rated depression and PTSD, widespread lower diffusivity along the main axis of WM tracts, and abnormal functional connectivity (FC) among resting state networks. Self-rated depression and PTSD inversely correlated with GM volumes in ACC and insula, axial diffusivity, and associated with FC.We observed overlapping associations between severity of inflammation during acute COVID-19, brain structure and function, and severity of depression and post-traumatic distress in survivors, thus warranting interest for further study of brain correlates of the post-acute COVID-19 syndrome. Beyond COVID-19, these findings support the hypothesis that regional GM, WM microstructure, and FC could mediate the relationship between a medical illness and its psychopathological sequelae, and are in agreement with current perspectives on the brain structural and functional underpinnings of depressive psychopathology.

Symptom burden, quality of life, functioning and emotional distress in survivors of human papillomavirus associated oropharyngeal cancer: An Australian cohort

BackgroundThis cross-sectional study examines patient-reported outcomes and functioning-based subgroups in human papillomavirus-associated oropharyngeal cancer survivors treated with chemoradiotherapy ≥12 months prior. MethodSurvivors completed EORTC QLQ-C30, MDASI-HN and PROMIS-Emotional distress questionnaires. Subgroups were identified via two-step clustering of QLQ-C30 functioning scales. Results136 patients were enrolled. Clinicians’ graded 19/136 (14%) patients as having at least one severe (Grade 3 CTCAE) toxicity, whereas 68/136 (50%) patients self-reported at least one toxicity in the severe range (MDASI-HN ≥ 7). QLQ-C30 Global health status score (mean 76, SD = 20) was comparable to population norms. Rates of moderate/severe anxiety (10%/1%) and depression (4%/1%) were low. Two functioning-based subgroups were formed based on auto-clustering statistics: high- (n = 93) and low-functioning (n = 41). Differences on all functioning scales were large (d: 1.57–2.29), as were differences on the remaining QLQ-C30 scales/items, most MDASI-HN symptom severity/interference scales, and PROMIS scales (d: 0.80–2.03). Differences and associations with patient/clinical characteristics were not significant. ConclusionIn this Australian cohort of HPV-OPC survivors there was significant discordance between clinician- and patient-reported toxicity. We observed population comparable global quality of life and low rates of emotional distress. However, we identified a low-functioning subgroup reporting significantly worse outcomes on a range of patient-reported measures who may benefit from targeted support.

Social Support Source and Effectiveness Are Associated with Distress Among Hematopoietic Stem Cell Transplant Survivors Experiencing Stress Due to Negative Life Events after Treatment

