Global Psychological Distress Research Articles

Self-esteem, Social and Affective Outcomes of Students with Special Educational Needs in Tertiary Education

The core values of inclusive education (IE) proclaim to provide equal educational opportunities to all students regardless of disabilities or special educational needs (SEN). Nonetheless, there were no consistent indications that IE was beneficial to students with SEN. Despite lacking solid evidence for the efficacy of IE, more and more students with SEN completed their secondary education and pursue their studies in tertiary education. This study was conducted in an institute of tertiary education to investigate psychosocial outcomes of inclusive practice. A total of 91 students with special educational needs participated in this study. Validated outcome measures of global self-esteem, social relationship, and psychological distress were incorporated in a questionnaire for online data collection. Results showed that students with SEN were able to maintain good social relationship with their peers, but their global self-esteem was significantly lower and their psychological distress was higher than their peers without SEN. Students with mental illness or emotional problems were most vulnerable to academic stress of tertiary education, whereas students with physical and sensory impairments were very well adjusted and their psychosocial outcomes were not significantly different from their pees without SEN. Findings of the study were discussed and implications of the findings for IE research considered.

Psychosocial impacts of being nil-by-mouth as an adult: A scoping review.

To map existing evidence and identify gaps in the literature concerning psychosocial impacts of being nil by mouth (NBM) as an adult. A scoping review of the literature was undertaken using JBI guidance. A protocol was registered on the Open Science Framework (osf.io/43g9y). Reporting was guided by Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR). A comprehensive search of six databases (CINAHL, Embase, MEDLINE, PsycINFO, SCOPUS and Web of Science) was performed for studies published up to February 2023, with no restriction to study type. A scope of the grey literature was also undertaken. Two authors independently assessed eligibility and extracted data. Descriptive statistical analysis and narrative synthesis were used, and patient and public involvement included in funding discussions. A total of 23 papers were included in the review, consisting of 14 primary studies (7 qualitative and 7 quantitative) and 9 grey literature. Both global psychological distress and distress specific to being NBM (thirst, missing food and drink) were reported. Caregivers also experience distress from their family member being NBM. Furthermore, social impacts were reported for both patient and caregiver, primarily social isolation and subsequent low mood. Furthermore, research is needed to understand the prevalence of this population, how best to measure psychosocial impacts and to explore whether (and how) psychosocial impacts change over time. Advancement in this area would enable better service development to optimize care for this patient group. WHAT IS KNOWN ABOUT THIS TOPIC?: Eating and drinking provides more than nutrition and hydration. A wide range of conditions can lead to recommendations for no longer eating and drinking (nil by mouth). Being nil by mouth (NBM) for short periods such as pre-operative fasting causes distress; however, little is understood about impact on longer-term abstinence from eating and drinking. WHAT THIS PAPER ADDS?: Psychosocial consequences of being nil by mouth (NBM)have been investigated by both quantitative and qualitative studies. Being NBM impacts both patients and caregivers in various psychosocial aspects, including distress and social isolation. Several gaps remain, however, regarding ways to measure psychosocial impact of being NBM.

Cognitive behavioural therapy including habit reversal training for treating dermatillomania in the context of anxiety and low mood

Abstract Dermatillomania is characterised by repetitive skin picking, resulting in tissue damage and significant distress and/or functional impairment. Cognitive behavioural therapy (CBT) is the recommended psychological intervention for dermatillomania in clinical guidelines, with the evidence base also supporting habit reversal training (HRT) as part of CBT. However, research evaluating CBT and HRT for dermatillomania remains scarce. This case study describes a young woman with dermatillomania, in the context of co-morbid anxiety and low mood, treated with 20 sessions of CBT including HRT in a community setting. Guided by her formulation, additional techniques such as those fostering self-compassion were also integrated, and sociocultural factors were adapted for. Improvements were reported in client-centred goals and outcomes of global psychological distress, functioning, anxiety and symptoms and psychosocial impacts of skin picking. The intervention was well received by the client. Limitations as well as clinical practice implications and research recommendations for dermatillomania are discussed. Key learning aims (1) To understand using CBT, including HRT, to treat a case of dermatillomania in the context of anxiety and depression. (2) To use a formulation-driven approach to guide the intervention. (3) To consider adapting interventions for sociocultural factors.

