Distress Symptomatology Research Articles

Insights from the EQUALS4COVID19 study on migrant mental health in Portugal: a cross-sectional mixed-methods approach

BackgroundThe COVID-19 pandemic and related disruptive consequences in the economic, health, and educational sectors have impacted people’s lives, contributing to a context of increased economic and social vulnerability. The pandemic has revealed and accentuated social inequalities and discrimination based on racial or ethnic origin. This study aimed to contribute to the promotion of the mental health and well-being of migrant populations living in Portugal via the definition of an analytical framework and recommendations emerging from the EQUALS4COVID19 project.MethodsTo gather information on the impact of the COVID-19 pandemic and resilience determinants among immigrants, a mixed-methods approach was implemented in 2022, combining a cross-sectional survey targeting immigrant adults in Portugal, focus groups with immigrants, focus groups with healthcare professionals, and in-depth individual interviews with stakeholders involved in the implementation of measures related to mental health and well-being during the pandemic. The analysis followed an integrated framework; quantitative data informed the script of qualitative data collection methods, and qualitative analysis informed the reinterpretation of quantitative data.ResultsThe survey with 604 Brazilian and Cape Verdean immigrants revealed that gender (being a woman) was associated with both psychological distress and depression-related symptomatology and that the perception of discrimination was a major risk factor for psychological suffering, while perceived social support and individuals’ resilience characteristics were protective factors. Qualitative data provided deeper insights into these findings, revealing the ways mental health is affected by social structures, such as gender and ethnic hierarchies. Migrants tend to work in precarious jobs requiring physical presence, which, together with dense housing conditions, puts them at higher risk of infection. The deterioration of the economic conditions of the general population has also increased the perception of ethnic-racial discrimination, which was found to be related to the increase in insecurity and anxiety-related symptomatology among the migrant population. Newly arrived migrants, with reduced support networks, experienced a greater sense of insecurity as well as concern and anguish regarding relatives who live far away, in their home country. Migrant women reported greater family-related distress, including work-life balance problems.ConclusionsProposals to address mental health inequalities should be considered in the context of the necessary global changes both at the societal level and in the delivery of mental health services. Additionally, they should be considered with the active involvement of migrants, families, and communities in the design and delivery of mental health promotion and care processes.

The Myth of Social Mobility: Subjective Social Mobility and Mental Health

A common assumption is that upward mobility produces positive psychological outcomes. However, status-based identity framework and social class worldview model propose that perceived social mobility in either direction will lead to increased distress. Based on this claim, we examined relations among subjective social mobility, life satisfaction, and mental health using polynomial regression with response surface mapping. In Study 1, groups that experienced both subjective downward and upward mobility reported more depressive symptomatology than groups that remained in middle or upper social statuses in a sample of 567 adults. We did not find significant relations between subjective social mobility and life satisfaction. In Study 2, both groups that experienced subjective downward and upward mobility reported more depressive and academic distress symptomatology than groups that remained in middle or upper social social statuses in a sample of 7,598 clients from college counseling center data. The results provide insights relevant to multicultural counseling and training.

Monthly correlates of longitudinal child mental health during the COVID-19 pandemic according to children and caregivers.

Multiple reviews identify the broad, pervasive initial impact of the global COVID-19 pandemic on the mental health of children, who may be particularly vulnerable to long-term psychiatric sequelae of the ongoing pandemic. However, limited longitudinal research examines persistence of, or change in, children's distress or psychiatric symptomatology. From June 2020 through December 2021, we enrolled two cohorts of families of children aged 8-13 from Southwestern Ontario into a staggered baseline, longitudinal design that leveraged multi-informant report (N = 317 families). In each family, one child and one parent/guardian completed a baseline assessment, 6monthly follow-up assessments, and one final follow-up assessment 9months post-baseline. At each assessment, the child and parent/guardian completed the CoRonavIruS health Impact Survey and measures of child anxiety, depressive, irritability, and posttraumatic stress syndromes. Children's mental health, indexed by the severity of multiple syndromes, fluctuated over the study period. Elevated local monthly COVID-19 prevalence, hospitalization, and death rates were associated with monthly elevations in children's reported worry about contracting COVID-19 and stress related to stay-at-home orders. In turn, both elevated monthly worry about contracting COVID-19 and stress related to stay-at-home orders were associated with monthly elevations in child- and parent-/guardian-report of children's emotional distress and psychiatric syndromes. This study illustrates the importance of, and informs the potential design of, longitudinal research to track the mental health of children, who may be particularly vulnerable to broad psychosocial sequelae of health crises such as the COVID-19 pandemic.

