Symptom Distress Research Articles

Music therapy Embedded in the Life Of Dementia Inpatient Care (MELODIC) to help manage distress: A mixed methods study protocol for co-designing a complex intervention

ABSTRACT Introduction Best practice guidelines state that psychosocial interventions should be the first line of treatment for people with dementia who are experiencing distress. However, little research explores psychosocial support for those experiencing the most complex symptoms of distress in inpatient mental health wards. Music therapy may reduce behaviours of distress and staff report it to be helpful, yet interventions are not common in the National Health Service (NHS) in the United Kingdom, and the type and method of delivery vary. Methods and design This study, funded by the National Institute for Health and Care Research, will co-develop and pilot a standardised protocol and guide, MELODIC (Music Therapy Embedded in the Life Of Dementia Inpatient Care), for music therapy in NHS inpatient mental health dementia wards. Two reviews, using realist and systematic methods, will be conducted to increase understanding of the current evidence base. Focus groups will then be facilitated to explore experiences of distress and the use of music on wards. MELODIC v1 will then be co-designed with experts by experience and stakeholders, and piloted on two NHS wards with differing experiences of music therapy. Mixed methods data collection will support protocol and theory refinement and establish the appropriateness of the methods to inform a future trial. Ethical approval has been received for all research activities. Discussion The protocol and findings will be disseminated in academic, clinical and public spaces. MELODIC can then be tested for feasibility and acceptability, with clinical and cost-effectiveness ultimately established in a definitive randomised controlled trial. Registration Realist review: CRD42023409635; systematic review: CRD42023429983.

Study on the prevention of vocal cord adhesion after operation of T1b glottic carcinoma by repairing the wound with transposition of ventricular mucosal flap

Objective: To explore the feasibility of one-stage repair and reconstruction of glottic area wounds with the ventricular mucosal flap to prevent postoperative vocal cord adhesion in patients with T1b glottic laryngeal cancer. Methods: This case series study involved the research and analysis of clinical data of 12 patients with T1b glottic laryngeal cancer treated in the Department of Otorhinolaryngology, the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2021 to June 2023. All patients were male, aged 50-85 years (median age 64.5 years), and underwent CO2 laser vocal cord resection under oral support laryngoscopy, followed by one-stage reconstruction of the glottic wound using a ventricular mucosal flap transfer. Postoperative observation indicators included oncological efficacy, surgical complications, degree of vocal cord adhesion, and vocal function, with routine follow-up conducted. The preoperative and postoperative Voice Handicap Index (VHI) scores were compared using a paired-sample Wilcoxon signed-rank test. Results: All 12 patients were followed up for more than 1 year, with follow-up periods ranging from 12 to 37 months and a median follow-up period of 19.5 months. During the follow-up period, no tumor recurrence was observed in any of the patients. One patient experienced suture detachment and displacement of the ventricular mucosal flap postoperatively, and no patient reported respiratory distress symptoms after surgery. 6 patients had no postoperative vocal cord adhesion, and the vocal cord length ratio in 12 patients was (0.80±0.23). The maximum glottic opening angle after surgery was (46.5±7.7) degrees. Voice function was evaluated before surgery and in six months postoperatively, when the laryngeal mucosa was on the stable phase. The median VHI-10 score for the 12 patients was 20 preoperatively and 10 postoperatively, the difference was statistically significant (Z=-2.827,P<0.05). Conclusions: The application of ventricular mucosal flap repair and reconstruction for glottic wound following laser resection of T1b laryngeal cancer effectively prevents postoperative vocal cord adhesion. The postoperative recovery of vocal function in these patients is favorable.

Nurses' work environment and health promotion in relation to psychological distress symptoms, and sleep disturbance: A structural equation modeling approach.

