General Distress Research Articles

Getting into a good headspace: a study protocol of a pragmatic trial for an eating disorder prevention program in an Australian youth mental health service

Eating disorders (EDs) are serious, deadly disorders that emerge in adolescence and early adulthood. Further, reported incidences of EDs are increasing worldwide. As such, accessible, affordable, and effective early intervention and prevention efforts are critical. The Body Project is a well-established ED prevention program with demonstrated success at reducing ED symptom severity and the risk of onset of EDs in young females. However, it has not yet been formally evaluated in an Australian population, nor have the benefits of the treatment for young people of all genders been thoroughly investigated. This protocol paper outlines the design for a study which aims to investigate the outcomes and feasibility of the Body Project as a brief ED prevention program within an Australian youth mental health service: headspace Camperdown. This pragmatic trial will compare outcomes between a Body Project treatment group and a Treatment-as-usual control group. Primary outcomes include body image concerns, ED symptomatology and general psychological distress, measured pre- and post-treatment, and at one-month follow-up. All young people attending headspace Camperdown for care are eligible for participation in the trial. The Body Project program is comprised of four group-based 1.5 h sessions run over 4 consecutive weeks. Overall, a trial of the Body Project as an ED prevention program is warranted to investigate the outcomes of the intervention in this sample and will provide valuable information about the feasibility for widespread implementation of the treatment as part of a stepped-care approach to intervention for EDs at youth mental health service locations across Australia. ANZCTR Trial Registration Number: ACTRN12623000695606 (registered 29 June 2023).

Is the Self-reported Information by Male Sentenced of Violence against Women in the Intervention Phase Valid?

The evaluation of the needs of convicts is a critical issue for the design of the intervention. Nonetheless, in the information reported by convicts in penitentiary evaluation, simulation (malingering) and dissimulation (denial of symptoms, social desirability, and both) must be suspected. Thus, a field study with the aim of estimating the prevalence rate of the distortions and its effects in the needs reported by convicts was designed. A total of 624 men convicted for intimate partner violence reported their needs in the MMPI-2 in the reception phase of a penitentiary intervention program. Results: tion consisting in denial of symptoms, .112 [.087, .137], social desirability, .223 [.190, .256], and the combination of both two, .120 [.095, .145]. The effects in denial of symptoms emerged in the information of less depressive (i.e., lack of interest in activities, excessive sensitivity, lack of sociability), paranoid (i.e., interpersonal sensitivity and perceptiveness), psychasthenic (i.e., general subjective distress and negative affect), schizoid (i.e., alienation, chaotic interpersonal relations, and disruptive cognitive processes), and hypomanic (i.e., hyperactivity, irritability, and sensation seeking) symptoms. Likewise, social desirability dissimulators detailed significantly less depressive, psychopathic (i.e., less general social maladjustment), paranoid, psychasthenic, schizoid, and hypomanic symptoms. Similarly, the whole dissimulators (combining denial of symptoms and social desirability responses) informed less depressive, psychopathic, paranoid, psychasthenic, schizoid, and hypomanic symptoms, and fewer problems of social introversion. Conversely, they related significantly more symptoms of hysteria (i.e., physical complaints). Distortions introduced by convicts in self-reports must be controlled to design effective correctional interventions.

Longitudinal and Gender Measurement Invariance of the General Health Questionnaire-12 (GHQ-12) From Adolescence to Emerging Adulthood.

Psychological distress often onsets during adolescence, necessitating an accurate understanding of its development. Assessing change in distress is based on the seldom examined premise of longitudinal measurement invariance (MI). Thus, we used three waves of data from Next Steps, a representative cohort of young people in the UK (N = 13,539) to examine MI of the General Health Questionnaire-12 (GHQ-12). We examined MI across time and gender from ages 15 to 25 in four competing latent models: (a) a single-factor model, (b) a three-factor correlated model, (c) a bifactor model of "general distress" and two orthogonal specific factors capturing positive and negative wording, and (d) a single-factor model including error covariances of negatively phrased items. We also tested acceptability of assumptions underlying sum score models. For all factor models, residual MI was confirmed from ages 15 to 25 years and across gender. The bifactor model had the best fit. While sum score model fit was not unequivocally acceptable, most mean differences across time and gender were equivalent across sum scores and latent difference scores. Thus, GHQ-12 sum scores may be used to assess change in psychological distress in young people. However, latent scores appear more accurate, and model fit can be improved by accounting for item wording.