Group schema therapy: the temporal relationship between early maladaptive schemas and global psychological distress

Objective: Schema therapy is an effective treatment for personality disorders (PDs). The theory of schema therapy assumes that the decrease of global psychological distress is mediated by change in Early Maladaptive Schemas. The few studies that have investigated a temporal relationship have produced contradictory results. This study examined the temporal relationship between changes in Early Maladaptive Schemas and global psychological distress in Group Schema Therapy (GST) for patients with personality disorders. Method: Assessments were made of 115 patients at baseline, after 20, 40 and after 60 sessions of treatment. We used the Young Schema Questionnaire (YSQ) to measure the severity of Early Maladaptive Schemas and the Symptom Check List-90 Revisited (SCL-90R) to measure global psychological distress. Linear mixed model analyzes were used to examine the temporal relationship between the initial phase (0–20 and 0–40 sessions) and the later phase (40–60 sessions). Results: Change in Early Maladaptive Schemas does not precede change in global psychological distress. Conversely, global psychological distress does not precede change in Early Maladaptive Schemas; the improvement in both indicators is concurrent. Conclusion: In this study, we could not confirm that the decrease of Early Maladaptive Schemas precedes decrease of global psychological distress. We found a concurrent relationship.

50 BSI-18 as a Measure of Psychological Distress Across Different Domains in TMS Patients

Objective:Transcranial magnetic stimulation (TMS) is an effective treatment for individuals with pharmacoresistant major depressive disorder (MDD), yet identifying which patients best respond remains an important area of inquiry. The Brief Symptom Inventory (BSI-18) serves as a screen for psychological distress, providing measures across three separate domains (e.g., somatization, depression, and anxiety) and one composite score (i.e., global severity index). The psychometric properties of the BSI-18 have been validated across multiple studies; however, it has sparsely been used to track changes in patient symptoms in response to intervention. Assessing patient symptom severity across these domains is imperative since these symptoms can negatively influence cognitive functioning. Accordingly, the current study utilized the BSI-18 to measure psychological distress across these different domains in patients receiving TMS treatment. We hypothesized that all domains of the BSI-18 would see a significant decrease after treatment, that elevated scores in specific domains would predict a less favorable response to treatment, and that measurement of depressive symptoms will be consistent across measures of similar scope.Participants and Methods:Veterans (n=94) with MDD and met standard clinical TMS criteria were administered the BSI-18 before and after receiving an adequate dose of treatment (e.g., 30 sessions). Paired Samples T-test were used to compare the pre-treatment and post-treatment scores across domains.Results:The results of paired sample t-tests indicated a statistically significant reduction in measures of global psychological distress (t(93) = 7.99, p < .001, Cohen's d =.82), as well as depressive (t(93) = 8.34, p < .001, d = .86), anxious (t(93) = 7.64, p < .001, d = .79), and somatic symptoms (t(92) = 5.29, p < .001, d = .55) after receiving treatment. Individuals with elevated levels of anxiety (e.g., BSI-A>63) saw a significant reduction in depressive (t(62) = 8.15, p < .001, d = 1.03), anxious (t(62) = 8.34, p < .001, d = 1.05) and somatic (t(61) = 4.94, p < .001, d = .63) symptoms. Lastly, two measures of depressive symptoms, the BSI-D and PHQ-9, had a statistically significant strong, positive relationship before (r=.66) and after (r=.88) treatment (all n=65 and p<.001).Conclusions:The BSI-18 can detect changes in different domains of psychological distress as a function of TMS treatment. Unexpectedly, TMS patients with elevated levels of anxiety responded well to treatment despite comorbid anxiety often being associated with less favorable outcomes in treatment trials. The positive relationship of the BSI-D and PHQ-9 before and after treatment suggests the use of the BSI as a valid, additional measure of depressive symptoms.