The healthcare work environment has numerous stressors that can contribute to distress and poor health outcomes among nurses. The impact of distress can be detrimental, resulting in nurses leaving the profession. Thus, it is critical to explore factors in the work environment that contribute to the distress symptoms and behaviors that promote nurses' health. This study aimed to examine the constructs associated with the conceptual model of distress, such as the work environment, specifically workload and the practice environment (quality of care, salary, staffing, time, and satisfaction) and associations with psychological distress, sleep disturbance, and health promotion behaviors in nurses, using structural equation modeling. This study was a cross-sectional survey design collected as part of the Nurse Worklife and Wellness Study (NWWS) using balanced stratified sampling methods. A confirmatory factor analysis tested the factorial structure of the latent constructs using weighted least squares estimation with missing data (WLSMV) for the sample (n = 1170). A structural equation modeling approach examined the direct and indirect associations between workload, practice environment, health promotion behaviors, psychological distress symptoms, sleep disturbance, and health. Based on the confirmatory factor analysis, the measurement model reported adequate model fit (CFI = 0.96; TLI = 0.95; SRMR = 0.048 and RMSEA = 0.039). The structural model showed that the workload was related to significantly increased psychological distress (β = 1.47, p < 0.001), sleep disturbance (β = 1.22, p < 0.01), and decreased overall health (β = -1.36, p < 0.01). Similarly, a positive practice environment was associated with significantly higher psychological distress (β = 1.61, p < 0.001), sleep disturbance (β = 1.31, p < 0.01), and lower overall health (β = -1.51, p < 0.01). Workload and the practice environment were associated with significantly increased health promotion behaviors such as interpersonal relations, spiritual growth, stress management, physical activity, and nutrition. A statistically significant indirect relationship was found between workload and psychological distress, mediated by health promotion behaviors. Psychological and physical health promotion had restorative effects in relation to decreasing the impact of distress and sleep disturbance while increasing overall health. Our results highlight the need to improve the work environment by decreasing the nurses' workload and using health promotion behaviors to mitigate nurses' psychological distress. Future studies should focus on exploring distress in the context of non-pandemic work conditions and finding ways to promote coping behaviors in nurses. In addition, healthcare organizations should develop policies and strategies to incentivize nurses' participation in health promotion behaviors to promote their well-being and ultimately stabilize the nursing workforce.

We Are Not Equipped to Identify the First Signs of Cyber–Physical Attacks: Emotional Reactions to Cybersecurity Breaches on Domestic Internet of Things Devices

The increasing number of domestic Internet of Things (IoT) devices in our lives leads to numerous benefits, but also comes with an increased risk of cybersecurity breaches. These breaches have psychological consequences for the users. We examined the nature of the psychological impact of cybersecurity breaches on domestic IoT by investigating emotional experiences in a scenario study (Study 1) and a field experiment (Study 2) using the five emotion components of the Component Process Model (CPM) and emotion regulation as a framework. We replicated a three-dimensional structure for emotional experiences found in a previous study, with an addition of an ancillary fourth dimension in the second study. The first dimension represents emotional intensity. The second bipolar dimension describes constructive vs. unconstructive action tendencies. On the third dimension, also bipolar, cognitive and motivational emotion features are opposed to affective emotion features. The fourth dimension, labeled distress symptoms, mainly reflects negative emotions. In Study 2, most of the introduced frequent irregularities on IoT devices were not noticed, and the intensity of emotional reactions and tendencies to react in a constructive way decreased throughout the phases of the experiment. These findings reveal that we are not emotionally equipped to identify potential threats in the cyber world.

Correlates of Using Medically-Authorized Cannabis in a Large Cohort of People Living with HIV Who Use Cannabis.