Trait and situation-specific intolerance of uncertainty predict affective symptoms during the COVID-19 pandemic

BackgroundThe COVID-19 pandemic, a high-uncertainty situation, presents an ideal opportunity to examine how trait intolerance of uncertainty (IU) and situation-specific IU relate to each other and to mental health outcomes. The current longitudinal study examined the unique associations of trait and COVID-specific IU with general distress (anxiety and depression) and pandemic-specific concerns (pandemic stress and vaccine worry). MethodsA community sample of Florida adults (N = 2152) was surveyed online at three timepoints. They completed measures of trait IU at Wave 1 (April–May 2020) and COVID-specific IU at Wave 2 (May–June 2020). At Wave 3 (December–February 2021), they reported symptoms of depression, anxiety, pandemic stress, and vaccine worry. ResultsWe used structural equation modeling to test our overall model. Trait IU significantly predicted later COVID-specific IU, however there was no significant effect of trait IU on any outcome measure after accounting for COVID-specific IU. Notably, COVID-specific IU fully mediated the relationship between trait IU and all four symptom measures. LimitationsThere were several limitations of the current study, including the use of a community sample and high participant attrition. ConclusionsResults suggest that COVID-specific IU predicts mental health outcomes over and above trait IU, extending the existing literature. These findings indicate that uncertainty may be more aversive when it is related to specific distressing situations, providing guidance for developing more specific and individualized interventions. Idiographic treatments which target situation-specific IU may be more efficacious in reducing affective symptoms and related stress during the COVID-19 pandemic or other similar events.

Alexithymia or general psychological distress? Discriminant validity of the Toronto Alexithymia Scale and the Perth Alexithymia Questionnaire

BackgroundAlexithymia is an important transdiagnostic risk factor for emotion-based psychopathologies. However, it remains unclear whether alexithymia questionnaires actually measure alexithymia, or whether they measure emotional distress. Our aim here was to address this discriminant validity concern via exploratory factor analysis (EFA) of the 20-item Toronto Alexithymia Scale (TAS-20) and the Perth Alexithymia Questionnaire (PAQ). MethodUnited States general community adults (N = 508) completed the TAS-20, PAQ, and the Depression Anxiety Stress Scales-21 (DASS-21). EFA was used to examine the latent dimensions underlying these measures' scores. ResultsOur EFA extracted two higher-order factors, an “alexithymia” factor and a “general distress” factor (i.e., depression, anxiety, stress). All PAQ scores loaded cleanly on the alexithymia factor, with no cross-loadings on the distress factor. However, for the TAS-20, Difficulty Identifying Feelings (DIF) facet scores cross-loaded highly on the distress factor. LimitationsOur sample consisted of general community adults; future work in clinical settings will be useful. ConclusionsOur data indicate that the PAQ has good discriminant validity. However, the TAS-20 appears to have significant discriminant validity problems, in that much of the variance in its DIF facet reflects people's current levels of distress, rather than alexithymia. The TAS-20, which has traditionally been the most widely used alexithymia questionnaire, may therefore not be the optimal alexithymia tool. Our findings add to the body of evidence supporting the validity and utility of the PAQ and suggest that, moving forward, it is a superior option to the TAS-20 for alexithymia assessments.

Daily routine disruptions and psychiatric symptoms amid COVID-19: a systematic review and meta-analysis of data from 0.9 million individuals in 32 countries