More than a year of pandemic: Longitudinal assessment of anxiety and depressive symptoms in the argentine general population during the COVID-19 outbreak.

The COVID‐19 pandemic has radically changed daily life and the way we interact with others. It has also brought negative psychological consequences: several studies have reported increased levels of distress symptomatology at the onset of the pandemic. However, few longitudinal studies have been carried out, and even fewer in low‐ and middle‐income countries. Therefore, the aim of this study was to analyse longitudinally the anxiety and depressive symptomatology of the Argentine general population during the first 13 months of the pandemic. The total sample included 988 adults (ages 18–77) from different regions of Argentina. Open‐access surveys were distributed via social media at five time points (March, April, May, August 2020 and April 2021). Depression and anxiety symptoms were assessed through the Beck Depression Inventory‐II and the State‐Trait Anxiety Inventory. Mixed repeated‐measures ANOVA were applied, with time as a within‐subjects factor, and socioeconomic status, gender, and age group as between‐subjects factors. Results showed a progressive increases in anxiety (F (27.78, 3417.60) = 62.88, p < 0.01, ηp2 = 0.060) and depression (F (3.42, 3373.75) = 84.78, p < 0.01, ηp2 = 0.079) symptoms in the general population throughout the pandemic (except for a slight decrease in anxiety in Wave 2). All of the between‐subjects factors showed significant effects on both types of symptoms: female gender, younger age and lower income were associated with greater depression and anxiety in all waves. A time‐age interaction effect was found (F (10.26, 3364.05) = 2.99, p < 0.01, ηp 2 = 0.009): after the third wave, depressive symptoms tended to decrease or stabilise in the young adult group, whereas there was a positive linear increase in the older groups. This study provided evidence that anxiety and depression symptoms tend to increase during crisis contexts, and that this effect is even more pronounced for certain vulnerable population groups. Mental health monitoring and support interventions should be included in government strategies to deal with the long‐term impact of the pandemic.

Relieving Pandemic-Related Psychological Distress: Key Protective Factors Against Mental Health Impairment

Over the two past years, mental health professionals have warned about the negative mental health consequences related to the covid pandemic. Most commonly reported are increased rates of depression, anxiety disorders, post-traumatic stress symptoms, sleep and appetite disturbance, contagion fears, frustration, burden, boredom, and suicidal behavior [1-5]. Previous resreach by our group has found that in low-resourced, high-risk communities characterized by pre-existing condition of extreme poverty, violence, and limited educational and occupational opportunities, there is a high prevalence of Persistent Pandemic-Related Distress Syndrome (Authors, in press), a condition representing on-going mental health impairment consisting of psychological distress and physical symptomatology persisting for an extended period of at least 6-months after mitigation efforts such as lockdown and social distancing restrictions were lifted and unrelated to contagion and infection fears.

The moderating effects of psychological flexibility and psychological inflexibility on the relationship between climate concern and climate-related distress

ObjectiveThis study investigated the moderating roles of psychological flexibility and inflexibility on the relationship between climate concern and climate-related distress. It was hypothesised that higher levels of psychological flexibility would negatively moderate the relationship between climate concern and climate-related distress, while higher levels of psychological inflexibility would positively moderate the same relationship. MethodsA moderation analysis was performed in R on a sample of 771 participants from the Prolific recruitment platform. Participants completed a survey which included a climate change concern index, the Climate Change Anxiety Scale, the Multidimensional Psychological Flexibility Inventory, and the 4-item Patient Health Questionnaire. ResultsThe interaction term between climate-related distress and psychological inflexibility was significant (b = −0.07, SE = 0.03, p < 0.05), indicating that psychological inflexibility is a moderator of the association between concern about climate change and climate-related distress. This model explained 23% of the variance of climate-related distress symptomatology. For the same level of concern about climate change, participants who reported higher psychological inflexibility, reported higher levels of climate-related distress. DiscussionHigher psychological inflexibility may be a risk factor for climate-related distress symptomatology, particularly for those who indicate greater concern about climate change. These findings contribute to the broader psychological flexibility literature in support of using ACT-based interventions for those experiencing significant distress associated with global crises such as climate change.