Hematopoietic stem cell transplant (HSCT) survivors face a variety of stressful challenges in the months and years after treatment including risk for disease relapse, transplant failure, and late effects of treatment; chronic symptoms and complications; and the need to adhere to continuing medical management. Layered on treatment-related challenges are treatment- and non-treatment-related financial, family, work, or other psychosocial strains. Research suggests that these kinds of “life event stressors” can cause psychological distress, which in turn may influence survivors' health behaviors and clinical outcomes. Receiving effective social support from a caregiver has been associated with lower distress (main effects), and the effectiveness of caregiver support could also be an important determinant of whether the support mitigates or “buffers” adverse effects of life event stressors. We applied our Social Support Effectiveness framework to investigate whether: (1) the effectiveness of social support from a partner or non-partner caregiver was associated with survivor distress (main effect); (2) the effectiveness of caregiver support was associated with the association between life event stress and distress among survivors (buffering); and (3) whether buffering effects depended on the source of support (partners versus non-partner caregivers).As part of a larger study, 264 adults who had undergone HSCT 9 months to 3 years previously completed measures of caregiver social support effectiveness (SSE), distress, life event stress, and sociodemographic and medical variables. Life event stress was a count of negative life events experienced in the prior 6 months, measured with a validated scale and scored using recommended procedures. The SSE measure assesses survivors' appraisals of the extent to which social support they receive from their partner or non-partner caregiver generally approximates their needs in terms of its quantity (i.e., it is not too much nor too little) and quality (i.e., it is the right “type” of support, provided skillfully, is not hard to get or is provided without having to ask for it, and does not cause the survivor to feel bad for needing or getting it). SSE is theorized to be a stable feature of support in dyadic relationships (such as those with a partner or family member), with little change over time. Survivors in a committed romantic relationship reported the effectiveness of support received from their partner and those not in a committed relationship reported the effectiveness of support received from their most important transplant caregiver. Hierarchal linear regression was used to evaluate a three-way interaction between life event stress, caregiver SSE, and source of support (partner versus non-partner caregiver) on distress in these cross-sectional data.In models controlling for covariates, main effects revealed that having greater life event stress (B=0.04; 95% CI 0.04, 0.05; p <0.001) and receiving less effective caregiver support (B=-0.01; 95% CI -0.01, -0.003; p <0.001) were independently associated with greater survivor distress. These main effects were qualified by a 3-way interaction of life event stress, caregiver SSE, and source of support (B=-0.003; CI:-0.004, -0.002; p <0.001). When support was provided by a partner caregiver, higher life event stress was associated with greater distress when partner SSE was low (B=0.03, SE=0.01, p=0.02). There was no association between life event stress and distress when partner SSE was average (B=0.04, SE=0.01, p=0.26) or high (B=-0.003, SE=0.01, p=0.87). Among non-partnered cancer survivors, there was a positive association between life event stress and distress regardless of non-partner caregiver SSE. Thus, effective support from a partner caregiver buffered adverse effects of life event stress on survivor distress, but this salutary effect was not observed for non-partner caregivers.Our findings are consistent with evidence showing that the effectiveness of caregiver support is an important correlate of distress after HSCT. They extend that work by showing that effective support from a partner caregiver (but not a non-partner caregiver) can mitigate or “buffer” adverse effects of negative life events experienced after HSCT. Findings highlight a need for additional research among HSCT recipients who rely on caregivers other than a partner. DisclosuresNo relevant conflicts of interest to declare.

Massacre, Earthquake, Flood

Abstract. Natural (e.g., earthquake, flood, wildfires) and human-made (e.g., terrorism, civil strife) disasters are inevitable, can cause extensive disruption, and produce chronic and disabling psychological injuries leading to formal diagnoses (e.g., post-traumatic stress disorder [PTSD]). Following natural disasters of earthquake (Christchurch, Aotearoa/New Zealand, 2010–11) and flood (Calgary, Canada, 2013), controlled research showed statistically and clinically significant reductions in psychological distress for survivors who consumed minerals and vitamins (micronutrients) in the following months. Following a mass shooting in Christchurch (March 15, 2019), where a gunman entered mosques during Friday prayers and killed and injured many people, micronutrients were offered to survivors as a clinical service based on translational science principles and adapted to be culturally appropriate. In this first translational science study in the area of nutrition and disasters, clinical results were reported for 24 clients who completed the Impact of Event Scale – Revised (IES-R), the Depression Anxiety Stress Scales (DASS), and the Modified-Clinical Global Impression (M-CGI-I). The findings clearly replicated prior controlled research. The IES-R Cohen’s d ESs were 1.1 (earthquake), 1.2 (flood), and 1.13 (massacre). Effect sizes (ESs) for the DASS subscales were also consistently positive across all three events. The M-CGI-I identified 58% of the survivors as “responders” (i.e., self-reported as “much” to “very much” improved), in line with those reported in the earthquake (42%) and flood (57%) randomized controlled trials, and PTSD risk reduced from 75% to 17%. Given ease of use and large ESs, this evidence supports the routine use of micronutrients by disaster survivors as part of governmental response.

The Gray Area of Defining Sexual Assault: An Exploratory Study of College Students' Perceptions.

College-age women are disproportionately at risk of experiencing sexual assault. Sexual assault causes tremendous psychological distress for survivors. Therefore, it is imperative to understand the perceptions that affect the perpetration of sexual assault. One of those potential factors is how college students conceptualize and define sexual assault. The current qualitative study demonstrated that college students do not have consistent images of sexual assault and often rely on their own perceptions and experiences to define it. Creating and providing a standard of sexual assault based on the reality of college students can provide a foundation for creating effective prevention strategies.