BackgroundThere is currently a deficit of knowledge about how to define, quantify, and measure different aspects of daily routine disruptions amid large-scale disasters like COVID-19, and which psychiatric symptoms were more related to the disruptions. This study aims to conduct a systematic review and meta-analysis on the probable positive associations between daily routine disruptions and mental disorders amid the COVID-19 pandemic and factors that moderated the associations.MethodsPsycINFO, Web of Science, PubMed, and MEDLINE were systematically searched up to April 2023 (PROSPERO: CRD42023356846). Independent variables included regularity, change in frequency, and change in capability of different daily routines (i.e., physical activity, diet, sleep, social activities, leisure activities, work and studies, home activities, smoking, alcohol, combined multiple routines, unspecified generic routines). Dependent variables included symptoms and/or diagnoses of mental disorders (i.e., depression, anxiety, post-traumatic stress disorder, and general psychological distress).ResultsFifty-three eligible studies (51 independent samples, 910,503 respondents) were conducted in five continents. Daily routine disruptions were positively associated with depressive symptoms (r = 0.13, 95% CI = [0.06; 0.20], p < 0.001), anxiety symptoms (r = 0.12, 95% CI = [0.06; 0.17], p < 0.001), and general psychological distress (r = 0.09, 95% CI = [0.02; 0.16], p = 0.02). The routine-symptom associations were significant for physical activity, eating, sleep, and smoking (i.e., type), routines that were defined and assessed on regularity and change in capability (i.e., definition and assessment), and routines that were not internet-based. While the positive associations remained consistent across different sociodemographics, they were stronger in geo-temporal contexts with greater pandemic severity, lower governmental economic support, and when the routine-symptom link was examined prospectively.ConclusionsThis is one of the first meta-analytic evidence to show the positive association between daily routine disruptions and symptoms of mental disorders among large populations as COVID-19 dynamically unfolded across different geo-temporal contexts. Our findings highlight the priority of behavioral adjustment for enhancing population mental health in future large-scale disasters like COVID-19.

Resilience of racial and ethnic minority older adults during the COVID-19 pandemic: The role of a prior disability prevention intervention.

Older adults from racially and ethnically diverse backgrounds and with preexisting mental illness have been disproportionately vulnerable to severe illness, disability, and death due to the adverse impacts of the COVID-19 pandemic. This study used a sample of older adults (60 +; N = 307) from a randomized clinical trial (Positive Minds-Strong Bodies [PMSB]) conducted between May 25, 2015, and March 5, 2019. Participants were recontacted to assess symptoms of anxiety, depression, general distress, and physical functioning during the COVID-19 pandemic between March 2, 2021, and July 18, 2022 (62.7% recontacting rate excluding ineligible participants; N = 165). We estimated an analysis of covariance model to evaluate whether or not prior differences between the PMSB intervention and enhanced usual care (EUC) groups continued to be observed at the COVID-19 follow-up. Results showed that, compared to EUC, participants who received the PMSB intervention reported fewer depression symptoms (Geriatric Depression Scale-15 scores) and greater physical functioning (Late-Life Functioning and Disability Instrument scores) at the COVID-19 follow-up. No significant differences were observed between the PMSB intervention and EUC groups on anxiety symptoms (Generalized Anxiety Disorder-7 scores) during the pandemic. Last, findings suggested that the lower depression symptoms and greater physical functioning observed after treatment completion were sustained, though not further improved, over time. These findings provide evidence that the PMSB intervention is a powerful intervention to promote resilience and prevent disability associated with major life stressors, such as the COVID-19 pandemic. Future research is needed to examine the underlying mechanisms of psychosocial and exercise training interventions that lead to lasting resilience. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Lack of Identity and Suicidality: The Mediating Role of Emotion Regulation Difficulties.

Identity disturbance has been connected to both psychological distress and suicidality, and associated with emotion dysregulation. However, despite empirical evidence of a relationship between lack of identity and poor psychiatric outcomes, the link between impaired identity and emotion dysregulation in suicide risk remains underexplored, particularly among individuals seeking outpatient mental health services. Using data from a large clinical sample (n = 246), the present study examined the association between lack of identity and suicidality and the role of emotion dysregulation within this process. Findings indicated that the mediation model was significant, with emotion regulation difficulties significantly mediating the association between lack of identity and future suicidal behavior. Furthermore, the indirect effect of lack of identity on anticipated suicidality remained significant beyond general distress and past suicide attempt. Our findings add to the literature examining the complex relationship among lack of identity, emotion regulation, and suicidality.

Self-Critical Perfectionism and Anxious and Depressive Symptoms Over 2 Years: Moderated Mediation Models of Anxiety Sensitivity and Experiential Avoidance