Many people living with HIV (PLWH) use cannabis to manage symptoms, but a large proportion do so without medical cannabis authorization and use cannabis obtained outside the medical stream. In jurisdictions where non-medical cannabis use is legal, PLWH who hold medical cannabis authorization may represent a unique subgroup; yet, research on the correlates of using medical cannabis (authorized by a healthcare provider) in the context of non-medical cannabis legalization is lacking. Thus, this study examined the cannabis- and health-related correlates of medical cannabis use among PLWH in Ontario, Canada, where non-medical cannabis is legal. PLWH (N = 868; 85.37% men, mean age 51.34years [SD = 12.25]) who were enrolled in the Ontario HIV Treatment Network Cohort Study in 2022 and who reported past-year cannabis use completed an assessment of sociodemographic characteristics, HIV-related variables, cannabis and other substance use, and health-related quality of life. Relatively few participants (n = 122; 14.06%) reported any medical cannabis use, with most (n = 746; 85.94%) reporting exclusive use of non-medical cannabis. Logistic regression analyses showed that greater HIV symptom distress, poorer physical-health-related quality of life, more frequent cannabis use, and using smokeless forms of cannabis were each uniquely associated with increased likelihood of using medical cannabis relative to exclusively using non-medical cannabis. Results suggest that even in jurisdictions where non-medical cannabis is legal, a subset of PLWH continue to access cannabis through the medical stream, and these individuals report distinct patterns of cannabis use and poorer physical health. Findings may inform cannabis policy and clinical care for PLWH who use cannabis.

What Happens to Unused Symptom Response Kits in the Community: A Narrative Review.

Introduction: It is a common practice in Ontario to prescribe patients with advanced life-limiting illness a Symptom Response Kit (SRK), an emergency medication and medical supply kit, to manage distressing symptoms in the community toward the end of life (EOL). These are hugely beneficial to patients; however, the medications included have high risk profiles, and there is no uniform procedure in place for the return or disposal of SRKs. This narrative review aims to identify what happens to unused SRKs when no longer needed. Methodology: The literature search was conducted on Medline Ovid, Embase, and CINAHL databases in early 2022 and re-conducted from 2022 to September 15, 2023. Ontario Health at Home (OHAH) websites were also searched in early 2022 and again in January 2024. We included conference abstracts, systematic reviews, scoping reviews, and clinical trials published in the English language that discussed the use of SRK (or equivalent) in community palliative care. Results: Twenty-six studies were included, 12 (46.2%) of which originated from the United States and 3 (11.5%) from Canada. Few studies (34.6%) discussed safety. One study provided instructions given to patients and families regarding return or disposal of unused kits. There was no consistent terminology for SRKs in studies or throughout OHAH organization websites. Three OHAH organizations' websites had instructions available on procedures for disposal or return of unused kits. Conclusions: There is a paucity of research on the use of SRK, although the practice is common. There is no consensus on SRK terminology and no studies evaluating the return or safe disposal of SRKs in the community when no longer needed. Future work should establish safety regulations, disposal monitoring, supervision of use, and terminology standardization. OHAH organizations provincially are conducting innovative work in this area.

Measuring Emotional Reactivity: Reliability and Validity of the Turkish Versions of the Perth Emotional Reactivity Scale (PERS) and its Short Form (PERS-S)

Objective: Individual differences in emotional reactivity are generally investigated using psychophysiological measures and self-report scales. This study aimed to adapt the Perth Emotional Reactivity Scale (PERS) and its short form (PERS-S), which assess individual differences in emotional reactivity to positive and negative emotions with three subscales (activation, intensity, and duration), into Turkish. Method: Participants (N=393, 73% female; for usable data) completed the PERS and other related measures including positive and negative affect, emotion dysregulation, and psychological distress symptoms. Results: Confirmatory factor analyses supported the 6-factor structure of both the PERS and PERS-S. Results also showed that the Turkish versions of the scales can be used as 6- or 2-factor scales, depending on the research interest (PERS: χ2/df = 4.15, CFI=0.9, NFI= 0.9, RMSEA= 0.09 [0.085 - 0.094]; PERS-S= χ2/df = 3.19, CFI=0.96, NFI=0.94, RMSEA= 0.075 [0.067 - 0.083]). The positive and negative emotional reactivity subscales showed satisfactory internal consistencies (all ’s &gt; .63) and two-week test-retest reliability levels (all r’s &gt; .62) and were correlated with emotion dysregulation, psychopathology, and positive/negative affect. Conclusion: The Turkish versions of PERS and PERS-S are reliable and valid tools for measuring individual differences in emotional reactivity.

