Greater Psychological Distress Research Articles

Comparing the mental health of Australian university students with that of young people who are not in higher education

Abstract Compared with their non-student counterparts, young adults engaged in higher education are often reported to be at greater risk for mental health concerns. However, research directly comparing university student and non-student populations is limited. This study uses a community sample to investigate differences in the mental health and wellbeing of young Australians (17–25 years) engaged in university study (n = 828) compared with their age-matched non-studying peers (n = 880). Comparisons are made on mean levels of psychological distress, wellbeing, resilience, and loneliness, as well as the proportion of individuals meeting commonly used classifications for mental health and wellbeing. We then examine the role of employment on reported distress and wellbeing. While a substantial proportion of the sample reported high to very high distress, our study found no overall substantive difference in levels of distress or wellbeing between students and non-students. An examination of employment status revealed a more nuanced result. Full-time employment was associated with greater psychological distress in students, where otherwise students reported better wellbeing and lower distress than their non-student peers. These findings challenge the common discourse of tertiary students as having a greater risk of distress than the general community. However, attempting to combine full-time work with full-time study is challenging, and the pressures of such work can increase distress. Increased financial assistance for tertiary students is needed to ease work pressures, along with greater understanding of the flexibility needed to balance work and study commitments.

Pain severity contributes to worse outcomes in opioid use disorder recovery than pain status.

Opioid use disorder (OUD) continues to pose a significant challenge to public health in the United States. Chronic pain and OUD are highly comorbid conditions, yet few studies have examined the relative associations of pain status and severity toward multidimensional OUD recovery outcomes (e.g., psychopathology and withdrawal). Participants (N = 214) were from the RECOVER-LT study, conducted 4.2-years after completion of a clinical trial program assessing extended-release buprenorphine. Group differences by pain status (i.e., chronic, acute, or no pain) were evaluated in this cross-sectional data set using analysis of variance and Fisher's exact test. Linear regression was utilized to understand the associations between average pain severity and recovery outcomes. Model selection was performed to examine the relative importance of pain status and average pain severity to recovery outcomes. A majority of the sample endorsed chronic pain (73.8 %). The multivariate regression analysis with model selection found that higher average pain severity (p < .001), but not pain status, was significantly associated with the multidimensional recovery outcomes greater total number of DSM-5 OUD symptoms, higher opioid withdrawal score, reduced physical quality of life, higher depressive symptoms, negative affect, and greater psychological distress. Pain status and average pain severity were not associated with past 7- or 30-day opioid use (p > 0.001). These findings highlight pain severity, but not pain status, as a key dimension of OUD recovery. This suggests a need for integration of OUD treatment and pain management, particularly for individuals experiencing elevated pain severity regardless of pain status.

Association between higher mortgage payment-to-income ratio and greater psychological distress among high-income homeowners in Japan: A cross-sectional study

Association between higher mortgage payment-to-income ratio and greater psychological distress among high-income homeowners in Japan: A cross-sectional study

Eating disorder risk in undergraduate students: exploring academic, wellness and social factors and potential to flourish

ABSTRACT Eating disorder (ED) psychopathology is a public health concern for undergraduate students and likely to coincide with university adjustment challenges. Using the National College Health Assessment (NCHA-III) (2023) survey, undergraduates enrolled at an Atlantic Canadian university (N = 887; mean age 22.1 years) were screened for EDs based on the Sick Control One-stone Fat Food (SCOFF) questionnaire, and assessed whether performance, wellness, and social factors predicted positive mental health (PMH). Overall, 29.4% (33.2% female vs. 21.9% male) screened positive for an ED, and relative to undergraduates not at risk, were more likely to report problems with academics, faculty, family, partners, and peers, greater isolation/loneliness, and weaker university belongingness, poorer health status, and greater psychological distress. Although more likely to languish, 20% of ED risk students were observed to flourish, with academic success, university belongingness, better health, and lower ED severity, distress, and loneliness predictive of higher PMH. Implications of findings are discussed.