Mental distress and mental health services receipt in foreign-born survivors of cancer: A national health interview survey analysis.

e19001 Background: There is a greater burden of mental illness, in survivors of cancer compared with the general population. Though mental health interventions may reduce mental distress and improve subsequent oncological outcomes, there are disparities in mental health service (MHS) receipt in immigrant populations. Therefore, we examined contemporary patterns of mental distress and mental health service receipt by immigrant status in cancer survivors in the United States. Methods: Data are collected in non-institutionalized civilian adults by the US National Health Interview Survey. For this study, harmonized data of participants reporting a cancer diagnosis were extracted from the Integrated Health Interview Series from 2009-2018. Sample weight-adjusted estimates of mental distress were defined by the validated Kessler 6 (K6). MHS receipt in the past 12 months was estimated, stratified by K6 status. Multivariable logistic regression defined adjusted odds ratios (AOR) and 95% confidence intervals (95CI) for the odds of MHS receipt, with birth status (US vs. non-US) as the primary independent variable of interest. Results: Among 14,653 adult survivors of cancer and 207,018 adults without cancer, 4.16% vs. 3.01% had K6 &gt;13, respectively (AOR 0.96, 95CI 0.87-1.07, P = 0.504). Among survivors of cancer, younger age, female sex, and white race were associated with K6&gt;13, while factors associated with lower MHS receipt included non-US born status, non-white race, and older age. The distribution of severe mental illness (K6&gt;13) did not differ by place of birth. However, non-US birth status was associated with lower MHS receipt among survivors of cancer with K6 &lt; 13 (5.61% vs 8.15%, AOR 0.67, 95CI 0.49-0.92, P = 0.013), and there was a greater disparity among those with K6&gt;13 (9.43% vs 37.8%, AOR 0.19, 95CI 0.08-0.45, P &lt; 0.001) (Pinteraction= 0.002). Conclusions: In this large contemporary cross-sectional survey, though there was a similar distribution of mental distress in survivors of cancer based on birth status, non-US born adults with severe mental distress (K613) were 81% less likely to receive MHS relative to US born adults. These data suggest that immigrant survivors of cancer who suffer from severe mental distress may be a greater risk not receiving appropriate MHS, which could lead to subsequent adverse outcome. Given the demonstrated gap in use of MHS in non-US born adults with cancer and severe mental distress, increased efforts are needed to screen for mental illness and the need for MHS in immigrant populations.

Dimensions of burn survivor distress and its impact on hospital length of stay: A national institute on disability, independent living, and rehabilitation research burn model system study

ObjectiveGuided by the Transactional Model of Stress and Coping, this study seeks to (1) examine the independent relationships between the level of distress among burn survivors, pre-morbid psychiatric history, and burn severity on length of hospital stay, and (2) to examine the relationship between having a premorbid psychiatric history and level of distress following a burn injury. MethodsData collected by the National Institute on Disability, Independent Living, Rehabilitation Research funded Burn Model System (N = 846) was used to theoretically link psychological distress with the length of hospital stay for survivors of burn injuries. Structural Equation Modeling was used to evaluate the aims of this study. ResultsAlthough counterintuitive, and while significant, burn severity was found to have a rather modest association with a burn survivor’s level of distress, indicating that one’s ability to cope may be a better predictor of distress rather than burn severity alone. Premorbid psychiatric history was significantly associated with increased levels of distress. While burn severity was associated with length of stay, level of distress did not act as a partial mediator. Length of stay was, however, significantly related to having a premorbid-psychiatric history. Of notable interest, a significant racial, ethnic, and gender difference exists in level of distress. Women and people of color experience higher levels of distress holding constant burn severity and psychiatric history. ConclusionA need exists to assess for and address premorbid and current mental health challenges of burn survivors, specifically the ability to cope, especially among people of color and women, regardless of the burn size or severity.

Primary Blast Lung Injury: The UK Military Experience.

