Greater Emotional Distress Research Articles

Screening for religious/spiritual struggle in blood and marrow transplant patients

A growing body of research documents the harmful effects of religious/spiritual (R/S) struggle (e.g., feeling abandoned or punished by God) among patients with a wide variety of diagnoses. Documented effects include poorer quality of life, greater emotional distress, poorer recovery, and increased disability. This study reports the use of a screening protocol that identified patients who may have been experiencing R/S struggle. We also examined the prevalence and correlates of possible R/S struggle, its association with quality of life, pain, and depressive symptoms and compared the results from the screening protocol with social workers' assessments. One hundred seventy-eight blood and marrow transplant patients completed the Electronic Self-Report Assessment--Cancer (ESRA-C) which included the Rush Religious Struggle Screening Protocol and other measures of quality of life, pain, and depressive symptoms prior to transplant therapy. All participants were assessed by a social worker, 90 % within 2 weeks of the ESRA-C assessment. Using the Rush Protocol, 18 % of the patients were identified as potentially experiencing R/S struggle. R/S struggle was not reported in any social work assessments. In a multivariable model, potential R/S struggle was more likely in patients who were more recently diagnosed, male, and Asian/Pacific Islanders. There were no significant associations between potential R/S struggle and quality of life, pain, or depressive symptoms. Early identification of patients with R/S struggle will facilitate their referral for further assessment and appropriate intervention. Further research is needed to identify the best methods of screening patients for R/S struggle.

Social support and self‐management behaviour among patients with Type 2 diabetes

To investigate the relationship between structural and functional social support and patient activation, diabetes-related emotional distress, perceived diabetes care, self-management behaviour and HbA(1c) levels among patients with Type 2 diabetes. Self-administered questionnaires were collected from 2572 patients with Type 2 diabetes. After adjusting for gender, age and education, Tobit and logistic regression models were used to examine associations between social network and patient activation, psychosocial problems, self-management behaviours and HbA(1c) levels. Frequent contact with friends was associated with more positive scores for activation, fewer psychosocial problems, more positive assessment of care and health-promoting self-management behaviours such as frequent exercising and frequent foot examinations. Frequent contact with family was associated with more positive assessments of care. Living with a partner was associated with lower prevalence of smoking, a higher frequency of foot examinations and higher HbA(1c) levels. A poor functional social network, measured as perceived lack of help in the event of severe illness, was associated with low patient activation, greater emotional distress, negative assessment of care, less health-promoting eating habits and less frequent foot examinations. Good social support is significantly associated with health-promoting behaviours and well-being among patients with Type 2 diabetes. However, HbA(1c) levels are higher for cohabitant persons, indicating barriers for social support. Intervention research is needed to investigate the causal relationship between social networks and health-promoting behaviours. This knowledge should be used in clinical practice when targeting and designing education, support and care for patients with Type 2 diabetes.

Life stressors, emotional distress, and trauma-related thoughts occurring in the 24 h preceding active duty U.S. Soldiers' suicide attempts

External life events and internal experiences (i.e., emotional distress and trauma-related thoughts) occurring in the 24 h preceding suicide attempts were examined in a sample of active duty U.S. Soldiers. Seventy-two Soldiers (66 male, 6 female; 65.3% Caucasian, 9.7% African-American, 2.8% Asian, 2.8% Pacific Islander, 4.2% Native American, and 9.7% “other”; age M = 27.34, SD = 6.50) were interviewed using the Suicide Attempt Self Injury Interview to assess the occurrence of external events and internal experiences on the day of their suicide attempts, and to determine their associations with several dimensions of suicide risk: suicidal intent, lethality, and deliberation about attempting. Multiple external stressors and internal states were experienced by Soldiers in the 24 h preceding their suicide attempts, with emotional distress being the most common. Trauma-related thoughts were much less frequently reported in the 24 h preceding suicide attempts. Emotional experiences were directly associated with suicidal intent, and explained the relationship between external events and suicidal intent. Lethality was unrelated to any external events, emotional experiences, or trauma-related thoughts. Greater emotional distress and trauma-related thoughts were associated with shorter deliberation about whether or not to attempt suicide. Soldiers experience multiple sources of distress in the period immediately preceding their suicide attempts. Soldiers who experience more negative emotional experiences have a stronger desire for suicide and spend less time deliberating before an attempt.