Anxiety, depression, and fatigue in middle-aged and older persons with spina bifida: a cross-sectional study

Purpose To study psychological distress and fatigue among persons with spina bifida (SB) 50 years or older and living in Norway. Methods In 2017, cross-sectional data were collected (n = 30). The Hospital Anxiety and Depression Scale (HADS) and the Fatigue Severity Scale (FSS) were used. Descriptive statistics, non-parametric tests, and Spearman correlations were performed. Relevant information from previous studies on adults with chronic spinal cord injury (SCI) and the general population, were collected for comparison. Results Participants were 18 women and 12 men, mean age 57.5 (SD 5.6), 26 with myelomeningocele, and six with hydrocephalus. Thirty percent scored above the HADS-A- and 20% above the HADS-D thresholds, thus in the same range as previous studies of SB, but higher compared to persons with SCI and norms. HADS-D correlated with pain and FSS scores. Forty percent reported fatigue symptoms (9/15 without hydrocephalus, 3/6 with hydrocephalus). Conclusions The study revealed a high prevalence of fatigue symptomatology among middle-aged and older adults with SB. Symptoms of anxiety and depression were more common than among persons with chronic SCI and norms. SB follow-ups should include awareness of psychological distress and fatigue, and investigate pain and medication side effects among possible influencing factors. IMPLICATIONS FOR REHABILITATION Clinicians treating adult persons with SB should be aware of possible psychological distress and fatigue symptomatology among these patients. We suggest an initial screening for psychological distress and fatigue in persons with SB during follow-up visits and rehabilitation. Interventions to reduce pain may influence levels of psychological distress and/or fatigue in patients with SB. Clinicians should enquire about the effects of medication on fatigue when assessing and prescribing new medications; a thorough medication review helps to assess the benefits and risks.

Uptrend in Distress and Psychiatric Symptomatology in Pregnant Women During the Coronavirus Disease 2019 Pandemic

(Acta Obstet Gynecol Scand. 2020;99:848–855) It is well established that psychological distress in pregnancy is associated with a range of negative outcomes, including delivery at an earlier gestational age, lower neonatal birthweight, and poor maternal psychosocial functioning. Expectant mothers of all social classes and educational levels can experience antenatal psychological distress, and the COVID-19 pandemic has introduced additional stress to people around the world. Most obstetric research on COVID-19 has focused on respiratory issues rather than mental health implications. This study aimed to provide data on any increase in prenatal psychological distress symptoms caused by the COVID-19 pandemic. As a secondary objective, the study aimed to identify which subgroup of women would be particularly vulnerable.

Efficacy of Acceptance and Commitment Therapy in Daily Life (Act-Dl) in Early Psychosis: Results from the Multi-Centre Interact Randomized Controlled Trial

Background: Treatment in the early stages of psychosis is crucial to prevent poor clinical and social outcomes. The aim of this study was to investigate the efficacy of Acceptance and Commitment Therapy in Daily Life (ACT-DL), combining face-to-face therapy with an Ecological Momentary Intervention (EMI), in reducing psychotic distress in a multi-centre randomised controlled trial of individuals with an Ultra-high Risk for Psychosis (UHR) or a first-episode of psychosis (FEP). Methods: Individuals aged 15-65 years with a clinically established UHR or FEP status were recruited from secondary mental health services in 5 regions and were randomly assigned to treatment as usual (TAU) or ACT-DL+TAU. ACT-DL consisted of 8 ACT sessions augmented with an EMI app. The primary outcome was a reduction in psychotic distress as assessed with CAARMS at post-intervention, 6- and 12-month follow-up. Secondary outcomes were symptom severity, functioning and momentary psychotic distress. We performed multivariate mixed models according to intent-to-treat principles. Findings: Between June 1, 2015 and December 31, 2018, 668 participants were referred, of whom 148 were randomised to ACT-DL+TAU (n=71) or TAU (n=77). 115 (78%) provided primary outcome data at least at one follow-up assessment. There was no evidence of a greater reduction in CAARMS distress in ACT-DL+TAU compared to TAU (χ2(3)=2·38; p=0·50). However, momentary psychotic distress (χ2(3)=21·56; p<0·001) and negative symptom severity (χ2(3)=15·96; p=0·001) was reduced and global functioning improved (χ2(3)=8·72; p=0·033) in ACT-DL+TAU compared to TAU. No serious adverse events directly related to the therapy occurred. Interpretation: Although the trial did not support a significant effect on psychotic distress as assessed with the CAARMS, significant improvements were found for momentary psychotic distress, global functioning and negative symptomatology. These results are promising given that these latter problems are among the hardest to treat. Clinical Trial Registration Details: The trial was prospectively registered in the Netherlands Trial Register (NTR4252). Funding Information: This work was supported by an ERC Consolidator Grant (ERC-2012-StG, project 309767—INTERACT) to IMG as well as an NWO VENI Grant (no. 451– 13-022) and DFG Heisenberg professorship (no. 389624707) to UR. Declaration of Interests: The study received ethical approval from the MERC at Maastricht University Medical Centre (MUMC), the Netherlands (reference: NL46439.068.13) and the University Clinic Leuven, Belgium (reference: B322201629214). Ethics Approval Statement: A week after being fully informed by a researcher, informed consent was obtained.