Dysmenorrhea and psychological distress: a meta-analysis.

Dysmenorrhea is characterized by pelvic pain associated with menstruation. Similar to people with other pain conditions, females who experience dysmenorrhea report increased psychological distress. However, the pooled magnitude of this association has not been quantified across studies. Accordingly, this meta-analytic review quantifies the magnitude of the associations between dysmenorrhea severity and psychological distress. We conducted a systematic search of the literature using PsycINFO, PubMed, CINHAL, Embase, and Web of Science. Analyzed studies provided observational data on dysmenorrhea severity and anxiety symptoms, depressive symptoms, and/or global psychological distress. A total of 44 studies were included, and three random-effects meta-analyses were conducted, with average pooled effect sizes calculated using Person's r. We found significant, positive associations between measures of dysmenorrhea severity and measures of depressive symptoms (r = 0.216), anxiety symptoms (r = 0.207), and global psychological distress (r = 0.311). Our review suggests that females with greater dysmenorrhea severity experience greater psychological distress. Future directions include defining a clinically meaningful dysmenorrhea severity threshold, understanding the mechanisms and directionality underlying the dysmenorrhea-psychological distress relationship, and designing and testing interventions to jointly address dysmenorrhea and psychological distress.

High Prevalence and Burden of Physical and Psychological Symptoms in a Chronic Obstructive Pulmonary Disease Population in Primary Care Settings in South Africa.

Many deaths globally are attributable to non-communicable disease, and four-fifths of these deaths are in low- and middle-income countries. Globally, COPD is currently the third leading cause of mortality. 1) To determine the prevalence and burden of symptoms and concerns, and 2) determine predicting factors of symptom burden among patients with COPD. A cross-sectional survey was conducted at eight primary care sites in Western Cape. We collected socio-demographic data (age, gender, smoking status, number of missed doses of prescribed medication in the last seven days) and clinical data (PEF and KPS). The Memorial Symptom Assessment Scale (MSAS), the Medical Outcomes Study, Social Support Survey (MOS-SSS), the London Chest Activity of Daily Living Scale (LCADLS) and the COPD Assessment Test (CAT) (impairment on person's life) were administered to patients. We conducted ordered logistic regression analysis to assess factors associated with the burden of symptoms. MSAS subscales: 1) Global symptom distress index, 2) physical symptom distress and 3) psychological symptom distress were dependent outcomes. We constructed three ordinal logistic regression models for each of the three subscales. Covariates were MOS-SSS, LCADLS, CAT, demographic and clinical variables. We recruited n=387 patients, mean age 59.5 years, 53.0% female. In multivariate analysis, each of the three models (ie, global, psychological and physical symptom distress) was positively associated with impairment on person's life p<0.001, difficulty to perform activities of daily living p<0.001, and low social support p<0.001. Old age was associated with lower global symptom distress (p=0.004), psychological and (0.014) physical distress (0.005). Missing 1 or more doses of medication was associated with higher levels of global (0.004) and physical (0.005) symptom distress. The high prevalence and burden of physical and psychological symptoms provides strong evidence of the need for integrating person-centred assessment and management of symptoms in primary care settings.

Perceived social support attenuates increased hostile reactions to traumatic threat.