The Association Between Internet Addiction and Adolescents’ Mental Health: A Meta-Analytic Review

This study examines the association between problematic internet use, or internet addiction, and adolescent mental health, focusing on key psychological variables, assessing the strength of these associations, and identifying potential moderating factors. Methods: A search of the Web of Science databases over the past five years identified 830 articles. Of these, 33 met the inclusion criteria, involving 303,243 participants (average age 14.57; 49.44% female). The selection process was verified by two researchers. Results: Nine psychological variables were analyzed: depression, anxiety, stress, suicidal behaviour, psychological well-being, self-esteem, externalizing problems, aggressiveness, and impulsiveness. Internet addiction showed positive correlations with aggressiveness (r+ = 0.391), depression (r+ = 0.318), anxiety (r+ = 0.252), and suicidal behaviour (r+ = 0.264). Negative correlations were observed with psychological well-being (r+ = −0.312) and self-esteem (r+ = −0.306). No significant associations were found for externalizing problems, impulsiveness, or stress. None of the moderators showed a significant correlation with internet addiction and depression. Conclusions: Although limited by small sample sizes for some variables and the cross-sectional design of most studies, the findings confirm that there is a negative relationship between internet addiction and adolescent mental health. It is related to poorer self-perceived health, greater psychological distress, and greater aggression.

“Stop, pause and take a break”: a mixed methods study of the longer-term outcomes of digital emotional wellbeing training for perinatal women

BackgroundMaternal psychological distress is related to poorer physical and mental health as well as child developmental problems. Interventions that optimise maternal mental health and wellbeing during the “first 1,000 days” of life should have wide-reaching benefits for the mother and her child. Digital mental health interventions (DMHIs) during this critical period have the potential to equip women with enhanced coping strategies that can be applied and maintained in daily life. This study aimed to understand uptake of DMHIs in pregnancy, and the extent participants apply intervention strategies 10–12 months post-participation in a pilot randomised controlled trial (RCT) comparing different digital programs.MethodsA mixed methods triangulation approach was undertaken. We explored demographic data and psychological distress measures in the intervention groups and a comparison group that were offered the intervention but did not participate or did not meet the inclusion criteria based on gestational age (n = 525). Intervention participants (n = 54) were invited to undertake an interview up to 12 months post-intervention to understand ongoing skills application. Fifteen interviews were undertaken using a phenomenological approach to analyse the data.ResultsBaseline psychological distress results showed a significant difference between those who enrolled in the intervention, compared to those who did not, with higher psychological distress (combined), and stress and depression (sub-scale) scores for the intervention groups. Qualitative content analysis identified four main themes relating to long-term engagement: (1) Motivations to use skills; (2) Taking time for oneself; (3) Emotional support; and (4) Improving wellbeing (such as aids sleep and emotional impacts). Within each theme there were several sub-themes, including enablers or barriers to engagement.ConclusionsThis study indicated that women who chose to enrol in DMHIs in pregnancy have greater psychological distress than those who chose not to participate. Many participants in this study continued to apply learnt skills in everyday life, such as breathing exercises. This implies that digital strategies may be effective and applicable longer-term to enable women to apply positive coping skills during critical child developmental periods. Ultimately, this will contribute to designing apps that sustain wellbeing and could be protective in preventing postnatal psychological distress.Trial registrationAustralian New Zealand Clinical Trials Registry Number (ACTRN12620000672954p); (12/06/2020).

Prevalence, Activity Limitations and Quality of Life in Patients with Non-Specific Neck Pain in Burundi: A Cross-Sectional Study.