Characteristics and Prevalence of Lifetime Sexual Victimization Among a Sample of Men and Women with Intellectual Disabilities.

This study examines the prevalence and characteristics of sexual victimization experiences suffered by people with intellectual disabilities (ID). The sample consisted of 260 adults with an ID diagnosis (154 men and 106 women), ranging in age from 20 to 71 years (M = 41.69, SD = 12.05). The results showed that 35% of the sample had been sexually victimized at some point in their life. Being a woman, being declared legally incapable, and having comorbid mental health diagnoses were the most relevant characteristics of sexual victims with ID. Fondling was the most reported victimization, and rape showed the greatest gender differences, with a higher risk for women with ID of being raped compared to their male counterparts (odds ratio = 4.28, p < .05). The offender was generally a known male adult, and the percentage of incidents reported to the authorities was very low (7.4%). The psychological consequences of abuse were general distress, anxiety, and depressive symptomatology. Intervention and prevention programs targeting this population, as well as the training of professionals and caregivers, are essential to deal with sexual victimization and to protect and ensure the quality of life of people with ID.

Natural Language Processing-Based Virtual Cofacilitator for Online Cancer Support Groups: Protocol for an Algorithm Development and Validation Study.

BackgroundCancer and its treatment can significantly impact the short- and long-term psychological well-being of patients and families. Emotional distress and depressive symptomatology are often associated with poor treatment adherence, reduced quality of life, and higher mortality. Cancer support groups, especially those led by health care professionals, provide a safe place for participants to discuss fear, normalize stress reactions, share solidarity, and learn about effective strategies to build resilience and enhance coping. However, in-person support groups may not always be accessible to individuals; geographic distance is one of the barriers for access, and compromised physical condition (eg, fatigue, pain) is another. Emerging evidence supports the effectiveness of online support groups in reducing access barriers. Text-based and professional-led online support groups have been offered by Cancer Chat Canada. Participants join the group discussion using text in real time. However, therapist leaders report some challenges leading text-based online support groups in the absence of visual cues, particularly in tracking participant distress. With multiple participants typing at the same time, the nuances of the text messages or red flags for distress can sometimes be missed. Recent advances in artificial intelligence such as deep learning–based natural language processing offer potential solutions. This technology can be used to analyze online support group text data to track participants’ expressed emotional distress, including fear, sadness, and hopelessness. Artificial intelligence allows session activities to be monitored in real time and alerts the therapist to participant disengagement.ObjectiveWe aim to develop and evaluate an artificial intelligence–based cofacilitator prototype to track and monitor online support group participants’ distress through real-time analysis of text-based messages posted during synchronous sessions.MethodsAn artificial intelligence–based cofacilitator will be developed to identify participants who are at-risk for increased emotional distress and track participant engagement and in-session group cohesion levels, providing real-time alerts for therapist to follow-up; generate postsession participant profiles that contain discussion content keywords and emotion profiles for each session; and automatically suggest tailored resources to participants according to their needs. The study is designed to be conducted in 4 phases consisting of (1) development based on a subset of data and an existing natural language processing framework, (2) performance evaluation using human scoring, (3) beta testing, and (4) user experience evaluation.ResultsThis study received ethics approval in August 2019. Phase 1, development of an artificial intelligence–based cofacilitator, was completed in January 2020. As of December 2020, phase 2 is underway. The study is expected to be completed by September 2021.ConclusionsAn artificial intelligence–based cofacilitator offers a promising new mode of delivery of person-centered online support groups tailored to individual needs.International Registered Report Identifier (IRRID)DERR1-10.2196/21453

Body mass index and neuropsychological and emotional variables: joint contribution for the screening of sleep apnoea syndrome in obese.