Extant literature has seldom examined the naturalistic role of reaction to threat on downstream emotional distress while also considering buffers, such as perceived social support, to acute negative mental health outcomes. The present study examined how trauma symptoms, in reaction to a global stressor, predicted increased psychological distress via elevated emotional hostility and whether perceived social support modified such effects. We predicted a priori that increased exposure to trauma would be associated with increased hostility and global psychological distress, but that this path would be attenuated by greater levels of perceived social support, as individuals who report greater support exhibit greater emotional coping. We recruited 408 adults from a large university in the Midwestern United States to participate in a survey assessing past-week trauma, hostility, distress, and perceived social support following the initial COVID-19 lockdown. The survey was conducted in March 2020, directly after strict shelter-in-place orders were locally mandated. To test our hypotheses, we employed a moderated mediation analysis approach. Results demonstrate that higher trauma predicted increased hostility, which in turn predicted increased distress, and trauma predicted distress via hostility (an indirect effect). As hypothesized, higher perceived social support attenuated the association between trauma and hostility. Results support a hostile emotional pathway that may increase distress in the context of increased traumatic impact; however, social support likely buffers these effects, particularly in the face of new or novel threats and stressors. Findings suggest broad application for understanding the relation between the introduction of stressors, psychological distress, and social support.

Delirium related distress experienced by nurses

Background: Delirium is described as a distressful experience by patients and their families. Also, among healthcare staff, nurses caring for patients with delirium are the most at risk of high distress related to this syndrome. Aims: To assess nurses’ distress related to delirium and its specific symptoms and severity. To identify factors nurses’ sociodemographic and psychological characteristics and professional experience, that may be associated to this distress. Methods: A prospective study was carried out with nurses caring older adults with delirium in Intensive Care Medicine Service. Distress related to delirium, global psychological distress and burnout in nurses were measured with Delirium Experience Questionnaire, Kessler Psychological Distress Scale and Copenhagen Burnout Inventory, respectively. Results: Eighteen nurses were included (mean age=32 years; 89% women). About 46% of the nurses classified the experience of caring for patients in delirium as moderately distressing. Disorientation and psychomotor agitation were the most distressing symptoms. High distress related to delirium was associated with greater personal (p=0.040) and work-related burnout (p=0.020), and more global psychological distress (p=0.007). Conclusion: Caring for patients with delirium is distressing for nurses, particularly if the disorientation and psychomotor agitation are present and if nurses presented high burnout or psychological distress. This study highlights the need for development of education and support strategies for all professionals dealing with these patients.

The Importance of Measuring Mental Wellbeing in the Context of Psychological Distress: Using a Theoretical Framework to Test the Dual-Continua Model of Mental Health.

In total, 2065 participants (female n = 1193; 57.8%) completed two online assessments (minimum 30 days apart) measuring psychological distress, mental wellbeing, and demographic information. In total, 1.1% of participants experienced high distress as well as mental wellbeing confirming that psychological distress and mental wellbeing exist independently (Criterion 1). Bipolarity (Criterion 2) was partly disconfirmed: mental wellbeing consistently decreased as symptom severity increased for depression; however, anxiety and stress did not meet bipolarity requirements. Functional independence (Criterion 3) was established: longitudinal analysis found that participants reliably and simultaneously increased (2.7%) or decreased (4.2%) in distress and mental wellbeing, while cross-sectional analysis showed that psychological distress only explained 38% of the variance in mental wellbeing. Findings provide further support for the dual-continua model through analysis of the proposed assessment criteria, suggesting a further need to measure the dual-continua model at the subdomain level, e.g., depression, anxiety, and stress, as opposed to global psychological distress. Validation for the proposed assessment criteria provides important methodological foundations for future studies.