Palliative Care in Advanced Cancer Patients: How and When?

Cancer patients develop severe physical and psychological symptoms as a result of their disease and treatment. Their families commonly suffer great emotional distress as a result of caregiving. Early palliative care access can improve symptom control and quality of life and reduce the cost of care. Preliminary results show that early palliative care access can also extend survival. Unfortunately, only a minority of cancer centers in the U.S. have the two most important resources for palliative care delivery: outpatient palliative care centers and inpatient palliative care units. In this article, we use a case presentation to discuss the impact of early palliative care access in light of the currently available evidence, and we recommend ways to improve early access to palliative care through education and research.

Food insecurity, childhood illness and maternal emotional distress in Ethiopia

The relationship between food insecurity, maternal emotional distress and childhood morbidity in resource-poor settings is not well clarified. The present study aimed to assess independent associations between household food insecurity and childhood morbidity and potential modifications by maternal emotional distress. A cross-sectional survey. A food security scale was used to assess household food insecurity; maternal reports were used to assess recent childhood illness; and the Hopkins Symptom Checklist was used to assess symptoms of emotional distress among mothers. The Oromia Region, Ethiopia (rural area). A total of 936 mother-child pairs. Of 936 children assessed, 22·4% had experienced diarrhoea, 20·7% had cough and 21·5% had fever in the 2 weeks preceding the interview. Household food insecurity was reported by 39% of mothers. Greater food insecurity and greater maternal emotional distress were each independently associated with higher prevalence of cough and fever. Among mothers with low emotional distress, food insecurity was associated with a 2·3 times greater odds of diarrhoea in their children. Household food insecurity may increase the risk of childhood illness in rural Ethiopia, and children having mothers with greater emotional distress may be at highest risk. These findings highlight the importance of strengthening policy initiatives aimed at reducing the high prevalence of food insecurity and emotional distress in Ethiopia.

Highly stressed: stressful and traumatic experiences among individuals with HIV/AIDS in the Deep South

A history of traumatic and/or stressful experiences is prevalent among HIV-infected individuals and has been consistently associated with poorer health outcomes. However, little is known about incident stressful experiences and the factors that predict these experiences among HIV-infected individuals. Data from a longitudinal study of 611 HIV-infected individuals in the Southeastern USA were used to examine the frequency and types of incident stress reported in a 27-month period and to determine predictors associated with three incident stress measures (all stressful events, severe stressful events, and traumatic events such as physical assault). Incident stressful experiences frequently occurred among study participants, as 91% reported at least one stressful experience (median=3.5 experiences) and 10% of study participants reported traumatic stress in any given nine-month reporting period. Financial stressors were the most frequently reported by study participants. Greater emotional distress, substance use, and a higher number of baseline stressful experiences were significantly associated with reporting a greater number of incident stressful experiences and any traumatic experiences. Study results indicate that efforts are needed to identify individuals at risk for traumatic events and/or substantial stressors and to address the factors, including mental health and substance abuse, that contribute to these experiences.

Family emotion socialization and affective distress in Asian American and White American college students.

This study examined the retrospective reports of family emotion socialization experiences and current affective distress among 23 Asian American and 31 White American university students with subclinical levels of distress. Results indicated that most of the Asian Americans interviewed recalled being socialized by their family to suppress their emotions, whereas more than half of White Americans recalled being encouraged by their families to openly express emotions. For Asian Americans, growing up in a family that valued emotional suppression was associated with greater emotional distress. (PsycINFO Database Record (c) 2010 APA, all rights reserved)

Ethics and medico legal aspects of "Not for Resuscitation"

Not for resuscitation in India still remains an abstract concept with no clear guidelines or legal frame work. Cardiopulmonary resuscitation is a complex medical intervention which is often used inappropriately in hospitalized patients and usually guided by medical decision making rather than patient-directed choices. Patient autonomy still remains a weak concept and relatives are expected to make this big decision in a short time and at a time of great emotional distress. This article outlines concepts around ethics and medico legal aspects of not for resuscitation, especially in Indian setting.