ObjectiveObstructive sleep apnoea (OSA) is the most common sleep disorder and its prevalence has increased with the obesity pandemic. We aimed to explore the presence of OSA in severe obesity and to evaluate the association of body mass index (BMI) with sleep architecture, cognition, emotional distress and comorbidities in OSA versus non-OSA patients.MethodsA sample of 61 patients performed a neuropsychological battery that included tasks of attention, memory, perceptual/visuospatial ability, vocabulary, inhibition, cognitive flexibility and distress symptomatology, before overnight polysomnography.ResultsMore than half of the sample had OSA. Excessive daytime sleepiness was not a prominent complaint. Sleep architecture was worse in the OSA than in the non-OSA group, and hypertension was increased with OSA, especially in the severe OSA group. A higher BMI was associated with cognitive distress and sleep variables and with type 2 diabetes. The apnoea-hypopnoea index (AHI) was correlated with gender and cognitive measurements. Cognitive complaints were associated with enhanced distress in both OSA and non-OSA patients.DiscussionOSA is considerably present in severely obese patients. The BMI was strongly associated with other important anthropometric measurements along with worsening sleep architecture and lower executive functioning, both of which may contribute to weight gain. The AHI was significantly higher in men and affected memory and maintaining sets on the Wisconsin Card Sorting Test which may represent a barrier to treatment adherence for this disorder. The substantial presence of cognitive complaints in OSA and non-OSA patients suggests the need for psychological intervention focused on adaptive coping strategies, mostly for depressive symptoms. Given the current obesity epidemic, these results support the need for routine sleep investigation in obese people, particularly in primary care settings. BMI, neuropsychological and emotional screening can provide crucial information about asymptomatic and high-risk patients who require prompt sleep intervention and obesity treatment.

Psychological Distress and Post-Traumatic Symptomatology Among Dental Healthcare Workers in Russia: Results of a Pilot Study.

The spread of SARS-CoV-2 infection has increased the risk of mental health problems, including post-traumatic stress disorders (PTSD), and healthcare workers (HCWs) are at greater risk than other occupational groups. This observational cross-sectional study aimed to explore the symptoms of depression, anxiety, and PTSD among dental HCWs in Russia during the coronavirus disease 2019 (COVID-19) pandemic. The survey was carried out among 128 dental HCWs from three dental clinics of Ekaterinburg, Russia. The mean age of the sample was 38.6 years. Depression, anxiety, and stress were assessed using the Depression Anxiety and Stress Scale-21 (DASS-21); PTSD was assessed using the PTSD Symptom Scale-Self-Report (PSS-SR); subjective distress was assessed using the Impact of Event Scale-Revised (IES-R). The results indicated that 20.3–24.2% HCWs had mild to extremely severe symptoms of psychological distress, and 7.1–29.7% had clinical symptoms of PTSD. No differences between females and males were revealed. HCWs working directly with patients had significantly higher levels of PTSD symptoms and the risk of PTSD development compared to those working indirectly, whereas older HCWs had significantly higher levels of both psychological distress and PTSD symptoms compared to younger HCWs. Thus, dental HCWs are at high risk for psychological distress and PTSD symptoms during the COVID-19 pandemic.

