Experience Of Distress Research Articles

Experiences of distress and gaps in government safety net supports among parents of young children during the COVID-19 pandemic: a qualitative study

BackgroundThe COVID-19 pandemic prompted rapid federal, state, and local government policymaking to buffer families from the health and economic harms of the pandemic. However, there has been little attention to families’ perceptions of whether the pandemic safety net policy response was adequate, and what is needed to alleviate lasting effects on family well-being. This study examines the experiences and challenges of families with low incomes caring for young children during the pandemic.MethodsSemi-structured qualitative interviews conducted from August 2020 to January 2021 with 34 parents of young children in California were analyzed using thematic analysis.ResultsWe identified three key themes related to parents’ experiences during the pandemic: (1) positive experiences with government support programs, (2) challenging experiences with government support programs, and (3) distress resulting from insufficient support for childcare disruptions. Participants reported that program expansions helped alleviate food insecurity, and those attending community colleges reported accessing a range of supports through supportive counselors. However, many reported gaps in support for childcare and distance learning, pre-existing housing instability, and parenting stressors. With insufficient supports, additional childcare and education workloads resulted in stress and exhaustion, guilt about competing demands, and stagnation of longer-term goals for economic and educational advancement.ConclusionsFamilies of young children, already facing housing and economic insecurity prior to the pandemic, experienced parental burnout. To support family well-being, participants endorsed policies to remove housing barriers, and expand childcare options to mitigate job loss and competing demands on parents. Policy responses that either alleviate stressors or bolster supports have the potential to prevent distress catalyzed by future disasters or the more common destabilizing experiences of economic insecurity.

Supporting conservationists' mental health through better working conditions.

Biodiversity conservation work can be challenging but rewarding, and both aspects have potential consequences for conservationists' mental health. Yet, little is known about patterns of mental health among conservationists and its associated workplace protective and risk factors. A better understanding might help improve working conditions, supporting conservationists' job satisfaction, productivity, and engagement, while reducing costs from staff turnover, absenteeism, and presenteeism. We surveyed 2311 conservation professionals working in 122 countries through an internet survey shared via mailing lists, social media, and other channels. We asked them about experiences of psychological distress, working conditions, and personal characteristics. Over half were from and worked in Europe and North America, and most had a university-level education, were in desk-based academic and practitioner roles, and responded in English. Heavy workload, job demands, and organizational instability were linked to higher distress, but job stability and satisfaction with one's contributions to conservation were associated with lower distress. Respondents with low dispositional and conservation-specific optimism, poor physical health, and limited social support, women, and early-career professionals were most at risk of distress in our sample. Our results flag important risk factors that employers could consider, although further research is needed among groups underrepresented in our sample. Drawing on evidence-based occupational health interventions, we suggest measures that could promote better working conditions and thus may improve conservationists' mental health and abilities to protect nature.

The Dedication

In 2020, the COVID-19 pandemic exploded and nursing homes rapidly became overwhelmed with disease, death, and despair. During this time, I learned Sylvia, an old woman with dementia I had befriended, was one of the many old and disabled people confined in nursing homes who did not survive. In this reflective and part personal, part scholarly essay, I leave evidence of and for Sylvia and the nearly 200,000 old and disabled people and care workers who contracted COVID-19 and died within the confines of neoliberal, profit-driven long-term care institutions. Disability justice activist Mia Mingus writes, "We must leave evidence. Evidence that we were here, that we existed, that we survived and loved and ached." Leaving evidence is a political act, a form of resistance in an ableist word. And yet leaving evidence is particularly challenging in the context of dementia, care, confinement, and death—making it even more important, more urgent. Building on Ellen Samuels’ assertion, "Crip time is grief time," I consider how mourning Sylvia and countless other nursing home deaths, interwoven with my own experiences of distress, yet also solidified my need to survive, might leave evidence and keep working toward an abolitionist future—one in which old and disabled women like Sylvia, like my future self, might thrive.

