Elevated Levels Of Psychological Distress Research Articles

Poor psychological health status among patients with inflammatory rheumatic diseases and osteoarthritis in multidisciplinary rehabilitation: Need for a routine psychological assessment

Purpose. To examine psychological health status among patients with inflammatory rheumatic diseases (i.e. rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis) and osteoarthritis in multidisciplinary rehabilitation, and to describe changes in psychological distress, illness cognitions, and pain coping from pre- to post-treatment.Method. Eighty-nine patients referred to multidisciplinary rehabilitation completed a set of questionnaires to assess pain (AIMS2-SF), physical functioning (AIMS2-SF), psychological distress (IRGL), illness cognitions (ICQ) and pain coping (PCI) at pre- and post-treatment. Changes in physical functioning, pain, and psychological health status were determined. On the basis of the cut-off scores of psychological distress, distressed, and non-distressed patients were compared on physical and psychological outcomes.Results. Psychological distress was found in 64% of the study sample. In addition, high levels of helplessness and worrying, low levels of acceptance, and moderate levels of physical functioning were found. After treatment, positive changes in pain, psychological distress, and illness cognitions were observed. However, 69% (29/42) of the distressed patients at baseline still experienced elevated levels of psychological distress and maladaptive cognitions.Conclusions. Psychological distress and maladaptive illness cognitions are important characteristics of this study sample, and psychological distress remains high after rehabilitation. More attention should be given to the appropriate assessment and treatment of psychological distress within multidisciplinary rehabilitation.

Parental illness, caregiving factors and psychological distress among children orphaned by acquired immune deficiency syndrome (AIDS) in South Africa

Studies show elevated levels of psychological distress among acquired immune deficiency syndrome (AIDS)-orphaned children. Caregiving factors are critical in child mental health, but little is known about their effects among AIDS-orphaned children. This study aimed to explore whether caregiving factors (e.g. caregiver illness, monitoring and abuse) mediated between orphanhood status and psychological problems. A total of 1025 children and adolescents (aged 10–19 years), living in South African urban informal settlements, were interviewed using sociodemographic questionnaires and standardized psychological scales of depression, anxiety, post-traumatic stress disorder, peer problems, delinquency and conduct problems. AIDS-orphaned children (n = 425) were compared to control groups of other-orphans (n = 241) and non-orphans (n = 278). Results showed that child abuse, domestic violence, sibling dispersion and changes of caregiver were associated with psychological problems for all children, but did not mediate between orphanhood and psychological distress. AIDS-orphaned children reported more caregiver illness and excessive housework, and these two factors mediated the strong associations between psychological distress and AIDS-orphanhood. These findings suggest that interventions addressing caregiver ill-health and supporting young carers may have potential to ameliorate psychological distress among AIDS-orphaned children.

Psychiatric Symptoms and Same-Sex Sexual Attraction and Behavior in Light of Childhood Gender Atypical Behavior and Parental Relationships

This study explores the relation between the level of current symptoms of depression and anxiety and recalled childhood gender atypical behavior (GAB), and quality of relationships with parents among men and women who reported same-sex sexual attraction or engaged in same-sex sexual behavior and men and women who did not. Matched pairs, 79 men (n = 158) and 148 women (n = 296), with equal levels of GAB were created of Finnish participants with either same-sex sexual attraction or behavior and participants without. The measures used were retrospective questionnaires. Ratings of maternal and paternal over-control and coldness differed as a function of same-sex sexual attraction or behavior. Childhood GAB was correlated with negative ratings of parental relationships. Both same-sex sexual attraction or behavior and a history of childhood GAB affected the reported levels of current depression and anxiety. Only gender typical participants with no same-sex sexual attraction or behavior reported significantly lower levels of symptoms. The findings suggest that childhood GAB is related to later distress both among hetero- and homosexual individuals. The elevated level of psychological distress among homosexual individuals, reported in several studies, might—to some extent—be caused by their generally higher levels of childhood GAB as opposed to a homosexual orientation per se.

Sense of coherence and psychiatric morbidity: a 19-year register-based prospective study

BackgroundMost prospective studies on the relationship between sense of coherence (SOC) and mental health have been conducted using subjective health indicators and short-term follow-ups. The objective of this prospective occupational...