COVID-19 Anxiety and Mental Health in Healthcare Workers: Examining the Role of Compassion Fatigue During the Last Wave of the Pandemic

Objective Pandemics have been shown to affect both physical and mental health, with healthcare workers (HCWs) bearing a particularly heavy burden. During the COVID-19 pandemic, HCWs faced a high volume of cases, extended work hours, and heightened pandemic-related stressors, which placed them at increased risk for mental health issues. This study examines the effects of COVID-19-related anxiety on HCWs’ mental health, specifically exploring the roles of compassion fatigue (comprising burnout and secondary traumatic stress) as potential mediators in this relationship. Method A sample of 104 HCWs completed an online survey measuring their demographic characteristics (such as gender, age, length of service, marital status, and education), levels of COVID-19 anxiety, compassion fatigue, and mental health outcomes. Path analysis and bootstrapping procedures were used to analyze the data. Results Results indicated that COVID-19 anxiety was positively associated with compassion fatigue, defined as the emotional strain of caring for others, which includes both burnout (emotional exhaustion from work) and secondary traumatic stress (stress from exposure to others’ trauma). Compassion fatigue, particularly secondary traumatic stress, mediated the relationship between COVID-19 anxiety and various mental health indicators, including symptoms of anxiety, depression, and psychological distress. Both COVID-19 anxiety and compassion fatigue were significant predictors of these mental health outcomes. Conclusions These findings suggest that COVID-19 anxiety alone does not fully explain mental health outcomes among HCWs, as compassion fatigue, specifically secondary traumatic stress, plays a substantial role. Recognizing the complex interplay of pandemic-related stressors and compassion fatigue may guide interventions to better support HCWs’ mental health.

The Effects of Symptom Distress and Depression on Quality of Life in Patients With Terminal Cancer: The Mediating Role of Meaning in Life and Spiritual Well-being.

Terminal cancer patients experience worsening physical symptoms, psychological challenges, and spiritual difficulties. Improving the quality of life (QOL) and reconstructing the meaning of life (MIL) for these patients ensure a dignified end-of-life experience. Spiritual well-being is necessary to promote effective end-of-life coping strategies. This study aimed to construct and verify the suitability of a model that explains the impact of physical and psychological factors on the QOL of patients with terminal cancer using MIL and spiritual well-being as mediating factors. The participants were patients with terminal cancer 25 years or older hospitalized in 40 nationally designated hospices. A total of 172 patients were included in the final analysis. Data analysis was performed using structural equation modeling. In the effect analysis of the final model, the variables affecting QOL were depression (β = -.62, P < .001), symptom distress (β = -.33, P = .001), and spiritual well-being (β = .36, P = .002), and a significant indirect effect of MIL was found in the depression-MIL-spiritual well-being and depression-MIL-QOL paths. Spiritual interventions that help people find their MIL can serve as an important component of optimal hospice and palliative care for patients with terminal cancer. In clinical practice, interventions that increase the MIL and spiritual well-being of patients with terminal cancer are needed. Additionally, the practice will see other benefits including enhanced patient care, psychological support, effective treatment planning, family caregiver support, and further research advancement.

Emerging Pharmacological Approaches for Psychosis and Agitation in Alzheimer's Disease.

Psychosis and agitation are among the most distressing neuropsychiatric symptoms (NPSs) of Alzheimer's disease (AD), linked to faster disease progression and earlier admission to nursing homes. While nonpharmacological treatments may alleviate mild behavioral symptoms, more severe syndromes often require pharmacological intervention. Brexpiprazole is the only medication approved for agitation in AD, although its limited clinical efficacy has raised criticism. No drugs have been approved for treating psychosis in AD, highlighting the critical need for new, effective, and safe treatments. Recent studies have elucidated part of the neurobiological basis of NPSs in the AD brain, offering insights for testing repurposed and novel drugs. We conducted a comprehensive nonsystematic literature review, aiming to provide a critical overview of both current treatments and emerging pharmacological interventions under clinical development for treating psychosis and agitation in AD. Additionally, we present strategies to optimize the clinical development of new drug candidates. We identify three promising compounds that are currently in phase 3 trials: xanomeline-trospium for AD psychosis, and dextromethorphan-bupropion and dexmedetomidine for agitation in AD. We propose that biomarkers linked to the neuropsychiatric traits of AD patients should be identified in dedicated studies and then included in phase 2 dose-range-finding studies with novel compounds to establish biological engagement. Furthermore, phase 3 placebo-controlled studies should be carried out in AD biomarker-confirmed subjects with narrower cognitive impairment ranges and precise NPS severity at screening. Alternative study designs, such as sequential phase approaches, may also be adopted.