Non-specific neck pain (NSNP) causes a great deal of discomfort, impacting a person's functionality and quality of life. This study aimed to determine the prevalence, activity limitations, and quality of life in patients with NSNP in Burundi. This was a cross-sectional study with descriptive and analytical aims, covering the period from September 2023 to February 2024. It focused on NSNP patients received in three health facilities of Bujumbura. In addition to sociodemographic data, clinical data including pain, disability, psychological status and quality of life were collected. Most of patients (47.1%) were over 40 years old, with an average of 49.30 (13.30) years. The majority was female, married, employed, and had a university education. Most of them (64.70%) described their pain as moderate to severe, with a mean score of 6.20 (1.60) on the numerical scale. A minority had poor health-related quality of life (20.60%). The majority had mild to moderate disability in both the psychological (41.20%) and physical (55.90%) components. Pain location during the current episode had a statistically significant association with social aspects (p=0.049). Individuals with lower levels of education, a more sedentary lifestyle, and greater psychological distress are likely to experience increased activity limitations (p<0.05). NSNP is a significant public health concern in Burundi, impacting individuals' socio-professional lives and overall quality of life. Individuals with lower levels of education, a more sedentary lifestyle, and greater psychological distress are likely to experience increased activity limitations. The state of health was perceived as poor by 20.60% of the sample. The physical component of health status was more impaired than the mental component, and the majority of patients presented moderate to severe disabilities, highlighting the need for preventive and management measures to mitigate its impact on individuals and the healthcare system in Burundi.

Loneliness Trajectories in U.S. Military Veterans: A 3-Year Longitudinal Study of Risk and Protective Factors.

Loneliness is a significant public health concern associated with adverse mental and physical health outcomes in older adults. This study examined the nature and correlates of predominant loneliness trajectories in a nationally representative sample of older U.S. military veterans. Participants included 2,441 veterans (mean age = 63, 8% female, 80% White) from the National Health and Resilience in Veterans Study, a 3-year longitudinal cohort study. Growth mixture modeling (GMM) was used to identify distinct trajectory classes of loneliness based on self-reported ratings. Multinomial logistic 3-step regression analyses examined potential psychosocial risk and protective factors associated with loneliness trajectories. GMM revealed 3 distinct loneliness trajectories: low-decreasing loneliness (61.2%), moderate-increasing loneliness (31.6%), and high-increasing loneliness (7.2%). Being married/partnered and perceiving a greater purpose in life emerged as protective factors against elevated levels of loneliness. Worse cognitive functioning was a risk factor for the moderate-increasing loneliness trajectory, while greater psychological distress and more adverse childhood experiences were risk factors for the high-increasing loneliness trajectory. Nearly 40% of older U.S. veterans exhibited trajectories characterized by moderate to high levels of loneliness, with both groups showing increases over time. Targeted interventions that promote social connectedness, enhance purpose in life, and address mental health concerns and early life adversities may help mitigate the negative health consequences associated with chronic loneliness in this vulnerable population.

Evaluation of depression at 6 and 12 months postpartum by examining depressive symptoms and self-harm ideation during the early postpartum period: Tohoku Medical Megabank Project Birth and Three-Generation Cohort Study.

The aim of this study was to evaluate depression at 6 and 12 months postpartum, using the Edinburgh Postpartum Depression Scale (EPDS) total score and its subitem regarding self-harm ideation (SHI) at 1 month postpartum. A sample of 12,358 postpartum women answered the EPDS and questionaries at 1, 6, and 12 months postpartum longitudinally. For participants with postpartum depression (PPD; EPDS total score ≥9) and SHI (SHI sub-score ≥1) at 1 month postpartum, the risk of depression at 6 and 12 months postpartum (odds ratio [95% confidence interval] at 6 and 12 months postpartum: 20.03 [16.8-23.8] and 14.55 [12.3-17.2], respectively) was higher than for those with PPD but without SHI at 1 month postpartum (OR: 8.57 [7.36-10.0], and 6.24 [5.38-7.24], respectively). Additionally, SHI even without depressive symptoms at 1 month postpartum is also a risk for depression at 6 and 12 months postpartum. To support our longitudinal evaluation of depression at 6 and 12 months postpartum, these related factors were examined: traumatic events or relocations after the Great East Japan Earthquake, employment status, household income, personality traits, sleep status, psychological distress, and social networks. The result showed employment status, low household income and poor social networks were significantly associated with depression at 12 months postpartum but not at 6 months postpartum. This study showed a high risk of depression at 6 and 12 months postpartum for those who had depressive symptoms with SHI at 1 month postpartum. Our findings may contribute to the precise evaluation of depression at 6 and 12 months postpartum while considering sleep status, psychological distress and social network during pregnancy.