Psychological distress among men suffering from couple infertility in South Africa: a quantitative assessment

Recent years have seen a growing interest in the impact of infertility on reproductive health in developing countries. Most of the research which has addressed the psychosocial consequences of infertility in African countries has been qualitative in nature and focused on women. It was the aim of this study to assess psychological distress quantitatively in men suffering from couple infertility living in an urban community in South Africa. The Symptom Checklist-90-R, a standardized instrument for the measurement of current psychological symptom status, was administered to 120 men upon first presentation to a public health sector infertility clinic (study group) in a tertiary referral centre. The control group comprised 120 men who attended an antenatal clinic with their partner. All men may have previously fathered a child. Raw test scores were converted into standard area T scores and analyzed further. Participants in the study group differed in their psychological symptom status when compared with controls. Male partners of infertile couples had significantly elevated mean T scores for all nine primary symptom dimensions as well as the three global markers of distress (P < 0.0001 versus control), but these did not exceed the upper range of normal. When compared with controls, male partners of infertile couples experienced elevated levels of psychological distress, but without, on average, suffering from psychopathology. A comparison with qualitative studies from African countries and with quantitative studies from the Western industrialized world revealed both similarities and differences. Understanding and addressing the male perspective of infertility is an important component of infertility management.

Rasch model analysis of the Depression, Anxiety and Stress Scales (DASS)

BackgroundThere is a growing awareness of the need for easily administered, psychometrically sound screening tools to identify individuals with elevated levels of psychological distress. Although support has been found for the psychometric properties of the Depression, Anxiety and Stress Scales (DASS) using classical test theory approaches it has not been subjected to Rasch analysis. The aim of this study was to use Rasch analysis to assess the psychometric properties of the DASS-21 scales, using two different administration modes.MethodsThe DASS-21 was administered to 420 participants with half the sample responding to a web-based version and the other half completing a traditional pencil-and-paper version. Conformity of DASS-21 scales to a Rasch partial credit model was assessed using the RUMM2020 software.ResultsTo achieve adequate model fit it was necessary to remove one item from each of the DASS-21 subscales. The reduced scales showed adequate internal consistency reliability, unidimensionality and freedom from differential item functioning for sex, age and mode of administration. Analysis of all DASS-21 items combined did not support its use as a measure of general psychological distress. A scale combining the anxiety and stress items showed satisfactory fit to the Rasch model after removal of three items.ConclusionThe results provide support for the measurement properties, internal consistency reliability, and unidimensionality of three slightly modified DASS-21 scales, across two different administration methods. The further use of Rasch analysis on the DASS-21 in larger and broader samples is recommended to confirm the findings of the current study.

Prevalence of mental health problems in Australian university health services

General practice patients report greater mental health problems than the general population, and students attending one university health service have reported greater prevalence rates at the end of the academic year. This study assessed the overall prevalence rate of mental health problems in university students using a cross-sectional survey design of 1,168 students from three large, predominantly urban, Australian university health services. Approximately half of the students attending university health services reported elevated levels of psychological distress. The majority of severely distressed students had not sought any professional assistance for mental health problems. While there is scope for general practitioners to take a lead role in the identification of mental health problems in tertiary students, adequate treatment pathways need to be available. Implications for the role of universities in prevention work are discussed.

Tricks of the Trade: Sexual Health Behaviors, the Context of HIV Risk, and Potential Prevention Intervention Strategies for Male Sex Workers

Sex work is a significant risk for HIV and sexually transmitted infection (STI) among men who have sex with men (MSM); however, there is a dearth of knowledge about how to reduce risk in this group. MSM sex workers (N = 32) completed a semistructured qualitative interview and a close-ended quantitative assessment. Analyses focused on themes relevant to intervention development. Participants reported an average of 46 male sex partners in the prior 12 months; 31% of participants were HIV-infected. Male sex workers frequently used substances during sex and had elevated levels of psychological distress. Qualitative findings suggest that trauma-informed mental health and substance abuse treatment, ready access to HIV/STI testing and treatment and condoms/informational materials, support groups to address isolation/loneliness, skill-building for risk reduction with sex partners, and paid incentives as add-ons to effective behavior change interventions may be valuable intervention components. Targeting consumers of paid/exchanged sex may assist with changing community norms regarding the practice of transactional sex. Multipronged interventions to decrease sexual risk taking among male sex workers would also benefit from addressing the unique socioeconomic and legal needs of this population.

Psychological Health Before, During, and After an Economic Crisis: Results from Indonesia, 1993 - 2000.