The Role of Family Support and Dyadic Adjustment on the Psychological Well-being of Transgender Individuals: An Exploratory Study

IntroductionThis study aimed to measure dyadic adjustment, social support, and psychological well-being.MethodsA research protocol composed of the Dyadic Adjustment Scale, the Outcome Questionnaire 45.2, and the Multidimensional Scale of Perceived Social Support was administered to a sample of 109 Italian transgender individuals.ResultsHigher levels of global psychological distress, symptom severity, and interpersonal relationship distress were associated with lower levels of family support and dyadic adjustment. In addition, transgender women and younger transgender individuals reported higher levels of interpersonal relationship distress.ConclusionsThe results indicate that the support and acceptance of one’s partner and family of origin play a crucial role in promoting well-being. It represents an important protective factor with respect to negative psychological health outcomes.Policy ImplicationsThe findings emphasize the need to develop specific clinical and social practices for transgender individuals and their families. Building family and partner-centered policies and programs is particularly important to enable transgender individuals to avoid paying the emotional and psychological costs associated with rejection and non-acceptance.

Network Analysis of the Structure of the Core Symptoms and Clinical Correlates in Comorbid Schizophrenia and Gambling Disorder.

The online version contains supplementary material available at 10.1007/s11469-022-00983-y.

Psychological distress among parents of children with autism spectrum disorders: A randomized control trial of cognitive behavioural therapy

High psychological distress that ranges from stress reactions to anxiety and depression are prevalent among parents and caregivers of children with Autism Spectrum Disorder (ASD) and undermine positive parenting and health outcomes. The current study sought to investigate cognitive-behavioral therapy (CBT) in curtailing psychological distress in a sample of those parenting children with autism. We conducted the study in Enugu state, Nigeria, with 97 parents of children with ASD. Participants were randomly allocated into CBT (N = 48) and waitlist comparison (WLC) (N = 49) groups. The CBT group participated in a 120 min CBT program weekly for 12 weeks. Data were collected using Demographic Questionnaire; Depression, Anxiety, and Stress Scale-21 items (DASS-21) and Satisfaction with therapy and therapist scale- revised (STTS-R). Three data sets were collected at baseline, post-test, and follow-up. Descriptive statistics, Repeated measures Multivariate Analysis of Variance (MANOVA), and t-test statistics were used to analyze the data. Raincloud plots were also used to illustrate results. Results revealed that all dimensions of psychological distress (DASS-depressive symptoms, DASS-anxiety, and DASS-stress) reduced significantly at post-CBT intervention and follow-up assessments in the CBT group, compared to the WLC. Multivariate analysis showed that the global psychological distress score was responsive to CBT intervention. We concluded that stress, anxiety, and depression among those parenting children with autism could be lessened with CBT.

The Posttaumatic Adjustment Scale (PAS) is an effective measure in predicting psychological distress in patients following major trauma

AimsTo determine whether a psychological screening tool - the Posttraumatic Adjustment Scale (PAS), predicts later psychological distress for admissions to a Major Trauma Centre (MTC) and to identify whether there was an unmet need in relation to the psychological support offered. MethodsPatient demographics and details of their injuries were retrieved from the Trauma Audit & Research Network (TARN) database. All patients admitted to Leeds General Infirmary MTC were approached for inclusion in the study over a three-month period. The PAS was administered to all participants at baseline. Following discharge, patients were sent two validated psychological measures via post, the Impact of Events Scale – Revised (IES-R) and the Clinical Outcomes in Routine Evaluation System (CORE-10). Relationships between continuous variables were examined using a Spearman's rank test (SR). The diagnostic accuracy of the different psychological screening systems was examined and compared using Receiver Operator Characteristic (ROC) analysis. ResultsEighty-two patients completed the PAS, 26 of whom had been referred to clinical psychology and 56 who were not. Fifty-seven of these patients (70%) returned follow-up IES-R and CORE-10 data, 20 who had been referred to psychology and 37 who had not. The PAS-P score recorded shortly after admission correlated strongly with the CORE-10 (SR rs 0.54, p<0.0001) and IES-R (SR rs 0.63, p<0.0001) scores recorded at early follow up. A PAS-P of more than 10 predicted the development of PTSD symptoms (IES-R 33 or more) or moderate global psychological distress (CORE-10 15 or more) with 72% sensitivity and 71% specificity. To identify patients who went on to develop psychological symptoms according to either measure (IES-R 33 or more or CORE-10 15 or more), the PAS-P was more sensitive than clinician referral (71% vs 52%, p<0.05) with similar specificity (72% vs 75%, p=0.78). ConclusionsIn an unselected group of trauma inpatients treated in a MTC, the PAS is an effective means of identifying those who are likely to go on to suffer PTSD symptoms or psychological distress. It may useful to use the PAS as a measure to formalise psychology referrals.