Multilevel Sexual Minority Stigma-Based Experiences and Mental Health Among U.S. Sexual Minority Adults: A Socio-Ecological Longitudinal Moderated Mediation Analysis

Abstract Background The current study aimed to longitudinally examine whether intrapersonal stigma (i.e., internalized stigma; identity concealment) mediates the associations between interpersonal stigma (i.e., adulthood and childhood victimization; everyday discrimination; perceived external stigma) and mental health outcomes among sexual minority adults, and as a function of two moderators: structural climate and generation. Methods Data from 600 sexual minorities across three generations (i.e., ages 18-25, 34-42, 48-55) who completed all three waves of the 2016-2019 Generations Study were merged with census division data on legal climate (2016 Human Rights Campaign State Equality Index). A series of three-wave time-lagged simplex moderated mediation models were estimated for each independent and dependent variable combination through two parallel mediators, with both moderators included on each independent-mediator variable pathway. Results Greater identity concealment partially explained the effects of perceived external stigma on greater psychological distress and suicidal ideation, but most strongly among older generations. Other mediation was not supported. Reversed sensitivity analyses revealed how identity concealment’s positive effect on suicidal ideation may be suppressed through lower adulthood victimization and, only among younger generations in higher stigma climates, how it’s positive effects on psychological distress and suicidal ideation may be suppressed through lower everyday discrimination. Conclusions Identity concealment may represent a salient mechanism through which sexual minorities navigate structural climates and the harmful effects of interpersonal stigma on distress and suicidal ideation. While the longitudinal findings provide some support for the cross-level effects of sexual minority stigma on mental health outcomes, further advanced time-lagged examinations are warranted.

Gaza’s hidden crisis: adults, children, and generations of psychological torment to come

ABSTRACT For more than a year, the world has been exposed to the ongoing conflict in Gaza, and the destruction, medical devastation, and the death toll of this crisis. What has been largely missing from the picture, has been an attention to the long-term mental health impact of the ongoing trauma among the Palestinian civilians and the Israeli hostages in Gaza. This article anticipates the enduring generational impact of war trauma on mental health of the civilians in Gaza, drawing from the author’s clinical and research experiences of Iraqi, Syrian, Afghan, African, and Ukrainian war-exposed civilians, refugees, and survivors of torture. Across most different studies, war exposure leads to PTSD in nearly 30–50% of adult civilians, and similar rates of depression and anxiety. Civilians in Gaza, facing daily horrors and a profound sense of helplessness, are likely experiencing even greater psychological distress. Children, significantly affected during critical developmental stages, are at risk of long-term mental and physical health issues. The psychological, cultural, and epigenetic aspects of the intergenerational transmission of trauma can lead to psychological torment across generations. Addressing the mental health needs of these populations is crucial to mitigating the profound and lasting impact of war.