This three-wave longitudinal study of 297 community adults (mean age = 38.66 years, 67% female) examined how anxiety sensitivity and experiential avoidance work together to explain the relation between perfectionism and anxious and depressive symptoms over 2 years. Participants completed measures of self-critical (SC) and personal standards (PS) higher-order dimensions of perfectionism, anxiety sensitivity, experiential avoidance, and anxious and depressive symptoms at Time 1. Participants completed measures of anxiety sensitivity, experiential avoidance, and symptoms again at Time 2 one year later, and symptoms measures again at Time 3 two years after baseline. Moderated mediation analyses showed that for those with higher Time 1 experiential avoidance, Time 1 SC perfectionism was indirectly related to Time 3 anxious arousal symptoms through Time 2 anxiety sensitivity. For those with moderate to higher Time 1 anxiety sensitivity, Time 1 SC perfectionism was indirectly associated with Time 3 general distress and anxious arousal symptoms through Time 2 experiential avoidance. These moderated mediation effects were not found for PS perfectionism. These results support anxiety sensitivity and experiential avoidance as moderating and mediating processes that may be important treatment targets for reducing vulnerability to anxious and depressive symptoms over the longer-term in SC perfectionistic individuals.

Implications of Patient-Reported Outcome Measures among patients with recently diagnosed type 2 diabetes

BackgroundFor the past two decades, the assessment of the quality of diabetes care has mostly relied on clinical quality indicators. These have not included Patient-Reported Outcome Measures (PROMs) which provide information on outcomes deemed valuable by patients. We aimed to examine the potential utility of PROMs in type 2 diabetes care and to study the association of PROMs with patients' characteristics and clinical quality indicators.MethodsA cross-sectional survey of recently (≤ 4 years) diagnosed patients with type 2 diabetes (n = 392) in the setting of a large health plan. PROMs were based on two well-validated questionnaires, the Problem Areas in Diabetes (PAID) one-page questionnaire that measures diabetes-related distress, and the ten item PROMIS-10 global health questionnaire that measures general health. Additional items were added following a previous qualitative study among Israeli patients with diabetes. The survey was carried out using phone interviews, and data collected were linked to the electronic medical records. Multivariable regression models were used to assess the associations of socio-demographic variables and clinical quality indicators with the PROMs.ResultsAbout a fifth of participants (22%) had high diabetes-related distress (PAID score ≥ 40), a third reported that they did not feel confident in self-management of diabetes and about a third reported having sexual dysfunction. Women, younger patients, and those with a low education level (≤ 12 years) reported worse general health, were more likely to experience high diabetes-related distress, and to have low confidence in diabetes self-management. Interestingly, performance of all seven diabetes quality indicators was associated with worse general health and high diabetes-related distress. Of note, levels of glycated hemoglobin, LDL-cholesterol, or blood pressure were not associated with PROMs.ConclusionsPROMs provide important information on patient self-reported health status and are likely to reflect aspects of the quality of care that are not otherwise available to clinicians. Thus, the use of PROMs has the potential to expand the evaluation of diabetes care and promote patient-centered care. We recommend that policy-makers in the Ministry of Health and health maintenance organizations implement PROMs for assessing and improving the care for patients with type 2 diabetes.

Psychosocial factors, health behaviors and risk of cancer incidence: Testing interaction and effect modification in an individual participant data meta-analysis.

Depression, anxiety and other psychosocial factors are hypothesized to be involved in cancer development. We examined whether psychosocial factors interact with or modify the effects of health behaviors, such as smoking and alcohol use, in relation to cancer incidence. Two-stage individual participant data meta-analyses were performed based on 22 cohorts of the PSYchosocial factors and CAncer (PSY-CA) study. We examined nine psychosocial factors (depression diagnosis, depression symptoms, anxiety diagnosis, anxiety symptoms, perceived social support, loss events, general distress, neuroticism, relationship status), seven health behaviors/behavior-related factors (smoking, alcohol use, physical activity, body mass index, sedentary behavior, sleep quality, sleep duration) and seven cancer outcomes (overall cancer, smoking-related, alcohol-related, breast, lung, prostate, colorectal). Effects of the psychosocial factor, health behavior and their product term on cancer incidence were estimated using Cox regression. We pooled cohort-specific estimates using multivariate random-effects meta-analyses. Additive and multiplicative interaction/effect modification was examined. This study involved 437,827 participants, 36,961 incident cancer diagnoses, and 4,749,481 person years of follow-up. Out of 744 combinations of psychosocial factors, health behaviors, and cancer outcomes, we found no evidence of interaction. Effect modification was found for some combinations, but there were no clear patterns for any particular factors or outcomes involved. In this first large study to systematically examine potential interaction and effect modification, we found no evidence for psychosocial factors to interact with or modify health behaviors in relation to cancer incidence. The behavioral risk profile for cancer incidence is similar in people with and without psychosocial stress.