Restoring Healthy Developmental Trajectories for Sexually Exploited Young Runaway Girls: Fostering Protective Factors and Reducing Risk Behaviors

To examine effects of the Runaway Intervention Program (RIP), a strengths-based home visiting, case management, and group support program for sexually assaulted or exploited young runaway girls; staffed by advanced-practice nurses, RIP aims to restore healthy developmental trajectories by reestablishing protective factors, reducing trauma responses, and lowering risk behaviors that are common sequelae of sexual violence. Quasi-experimental study of RIP girls (N = 68) ages 12 to 15 (mean, 13.75 years), assessed at baseline, 6 and 12 months for changes in family and school connectedness, other adult caring, self-esteem, emotional distress, suicidality, recent substance use, plus risky sexual behaviors. Responses at each time were also compared to nonabused and abused urban ninth-grade girls (mean age, 14.64, N = 12,775) from the 2004 Minnesota Student Survey (MSS). Analyses used paired t-tests, McNemars test, Wilcoxon sign-rank, chi-square, and Pearson's correlations. At entry, RIP girls were most like sexually abused MSS peers, with lower levels of protective factors and higher levels of distress and risk behaviors than nonabused MSS girls (p < .05 to p < .01). However, they saw significant improvements by 6 and 12 months, such that all measures of protective factors, positive development, distress, and risk behaviors more closely resembled nonabused MSS girls by 12 months. Of equal note, RIP girls with the greatest emotional distress, the lowest levels of connectedness, and lowest self-esteem at baseline demonstrated the greatest improvement (all p < .001). This appears to be a promising intervention for restoring sexually abused runaway girls to a healthy developmental trajectory.

Headache sufferers' drawings reflect distress, disability and illness perceptions

ObjectiveDrawings have recently been used with patients with heart problems to assess their perceptions of their illness. This study aimed to investigate whether drawings could be a useful way to assess headache patients' perceptions of their headaches and their reactions. MethodsIn a cross-sectional study, 65 university students who experienced persistent headaches were asked to draw a picture of how their headaches usually affected them. Drawings were assessed in three ways: they were categorized based on content; their size was measured; and image analysis software assessed their darkness. Associations between drawings, illness perceptions, mood, and health outcomes were assessed. ResultsTwenty-seven people drew an external force to the head and these people had greater ratings of average pain and were more likely to attribute their headache to stress. Darker drawings were associated with greater emotional distress and lower vitality. Larger drawing size was associated with perceptions of worse consequences, worse symptoms, worse emotional representations, lower vitality, higher pain, and more days of restricted activity, lower happiness, and higher sadness. ConclusionDrawings offer an additional way to assess peoples' experience of their headaches and reflect illness perceptions and distress. People draw how they see themselves experiencing their headache and often include expressions and reactions. The inclusion of force to the head, darker drawings, and larger drawings are associated with worse perceptions of the headache and higher pain. Drawings may be a useful way for clinicians to understand patients' experience of pain.

Perceived financial status, health, and maladjustment in adolescence

This study examines the relationship between adolescent perception of family financial status and diverse aspects of health and maladjustment. Data were derived from the 2005 Ontario Student Drug Use Survey of 7th–12th grade students in ontario, Canada. This biennial survey monitors mental and physical health, substance use, and delinquent behavior in adolescent students. Results indicate that the significance of perceived financial status varies across adolescent outcomes. Greater emotional distress and lower self-rated health are associated with a perception of below average financial status. The associations of illicit drug use and hazardous and harmful drinking with perceived financial status vary for younger and older adolescents. Adjustments for parental education highlight differences in the influences of perceived financial status and parental education on health and behavior. Results highlight the utility of perceived family financial status in examinations of adolescent health and behavior, and the importance of examining diverse aspects of health and maladjustment.