A Service Based Evaluation of Compassion Focused Group Therapy Within a Community Mental Health Team Setting

The current paper explores the impact of Compassion Focused Therapy (CFT) when delivered in a group setting to people with a range of diagnoses presenting to a Community Mental Health Team. In total five groups of 14 to 18 sessions were run with an average of five participants completing each group. A range of self-report measures examining global psychological distress, self-criticism, depression, anxiety and stress, emotion regulation, social comparison, shame and compassionate attributes and skills were administered pre and post group. Results indicate overall reductions in psychological distress, depression, anxiety and stress and suggest improved emotion regulation and improved perception of social rank and how others may see them following completion of the group. In addition participants appeared to rate themselves as more compassionate towards themselves and more accepting of compassion from others following the group, according to the Compassionate Engagement and Action Scales. These results appear to be generally in keeping with the findings of other similar studies examining the effectiveness of CFT groups with trans-diagnostic populations thus adding to the evidence base in this area, however larger, more robust trials including a control group for comparison would be beneficial.

Recall of delirium and related distress in elderly hospitalized patients: A prospective study.

Background: Delirium is a very common neuropsychiatric disorder in the elderly, with a significant physical and psychological burden. Much is still unknown about its psychological effects. This study aims to identify the proportion of patients who recall delirium and to analyze the distress caused by it. In addition, this study aims to analyze the association between delirium recall and related distress and global psychological distress regarding hospitalization. Methods: This is a prospective study with elderly hospitalized patients in level-2 units of intensive care medicine department of a university hospital. Exclusion criteria were a Glasgow Coma Scale total ≤11, brain injury, blindness, deafness, or inability to communicate. Delirium was daily assessed with the Confusion Assessment Method. Delirium recall and related distress in patients were measured using the Delirium Experience Questionnaire. Global psychological distress was assessed with the Kessler Psychological Distress Scale. Results: From 105 patients, 38 (36.2%) developed delirium. Most patients did not remember the delirium episode (64.7%). Among those who remembered (35.3%), most described delirium as a distressing experience (75%). Delirium recall was associated with high global psychological distress (P = .029). Conclusions: Distress related to delirium is high, namely in patients who recall the episode. Global psychological distress during hospitalization is associated with delirium recall. This study highlights the need to assess the experience of delirium in these patients, as well as the importance of providing support and psychological interventions to minimize the associated distress.

Behavioral coping phenotypes and associated psychosocial outcomes of pregnant and postpartum women during the COVID-19 pandemic

The impact of COVID-19-related stress on perinatal women is of heightened public health concern given the established intergenerational impact of maternal stress-exposure on infants and fetuses. There is urgent need to characterize the coping styles associated with adverse psychosocial outcomes in perinatal women during the COVID-19 pandemic to help mitigate the potential for lasting sequelae on both mothers and infants. This study uses a data-driven approach to identify the patterns of behavioral coping strategies that associate with maternal psychosocial distress during the COVID-19 pandemic in a large multicenter sample of pregnant women (N = 2876) and postpartum women (N = 1536). Data was collected from 9 states across the United States from March to October 2020. Women reported behaviors they were engaging in to manage pandemic-related stress, symptoms of depression, anxiety and global psychological distress, as well as changes in energy levels, sleep quality and stress levels. Using latent profile analysis, we identified four behavioral phenotypes of coping strategies. Critically, phenotypes with high levels of passive coping strategies (increased screen time, social media, and intake of comfort foods) were associated with elevated symptoms of depression, anxiety, and global psychological distress, as well as worsening stress and energy levels, relative to other coping phenotypes. In contrast, phenotypes with high levels of active coping strategies (social support, and self-care) were associated with greater resiliency relative to other phenotypes. The identification of these widespread coping phenotypes reveals novel behavioral patterns associated with risk and resiliency to pandemic-related stress in perinatal women. These findings may contribute to early identification of women at risk for poor long-term outcomes and indicate malleable targets for interventions aimed at mitigating lasting sequelae on women and children during the COVID-19 pandemic.