“You matter”: Patient reported outcomes on cancer disparities related to the COVID-19 pandemic.

e13674 Background: Disparities in cancer care have been exacerbated by the COVID-19 pandemic. Understanding the challenges encountered by patients can help alleviate the burden of cancer and improve access to care. Methods: We recruited consecutive patients with cancer at a comprehensive academic cancer center and analyzed patient reported socioeconomic and mental health challenges, and their perception of access to care since the start of the pandemic using a modified version of the You Matter: COVID-19 Mental Health Impact Survey. The survey instrument was self-administered once from November 11, 2022 to January 12, 2023 and consisted of 21 items with questions focused on demographics, social health, telehealth attitudes, and mental health. Established patients diagnosed at the cancer center prior to the start of the COVID-19 pandemic and who are continuing care were included in the study. Results: A total of 136 participants were included in this analysis. Participants characteristics were as follows: 70% had age>65, 75% white, 70% female, 43 % had bachelor's degree or higher, 62.5% with non-private insurance, 95% maintained same insurance throughout the pandemic, and 80% had household of > 1 person. Since April 2020, 49.3% reported increased level of stress and 60.6% reported increased anxiety, stress or experience of distress as a direct result of COVID-19. Among the patients that reported they had participated in telehealth, 84.4% described it as easy and effective, and 70.6% found it either comfortable or neutral. Black participants were more likely to have less contact with providers compared to white participants (OR=5.54, p=0.0180); participants age ≥65 were more likely to report worse overall health compared to younger participants (OR=2.67, p=0.0359); male participants were more likely to experience challenges because of COVID-19 (OR=2.12, p=0.0496), were less uncomfortable with telehealth (OR=0.034, p=0.0350), had increased anxiety and stress, and experienced less distress due to COVID19 (OR=0.47, p=0.0490) compared to female participants. Conclusions: Challenges reported during the COVID-19 pandemic varied across sociodemographic groups, with elderly, male and black reporting the worst impact related to the pandemic. The vast majority of the survey participants reported increased stress, anxiety, or distress affecting quality of life and hindering access to care. The results of the study, however, suggest the important role of telehealth in addressing challenges and narrowing disparities in access to cancer care across the majority of participants.

Turning Rage Into Action: Abortion Care and Residency Training in the United States.

Turning Rage Into Action: Abortion Care and Residency Training in the United States.

Impact of the COVID‐19 pandemic on moral distress of care home staff caring for people with dementia

AbstractBackgroundHealthcare providers caring for people living with dementia may experience moral distress when faced with an ethically challenging situation, such as an inability to provide care that is consistent with their values. The COVID‐19 pandemic both created new and exacerbated pre‐existing factors which contributed to the experience of moral distress amongst healthcare providers in LTCHs.MethodWe conducted an online survey to examine changes in mortal distress during the first wave of the pandemic, its contributing factors and correlates, and its impact on the well‐being of LTCH staff. A total of 227 health care providers from LTCHs across Ontario, Canada completed the online survey. Using a Bayesian approach, we examined the associations between moral distress and staff demographics and roles, and characteristics of the LTCH in which they worked.ResultMore than 80% of LTCH healthcare providers working with people with dementia reported an increase in moral distress since the start of the pandemic. They frequently experienced physical and emotional symptoms related to moral distress more than once a week, with the most common symptoms being physical exhaustion (55%) powerlessness (39%), sadness/anxiety (38%) frustration/anger (31%), and difficulty sleeping (33%). There was no difference in the severity of distress by age, sex, role, or years of experience. The most common situations associated with moral distress were lack of activities and family visits, insufficient staffing and high turnover, and having to follow policies and procedures that were perceived to harm residents with dementia. Respondents working in not‐for‐profit or municipal homes reported less sadness/anxiety and feelings of not wanting to go to work than those in for‐profit homes. Front‐line staff were more likely to report not wanting to work than those in management or administrative positions. In the survey’s free‐text responses, respondents elaborated on the emotional impact of the change in care delivery for LTCH residents.ConclusionMoral distress increased during the pandemic, negatively affecting the well‐being of healthcare providers in LTCHs, with preliminary evidence suggesting that individual and systemic factors may intensify this negative effect.

Predictors of individual mental health and psychological resilience after Australia's 2019-2020 bushfires.