Disease Perception, Stigma, Distress, Physical Symptom Experience and Quality of Life in Colorectal Cancer Patients Undergoing Chemotherapy: A Cross-Sectional Study

Purpose: This study investigated the impacts of disease perception, stigma, distress, and physical symptom experience on the quality of life of colorectal cancer patients receiving chemotherapy. Methods: A descriptive study was conducted on 127 colorectal cancer patients receiving chemotherapy from June 2023 to November 2023. The collected data were analyzed using the t-test, analysis of variance, Pearson correlation coefficients, and hierarchical regression analysis in SPSS 26. Results: The participants' occupation (β=.14, &lt;i&gt;p&lt;/i&gt;=.002), religion (β=.11, &lt;i&gt;p&lt;/i&gt;=.018), disease perception (β=-.24, &lt;i&gt;p&lt;/i&gt;&lt;.001), stigma (β=-.12, &lt;i&gt;p&lt;/i&gt;=.028), distress (β=-.44, &lt;i&gt;p&lt;/i&gt;&lt;.001), and physical symptom experience (β=-.16, &lt;i&gt;p&lt;/i&gt;=.004) were significant factors influencing the quality of life of colorectal cancer patients receiving chemotherapy, and the explanatory power of the model was found to be 78%. Conclusion: The results of this study suggest the need to prepare various intervention strategies to comprehensively manage disease perception, stigma, distress, and physical symptom experiences in colorectal cancer patients receiving chemotherapy, thereby improving their quality of life.

The Associations between Mindfulness Processes and Emotional Distress Symptoms: A Network Analysis

The Associations between Mindfulness Processes and Emotional Distress Symptoms: A Network Analysis

Validating Ideal and Actual Positive Affect Measure Among Chinese Adolescents: Affect Valuation Theory

Cultural variations in affective experiences are observed. Research on positive affect with refined categorizations has been limited. This study examined the Affect Valuation Theory and its measure, the Affect Valuation Index (AVI), using a sample of high school students from rural China ( N = 676, Mage = 16.17 years, SD = .94). The AVI assesses the ideal-actual affect discrepancy and preferred and actual experiences of different affective states, but it has yet to be validated among adolescents. The AVI showed satisfactory validity and reliability in assessing ideal and actual affect and their discrepancies in our sample. Actual high-arousal affect showed the strongest association with wellness and distress symptoms, but ideal high-arousal affect was not associated with mental health indicators. In contrast, ideal and actual low arousal-affective states were related to wellness indicators. These findings underscore the potential utility of the AVI in capturing affective experiences among adolescents and suggest its application in developing targeted interventions.

Depression, Anxiety, Stress and Its Association with Coping Strategies among Malaysian University Students

Malaysia is one of the countries transitioning from the pandemic phase to an endemic phase of Covid-19. The spread of Covid-19 had a significant impact on university students, affecting their mental health just as it did for many others. This study investigates depression, anxiety, and stress symptom levels among Malaysian university students and the coping strategies used to prevent or reduce these psychological distress symptoms. A web-based questionnaire was developed using Google Forms to collect data from students who were selected non-randomly from three public universities and one from a private university in Malaysia. Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and Perceived Stress Scales-10 (PSS-10) were used for measuring depression, anxiety, and stress respectively. The coping strategies were measured using five strategies: seeking social support for emotional reasons, seeking social support for instrumental reasons, acceptance, mental disengagement, and humanitarian. The study findings indicated that 60.7% had depression symptoms, 30.4% had anxiety symptoms, and 86.3% had stress symptoms at moderate-to-severe levels. Acceptance was the most preferred coping strategy among the students while seeking social support for instrumental reasons was the least preferred coping strategy. Students with severe depression levels used mental disengagement coping strategies more than those with mild symptoms. Mental disengagement coping strategy was associated with severe anxiety symptoms compared to mild and minimal symptoms. Seeking social support for emotional reasons was also associated with moderate anxiety symptoms compared to mild anxiety symptoms.