Familial Incarceration, Social Role Combinations, and Mental Health Among African American Women

AbstractObjectiveThe current study uses insights from the stress process model and role theory to examine the relationship between familial incarceration, three key social roles—spouse, parent, and employee—and African American women's mental health.BackgroundResearch documents the spillover effects of mass incarceration on the families of those incarcerated. Approximately half of black women have at least one family member currently incarcerated; yet the potential psychological costs of familial incarceration among black women remains under‐investigated, particularly among those who are not parents.MethodUtilizing the National Survey of American Life, a nationally representative sample of never‐incarcerated African American women (N = 1,961), this study used regression to examine the association of mental health (measured by psychological distress and depressive symptomatology), familial incarceration, and combinations of social roles.ResultsFamilial incarceration was associated with higher levels of depressive symptoms and psychological distress. Women that were employed only typically had improved psychological adjustment compared to other role combinations; yet, employment did not mute the mental health costs of familial incarceration.ConclusionAfrican American women disproportionately experience the incarceration of family members, and the findings demonstrate that this experience is detrimental to mental health. Though social roles variably provide social, psychological, and economic resources to cope with familial incarceration, results show that the mental health costs of incarceration are generally consistent across role combinations. The expansive criminal justice system holds large implications for the well‐being of populations at the intersection of race, gender, and social roles.

Uptrend in distress and psychiatric symptomatology in pregnant women during the coronavirus disease 2019 pandemic.

Prenatal maternal distress has a negative impact on the course of pregnancy, fetal development, offspring development, and later psychopathologies. The study aimed to determine the extent to which the coronavirus disease 2019 (COVID-19) pandemic may aggravate the prenatal distress and psychiatric symptomatology of pregnant women. Two cohorts of pregnant volunteer women were evaluated, one that was recruited before the COVID-19 pandemic (n=496) through advertisements in prenatal clinics in Quebec, Canada, from April 2018 to March 2020; the other (n=1258) was recruited online during the pandemic from 2 April to 13 April 2020. Prenatal distress and psychiatric symptomatology were measured with the Kessler Distress Scale (K10), Post-traumatic Checklist for DSM-5 (PCL-5), Dissociative Experiences Scale (DES-II), and Positive and Negative Affect Schedule (PANAS). The 1754 pregnant women (Mage =29.27, SD=4.23) were between 4 and 41 gestational weeks (M=24.80, SD=9.42), were generally educated (91.3% had post-high-school training), and financially well-resourced (85.3% were above the low-income cut-off). A multivariate analysis of covariance controlling for age, gestational age, household income, education, and lifetime psychiatric disorders showed a large effect size (ES) in the difference between the two cohorts on psychiatric symptoms (Wilks' λ=0.68, F6,1400 =108.50, P<.001, partial η2 =0.32). According to post-hoc analyses of covariance, the COVID-19 women reported higher levels of depressive and anxiety symptoms (ES=0.57), dissociative symptoms (ES=0.22 and ES=0.25), symptoms of post-traumatic stress disorder (ES=0.19), and negative affectivity (ES=0.96), and less positive affectivity (ES=0.95) than the pre-COVID-19 cohort. Women from the COVID-19 cohort were more likely than pre-COVID-19 women to present clinically significant levels of depressive and anxiety symptoms (OR=1.94, χ2 [1]=10.05, P=.002). Multiple regression analyses indicated that pregnant women in the COVID-19 cohort having a previous psychiatric diagnosis or low income would be more prone to elevated distress and psychiatric symptoms. Pregnant women assessed during the COVID-19 pandemic reported more distress and psychiatric symptoms than pregnant women assessed before the pandemic, mainly in the form of depression and anxiety symptoms. Given the harmful consequences of prenatal distress on mothers and offspring, the presently observed upsurge of symptoms in pregnant women calls for special means of clinical surveillance.