We assessed the mental health effects of Australia's 2019-2020 bushfires 12-18 months later, predicting psychological distress and positive psychological outcomes from bushfire exposure and a range of demographic variables, and seeking insights to enhance disaster preparedness and resilience planning for different profiles of people. We surveyed 3083 bushfire-affected and non-affected Australian residents about their experiences of bushfire, COVID-19, psychological distress (depression, anxiety, stress, post-traumatic stress disorder) and positive psychological outcomes (resilient coping, wellbeing). We found high rates of distress across all participants, exacerbated by severity of bushfire exposure. For people who were bushfire-affected, being older, having less financial stress, and having no or fewer pre-existing mental disorders predicted both lower distress and higher positive outcomes. Being male or having less income loss also predicted positive outcomes. Severity of exposure, higher education and higher COVID-19-related stressors predicted both higher distress and higher positive outcomes. Pre-existing physical health diagnosis and previous bushfire experience did not significantly predict distress or positive outcomes. To promote disaster resilience, we recommend investment in mental health, particularly for younger adults and for those in rural and remote areas. We also recommend investment in mechanisms to protect against financial distress and the development of a broader definition of bushfire-related impacts than is currently used to capture brushfires' far-reaching effects.

Interventions to support parents and carers of young people with mental health difficulties: a systematic review protocol

IntroductionGlobally, 8%–14% of children and young people (CYP) have a diagnosable mental health condition, many of whom receive no formal interventions. Parents/carers of CYP experience stress and distress owing to...

Co-ideation and co-design in co-creation research: Reflections from the 'Co-Creating Safe Spaces' project.

Numerous frameworks for defining and supporting co-created research exist. The practicalities of designing and conducting co-created research are clearly important, yet the utility of these frameworks and their operationalisation within local contexts and involving a diversity of stakeholders and interests are currently not well-researched. Using an instrumental case study approach, we examined the utility of a published systematic framework designed to improve clarity about co-creation as a concept and approach. The framework is explored based on the first two processes that correspond to our own work to date: co-ideation and co-design. Our study showed that diverse stakeholders bring challenges regarding research priorities, methods, language and the distribution of power within co-creation processes. Co-creation activities were incremental, adaptable, responsive and made best use of established relationships, structures and collective leadership to meet the competing demands of funders and human research ethics committees, while ensuring the meaningful participation of multiple stakeholders. The findings highlight the iterative, fluid and deeply relational nature of co-created research. Rather than seeking to categorise these processes, we argue that the social relations of research production that provide the structures within which all co-created knowledge is generated are more important drivers of effective knowledge mobilisation and implementation. Thus, close attention to these social relations is needed in co-created research. People with lived experience of emotional distress and/or suicidal crisis, including academic researchers, service and peer workers, carers and advocates were involved in the co-ideation and co-design of this research. All authors identify as people with lived experience, from both academic and nonresearch backgrounds.

Psychometric testing of the Swedish version of the measure of moral distress for healthcare professionals (MMD-HP)

BackgroundMoral distress has been described as moral constraints and uncertainty connected with guilty feelings of being unable to give care in accordance with one’s values for good care. Various instruments to measure moral distress have been developed. The instrument measure of moral distress for healthcare professionals (MMD-HP) was developed to capture the experience and frequency of moral distress among various healthcare professionals. The MMD-HP has been translated and culturally adapted into the Swedish language and context; however, the translation has not been validated. Therefore, this study aimed to evaluate the validity and reliability of the Swedish version of the measure of moral distress for healthcare professionals (MMD-HP).MethodsEighty-nine staff from various professions at a hospital in northern Sweden participated in the study. A confirmatory factor analysis was performed to check for consistency with the original version of the MMD-HP. To evaluate internal consistency, Cronbach’s alpha was calculated for each domain and for the scale as a whole.ResultsThe scale as a whole showed a Cronbach’s alpha of 0.96, with a range between 0.84 and 0.90 between the different subscales. A confirmatory factor analysis based on the original four-factor structure showed good fit indices with a χ2/df of 0.67, CFI at 1.00, TLI at 1.02 and NFI at 0.97. RMSEA was at 0.00, and SRMR was at 0.08. A comparison of the total score between three equally large groups of years of experience at the present workplace showed no significant differences (F = 0.09, df = 2, p = 0.912).ConclusionsWe found that the Swedish version of the MMD-HP has shown validity and reliability for use in a Swedish context for measuring moral distress among health personnel.