The 1997 Indonesian financial crisis resulted in severe economic dislocation and political upheaval, and the detrimental consequences for economic welfare, physical health, and child education have been established in several studies. The crisis also adversely impacted the psychological well-being of the Indonesian population. Comparing responses of the same individuals interviewed before and after the crisis, we document substantial increases in several different dimensions of psychological distress among male and female adults across the entire age distribution. In addition, the imprint of the crisis can be seen in the differential impacts of the crisis on low education groups, the rural landless, and residents in those provinces that were most affected by the crisis. Elevated levels of psychological distress persist even after indicators of economic well-being such as household consumption had returned to pre-crisis levels, suggesting the deleterious effects of the crisis on the psychological well-being of the Indonesian population may be longer lasting than the impacts on economic well-being.

Proximate industrial activity and psychological distress.

This paper examines the role that gender, occupational status, and family status play in moderating the effect of industrial activity on the psychological well-being of nearby residents. Using a unique spatial assessment of industrial activity and an environmental risk/social stressor framework in conjunction with individual-level data from the Detroit Area Study (DAS) and demographic data from the U.S. census, we find that residents of neighborhoods in close proximity to industrial activity report elevated levels of psychological distress compared to residents of neighborhoods removed from this type of activity. These influences are more pronounced among women but gender differences are also contingent upon occupational and family statuses. We show that specific combinations of work and family statuses make persons particularly vulnerable to the influence of this environmental stressor and women are two and a half times more likely than men to have these vulnerable statuses. This study makes an important contribution to the environmental health literature because it reminds researchers of the fundamental influence of social roles when examining the link between environmental risks and mental health.

Factors influencing psychological distress during a disease epidemic: Data from Australia's first outbreak of equine influenza

BackgroundIn 2007 Australia experienced its first outbreak of highly infectious equine influenza. Government disease control measures were put in place to control, contain, and eradicate the disease; these measures included movement restrictions and quarantining of properties. This study was conducted to assess the psycho-social impacts of this disease, and this paper reports the prevalence of, and factors influencing, psychological distress during this outbreak.MethodsData were collected using an online survey, with a link directed to the affected population via a number of industry groups. Psychological distress, as determined by the Kessler 10 Psychological Distress Scale, was the main outcome measure.ResultsIn total, 2760 people participated in this study. Extremely high levels of non-specific psychological distress were reported by respondents in this study, with 34% reporting high psychological distress (K10 > 22), compared to levels of around 12% in the Australian general population. Analysis, using backward stepwise binary logistic regression analysis, revealed that those living in high risk infection (red) zones (OR = 2.00; 95% CI: 1.57–2.55; p < 0.001) and disease buffer (amber) zones (OR = 1.83; 95% CI: 1.36–2.46; p < 0.001) were at much greater risk of high psychological distress than those living in uninfected (white zones). Although prevalence of high psychological distress was greater in infected EI zones and States, elevated levels of psychological distress were experienced in horse-owners nationally. Statistical analysis indicated that certain groups were more vulnerable to high psychological distress; specifically younger people, and those with lower levels of formal educational qualifications. Respondents whose principal source of income was from horse-related industry were more than twice as likely to have high psychological distress than those whose primary source of income was not linked to horse-related industry (OR = 2.23; 95% CI: 1.82–2.73; p < 0.001).ConclusionAlthough, methodologically, this study had good internal validity, it has limited generalisability because it was not possible to identify, bound, or sample the target population accurately. However, this study is the first to collect psychological distress data from an affected population during such a disease outbreak and has potential to inform those involved in assessing the potential psychological impacts of human infectious diseases, such as pandemic influenza.

The Psychological Cost of Market Transition: Mental Health Disparities in Reform-Era China

China's post-1978 economic reform has led to fundamental changes in its urban life. Yet little attention has been paid to the effects of this massive societal transformation on individuals' psychological well-being. Using survey data collected from a national sample of 3,443 Chinese urban residents in 2005, 1 examine the effects of employment conditions, political affiliation, and regional level of marketization on self-reported symptoms of psychological distress. The findings show that individuals whose personal conditions expose them more to the risks and uncertainty brought about by market reform, such as self-employed workers, are more likely to suffer from psychological distress. By contrast, residents in more marketized areas tend to feel more satisfied with their economic conditions and therefore have lower levels of distress. Taken together, these results suggest that the reduced social protection resulting from reform contributes to an elevated level of psychological distress. However, a higher perceived level of economic well-being reduces distress and partly compensates for the disruptive effects of China's market transition.