Employment Outcomes of Persons With a Mental Disorder and Comorbid Chronic Pain

Employment Outcomes of Persons With a Mental Disorder and Comorbid Chronic Pain

Rumination in Interpersonal Relationships: Does Co-rumination Explain Gender Differences in Emotional Distress and Relationship Satisfaction Among College Students?

Rose (Child Dev 73:1830–1843, 2002) found evidence that co-rumination accounts for girls’ greater emotional distress as well as their greater friendship satisfaction compared to boys. Co-rumination is defined as a passive, repetitive discussion of symptoms or problems with a close other. The present study explored the associations between co-rumination in various types of close relationships and both emotional distress and relationship satisfaction in college students. First, confirmatory factor analyses demonstrated that co-rumination is distinct from depressive rumination. Further, co-rumination with one’s closest friend mediated the relationship between gender and both depressive symptoms and friendship satisfaction. Specifically, females reported higher levels of co-rumination with their closest friend, which in turn, predicted their higher levels of depressive symptomatology and friendship satisfaction. In contrast, there were no gender differences in co-rumination in other close relationships, and for the most part, co-rumination in these relationships was not associated with gender differences in emotional distress or relationship satisfaction. Therefore, co-rumination in close friendships may be particularly important in understanding the higher levels of both depression and relationship satisfaction among females compared to males.

Self-reported symptoms of depressed mood, trait anxiety and aggressive behavior in post-pubertal adolescents: Associations with diurnal cortisol profiles

The association between self-reported symptoms and diurnal cortisol profiles was studied in post-puberty adolescents (29 boys and 29 girls, M age = 15.06 years). The adolescents completed the Children's Depression Inventory, State Trait Anxiety Inventory, and an Aggressive behavior scale. The diurnal cortisol profile was derived from three saliva samples, collected at awakening, noon and evening on a week-end day. Univariate repeated measurement regressions revealed that depressed mood and trait anxiety were strongly and aggressive behavior was weakly related to the diurnal cortisol profile: greater emotional distress was associated with flatter diurnal cortisol profiles. Multivariate analysis, however, revealed that only trait anxiety made an independent contribution. Further analyses suggested that trait anxiety was related to elevated evening cortisol rather than to decreased awakening cortisol and that from a trait anxiety score of 38 onwards, high anxious adolescents show clearly higher evening cortisol than low anxious adolescents. These data suggest that anxiety disorder co-morbidity might explain some of the differences in HPA-axis function among depressed patients.

EMDR and Olfactory Reference Syndrome A Case Series

Olfactory reference syndrome (ORS) is an illness currently considered a delusional disorder under the DSM–IV criteria. Patients believe that they emit a foul odor, causing them great emotional distress and negative social consequences. Its etiology is inadequately understood, and there is generally a poor response to pharmacological and psychotherapeutic interventions. This article describes the treatment of four consecutive cases of ORS whose pathological symptoms had endured for 8–48 years. The administration of EMDR consisted of processing the various life experiences that appeared to cause and/or trigger the pathology. The EMDR sessions resulted in a complete resolution of symptoms in all four cases, which was maintained at follow-up. Given the rapid and sustained results, we offer a hypothesis based on the Adaptive Information Processing (AIP) model to explain the etiopathology and remission.

Characterizing the burden of premature ejaculation from a patient and partner perspective: a multi-country qualitative analysis