The Chinese Parenting Stress Scale for Preschoolers' Parents: Development and Initial Validation.

Parenting stress is the experience of discomfort or distress that results from the demands associated with the role of parenting. Although there are numerous parenting stress scales, relatively few scales have been developed with consideration of the Chinese cultural context. This study aimed to develop and validate the Chinese Parenting Stress Scale (CPSS) with a multidimensional and hierarchical structure for Mainland Chinese preschoolers' parents (N = 1,427, Mage = 35.63 years, SD = 4.69). In Study 1, a theoretical model and an initial 118 items were developed, drawing on prior research and existing measures of parenting stress. Exploratory factor analysis yielded 15 first-order factors with 60 items. In Study 2, confirmatory factor analyses supported a higher order solution consisting of 15 first-order factors covering four domains: Child Development (12 items), Difficult Child (16 items), Parent-Child Interaction (12 items), and Parent's Readjustment to Life (20 items). Measurement invariance indicated no gender differences between parents for the scale scores. The convergent, discriminant, and criteria validity of the CPSS scores was supported by its association with related variables in the expected directions. Moreover, the CPSS scores added significant incremental variance in predicting somatization, anxiety, and child's emotional symptoms more so than the Parenting Stress Index-Short Form-15. The CPSS total and subscale scores all had acceptable Cronbach's αs in both samples. The overall findings support the CPSS as a psychometrically sound tool.

LGBTQ College student health and wellbeing at the onset of the pandemic: additional evidence and lessons learned from COVID-19

BackgroundThe coronavirus (COVID-19) pandemic has killed more than six million people and disrupted health care systems globally. In the United States alone, more than one million people have died from COVID-19 infections. At the start of the pandemic, nearly all aspects of our lives paused to prevent the spread of the novel coronavirus. Many institutions of higher education transitioned to remote learning and enacted social distancing measures. This study examined the health needs and vulnerabilities of lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) college students at the start of the COVID-19 pandemic in the United States.MethodsWe fielded a rapid-response online survey between April and June of 2020. We recruited 578 LGBTQ-identifying college students aged 18 years and older by reaching out to LGBTQ-serving organizations on 254 college campuses and via targeted social media advertising.ResultsApproximately 40% of LGBTQ college students surveyed were dissatisfied with life at the start of the COVID-19 pandemic, and almost all (90%) were concerned that COVID-19 would threaten their mental health. Moreover, about 40% of LGBTQ college students reported unmet mental health needs, and 28% were worried about seeking care during the pandemic because of their LGBTQ identity. One out of four LGBTQ college students had to go back in the closet because of the pandemic, and approximately 40% were concerned about their finances or personal safety during the COVID-19 pandemic. Some of these adverse outcomes were prominent among younger students, Hispanic/Latinx students, and students with unsupportive families or colleges.ConclusionsOur study adds novel findings to the large body of research demonstrating that LGBTQ college students experienced distress and elevated mental health needs early in the pandemic. Future research should examine the long-term consequences of the pandemic among LGBTQ and other minoritized college students. Public health policymakers, health care providers, and college and university officials should provide LGBTQ students affirming emotional supports and services to ensure their success as the COVID-19 pandemic transitions to endemic.

Psychiatric nurses' experience of moral distress: Its relationship with empowerment and coping.

Research has shown that moral distress negatively impacts nurses, patients, and organizations; however, several scholars have argued that it can be an opportunity for positive outcomes. Thus, factors that may mitigate moral distress and catalyze positive change need to be explored. The purpose of this study was to explore the relationships among structural and psychological empowerment, psychiatric staff nurses' experience of moral distress, and strategies for coping with moral distress. A descriptive cross-sectional correlational study. A total of 180 registered nurses working in psychiatric hospitals in Japan participated. This study examined relationships among key variables using four questionnaires to assess structural and psychological empowerment, moral distress for psychiatric nurses, and coping strategies. Statistical analyses of correlations and multiple regressions were conducted. The study was approved by the institutional review board at the author's affiliated university. Psychiatric nurses perceived moderate levels of structural and psychological empowerment, and their experiences of moral distress were related to low staffing. Structural empowerment was negatively related to the frequency of moral distress but not the intensity. Contrary to expectations, psychological empowerment was not found to mitigate nurses' moral distress. Multivariate regression analyses revealed that the significant predictors of moral distress were the leaving issues unresolved coping style, the problem-solving coping style, and a lack of formal power, which explained 35% and 22% of the variance in the frequency and intensity of moral distress, respectively. In psychiatric hospitals in Japan, nurses experience moral distress that compromises the quality of care they provide. Therefore, formal support for nurses in voicing and investigating their moral concerns is required to bestow formal power by establishing a ward culture that includes shared governance.

