Experiences Of Emotional Distress Research Articles

Informed consent: exploring surgical residents' beliefs, attitudes and practices.

Patients rely on the knowledge and skill of the physician proposing treatment to relay information and inform their decision-making. In academic medical centres (AMCs), surgical trainees frequently request consent on behalf of an attending surgeon. There is a paucity of knowledge regarding the frequency of this practice and any associated impacts on surgical trainees. This study poses the following queries: (1) Are surgical residents requesting informed consent (IC) while perceiving themselves to possess insufficient knowledge to facilitate the IC process? (2) If yes, what motivates a resident to request IC with inadequate knowledge? (3) Do residents experience an emotional response? (4) What, if any, support mechanisms are sought? Surgical residents in a Canadian urban AMC (n = 38) completed a survey designed to assess how surgical trainees complete the process of IC as well as probe beliefs and attitudes associated with its execution. This study finds that surgical residents frequently seek consent from patients while perceiving themselves insufficiently informed to discuss the risks and benefits of proposed procedures. The majority of participants (82%) indicated that they had personally requested consent while believing themselves inadequately aware of relevant surgical risks. Surgical trainees see this as a significant issue, feel motivated to complete the IC process due to perceived pressures, experience emotional distress and commonly seek collegial support. A cohort of residents from various surgical departments reported requesting IC while possessing inadequate knowledge to inform patient decision-making. Management of this reality could better ensure that the surgical environment both safeguards patients and enhances trainee education.

Theory of Mind and Emotional Awareness Deficits in Patients With Somatoform Disorders

To explore whether deficits are present in the mental representation of emotion signals and whether these are related to more general deficits in Theory of Mind (ToM) functioning test. To test this hypothesis in patients suffering from somatoform disorders, we used the Frith-Happé-Animations Task (AT)-an established ToM measure. We previously demonstrated that somatization in psychiatric patients is associated with decreased emotional awareness as measured by the Levels of Emotional Awareness Scale (LEAS). These findings suggest that individuals with decreased emotional awareness often fail to experience affective arousal as feelings and instead experience emotional distress somatically. We administered the AT and the LEAS to 30 hospitalized patients with somatoform disorders and 30 healthy controls matched for sex, age, and educational level. Emotional awareness on the LEAS, the emotional content of AT narratives, and ToM content on the AT were assessed. Patients with somatoform disorders scored significantly lower on the LEAS than healthy controls. Patients also demonstrated both reduced emotional content and reduced ToM functioning on the AT compared with control subjects. Deficits in ToM functioning in patients overlapped with but were not fully explained by deficits in the emotional content of animation narratives. The combination of ToM functioning and LEAS scores permitted a correct classification of 80% of patients and 73% of controls. Patients with somatoform disorders requiring inpatient treatment manifest deficits in both emotional awareness and ToM functioning. These deficits may underlie the phenomenon of somatization.

Educating Medical Residents in End-of-Life Care: Insights from a Multicenter Survey

Physicians play a key role in the provision of quality end-of-life (EOL) care but often lack requisite knowledge and skills. Residency programs must ensure training in palliative/EOL care to address this gap. To guide the development of curricula, we assessed internal medicine residents' attitudes, knowledge, perceived competence, and learning priorities in EOL care. Cross-sectional, self-administered, descriptive survey using a convenience sample. Internal medicine residents at five universities across Canada. Of a total of 318 internal medicine residents, 185 (58%) participated in the survey. The majority (81.7%) agreed learning from dying patients was meaningful although 48.1% felt guilty, and 40.6% a failure at least sometimes after a patient's death. Two thirds had provided care to more than 10 dying patients. Most (73%) had conducted at least 3 family meetings; 26.7% were never observed. Mean self-assessed preparedness to provide EOL care was 6.1 +/- 2 (scale 0-10) and mean comfort level 3.2 +/- 0.8 (scale 0-5). Residents reported more than average competence in 50% of EOL competencies listed with record keeping highest (3.6 +/- 0.7) and use of nonpharmacologic interventions for pain lowest (2.2 +/- 0.8). Priority for learning was rated above average for all EOL competencies listed with use of opioids for management of pain highest (4.1 +/- 0.9) and discussing euthanasia lowest (3.1 +/- 1.3). Internal medicine residents value opportunities to learn from dying patients but often lack supervision and experience emotional distress. Comparing residents' attitudes, perceptions of competence, and learning priorities provide insights into why certain EOL competencies are more challenging to teach and can guide development of meaningful educational experiences.