Acceptability of bispectral Index monitoring in end-of-life care for dementia.

Assessing consciousness might benefit the care for people with Alzheimer's disease and other types of dementia at the end of life by indicating distressing symptoms and moments of awareness. This could guide symptom control and increase interaction with the person with dementia. This study aims to investigate the acceptability of a biosignal measurement of consciousness, the Bispectral Index monitoring (BIS), for persons with dementia at the end of life. Qualitative study using focus groups and interviews with demonstrations of BIS monitoring, with 17 individuals with dementia and 24 family caregivers. Qualitative content analysis was based on the theoretical framework of acceptability. People with dementia did not find BIS monitoring bothersome, yet acceptability varied across participants and situations. Family caregivers considered BIS acceptable for medical situations such as palliative sedation and pain assessment. Perceived effectiveness, ethicality, and usefulness considerations underpinned reasons and concerns around acceptability. Potential end-users expressed diverse attitudes towards BIS monitoring in dementia end-of-life care. If BIS or similar technologies are to be implemented in the future, care must be taken to ensure that the device has sufficient added value, that the person with dementia and family are well informed, and that the technology does not replace human care. Future research should investigate its efficacy and feasibility in the situations that were deemed acceptable.

Impact of Baduanjin Qigong Exercise on Fatigue in Patients with Lung Cancer: A Randomized Controlled Trial.

Background: Patients report fatigue as the most distressing symptom associated with cancer and treatment. Baduanjin has beneficial effects on reducing fatigue. However, no relevant randomized controlled trials comparing the effects of Baduanjin exercise with routine exercise in patients with lung cancer and fatigue have been reported. Methods: This blinded trial aimed to compare the effect of Baduanjin versus routine exercise on fatigue for patients with lung cancer. Participants in the intervention group received Baduanjin training and performed Baduanjin every week, while those in the control group performed routine exercise at the same frequency. Results: A total of 73 patients were analyzed. After the intervention, patients in the Baduanjin group experienced significant improvement in fatigue and pain (p < 0.05), while no significant difference in Edmonton Symptom Assessment System items were observed among patients in the exercise group. Conclusion: Our study showed that Baduanjin was a better exercise than routine activity in relieving their fatigue.

Examining associations among depressive symptoms, negative partner attributions, and relationship functioning in different‐gender couples using the actor‐partner interdependence mediation model

AbstractNegative attributions about the cause of and blame for relationship problems are highly predictive of relationship dysfunction and depression. Consequently, researchers have attempted to understand the role of negative relationship attributions in the association between depression and relationship functioning, with theory and research suggesting negative attributions may mediate the association between depression and relationship functioning. However, these studies were conducted on individuals, not couples. Including a couple of data and employing a dyadic design can provide a more holistic picture of the associations among these variables. The present study used the actor‐partner interdependence mediation model (APIMeM) to examine associations among depressive symptoms, relationship functioning, and negative partner attributions. Different‐gender couples (N = 200) seeking couples’ clinical services completed measures of negative relationship attributions, relationship distress, and depressive symptoms. Results revealed depressive symptoms to be indirectly related to one's own and one's partner's relationship functioning through one's own negative causal attributions. Actor and partner effects of responsibility attributions and depressive symptoms on relationship functioning were also observed. Results underscore the possible mechanistic role of negative attributions—particularly causal attributions—in maintaining the depression‐relationship dysfunction association.

The Relationship between the Mental Health of Refugee Parents and Their Children: An Investigation of Australian Longitudinal Data.