(113) The Application of the Stable-Modifiable Model of Vulnerability and Resilience Processes in the Ovarian Endometriosis Population

Abstract Introduction Endometriosis is a painful, chronic inflammatory condition characterized by the presence of tissue similar to the lining of the uterus growing outside of the uterus, with the most common location being the ovaries (Audebert et al., 2018; O’Hara et al., 2021). Endometriosis can significantly disrupt sexual function and is associated with negative outcomes in mental health, relationship satisfaction, and quality of life (Friggi Sebe Petrelluzi et al., 2012; Smorgick et al., 2013). Although up to 10% of women are affected by endometriosis (As-Sanie et al., 2019), there is little research on the experience of sexual distress in people with endometriosis, especially in women who identify as sexual minorities. Most work in the area of pain has identified the risks that make one more susceptible to developing pain and pain-related distress, while little work has focused on potentially protective factors that might mitigate these risks and promote resilience (Darnell, 2021). By enlisting women who identify as a sexual minority (e.g., non-heterosexual), and thus taking a broader view of women’s healthy sexual activity, we may gain insight into ways in which any woman (with ovaries) may mitigate their sexual distress related to endometriosis. Objective The current study examined vulnerability and resilience factors contributing to sexual distress within an inclusive sample of women with ovarian endometriosis. It was hypothesized that women with ovarian endometriosis who reported lower levels of sexual self-consciousness and higher levels of sexual flexibility would experience lower levels of sexual distress, and women who identify as a sexual minority would report higher levels of sexual flexibility and lower levels of sexual distress resulting from ovarian endometriosis. Methods The current study was online in nature and recruited individuals with a self-reported clinician-identified diagnosis, or a self-reported suspected diagnosis, of ovarian endometriosis. All eligible participants completed measures assessing pain characteristics, sexual distress, and various resiliency and vulnerability constructs. Associations among these variables were examined via correlational analyses (Pearson’s r), differences between groups were examined via independent samples t-tests, and several moderated mediation models were run to determine what factor(s) predicted adaptive outcomes related to less sexual distress. Results Participants were 265 women who identified as a sexual majority (75.1%) or sexual minority (24.9%) with a confirmed (99.2%) or suspected (.8%) diagnosis of ovarian endometriosis. Results of the correlational analyses indicated: (1) sexual flexibility was negatively associated with sexual distress, r(226) = -.23, p <.001; (2) sexual flexibility was negatively associated with sexual self-consciousness, r(226) = -.19, p <.005; and (3) sexual self-consciousness was positively associated with sexual distress, r(227) = .45, p <.001. Results from independent samples t-tests and moderated mediation models were nonsignificant. Conclusions As the first investigation of the role of cognitive-affective factors in influencing sexual distress in an inclusive ovarian endometriosis population, the results of this study will contribute significantly to clinical practice in terms of providing novel targets for psychotherapeutic treatment options. Through investigating resilience processes, we may be able to ascertain whether adaptive factors (such as pain self-efficacy) account for functional health, independent of vulnerability factors (such as sexual self-consciousness). Disclosure No

Exploring experiences of moral injury and distress among health care workers during the Covid-19 pandemic.