Is it Possible to Eradicate Poverty without Attending to Mental Health? Listening to Migrant Workers in Chile through their Idioms of Distress

Departing from the existing critique of the Millennium Development Goals (MDGs), regarding the absence of mental health dimensions in the formulation of its poverty related goal, this article explores the interrelation between poverty and mental health by examining experiences of emotional distress of Peruvian migrant workers in Chile. Through an analysis of the idioms that Peruvian migrants use to communicate their distress, this article proposes an understanding of Peruvian migrant's emotional suffering that attends to the broader unequal relations that migrant workers are subjected to in the host society. The analysis enables an understanding of their experiences of social exclusion and personal uprootedness, making visible the agency that the migrants display in giving meanings and coping with their emotional distress, most often outside the medical system. This article argues for the need to develop alternative and culturally sensitive approaches to mental health, in order to support the everyday struggles of the poor.

General psychological acceptance and chronic pain: There is more to accept than the pain itself

An increasing body of research demonstrates that acceptance of pain is significantly associated with the quality of daily functioning in people with chronic pain. The aim of the present study was to examine acceptance more broadly in relation to a wider range of undesirable experiences these people may encounter, such as other physical symptoms, experiences of emotional distress, or distressing thoughts. One hundred forty-four, consecutive, adult patients attending interdisciplinary treatment for chronic pain participated in this study. They completed the Acceptance and Action Questionnaire-II (AAQ-II [Bond F, Hayes SC, Baer RA, Carpenter KM, Orcutt HK, Waltz T, Zettle RD. Preliminary psychometric properties of the Acceptance Action Questionnaire-II: a revised measure of psychological flexibility and acceptance, submitted for publication]), measuring their general psychological acceptance. They also completed measures of emotional, physical, and psychosocial functioning, pain acceptance, and mindfulness. The AAQ-II achieved satisfactory internal consistency, α = .89, and factor analysis revealed a unitary factor structure. Primary results showed that general psychological acceptance significantly correlated with depression, r = −.69, pain-related anxiety, r = −.59, physical disability, r = −.42, and psychosocial disability, r = −.65, all p < .001. Hierarchical regression analyses showed that general psychological acceptance added a significant increment of explained variance to the prediction of patient functioning, independent of patient background characteristics, pain, acceptance of pain, and mindfulness. These results suggest that, when people with chronic pain are willing to have undesirable psychological experiences without attempting to control them, they may function better and suffer less. General acceptance may have a unique role to play in the disability and suffering of chronic pain beyond similar processes such as acceptance of pain or mindfulness.

Loss and the Experience of Emotional Distress in Childhood

The objective of this study was to investigate loss and the experience of emotional distress through a series of three studies. In Study 1, results indicated that when controlling for the total number of traumas experienced, children with loss traumas did not differ significantly from children with other types of traumas in terms of the level of PTSD symptoms reported and diurnal cortisol levels. In Study 2, results indicated that youth with loss traumas had significantly higher parent-reported internalizing and externalizing symptoms than control participants. In Study 3, we replicated and extended findings from Study 1 using an independent sample of non-clinic-referred youth. Findings are discussed in terms of how loss events may constitute a traumatic stressor in youth.

Factor Structure and Reliability of the Brain Impairment Behavior Scale

Stroke is a leading cause of adult disability because of its physical and cognitive consequences. Cognitive changes are important contributors to family caregivers' experiences of emotional distress. To date, measures to assess cognition treat it as a global construct, but it is more likely that unique domains differentially affect family caregivers. The research objectives in this study were to: (1) identify the different domains of cognitive changes in the form of behavioral and psychological symptoms after stroke, and (2) establish the reliability of the Brain Impairment Behavior Scale (BIBS) in measuring cognitive domains. Family caregivers of stroke survivors (N = 300) completed the BIBS as part of cross-sectional and longitudinal studies. A subsample of caregivers completed the BIBS twice, 2 weeks apart, to examine the scale's test-retest reliability. We used exploratory factor analysis to identify four domains of behavioral and psychological symptoms in the BIBS: apathy, depression/emotional distress, comprehension/memory problems, and irritability. Internal consistency for the subscales representing each identified domain ranged from .78 to .91, and the 2-week intra-class correlation coefficients ranged from .75 to .88. Future research and clinical use of this measure will increase our understanding of how specific domains of stroke survivors' behavioral and psychological symptoms affect the well-being of family caregivers.