T11-O-02 How are gender typicality/atypicality and experienced parenting during childhood and current sexual orientation related to psychiatric symptoms

The objective was to examine how childhood gender typicality/atypicality and sexual orientation of men and women are related to recalled quality of relations to parents and to the level of current symptoms of depression and anxiety. Questionnaires were completed by 3604 Finnish 33 to 43 year old twins from a population based sample. The measures used were an abbreviated version of Recalled Gender Identity/Gender Role Questionnaire, Measure of Parenting Style, Brief Symptom Inventory 18 and Sell Assessment of Sexual Orientation. Matched pairs of homosexual and heterosexual participants with equal levels of gender atypical behavior were created for men and women, respectively. This resulted in 158 male and 296 female participants for the analyses. Heterosexual male and lesbian participants reported more paternal over-control and parental abusiveindifference compared to gay male and heterosexual female participants. Both hetero- and homosexual participants with a history of childhood gender atypicality reported more negative parent-child relations and elevated levels of depression and anxiety when compared to gender typical homoand heterosexual participants. Gender typical heterosexual participants reported less psychiatric symptoms than the other groups. The findings suggest that gender atypicality in childhood causes later distress both among hetero- and homosexual participants. The elevated level of psychological distress among homosexual individuals might to some extent be caused by their generally higher levels of childhood gender atypical behavior. Negative parenting was positively related to psychiatric distress as an adult irrespective of the gender atypicality.

Continuity in self-report measures of maternal anxiety, stress, and depressive symptoms from pregnancy through two years postpartum

This study examined stability and change in maternal anxiety, stress and depression both during the second half of pregnancy and from pregnancy to six weeks and two years postpartum. Self-report measures included those designed to measure mood and state as well as more persistent attributes. Longitudinal data were collected from 137 women during pregnancy, 120 at six weeks, and 97 at two years. There was significant individual stability in scores on specific measures during pregnancy (range in Pearson rs = 0.30–0.86) and from pregnancy through two years postpartum (rs = 0.30–0.74). Comparable levels of convergence among measures of different constructs both within pregnancy and over time were also demonstrated, suggesting lack of precision in measurement instruments designed for specific constructs. Despite intra-individual stability, changes in mean levels were also observed over time with somewhat different patterns for each variable. However, maternal parity was an important contributor to both level and trajectory. A summary composite score showed an elevated level of psychological distress during pregnancy in multiparous women, followed by a decline through two years postpartum; primiparous women displayed a gradual increase in distress [main effect F (1,87) = 3.97, p < 0.05; time interaction F (2,174) = 7.15, p < 0.001] to multiparous levels by two years. Results are discussed in terms of a “motherhood” effect on psychological distress.

Self-injurious Behaviors in a College Population

The goal was to assess the prevalence, forms, demographic and mental health correlates of self-injurious behaviors in a representative college sample. A random sample of undergraduate and graduate students at 2 northeastern US universities were invited to participate in an Internet-based survey in the spring of 2005. Thirty-seven percent of the 8300 invited participants responded. The lifetime prevalence rate of having > or =1 self-injurious behavior incident was 17.0%. Seventy-five percent of those students engaged in self-injurious behaviors more than once. Thirty-six percent reported that no one knew about their self-injurious behaviors and only 3.29% indicated that a physician knew. Compared with non-self-injurers, those with repeat self-injurious behavior incidents were more likely to be female, bisexual or questioning their sexual orientation. They were less likely to be Asian/Asian American and >24 years of age. When controlling for demographic characteristics, those with repeat self-injurious behavior incidents were more likely to report a history of emotional abuse or sexual abuse, ever having considered or attempted suicide, elevated levels of psychological distress, and > or =1 characteristic of an eating disorder. A dose-response gradient was evident in each of these areas when single-incident self-injurious behaviors were compared with repeat-incident self-injurious behaviors. A substantial number of college students reported self-injurious behaviors in their lifetimes. Many of the behaviors occurred among individuals who had never been in therapy for any reason and who only rarely disclosed their self-injurious behaviors to anyone. Single self-injurious behavior incidents were correlated with a history of abuse and comorbid adverse health conditions but less strongly than were repeat self-injurious behavior incidents. The reticence of these clients to seek help or advice renders it critical that medical and mental health providers find effective strategies for detecting and addressing self-injurious behaviors.