Health care workers have been exposed to a variety of practical and emotional challenges because of the Covid-19 pandemic, leaving them vulnerable to experiencing moral injury and distress. However, there is currently sparse research which directly explores such experiences. This study aimed to explore and characterise the experiences and impacts of moral injury and distress among health care workers during the pandemic. Twenty semi-structured interviews were conducted with health care workers employed across both mental and physical health care services. Interviews were analysed from a critical realist perspective using thematic analysis. Three key themes were identified: attitudes towards moral injury, experiences of moral injury and consequences of moral injury. Participants appeared to identify with the idea of acting against their morals to varying extents based on their job roles. Participants experienced a range of potentially morally injurious and distressing events throughout the pandemic and many ultimately felt that they provided sub-standard levels of care due to extreme pressures on services. Detrimental impacts upon wellbeing were commonly reported, including high levels of emotional distress and feelings of guilt and shame. Some reported a loss of enthusiasm for their job and a desire to leave the profession entirely. Moral injury and distress presents a real concern for staff wellbeing and retention within the profession. During and beyond the Covid-19 pandemic, there is an urgent need for health care providers to implement wider strategies to target moral injury and distress, and support staff within health care settings.

Longitudinal assessment and determinants of short-term and longer-term psychological distress in a sample of healthcare workers during the COVID-19 pandemic in Quebec, Canada.

Previous research has demonstrated the negative impact of the COVID-19 pandemic emergency on the wellbeing of healthcare workers. However, few research contributions reported a longitudinal evaluation of psychological distress and examined determinants of its duration and course over time. The present study aims to explore the impact of the pandemic emergency on HCWs mental health by adopting a longitudinal design and assessing mental health as combination of overlapping clinical symptoms (post-traumatic stress disorder, depression and anxiety). Data were collected weekly through a mobile application during and after the first wave of COVID-19 in the province of Quebec, Canada, in 2020. Analysis was conducted on a final sample of 382 participants. Participants were grouped into "resilient" (RES) if they did not manifest clinical-level psychological distress during monitoring, "short-term distress" (STD) if distress exceeded the clinical threshold for 1-3 weeks, and longer-term distress (LTD) if it occurred for four or more weeks, even if not consecutively. Descriptive statistics for all variables were computed for each subgroup (RES, STD and LTD), and pairwise comparisons between each group for every descriptive variable were made using chi square statistics for categorical variables and t-test for continuous variables. Predictors of distress groups (STD and LTD vs RES) were assessed running multinomial hierarchical logistic regression models. In our sample, almost two third (59.4%) HCWs did not manifest moderate or severe distress during the monitoring time. Short-term distress, mostly post-traumatic symptoms that lasted for less than 4 weeks, were the most common distress response, affecting almost one third of participants. Longer psychological distress occurred only in a smaller percentage (12.6%) of cases, as a combination of severe posttraumatic, depressive and anxiety symptoms. Perceived occupational stress was the most significant risk factor; moreover individual, peritraumatic work and family risk and protective factors, were likely to significantly affect the stress response. Results tend to provide a more complex and resiliency-oriented representation of psychological distress compared to previous cross-sectional studies, but are in line with stress response studies. Findings allow us to better describe the profiles of distress response in STD and LTD groups. Participants that manifest short term distress experience acute stress reaction in which the interplay between personal, family and professional life events is associated with the stress response. Conversely, longer term distress response in HCWs presents a more complex mental health condition with an higher level of impairment and support needs compared to participants with short-term distress.

“Nothing's changed, baby”: How the mental health narratives of people with multiple and complex needs disrupt the recovery framework

The dominant narrative in mental health policy and practice has shifted in the 21st century from one of chronic ill health to a ‘recovery’ orientation. Knowledge of recovery is based on narratives of people with lived experience of mental distress. However the narratives of people experiencing structural inequalities are under-represented in recovery research. Meanwhile, uses of recovery narratives have been critiqued by survivor-researchers as a co-option of lived experience to serve neoliberal agendas.To address these twin concerns, we undertook a performative narrative analysis of two ‘recovery narratives’ of people with multiple and complex needs, analysing their co-construction at immediate/micro and structural/macro levels. We found two contrasting responses to the invitation to tell a recovery story: a narrative of personal lack and a narrative of resistance. We demonstrate through reflexive worked examples how the genre of recovery narrative, focused on personal transformation, may function to occlude structural causes of mental distress and reinforce personal responsibility in the face of unchanging living conditions. We conclude that unacknowledged epistemological assumptions may contribute to co-constructing individualist accounts of recovery. A critical, reflexive approach, together with transparent researcher positionality, is imperative to avoid the epistemic injustice of a decontextualised form of recovery narrative.