S190. WHEN WORDS AREN’T ENOUGH: DANCE/MOVEMENT THERAPY AND SCHIZOPHRENIA

BackgroundDance/Movement Therapy (DMT) is a language that transcends the verbal realm. This facet of communicating through dance and movement is significant particularly when the population you are working with often communicates in ways that are creative, unique, and not necessarily conventional. This is often the case when working with people who have been diagnosed on the schizophrenia spectrum. Although they fall under the same diagnosis, positive and negative symptoms of schizophrenia are embodied in quite different ways; as their names indicate, positive and negative symptoms are dichotomous and fall on opposite ends of a movement spectrum.MethodsWe will explore the many bodily manifestations of schizophrenia and DMT approaches to best support the specific needs associated with this complex diagnosis. The co-facilitators have each engaged in their own clinical practice and research exploring how DMT interventions can best serve the population in grounding, thought and behavioral organization, ego strengthening, and development of interpersonal relationships. As one can imagine, having a diagnosis of schizophrenia can be isolating and interrupt healthy relationship development due to stigmatization. The co-facilitators have found DMT to be a humanizing factor in this often dehumanized population. The use of creativity with people with schizophrenia allows the psychotherapeutic relationship to focus on personal strengths, individuality, and unconditional acceptance.ResultsDance/movement therapists assess patient functioning through non-verbal indicators in everyday behavior, postural and gestural patterns, and qualitative elements that emerge during therapeutic interactions. Oftentimes, their experiences with positive symptomatology affect their ability to relate in a shared reality base with others not experiencing these positive symptoms. Single-session DMT interventions have supported a decrease in psychological distress, and positive and negative symptomatology for people with schizophrenia in an inpatient psychiatric facility (Biondo, 2019).Within a group DMT approach to treatment, dance/movement therapist considers movement and body-based experiences, as natural and effective sources of self-awareness and expression, which can illuminate the interrelationships between the many dimensions of human behavior (Bryl, 2018). This approach integrates movement techniques, creative embodiment, the non-verbal aspects of self-awareness and interpersonal communication and targets core specific features of chronic schizophrenia and negative symptomatology. As such it provides links to outcomes directly related to affective, cognitive, behavioral, and functional processes in the treatment for schizophrenia in residual stages (Bryl, 2018).DiscussionSchizophrenia can manifest through many different representations: with positive and/or negative symptoms, and with acute episodes or chronicity. The diagnosis will interrupt healthy ego strength, the ability to relate with others, and the ability to function without supports. Dance/movement therapy is a wonderful approach to working with this population in its many forms, as it addresses the psychological, cognitive, social, and functional levels of participants. Although positive and negative symptoms often manifest quite differently on a movement level, DMT has the ability to support the many needs of those diagnosed with schizophrenia. The many limitations of psychopharmacological interventions for people with schizophrenia are evidence that inclusive, strengths-based, and body-informed therapy options would greatly benefit this population.

The enemy who sealed the world: effects quarantine due to the COVID-19 on sleep quality, anxiety, and psychological distress in the Italian population

BackgroundThe 2019 Coronavirus Disease (COVID-19) pandemic has become a global health emergency. The extreme actions aimed to reduce virus diffusion have profoundly changed the lifestyles of the Italian population. Moreover, fear of contracting the infection has generated high levels of anxiety. This study aimed to understand the psychological impact of the COVID-19 outbreak on sleep quality, general anxiety symptomatology, and psychological distress. MethodsAn online survey collected information on socio-demographic data and additional information concerning the COVID-19 pandemic. Furthermore, sleep quality, sleep disorders, generalized anxiety symptoms, psychological distress, and post-traumatic stress disorder (PTSD) symptomatology related to COVID-19 were assessed. ResultsThis study included 2291 respondents. The results revealed that 57.1% of participants reported poor sleep quality, 32.1% high anxiety, 41.8% high distress, and 7.6% reported PTSD symptomatology linked to COVID-19. Youth and women, those uncertain regarding possible COVID-19 infection, and greater fear of direct contact with those infected by COVID-19 had an increased risk of developing sleep disturbances, as well as higher levels of anxiety and distress. Finally, a significant relationship between sleep quality, generalized anxiety, and psychological distress with PTSD symptoms related to COVID-19 was evidenced. ConclusionsOur findings indicate that the COVID-19 pandemic appears to be a risk factor for sleep disorders and psychological diseases in the Italian population, as previously reported in China. These results should be used as a starting point for further studies aimed to develop psychological interventions to minimize the brief and long-term consequences of the COVID-19 pandemic.