Supportive care needs of women with lung cancer

The main purpose of this exploratory study was to identify the supportive care needs of women with lung cancer who attend an ambulatory regional cancer centre. Lung cancer has more than a physical impact on those who are diagnosed with the disease, yet relatively little has been reported on the supportive care needs beyond those for symptom management. A total of 34 women diagnosed with lung cancer participated in this exploratory study by completing a self-report questionnaire (Supportive Care Needs Survey). The data provided clear indication that a range of needs exists for this group of women and many needs remain unmet. Lack of energy, pain, and concern about those close to them were the most frequently reported needs. Patients expressed difficulty managing their needs and many experienced emotional distress because of their difficulties. Suggestions for practice and future research are offered to assist cancer nurses in caring for this group of patients.

Primary Care Physicians' Discussion of Emotional Distress and Patient Satisfaction

To assess: a) the prevalence and determinants of self-reported emotional distress in the Israeli population; b) the rate of self-reported discussion of emotional distress with family physicians; and c) the association between such discussions and patient satisfaction with care. Retrospective, cross-sectional survey that was conducted through structured telephone interviews in Hebrew, Arabic, and Russian. This study was part of a larger study assessing patients' perceptions of the quality of health services. A representative sample of 1,849 Israeli citizens aged 22 to 93 (response rate: 84%). Gender, age, ethnicity (spoken language), education, income, self-reported chronic disease, self-reported episode(s) of emotional distress during the last year, and having discussed emotional distress with the family physician. satisfaction with care. 28.4% reported emotional distress and 12.5% reported discussion of emotional distress with a primary care physician in the past year. Logistic regression identified female gender, Arab ethnicity, low income, and chronic illness as independent correlates of emotional distress. These as well as Russian speakers and having experienced emotional distress during the past year were identified as independent correlates of discussion of emotional distress with the family physician. Patients who reported discussion of emotional distress with their family physician were significantly more satisfied with care. Encouraging physicians to detect and discuss emotional distress with their patients may increase patient satisfaction with care, and possibly also improve patients' well-being and reduce health care costs.

Noncardiac chest pain in the emergency department: the role of cardiac history, anxiety or depression and Type D personality

Noncardiac chest pain is common in patients presenting to emergency departments and is frequently associated with panic disorder. This can represent a major burden for patients and the healthcare system. Little is known about the patient characteristics that increase the risk of noncardiac chest pain. We examined whether cardiac history or Type D personality was associated with panic disorder and/or depression-driven noncardiac chest pain. Patients presenting with noncardiac chest pain to the emergency department of the University Hospital Maastricht were screened using the Hospital Anxiety and Depression Scale (HADS). Patients scoring > or =8 on the HADS subscale were invited for a psychiatric interview; a consecutive sample of patients scoring <8 on the HADS was included as a reference group. Type D personality (tendency to experience emotional distress) was assessed with the DS14. Among the 304 HADS-positive patients, 89% were diagnosed with panic disorder/depression as compared with 8% of the 106 HADS-negative patients. Previous cardiac history was not associated with psychiatric diagnosis. Type D patients reported more anxiety symptoms (12.4+/-4.0 vs. 8.1+/-4.9) and depression symptoms on the HADS (10.2+/-4.7 vs. 5.8+/-4.9) and more often had comorbid panic disorder/depression (91/157=58% vs. 57/253=23%) than non-Type D patients (P<0.0001). Type D personality (odds ratio =8.67, 95% confidence interval 4.69-16.02), younger age and male sex were independently associated with increased risk of panic disorder or depression. Type D was independently associated with comorbid panic disorder/depression (odds ratio=14.49). Type D personality, but not cardiac history, is independently associated with the presence of psychopathology in noncardiac chest pain. Type D is associated with a substantially increased risk of co-occurring PD/depression in these patients.