Differential effects of COVID-19 stressor types on mental health and moderating roles of coping strategies.

Stress exposure often leads to poor mental health, but whether certain types of stressors predict differential levels of mental health symptoms and whether coping differentially moderates these associations remain untested. This study examined whether COVID-19 stressor types (financial-, activity-, and infection-related) differentially predicted subsequent mental health (general distress, posttraumatic stress symptoms (PTSS), and positive states of mind) and whether different types of coping moderated these relationships. In April, 2020, questionnaires assessing the impact of COVID-19 on daily life were administered to an adult sample across the US (N = 1,546); 861 (55.7%) of whom completed questionnaires one month later. Nearly all stressor types independently predicted each aspect of mental health. Behavioral disengagement moderated links between both activity- and infection-related stressors and mental health. Seeking emotional social support moderated links between infection-related stressors and both general distress and positive states of mind as well as activity-related stressors and general distress. Positive reappraisal moderated links between financial-related stressors and positive states of mind. Acceptance coping predicted better mental health but was not a significant moderator. Stressor types and coping strategies are important determinants of effects of COVID-19 on mental health; our findings suggest possible screening and intervention implications and directions for future research.

Effectiveness of Cognitive Behavioral Therapy (CBT) on Psychological Distress among Mothers of Children with Autism Spectrum Disorder: The Role of Problem-Solving Appraisal.

Mothers of children with autism spectrum disorder (ASD) face considerable psychological distress. Cognitive behavioral therapy (CBT) has shown promise in reducing caregiver burden, but evidence in the Arab world is lacking. Problem-solving appraisal training may optimize CBT's benefits. This study evaluated a tailored CBT program emphasizing the role of problem-solving appraisal in managing distress through the process of CBT. Sixty mothers were randomly allocated in a 1:1 ratio to either the CBT intervention group or the control group. The CBT group received 3-month sessions incorporating problem-solving appraisal training within a CBT curriculum from October 2022 to April 2023. Problem-solving techniques are focused on equipping individuals with the skills to identify, approach, and effectively resolve problems, leading to a reduction in stress levels and an improved capacity to cope with difficult situations. All mothers completed assessments of socio-demographics such as age, level of education, marital status, occupation, and adequacy of family income, the Depression Anxiety Stress Scale (DASS-21) and the Problem-Solving Inventory (PSI) before and after the program. The CBT group showed significant pre-to-post reductions in depression, anxiety, stress, and general psychological distress compared to controls (all p < 0.05). They also exhibited significant improvements in problem-solving confidence, approach-avoidance style and personal control (all p < 0.05). The customized CBT program markedly improved psychological well-being for mothers of children with ASD in Egypt. Incorporating problem-solving techniques may optimize CBT's benefits cross-culturally. These findings have implications for the implementation of evidence-based support programs for families impacted by ASD worldwide.

Specific emotion regulation deficits differentiate and mediate the relationship between adverse childhood experiences and internalizing psychopathology

Adverse childhood experiences (ACEs) including maltreatment, abuse, and household dysfunction, are associated with an increased risk for poor physical health, psychopathology, and early mortality (Felitti et al., 1998). Exposure to ACEs is pervasive with two out of three Americans experiencing at least one ACE and 12 % reporting exposure to four or more ACEs (Poole et al., 2017). Increased exposure to ACEs is associated with various negative outcomes, including internalizing disorders and higher emotion dysregulation (ED, Cloitre et al., 2019; Diaz & Eisenberg, 2015; Poole et al., 2017; Soenke et al., 2010). ED is believed to be the nucleus of internalizing psychopathology (Mennin et al., 2005, Newman et al., 2013; Suveg et al., 2010; Werner & Gross, 2010), and has been linked to numerous disorders including depression, anxiety, and posttraumatic stress disorder (PTSD; Mennin et al., 2005, Newman et al., 2013; Suveg et al., 2010). ACEs are also linked to greater internalizing symptoms via emotion regulation deficits (Miu et al., 2022; Poole et al., 2017; Soenke et al., 2010; Rudenstine et al., 2018). However, studies examining the role of ED on ACES and internalizing symptoms have utilized different conceptualizations and measures of ED, making it difficult to compare the unique contribution of ED to specific symptoms and disorders despite the therapeutic and research benefits. Therefore, the goal of the current study was first, to determine whether ED mediated the relationship between ACEs and anhedonic depression, anxious arousal, and general distress. Second, to establish which emotion regulation deficits mediated the relationship between ACEs and internalizing symptoms, and whether they differed across the three outcomes.