Evaluation of the Psychometric and Structural Properties of the Spanish Version of the Hospital Anxiety and Depression Scale in Latina Cancer Patients

ContextThe Hospital Anxiety and Depression Scale (HADS) is a brief self-report measure commonly used to screen for symptoms of anxiety and depression in cancer patients. The HADS has demonstrated validity in over 100 languages, including Spanish. However, validation studies have largely used European Spanish-speaking samples with a variety of medical diagnoses. ObjectivesThe aim of this study was to examine the psychometric properties of the Spanish version of the HADS in a sample of Spanish-speaking Latina women with cancer in the U.S. MethodsParticipants (N = 242) completed self-report measures of anxiety and depression (HADS), quality of life (Functional Assessment of Cancer Therapy–General Version), cancer-related distress (Impact of Events Scale–Revised Version Intrusion Subscale), and cancer symptomatology (Memorial Symptom Assessment Scale–Short Form) before initiating chemotherapy and five to seven weeks later. Analyses evaluated internal consistency and test-retest reliability, construct validity, and convergent validity. ResultsFactor analysis supported a two-factor structure as proposed by the original HADS developers (X2 [76, N = 242] = 143.3, P < 0.001, comparative fit index = 0.94, root-mean-square error of approximation = 0.06, and standardized root-mean-square residual = 0.06). The HADS and its subscales demonstrated good internal consistency (α = 0.83–0.88) and test-retest reliability (intraclass correlation coefficient = 0.76–0.82). Construct validity was evidenced by factor analysis and item-subscale, item-total, and subscale-total correlations. Convergent validity was demonstrated by strong positive correlations with cancer-related distress (r = 0.51–0.71) and symptom severity (r = 0.54–0.62) and strong negative correlations with quality of life (r = −0.63 to −0.76) (all P's < 0.001). ConclusionThe Spanish version of the HADS evidenced sound psychometric properties in Latinas with cancer in the U.S., supporting its use in clinical oncology research and practice.

Psychological distress among undergraduate medical students: the influence of excessive daytime sleepiness and family functioning

ABSTRACTMental health problems among undergraduate medical students is a well-known issue; however, their associated risk factors have been poorly studied. We aimed to assess the hypothesis that medical students have a higher prevalence of psychological distress and to explain this prevalence considering common risk factors for mental disorders. This was a cross-sectional, questionnaire-based descriptive study conducted with 467 Colombian undergraduate medical students from different years of training. Validated and widely used self-report questionnaires of psychological distress, daytime sleepiness, and family functioning were included. In addition, measurements of smoking, alcohol, and caffeine intake were used. We found a prevalence of psychological distress, depressive symptoms and anxiety symptomatology of 65.9%, 75.3%, and 50.5%, respectively. Furthermore, 20.6% showed both psychological distress and excessive daytime sleepiness. Adjusted risk ratio analysis showed that poor family functioning, the presence of excessive daytime sleepiness, and caffeine consumption were significant risk factors for high levels of psychological distress. Additionally, psychological distress and daytime sleepiness were related to the year of training. Our results replicate in part previous findings of poor mental health among undergraduate medical students compared with mental health in general population and provide novel findings that family functioning plays a significant role as an important explanatory factor. The current study has high relevance for future research and interventions focused on prevention of medical errors, conflicts in the physician–patient relationship and the personal safety of undergraduate medical students.

Interrelations Among Biologically Relevant Personality Traits, Emotion Regulation Strategies, and Clinical Symptoms.

Biologically relevant personality traits of weak inhibitory control (disinhibition) and threat sensitivity confer vulnerability to various clinical problems. Difficulties with emotion regulation have also been studied extensively in relation to risk for and maintenance of psychopathology. However, it remains unclear how emotion regulation strategies interface with dispositional vulnerabilities in affecting clinical symptomatology. The current study provided an initial examination of the roles of disinhibition, threat sensitivity, and use of key emotion regulation strategies (cognitive reappraisal, expressive suppression) in the occurrence of distress-related symptoms (i.e., depressivity, anxiousness, and borderline personality features). Analyses revealed that trait disinhibition and lowered use of cognitive reappraisal were related to each form of distress symptomatology, with the predictive relationship for disinhibition accounting entirely for that of reappraisal. This finding suggests that deficient top-down control capacity (i.e., disinhibition) is integral to failures in the use of an adaptive but cognitively demanding regulation strategy (i.e., reappraisal). By contrast, threat sensitivity was related both to anxiousness and use of expressive suppression, with the latter two variables unrelated to one another. Anxious individuals may avoid emotionally evocative situations, negating the downstream need to engage in the maladaptive strategy of expressive suppression. Despite certain study limitations (a cross-sectional, self-report design; modest sample size), the current study yielded evidence in line with study hypotheses, indicating a pivotal role for dispositional traits in associations between cognitive-behavioral processes and clinical problems.