Psychotic experiences and psychological distress in adolescents: an examination of longitudinal bidirectional effects across sex

BackgroundAlthough the co-occurrence of psychotic experiences (PEs) and psychological distress symptoms is growingly recognized in several previous studies, there is still a lack of literature, which clearly outlines how these two psychopathological entities affect each other over time. This study is intended to add to the literature by examining: (a) the longitudinal, bidirectional associations between PEs and psychological distress in a sample of Tunisian adolescents, and (b) whether these associations are moderated by sex.Methods510 adolescent students (mean age of 16.05 ± 1.01 years, 61.2% females) took part in a prospective longitudinal study. PEs and psychological distress were measured at three occasions over a one-year period. The cross-lagged panel modeling approach was adopted.ResultsThe current results showed that the experience of PEs at baseline tended to temporally precede prospective increases in psychological distress (at 6 months), which had in turn led to further exacerbation of psychological distress at 12 months of follow-up. Temporally primary psychological distress symptoms were not a significant predictor for the development of later psychotic symptoms in the whole sample. However, temporal patterns between adolescent distress and psychotic symptoms differed for girls and boys. Endorsing PEs at baseline was followed by greater psychological distress at 6 months, which was in turn associated with a significant increased risk of subsequent exacerbation of PEs at 12 months in boys, whereas psychological distress at 12-month follow-up was significantly predicted by pre-existing PEs in girls.ConclusionThese findings suggest that clinicians and support workers are recommended to take into account different social risk profiles for boys and girls when considering interventions to address PEs and distress in adolescents.

Lifestyle behaviors and mental health outcomes in sexual and gender minority graduate students

Objective There are well-documented health disparities among sexual and/or gender minority (LGBTQ+) individuals generally, but there is limited research investigating the disparities in health-related lifestyle factors and mental health among LGBTQ+ graduate students, which is a group that may be especially vulnerable. Participants This project was a secondary analysis of data from the American College Health Association’s National College Health Assessment’s (NCHA) Fall 2019 wave, which included 7,766 graduate students. Methods Students self-reported engagement in health-related lifestyle factors and psychological distress. Welch’s independent samples t-tests were used to compare differences in psychological distress and lifestyle behaviors and multiple linear regression models were used to test lifestyle factors as predictors of LGBTQ+ psychological distress. Results LGBTQ+ graduate students reported worse lifestyle profiles compared to their peers and greater psychological distress. Sleep quality had the strongest association with psychological distress among LGBTQ+ graduate students. Conclusions These findings have important implications for policies and interventions to improve health and decrease suffering in LGBTQ+ graduate students.

Risk Factors and Moderators of Intimate Partner Violence Victimization Versus Perpetration Among Women in Spain.

Bidirectional intimate partner violence (IPV) appears highly prevalent, but the extant literature, which has been dominated by work in North America, has not adequately accounted for how victimization overlaps with perpetration and how potential resources may interact with risk factors. A community sample of Spanish women completed measures of IPV approval, mental health risk factors (psychological distress and problematic substance use), and interpersonal resources (partner and social satisfaction). Using Mplus accounting for victimization and perpetration overlap, findings indicate that greater psychological distress and substance use were associated with IPV perpetration, and lower IPV approval was linked to victimization. Stronger partner satisfaction did not serve a buffering role but rather interacted to increase IPV perpetration; low social support was associated with victimization and exacerbated risk of perpetration.

Health behaviors at the start of the COVID-19 pandemic: Evidence for indirect effects of subjective social status via psychological distress.

Subjective social status (SSS), the perception of one's social standing compared to others in society, and socioeconomic status (SES) are interconnected but distinct determinants of health. Intermediary factors such as distress and health behaviors can contribute to this relationship. This pre-registered study hypothesized that, in the early months of the COVID-19 pandemic, nonspecific psychological distress would indirectly link SSS and SES to perceived changes in three health behaviors: sleep quality, physical activity, and alcohol consumption. Data from 412 US adults were collected from April to June 2020 through an online cross-sectional survey. Findings indicated that lower SSS was indirectly associated with lower current sleep quality, worsened sleep quality, and decreased physical activity since the pandemic onset via greater psychological distress. Path analyses controlled for age, gender, race, COVID-19-related worry, and shelter-in-place status. Results are discussed in light of findings from COVID-19 research and the broader literature on SES health disparities.

Impact of COVID-19 on psychological distress in subsequent stages of the pandemic: The role of received social support.