The temporal association between social isolation, distress, and psychotic experiences in individuals at clinical high-risk for psychosis.

Psychotic experiences (PEs) and social isolation (SI) seem related during early stages of psychosis, but the temporal dynamics between the two are not clear. Literature so far suggests a self-perpetuating cycle wherein momentary increases in PEs lead to social withdrawal, which, subsequently, triggers PEs at a next point in time, especially when SI is associated with increased distress. The current study investigated the daily-life temporal associations between SI and PEs, as well as the role of SI-related and general affective distress in individuals at clinical high risk (CHR) for psychosis. We used experience sampling methodology in a sample of 137 CHR participants. We analyzed the association between SI, PEs, and distress using time-lagged linear mixed-effects models. SI did not predict next-moment fluctuations in PEs, or vice versa. Furthermore, although SI-related distress was not predictive of subsequent PEs, general affective distress during SI was a robust predictor of next-moment PEs. Our results suggest that SI and PEs are not directly related on a moment-to-moment level, but a negative emotional state when alone does contribute to the risk of PEs. These findings highlight the role of affective wellbeing during early-stage psychosis development.

Longitudinal associations among adult attachment orientations, emotion regulation tendencies, and transdiagnostic anxiety and depression symptoms in young adults

Adult attachment orientations can influence emotion regulation. Such influence on the tendency to employ two strategies, cognitive reappraisal (which aims to modify emotional experiences) and expressive suppression (which inhibits emotional expression) and later symptoms is understudied. This longitudinal study evaluated indirect associations between adult attachment orientations—with a focus on the dimension of security—and transdiagnostic anxiety and depression symptoms (General Distress; GD) through reappraisal and suppression. Correlational analyses examined cross-sectional associations among constructs across four timepoints. A cross-lagged panel model was fit to examine prospective hypotheses using 30-month longitudinal data from young adults ( N = 270 at baseline). Correlational evidence provided support for expected cross-sectional associations. In prospective analyses, there was a significant unique effect of attachment-related avoidance on expressive suppression such that higher attachment-related avoidance predicted higher use of subsequent expressive suppression. There were significant unique effects of emotion regulation on symptoms such that higher reappraisal predicted lower subsequent GD and higher suppression predicted higher subsequent GD. There was no evidence for significant direct or indirect effects of attachment orientations on GD. Results suggest that adult attachment orientation may inform how one expresses emotions in the future, and how one regulates emotions may inform subsequent shared symptoms of depression and anxiety. There was no evidence that attachment orientations informed future transdiagnostic symptoms of depression and anxiety.

"The early bird catches the worm"-Prediction of early response and its importance for treatment outcome in a naturalistic setting of cognitive behaviour therapy.

Knowledge about predictors of early response (ER) remains limited. This study examined patient, process, and therapist variables to predict ER in a naturalistic setting. Data from 493 psychotherapy outpatients were analysed. ER was defined by a ≥25% reduction in general psychological distress (ER percent) and by the reliable change index (ER RCI) within the first 10 sessions measured by the Brief Symptom Inventory-18. ER prediction was determined using logistic regression. General psychological distress (GSI) throughout treatment in patients with and without ER was modelled using a multilevel linear model. This model aimed to predict GSI over treatment using repeated measurements, considering group affiliation (ER percent vs. no ER percent), controlled for other predictors. The prevalence of ER percent and ER RCI were 63.6% and 47.5%, respectively. GSI and therapeutic relationship significantly predicted ER (ER percent: χ2 (6) 70.32, p < .001, Nagelkerkes R2 = .19; ER RCI: χ2 (6) 134.71, p < .001, Nagelkerkes R2 = .35). Patients who rated the therapeutic relationship more positively were more likely to achieve ER (OR = 1.10). Difference in outcomes between patients with and without ER during treatment was influenced by factors such as therapeutic relationship, GSI, therapist experience, and mental comorbidities. Including these variables improved the predictive model from AIC = 17,042.98 to AIC = 16,730.24. The therapeutic relationship is a crucial predictor of ER. Patients achieving ER tend to have better outcome than those without ER. The early phase of therapy warrants particular attention to enhance psychotherapy outcomes.