We investigated the relationship between parent and child mental health, including parents' general psychological distress, among refugees resettled in Australia. We utilised longitudinal data from a sample (N = 602 children and 377 parents) of recently settled refugees from the Building a New Life in Australia Survey). Parent psychological distress and post-traumatic stress symptoms (PTSS) were measured by the Kessler 6 and PTSD-8, respectively. Harsh and Warm parenting behaviours were also measured to explore the mechanisms underlying the parent-child mental health relationship. Child mental health was measured using the SDQ. Using path analysis, we found that increases in parent psychological distress directly contribute to harsher parenting practices, which in turn increase child mental health difficulties as reported by parents. Parent psychological distress at Waves 1 and 3 also directly impacted child emotional and conduct difficulties, whilst parent PTSS was indirectly associated with all measured child mental health problems. While both parent PTSS and psychological distress indirectly impacted child mental health, only psychological distress directly impacted on any area of child mental health difficulty and overall explained more variance in the final model. Our findings highlight that non-trauma specific symptoms warrant attention in refugee parents' and children's mental health. Clinicians should assess for general psychological symptoms in addition to trauma-specific symptoms, and we recommend that parental mental health is assessed and treated simultaneously when working with refugee children. Moreover, to reduce the impact of other stressors in refugees' lives, community sector organisations should be resourced adequately to support refugee families in settlement.

Complicated grief following the perinatal loss: a systematic review

BackgroundPerinatal loss is a severe stressor that usually triggers distressing symptoms of acute grief. Moreover, acute grief can worsen with time and become a chronic debilitating state known as complicated grief. However, there is a lack of comprehensive reviews on this topic. This systematic review aims to synthesize the existing literature on complicated grief following the perinatal loss.MethodsWe systematically searched PubMed, Embase, Cochrane Library, CINAHL, ProQuest, and Web of Science to identify articles on complicated grief symptoms and influencing factors following perinatal loss. We performed a comprehensive, structured evaluation in full compliance with PRISMA guidelines.ResultsA systematic search produced 1163 results. Of these, 38 articles met the full-text screening criteria, and 10 pieces of literature met the inclusion criteria. Individuals may experience complicated grief following perinatal loss, manifesting in symptoms such as emotional reactions, physical responses, and social impairments. Furthermore, based on existing evidence, influencing factors include demographic characteristics, reproductive characteristics, marital relationships, social support, and coping strategies.ConclusionsComplicated grief following perinatal loss is easily overlooked and has not been adequately studied. Further empirical research is needed to explore the symptoms and factors influencing this condition. A better understanding of complicated grief will help develop and optimize care strategies, informing future clinical practice and improving psychological support for individuals affected by perinatal loss.Trial registrationPROSPERO registration number: CRD42023473510.

Effects of Integrating Palliative Care in Patients With Advanced Cancer: A Systematic Review and Meta-Analysis of Quality of Life and Psychological Outcomes.

Background: Patients with advanced cancer frequently have a wide range of mental and physical symptoms, making it difficult for them to communicate and make informed decisions. Necessitating the incorporation of palliative care in this population to meet their supportive care requirements. Objective: To investigate the effects of integrating Palliative care in advanced cancer patients. Methods: PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Google Scholar databases were comprehensively and systematically searched for Randomized clinical trials (RCTs) published up to February 2024. According to the PICOS criteria, trials enrolling adult patients with advanced cancer subjected to PC were included. Moreover, a risk of bias assessment was performed using the Cochrane Risk of Bias tool, and statistical analyses were performed using the Review Manager software. Results: Only 13 RCTs with 3,294 advanced cancer patients were included in the final analysis. A pooled analysis of data from these trials revealed that patients subjected to PC had improved quality of life (QoL) scores than those receiving standard care (SMD: 0.18; 95% CI: 0.07 - 0.30; p = 0.002). However, no significant difference was observed in depression (SMD: -0.03; 95% CI: -0.16 - 0.10; p = 0.63), anxiety (SMD: - 0.04; 95% CI: -0.23 - 0.15; p = 0.69), and survival (OR: 0.81; 95% CI: 0.56 - 1.16; p = 0.25). Conclusion: Integrating PC in patients with advanced cancer results in improved QoL with limited effect on psychological distress symptoms.