A network approach to understanding distance learners’ experience of stress and mental distress whilst studying

Research has shown that learners’ stress and mental distress are linked to poorer academic outcomes. A better understanding of stress and mental distress experiences during study could foster more nuanced course and intervention design which additionally teaches learners how to navigate through to protect their academic performance. The current study draws on data collected via validated self-reported questionnaires completed by final year undergraduate students (n = 318) at a large distance education university. We examined how common features of stress, depression and anxiety link to each other using a network analysis of reported symptoms. The results included findings demonstrating the symptoms with the greatest relative importance to the network. Specifically, these included the stress symptom ‘I found it difficult to relax’ and the depression symptom ‘I was unable to become enthusiastic about anything’. The findings could help institutions design interventions that directly correspond to common features of students’ stress and distress experiences.

Examining Diabetes Distress in Pre-existing Diabetes in Pregnancy: Protocol for an Explanatory Sequential Mixed Methods Study

Diabetes distress has been shown to be highly prevalent in adults living with type 1 and type 2 diabetes with important implications for glycemic control, self-care, and self-management behaviors. Despite considerable focus on self-management and glycemic targets during pregnancy, current literature lacks information on diabetes distress in pregnancy, particularly in women with type 2 diabetes. This article outlines an explanatory sequential mixed methods research protocol to examine diabetes distress during pregnancy in women with pre-existing diabetes. The aims of the study were to: (1) establish the prevalence and correlates of diabetes distress in women attending a diabetes and pregnancy clinic; (2) use this quantitative data to inform development of an interview guide and plan for sampling for telephone interviews; and (3) explore and describe the experiences of diabetes distress during pregnancy. The quantitative strand was a cross-sectional survey of 76 women using self-reported questionnaires to collect demographic and clinical data, and validated tools to assess health variables, including the outcome of interest of diabetes distress using the Problem Area in Diabetes scale. The qualitative strand applied interpretive description methodology to explore the quantitative results using semi-structured qualitative interviews with 18 women to obtain patient perspectives of diabetes distress and experiences of managing diabetes in pregnancy. The explanatory sequential mixed methods research will provide an opportunity to add contextual qualitative experiences from women with pre-existing diabetes during pregnancy to provide a comprehensive picture of diabetes distress. The results will inform further research priorities that protect and promote mental health, psychosocial well-being, and self-management practices for this population.

"And you feel like you're suffocating … how the fuck am I going to get out of all this?" Drivers and experiences of suicidal ideation in the Australian construction industry.

This research was designed to generate understandings of drivers and experiences of suicidal ideation and distress among Australian Construction Industry (ACI) workers, as well as what helped during these experiences. Fifteen participants, from a variety of ACI or closely associated roles, with an average age of 45 years (29-66), engaged in individual, semi-structured interviews. Interviews were audio-recorded with consent and analyzed using descriptive thematic analysis. Eight themes relating to what may drive the presence of suicidal ideation and distress were identified; 1) challenges of working within the ACI, 2) relationship and family issues, 3) social disconnection, 4) personal financial hardship, 5) perceived lack of support, 6) alcohol and drug use, 7) child custody/access and legal issues, and 8) experience of mental health challenges, trauma, or a significant adverse life event. Four themes relating to experience and expression of suicidal ideation and distress were identified: 1) suicidal thoughts, 2) impaired thinking, 3) observable expressions of suicidal distress, and 4) lack of observable expressions of suicidal distress. Six themes relating to what helped during experiences and well as what can be done by the ACI to help mitigate experiences, were identified: 1) presence of colleague and managerial support, 2) MATES in Construction, 3) engagement with non-work activities and social support, 4) personal skills and knowledge relating to suicide and mental health, 5) high level industry integration and engagement with support programs, and 6) work hours and expectations changes. Findings highlight several industry and personal related challenges that may drive experiences, with many potentially mitigatable by ACI changes and focused prevention strategies. Participant suicidal thought descriptions align with previously identified constructs deemed central in suicidal trajectories. While findings highlight several observable expressions of suicidal ideation and distress, challenges associated with identifying and assisting individuals in the ACI who may be struggling were also reported. Several factors that helped ACI workers during their experiences, as well as what the ACI can do to mitigate future experiences, were identified. Recommendations are made based on these findings, encouraging a more supportive work environment, as well as continued development and increased awareness of support and education systems.