Factors influencing social avoidance and distress after radical lung cancer resection: a mediation analysis.

To investigate factors influencing social avoidance and distress (SAD) in patients following radical resection of lung cancer (RRLC) and analyze the mediating effects among these factors. Clinical data from 320 patients who underwent RRLC between January 2022 and December 2023 at the General Hospital of Western Theater Command PLA were analyzed. Data were collected using the General Information Questionnaire, Social Avoidance and Distress Scale (SADS), Hospital Anxiety and Depression Scale (HADS), Perceived Social Support Scales (PSSS), General Self-Efficacy Scale (GSES), and Consumer Experiences of Stigma Questionnaire (CESQ). Spearman correlation analysis explored the relationships between SAD, anxiety and depression, social support, self-efficacy, and stigma. Multiple linear regression identified factors influencing SAD. The PROCESS tool was used to test the mediating effects of these factors. The mean SADS score was 16.73±4.69. SAD was positively correlated with anxiety, depression, and stigma (r=0.662, P<0.001; r=0.687, P<0.001) and negatively correlated with self-efficacy and social support (r=-0.682, P<0.001; r=-0.705, P<0.001). Multiple linear regression indicated that anxiety, depression, social support, self-efficacy, and stigma were significant influencers of SAD (β=0.132, P<0.001; β=-0.078, P<0.001; β=-0.178, P<0.001; β=0.115, P=0.002). Mediation analysis revealed that anxiety and depression directly affected SAD and indirectly influenced SAD through social support, stigma, and self-efficacy, both independently and via chain mediation (P<0.05). Patients post-RRLC generally exhibit moderate SAD levels. Anxiety and depression directly influence SAD and also indirectly through the mediating effects of social support, stigma, and self-efficacy. Therefore, reducing depression and stigma while enhancing social support and self-efficacy is crucial for alleviating SAD in these patients.

Dimensionality of the Swahili version of the General Health Questionnaire (GHQ-12) in a Kenyan population: A confirmatory factor analysis.

The current study evaluated the Kiswahili version of General Health Questionnaire (GHQ-12) in a Kenyan context comprising of women exposed to gender-based violence. Participants were randomly drawn from community sampling using household screening methods in peri-urban areas in Nairobi. A total of 1,394 participants with varying levels of literacy (years of education: mean [M] = 9.42; standard deviation [SD] = 3.73) and aged between 18 and 89 years were recruited for the study. The observed factor structure of the GHQ-12 was evaluated using six most tested models querying the dimensionality of the instrument insofar as the impacts of positive and negative wording effects in driving multidimensionality. Results from the confirmatory factor analysis supported a bifactor model, consisting of a general distress factor and two separate factors representing common variance due to the positive and negative wording of items. Overall, the findings support the use of the Kiswahili version of the GHQ-12 as a unidimensional construct with method-specific variance owing to wording effects. Importantly, GHQ-12 responses from a sample of Kenyan women with relatively low levels of literacy are congruent with the factor structure observed in other cross-cultural settings in low- and-middle-income countries.

Parallel processes of posttraumatic stress and cardiometabolic dysfunction: A systemic illness of traumatic stress.

To determine if and how cardiometabolic conditions (MetC) may be associated with posttraumatic stress disorder (PTSD) symptoms over time when controlling for the influence of potentially confounding variables. Parallel process latent growth modeling was applied to self-reported longitudinal data collected from 35,788 World Trade Center 9/11 survivors to determine how the development and course of PTSD symptoms and MetC influence each other when controlling for age, sex, race/ethnicity, preexisting traumas, physical health problems, general psychological distress, smoking, and alcohol use. A unidirectional relationship was found in which the intercept of PTSD symptoms predicted the slope of MetC. Hyperarousal (β = .172) and emotional numbing (β = .171) PTSD symptoms demonstrated the strongest association with MetC changes over and above the effects of control variables and potential confounders. Post hoc analyses indicated that utilization of PTSD-related psychotherapy was associated with decreased early presentations of MetC following trauma, which may have vital implications for the integrated treatment of trauma-exposed individuals. Findings have strong theoretical and clinical implications for conceptualizing traumatic stress reactions as systemic processes and utilizing integrated treatment practices following psychological trauma. (PsycInfo Database Record (c) 2024 APA, all rights reserved).