Coping Under Extreme Conditions: Do Coping Dispositions Matter.

The role of coping dispositions in predicting coping with a potentially traumatic event (PTE; situational coping) has been bypassed. We explored the degree to which the dispositional coping of 103 mountain rescuers predicted coping with their last PTE. Dispositional venting of emotions and turning to religion explained more than half of the variance in the use of the same strategy to cope with the PTE. Most coping dispositions predicted about 30% to 40% of the variance in comparable situational coping. Dispositional denial did not predict situational use of denial. Multivariate dispositional coping style explained a great deal of the variance in most situational coping responses. Dispositional coping was more relevant than situational to participants' global psychological distress and explained about one-fourth of the variance in distress. These results suggest that most dispositional styles considerably impact coping with PTE but to the extent that varies across different coping styles.

Nighttime Waking to Smoke, Stress, and Nicotine Addiction

ABSTRACT Introduction Up to one-half of cigarette smokers may wake up during the night and smoke. This behavior may result in greater likelihood of cessation failure, clinically relevant sleep difficulties, and a range of health issues. Whereas the scientific literature has often attributed this behavior to nicotine dependence, up to 85% of smokers who wake at night and smoke attribute this behavior to factors other than nicotine. This study examines the relations between nicotine dependence, psychological distress, perceived stress, and waking at night to smoke. Methods A total of 351 adult smokers from the Pennsylvania Adult Smoking Study (PASS) completed self-report surveys and provided saliva for the evaluation of cotinine values. Survey instruments included measures of nicotine addiction, perceived stress, a broad measure of global psychological distress, and a range of demographic factors. Results Logistic regression demonstrated that nicotine addiction, psychological distress, and perceived stress were all related to waking at night to smoke, but cotinine levels were not. Mediation models found that psychological distress had a direct relation to waking at night to smoke, even when considering nicotine addiction and other causes of sleep disturbances (e.g., apnea and chronic physical pain). Alternative moderation and mediation models were conducted but did not support other plausible associations between variables. Conclusions Waking at night to smoke is likely the result of both nicotine dependence and psychological distress. Given that cotinine levels were not associated with waking at night, the mechanisms of how nicotine dependence may affect waking at night need further investigation.

Profile of Treatment-Seeking Gaming Disorder Patients: A Network Perspective.

The increasing presence of gaming disorder in recent years has led to major efforts to identify the specific predictors that have a high impact on the profile of people seeking treatment for this mental condition. The purpose of this study was to explore the network structure of the correlates of gaming disorder considering sociodemographic features and other clinical symptoms. Network analysis was applied to a sample of patients who met clinical criteria for gaming disorder (n = 117, of ages ranging from 15 to 70 yrs-old). Variables considered in the network included sex, age, socioeconomic position, global emotional distress, age of onset and duration of the gaming disorder, personality traits and the presence of other addictive behaviors (tobacco, alcohol and behavioral addictions). The central nodes in the network were global psychological distress, chronological age, and age of onset of gaming related problems. Linkage analysis also identified psychopathological status and age as the variables with the most valuable information in the model. The poorest relevance in the analysis was for the duration of gaming problems and socioeconomic levels. Modularity analysis grouped the nodes within four clusters. Identification of the variables with the highest centrality/linkage can be particularly useful for developing precise management plans to prevent and treat gaming disorder related problems.