This longitudinal study examined a sample of adult Poles (N = 1245), who were interviewed three times from July 2021 to August 2022, during the later stages of the COVID-19 pandemic. The study had two primary objectives. The first was to assess the impact of the pandemic on psychological distress, measured through symptoms of depression and anxiety. The pandemic's effects were evaluated using three predictors: direct exposure to COVID-19, COVID-19 related stressors, and perceived threats from COVID-19. The second objective was to investigate the role of received social support in coping with the pandemic's hardships. Receipt of social support was measured by both the quantity of help received and the perceived quality of that support. A Latent Growth Curve Model (LGCM) was employed to analyze psychological distress across three waves, controlling for sociodemographic variables, non-COVID life events, coping self-efficacy, and perceived social support. Findings indicated that COVID-19 stressors and COVID-19 threats were strongly and consistently associated with greater psychological distress throughout the study period. The impact of direct COVID-19 exposure was limited. The quantity of received support predicted higher distress, whereas higher quality of received support was linked to better mental health. Crucially, the relationship between the quantity of support and distress was moderated by the quality of support. Effective social support was associated with the lowest distress levels, regardless of the amount of help received. Conversely, receiving large amounts of low-quality support was detrimental to psychological health. In summary, the ongoing psychosocial challenges of COVID-19 significantly eroded mental health, highlighting the importance of support quality over quantity in coping with significant life adversities.

Differential Item Functioning and Clinical Utility of the Subjective Memory Complaints Questionnaire in a Multi-Ethnic Cohort

Introduction: This study evaluated the psychometric properties of the Subjective Memory Complaints Questionnaire (SMCQ) in a non-Hispanic White (NHW) and Mexican American (MA) sample from Texas in the USA. Methods: Data were obtained from the Health and Aging Brain Study – Health Disparities (HABS-HD; N = 1,691, age = 66.5 ± 8.7, education = 12.4 ± 4.8, 60.6% female, 33.2% MA Spanish speaking). Unidimensionality of the SMCQ was evaluated with confirmatory factor analysis. Differential item functioning (DIF) of the SMCQ was assessed across age, sex, education, and ethnicity/language using item response theory/logistic ordinal regression. Associations of the SMCQ in relation to cognitive status, Alzheimer’s disease (AD) blood-based biomarkers, and psychological distress were examined. Results: The SMCQ showed excellent fit in a single-factor model (CFI = 0.97, TLI = 0.97, RMSEA [95% CI] = 0.05 [0.04, 0.05], SRMR = 0.07). Significant item-level DIF was detected by education level and ethnicity/language, but not by age or sex; when detected, DIF was not salient (i.e., adverse). The SMCQ was associated with greater psychological distress, worse Clinical Dementia Rating scores, and greater disease burden as measured by total tau and neurofilament light. Conclusions: Practically negligible item-level bias was identified across education and ethnicity/language. Detected DIF can be described as benign, indicating that some items manifested differently between groups but had minimal impact on measurement properties. These results demonstrate that the SMCQ performs appropriately across demographic variables. Our findings also provide support for the associations of SMCQ scores with self-reported mood, cognitive status, and AD blood-based biomarkers.

The impact of negative COVID-19 experiences on cancer survivors' health-related quality of life and psychological distress: a moderated mediation model.