Well-being in informal caregivers of survivors of acute respiratory distress syndrome*

With limited community services, the complex rehabilitation period after critical illness is often the responsibility of family members who, as a result, may experience negative health outcomes. The objectives of this research were to a) identify aspects of the caregiving situation that are associated with caregivers' experiences of emotional distress and psychological well-being; and b) compare health-related quality of life of informal caregivers to survivors of acute respiratory distress syndrome (ARDS) with age- and gender-matched population values. Cross-sectional survey of informal caregivers to ARDS survivors. Toronto, Ontario, Canada. Informal caregivers were individuals who were primarily responsible for providing and/or coordinating ARDS survivors' posthospital care and were not paid to do so. None. The dependent variables were emotional distress, psychological well-being, and health-related quality of life. They were evaluated by the Center for Epidemiologic Studies Depression Scale, the Positive Affect Scale, and Medical Outcomes Study Short Form 36, respectively. Independent variables included severity of illness indicators, patient depression (Beck Depression Inventory II), aspects of the caregiving experience (care provided, lifestyle interference, personal gain), and psychosocial resources (mastery and social support). Caregivers experienced more emotional distress when they experienced more lifestyle interference, had lower levels of mastery, and were caring for ARDS survivors with more depressive symptoms (F3,42 = 15.69, p < .001, adjusted R = .50). In contrast, caregiver psychological well-being was associated with personal gains as a result of providing care and having more mastery and social support (F4,41 = 9.40, p < .001, adjusted R = .43). Caregivers reported poorer health-related quality of life across all domains of the Medical Outcomes Study Short Form 36 compared with age- and gender-matched population values. Informal caregivers experience negative health outcomes that persist almost 2 yrs after ARDS. New approaches, such as family-centered rehabilitation, caregiver education, improved respite, and home care, may benefit informal caregivers.

The Conditional Effects of Gender and Delinquency on the Relationship Between Emotional Distress and Suicidal Ideation or Attempt Among Youth

Using data provided by a national sample of youth studied at two points in time (N = 4,221), this study assesses the independent and interactive effects of emotional distress and delinquency involvement on suicidal gestures (i.e., ideation and attempt), and gender differences in these interrelationships. Logistic regression analyses produced results generally consistent with the hypothesized relationships: (a) Experience of emotional distress predicts subsequent suicidal ideation or attempt while controlling for initial suicidal attempt and other common antecedent variables; (b) delinquency involvement also predicts suicidal gestures among girls. For boys, however, these effects are in the same direction but not statistically significant; (c) furthermore, adolescent girls who experience emotional distress but are simultaneously antisocial or delinquent are less suicidal than those who experience distress but are conforming to social rules. For boys, the effects are much weaker and not statistically significant. These findings are discussed in light of theoretical importance and policy implications.

More Than Just Menstrual Cramps: Symptoms and Uncertainty Among Women With Endometriosis

To examine the frequency, severity, interference with daily life, and symptom distress associated with endometriosis and to explore the relationships among symptoms, emotional distress, uncertainty, and preference for and adequacy of information. A descriptive, cross-sectional correlational study. Data were collected at a conference of the Endometriosis Association in Milwaukee, Wisconsin. A convenience sample of 298 women attending an educational program. Endometriosis symptoms and symptom distress, emotional distress, and adequacy of information were assessed using author-developed scales. Preference for information was measured by a revision of the Krantz Health Opinion Survey Information Subscale. Uncertainty was assessed using the Mishel Uncertainty in Illness Scale-Community Form. Women experienced multiple symptoms associated with varying levels of distress, including symptoms not typically associated with endometriosis. Participants sought out information but were undecided about whether they had sufficient information about the disease. Uncertainty about endometriosis was relatively high and associated with emotional distress and lack of information about the disease. Reported symptoms demonstrate the complexity and impact of endometriosis. Women's preference for information and experience of emotional distress and uncertainty suggest the need for information and support. Prospective, controlled studies on the impact of endometriosis and interventions to inform and support patients are needed.

What ensues from emotional distress? Implications for competence estimation.