Primary blast lung injury occurs when an explosive shock wave passes through the thorax and transits through tissues of varying densities. It requires close proximity to an explosion and presents quick with respiratory distress in survivors. The Joint Theatre Trauma Registry and the Defence Statistics (Health) Database were interrogated for casualties injured as a result of an explosion during the conflict in Afghanistan. The case notes and imaging of casualties meeting the criteria for diagnosis were reviewed. Demographic and clinical data on casualties with primary blast lung injury were analyzed. 848 blast-exposed casualties survived to discharge from intensive care, and 238 blast-exposed casualties were killed in action. Following exclusions, 111 case notes and all postmortem reports were reviewed in detail. About, 25 casualties had isolated primary blast lung injury (2.9% of casualties surviving to discharge from intensive care) and 31 nonsurvivors (13% of nonsurvivors) had the disease documented at postmortem. Severe cases of primary blast lung injury required an estimated average of 4.5days of conventional mechanical ventilation. 8.1% of blast exposed casualties suffered primary blast lung injury. It was a less severe disease than other nontraumatic forms of acute lung injury and did not cause deaths once a casualty had reached a combat support hospital. It was well managed with a relatively brief period of conventional mechanical ventilation.

Trust After Terror: Institutional Trust Among Young Terror Survivors and Their Parents After the 22nd of July Terrorist Attack on Utøya Island, Norway.

In the aftermath of terrorist attacks and disasters, public institutions play an important role in re-establishing safety and justice. However, little is known about the importance of institutional trust for victims’ potential for healing in the aftermath of mass trauma. This study examines levels of post-terror trust in the police and in the justice system among young survivors from the 2011 Utøya terror attack and their parents. Furthermore, it investigates how institutional trust develops over time among directly affected populations, and whether it is associated with psychological distress. 325 survivors and 463 parents were interviewed face-to-face at wave one (4–5 months post-terror) and 285 survivors and 435 parents at wave two (14–15 months). Levels of institutional trust in victims were compared to general population data from the European Social Survey adjusted for age, gender, and ethnic background. Measures included trust in the police and justice system, post-traumatic stress reactions, anxiety and depression, and quality of life. Trust in the police among survivors and parents was higher than or comparable to trust levels in the general population at wave one, but decreased for survivors and parents at wave two. Trust in the justice system was higher among those directly affected than in the general population, and increased from wave one to wave two. Levels of institutional trust were negatively associated with distress for survivors in both waves and for parents in wave two. Levels of institutional trust were positively associated with perceived quality of life in parents and survivors. Directly affected groups’ institutional trust differed from that of the general population following the terrorist attack, although being directly affected did not necessarily imply weakened institutional trust. This study found trust to be institution specific, however, trust in institutions changed with time, and the passing of time might be an important factor in better understanding whether trust will generalize across institutions or not. Institutional trust was negatively associated with psychological distress. This finding highlights the potential for institutions to create a healing post-disaster environment.

Fear of Cancer Recurrence: A Model Examination of Physical Symptoms, Emotional Distress, and Health Behavior Change.

Fear of cancer recurrence is highly prevalent among adult survivors of cancer. The role of fear of recurrence in the emotional distress of survivors of cancer, as well as health behaviors that may directly affect their health, remains unclear. To advance oncology practice, this study sought to examine the extent to which fear of recurrence stemming from physical symptoms accounts for emotional distress in a large sample of adult survivors of cancer and to extend the model to explain postdiagnosis self-reported health behavior change. In 2016, 258 survivors of cancer at an academic hospital completed a survey of psychosocial needs. Items assessed physical symptoms (checklist), fear of cancer recurrence (Assessment of Survivor Concerns), emotional distress (anxiety and depressed mood), and health behaviors (current alcohol use, physical activity, diet, and sunscreen use, as well as changes after cancer diagnosis) informed by National Comprehensive Cancer Network survivorship guidelines. Indirect effects regression models accounting for relevant covariates (age and treatment history) used 5,000-iteration bootstrapping. Higher fear of cancer recurrence was associated with greater number of physical symptoms (P < .001), greater emotional distress (P < .05), lower moderate or vigorous physical activity (P < .05), higher sunscreen use (P < .05), and postdiagnosis increases in alcohol use (P < .01) and reductions in physical activity (P < .01). Fear of cancer recurrence models accounted for almost half of the variance in distress of survivors of cancer (R2 = 0.44, P < .001) and, to a lesser yet significant extent, changes in alcohol consumption (R2 = 0.09, P < .001) and physical activity (R2 = 0.06, P = .003). Fear of cancer recurrence plays a central role in the emotional distress and key health behaviors of survivors of cancer. These findings support fear of cancer recurrence as a potential target for emotional health and health behavior change interventions.