Cancer survivors experienced poorer health-related quality of life (HRQoL) and greater psychological distress during the COVID-19 pandemic than those without cancer. However, the underlying mechanisms that may explain how negative experiences during the pandemic are associated with distress and HRQoL remain unknown. We examined whether psychosocial risk factors (i.e., healthcare disruption, disruption to daily activities and social interaction [DDASI], and financial hardship) mediated the relationship between negative COVID-19-related experiences and cancer survivors' HRQoL and psychological distress (i.e., depressive symptoms, and anxiety) and whether the mediating effects were moderated by psychosocial protective factors (i.e., stress management ability and social support). A total of 9,651 cancer survivors completed a questionnaire assessing negative COVID-19-related experiences, psychosocial and practical experiences, and HRQoL. Conditional process analysis was used to evaluate the proposed moderated mediation models. Participants had a mean age of 63.8 years (SD = 12.3) and were mostly non-Hispanic White (82.3%). DDASI and financial hardship mediated the relationship between negative COVID-19-related experiences and cancer survivor's HRQoL and psychological distress. Stress management ability buffered the indirect effect of DDASI on cancer survivors' HRQoL and psychological distress. Social support buffered the indirect effect of financial hardship on HRQoL and depressive symptoms. Financial resources and social interactions may buffer negative effects of major disruptions such as the COVID-19 pandemic. Future studies should assess the longitudinal impact of these associations.

Sexual Identity Continuity and Change in a U.S. National Probability Sample of Sexual Minority Adults: Associations With Mental Health and Problematic Substance Use.

Sexual minority disparities in behavioral health (e.g., mental health and substance use) are well-established. However, sexual identity is dynamic, and changes are common across the life course (e.g., identifying with a monosexual [lesbian or gay] label and later with a plurisexual [queer, pansexual, etc.] label). This study assessed whether behavioral health risks coincide with sexual identity change among sexual minority people. Associations in a 3-year U.S. national probability sample of sexual minority adults were assessed between sexual minority identity change (consistently monosexual [N=400; 44.3% weighted], consistently plurisexual [N=239; 46.7% weighted], monosexual to plurisexual [N=19; 4.2% weighted], and plurisexual to monosexual [N=25; 4.8% weighted]) and five behavioral health indicators (psychological distress, social well-being, number of poor mental health days in the past month, problematic alcohol use, and problematic use of other drugs), controlling for demographic characteristics and baseline behavioral health. Among female participants, monosexual-to-plurisexual identity change (vs. consistently monosexual identity) was associated with greater psychological distress (B=3.41, SE=1.13), lower social well-being (B=-0.61, SE=0.25), and more days of poor mental health in the past month (B=0.69 [Bexp=1.99], SE=0.23). Among male participants, plurisexual-to-monosexual identity change (vs. consistently plurisexual identity) was associated with lower social well-being (B=-0.56, SE=0.25), and identity change (regardless of type) was generally associated with increased problematic use of alcohol and other drugs. Sexual identity change is an important consideration for sexual minority behavioral health research, with changes (vs. consistency) in identity being an important risk factor for compromised behavioral health. Prevention and treatment interventions may need to tailor messaging to sexual minority men and women differently.

Investigation of Social Constraints, Psychosocial Adjustment and Optimism among Dialysis Patients.

Social constraints are perceived as unsupportive behaviors, leading to inadequate psychosocial adjustment, while optimism can help people recover from distress and reduce any negative effects of chronic disease. The aim of this study was to investigate social constraints, psychosocial adjustment and optimism among patients on dialysis. In this study, 402 patients undergoing dialysis in Greece completed the following questionnaires: (i) the Social Constraints Scale (SCS) for the assessment of social constrains, (ii) the Psychosocial adjustment to illness scale (PAIS-SR) for the assessment of psychosocial adjustment, and (iii) the LOT-R scale for the assessment of optimism. A Mann-Whitney test was used for the comparison of continuous variables between two groups. Spearman correlation coefficients (rho) were used to explore the association of two continuous variables. Multiple linear regression analysis was used with the SCS scale. Greater difficulty in psychosocial adjustment in the domestic, vocational, extended family and social environments, sexual relationships, and health care as well as greater psychological distress were significantly associated with a greater occurrence of social constraints (p < 0.001). Additionally, greater optimism was significantly associated with fewer social constraints and lower difficulty in adjusting to their disease (p < 0.001). Greater difficulty in all dimensions of psychosocial adjustment is associated with more social constraints, while optimism is associated with fewer social constraints and better disease adjustment.