Social and emotional characteristics of adults seeking a cochlear implant and their spouses

Because past research has shown that benefits of cochlear implantation may include a significant decrease in psychological and emotional difficulties, this study examined whether persons seeking cochlear implants in recent years differed psychologically from those referred in the early 1980s. A second objective was to explore mechanisms by which profound deafness could contribute to psychological and emotional difficulties for implant candidates and their spouses. 178 cochlear implant candidates referred from 1981 to 1998 at the University of Iowa Hospitals completed a standard battery of psychological tests and questionnaires. The sample was divided into six 3-year cohorts and compared on standardized measures of psychological and emotional adjustment, and in participation in social and non-social activities. Spouses of implant candidates completed a similar assessment. The sample was characterized by elevations in depression, social introversion, suspiciousness, and social anxiety and loneliness. There were no significant differences among cohorts across time except for an increase in expectations for implant success. Spouses also evidenced elevated levels of psychological distress. Hearing status was associated with significant differences in social activity participation. A paradoxical interaction was found between marital status and deafness. There was no evidence that the psychological status of implant candidates is changing across time, suggesting continued psychological benefit for persons receiving cochlear implants. Both candidates and their spouses participated in fewer social activities than normal controls. Findings underscore the complex relation between marital status, deafness, and engagement and participation in positive activities.

Physical and psychological factors maintain long-term predictive capacity post-whiplash injury

Higher initial levels of pain and disability, older age, cold hyperalgesia, impaired sympathetic vasoconstriction and moderate post-traumatic stress symptoms have been shown to be associated with poor outcome 6 months following whiplash injury. This study prospectively investigated the predictive capacity of these variables at a long-term follow-up. Sixty-five of an initial cohort of 76 acutely injured whiplash participants were followed to 2–3 years post-accident. Motor function (ROM; kinaesthetic sense; activity of the superficial neck flexors (EMG) during cranio-cervical flexion), quantitative sensory testing (pressure, thermal pain thresholds and brachial plexus provocation test), sympathetic vasoconstrictor responses and psychological distress (GHQ-28, TSK and IES) were measured. The outcome measure was Neck Disability Index (NDI) scores. Participants with ongoing moderate/severe symptoms at 2–3 years continued to manifest decreased ROM, increased EMG during cranio-cervical flexion, sensory hypersensitivity and elevated levels of psychological distress when compared to recovered participants and those with milder symptoms. The latter two groups showed only persistent deficits in cervical muscle recruitment patterns. Higher initial NDI scores (OR 1.00–1.1), older age (OR 1.00–1.13), cold hyperalgesia (OR 1.1–1.13) and post-traumatic stress symptoms (OR 1.03–1.2) remained significant predictors of poor outcome at long-term follow-up ( r 2 = 0.56). The robustness of these physical and psychological factors suggests that their assessment in the acute stage following whiplash injury will be important.

Unhappily Ever After: Effects of Long-Term, Low-Quality Marriages on Well-Being

The present study shows that long-term, low-quality marriages have significant negative effects on overall well-being. We utilize a nationally representative longitudinal study with a multi-item marital quality scale that allows us to track unhappy marriages over a 12-year period and to assess marital happiness along many dimensions. Remaining unhappily married is associated with significantly lower levels of overall happiness, life satisfaction, self-esteem and overall health along with elevated levels of psychological distress compared to remaining otherwise continuously married. There is also some evidence that staying unhappily married is more detrimental than divorcing, as people in low-quality marriages are less happy than individuals who divorce and remarry. They also have lower levels of life satisfaction, self-esteem and overall health than individuals who divorce and remain unmarried. Unhappily married people may have greater odds of improving their well-being by dissolving their low-quality unions as there is no evidence that they are better off in any aspect of overall well-being than those who divorce.

Journal scan

Elevated levels of psychological distress are found among women with ovarian cancer; levels higher than that found in either the general population or among women with other cancers, suggesting the need for careful assessment and appropriate treatment, according to the findings of this American research.

The role of coping strategies in mediating subjective disability in people who have psoriasis

The study examines the role of coping strategies in people with psoriasis and on their subjective disability and psychological distress. Utilizing the appraisal and coping paradigm (Lazarus & Folkman, 1984), the responses of 89 people with psoriasis were examined. A cross-section of a postal questionnaire design was used. Participants completed: the Psoriasis Disability Index (Finlay & Kelly, 1987); the Psoriasis Life Stress Inventory (Gupta & Gupta, 1995a); the Hospital Anxiety and Depression Scale (Zigmond & Snaith, 1983); and the COPE Scale (Carver et al ., 1989). Maladaptive coping strategies, in particular venting emotions and mental disengagement, were significantly associated with both subjective disability and psychological distress, accounting for a greater proportion of the variance on these measures than age, gender or duration of psoriasis. This study found elevated levels of psychological distress in a sample of people with psoriasis and provides evidence that maladaptive coping predicts subjective disability. Adaptive coping strategies were not inversely associated with the outcome measures.