Although much is known about what precedes emotional distress, less is known about what follows such distress. The goal of this research was to examine the process by which emotional distress contributes to competence estimation. Children 9 to 13 years of age in fourth through sixth grade (N = 932) participated in a 3-wave longitudinal study spanning 12 months. Their emotional distress, views of themselves and their world, and competence estimation were assessed. Emotional distress predicted negative beliefs about the self and the world over time; these beliefs in turn predicted decrements in competence estimation over time. Negative views of the self and the world mediated the path from emotional distress to competence underestimation. The findings suggest that the experience of emotional distress has negative implications for children's development.

Expectations of chemotherapy-related nausea: emotional and experiential predictors.

Despite literature indicating that expectations are important determinants of experiences of nonvolitional outcomes (e.g., pain, nausea), little research has explored their source. The dual process model suggests that concurrent experience of emotional distress should be a strong contributor, whereas social learning theory supports the position that expectations of nonvolitional outcomes should be based primarily on prior experience. These alternative hypotheses were tested in a sample of 80 breast cancer patients undergoing outpatient adjuvant chemotherapy, as such protocols provide a unique opportunity to study the impact of emotional distress and prior experience on patients' expectations of side effects. Bivariate analyses suggested that emotional distress contributed early in the course of treatment, but once prior experience of posttreatment nausea (PTN) was accounted for in the statistical model, distress no longer made significant contributions to patients' expectations of PTN, whereas prior experience did (p < .001). These findings suggest that experience of chemotherapy infusions is an important source of expectations for PTN, which may be representative of the source of expectations for nonvolitional outcomes in broader contexts.

Crying Out Loud: Understanding Women’s Emotional Distress as both Lived Experience and Social Construction

This article examines some of the issues involved in developing research strategies that are robust enough to attend to the complex relationship between gender and emotional distress. Social constructionism may be helpful because it highlights the discursive production of power, femininity and psychopathology. The strength of a phenomenological approach is that it emphasizes the richness and complexity of an individual’s lived experience and privileges agency. Working towards a rapprochement between these two approaches may help to deconstruct the stories that have been told about women and mental illness and help to generate more meaningful information about women’s experiences of emotional distress.

Emotional Reactions to Health Status Changes and Emotional Well-Being Among HIV-Positive Persons with Limited Reading Literacy

People living with HIV-AIDS experience emotional distress in response to negative changes in their health status. The current study hypothesized that individuals with poorer health literacy skills would evidence greater emotional distress in response to negative changes in health status compared to persons with higher health literacy skills. HIV positive persons (N = 294) completed anonymous surveys that included measures of depression and social support and a subset of 98 participants completed two experimental vignettes depicting a person receiving test results showing an increase in HIV viral load (negative health changes) followed by a vignette suggesting decreased viral load (improved health changes). Responses to affective reactions and coping strategies indicated that persons with lower health literacy skills more strongly endorsed negative affective states and maladaptive coping strategies compared to persons with higher health literacy skills. In addition, lower health literacy was associated with greater symptoms of affective depression and poorer social support, whereas higher literacy was associated with greater negativistic thinking. Findings suggest the need for patient education and counseling regarding changes in health status among people living with HIV-AIDS, particularly persons with limited health literacy skills.

The relationship of marital quality and psychosocial adjustment to heart disease.

Psychosocial adjustment to heart disease is variable. Some patients recover from a myocardial infarction or cardiac surgery quickly, return to work and leisure activities, and experience little emotional distress. Others suffer significant problems in psychosocial adaptation. We proposed and tested a theoretical model of adjustment that included the quality of the marital relationship, dysphoria, chronologic age, and time from the cardiac event (myocardial infarction or surgery) to identify the role that these variables play in adjustment. The study was conducted in 198 men diagnosed with coronary heart disease using the following instruments: the Spanier Dyadic Adjustment Scale, the Multiple Affect Adjective Checklist, and the Psychosocial Adjustment to Illness Scale. Data were collected on entry into the study and 3 months later to identify the stability of the relationships over time. The theoretical model was supported. Findings demonstrated that positive psychosocial adjustment to illness is influenced both by the quality of the patient's marriage and dysphoria. The spouse appears to influence psychosocial adjustment in an indirect manner by influencing the patient's experience of emotional distress or dysphoria. Nurses can enhance psychosocial adjustment to coronary heart disease by helping patients and spouses focus on ways to improve the quality of their marriage and by suggesting strategies to improve marital communication and decrease fear and misconceptions related to the illness.