BackgroundPremature ejaculation (PE) is a common sexual dysfunction among men which affects men and their partners. Little qualitative data are available to characterize the impact of PE on men and their partners about ejaculatory control, sexual satisfaction, emotional distress and relationships. The objective of this study was to assess the impact of PE from the perspective of men with PE and the female partners of men with PE on their sexual experience, distress and relationships.MethodsQualitative data were collected through 14 focus groups in the US and through one-on-one interviews in the US, UK, Italy, France, Germany, and Poland. Study participants included heterosexual men with PE and female partners of males with PE. All participants were asked about how PE affects their daily life, including emotional impacts. One-on-one interviews also included obtaining feedback on the male and female versions of 4-single item measures of PE focusing on ejaculatory control, satisfaction with intercourse, interpersonal distress, and relationship difficulty.ResultsParticipants included 172 males with PE and 67 female partners of men with PE. Lack of control over ejaculation and dissatisfaction with intercourse emerged as central themes of PE. Lack of ejaculatory control resulted in greater dissatisfaction and greater emotional distress, including feelings of inadequacy, disappointment, and anxiety. Continued PE ultimately leads to greater problems with partners and often disrupts partner relationships. Participants indicated that PE was keeping them from attaining complete intimacy in their relationships even when their partners were generally satisfied with sexual intercourse. Impacts of PE on sexual satisfaction, emotional distress and partner relationships were consistent across countries. Feedback on the single-item PE measures confirmed relevance of the item content and further confirmed major themes identified from the qualitative data.ConclusionThis qualitative study provides valuable insights on the substantial psychosocial burden of PE in the US and the Europe. Lack of control over ejaculation resulted in dissatisfaction with intercourse and increased emotional distress, and wide-ranging impact for both men with PE and their partners of men with PE. Data collected in this study may help inform the content of new patient reported measures for use in PE research.

Situational, Psychosocial, and Physical Health—Related Correlates of HIV/AIDS Risk Behaviors in Homeless Men

A biopsychosocial perspective is employed to assess associations among situational and psychosocial variables related to health, health care, and HIV/AIDS risk behaviors among 479 homeless men (aged 18-64 years). Poor health was not significantly associated with sexual risk behaviors and was only modestly associated with injection drug use (IDU). Health care was not significantly associated with sexual risk behavior or IDU. HIV/AIDS risk behaviors were highly associated with homelessness severity and posttraumatic stress disorder. IDU was significantly associated with greater emotional distress and was more likely among younger men and among White men. Sexual risk behavior was more frequent among those who had particularly poor-quality housing such as living on the street or in abandoned buildings. Because interactions with the medical community are limited and not associated with HIV/AIDS risk, outreach in areas in which homeless men congregate, mental health and substance abuse treatment, and permanent supportive housing may help reduce HIV risk among homeless men more effectively.

Association of baseline characteristics and motivation to change among patients seeking treatment for substance dependence

Background The current study evaluated the bottoming out hypothesis by determining the extent to which composite measures of motivation to change are associated with baseline characteristics among patients seeking treatment for substance dependence. Methods Two hundred treatment-seeking substance-dependent veterans were assessed. Motivation to change was assessed using the composite measures of Readiness to Change (RTC) and Committed Action (CA) derived from the University of Rhode Island Change Assessment. Baseline characteristics included recent life stressors, addiction severity, depression, anxiety and hostility. Linear regression was used to determine the association between baseline characteristics and the composite measures of motivation to change while controlling for age, gender and race. Results Linear regression indicated that RTC and CA were associated with different baseline characteristics. RTC was associated with anger expression ( B = −.28; 95% CI = −.6, −.01) and recent life events ( B = 1.1; 95% CI = .01, 2.2). CA was associated with alcohol problems ( B = −.33; 95% CI = −.62, −.05) and state anxiety ( B = −.13; 95% CI = −.21, −.04). Conclusions Our findings suggest that motivation to change was negatively, not positively, associated with greater emotional distress and problem severity. With the exception of recent life events, these findings are contrary to the notion of hitting bottom. Composite measures of RTC and CA also appear to represent different types of motivation to change.

The Emotional Well-Being of Asian-American Sexual Minority Youth in School

This study examined family and school correlates of emotional distress among Asian-American sexual minority youth in the Midwestern United States. Responses from 91 predominantly among Asian-American youth who participated in a state-wide, school-based census survey and reported recent same-gender sexual activity were analyzed. Results showed that sexual minority youth who perceived lower levels of family caring and those with negative perceptions of school climate reported lower self-esteem, which in turn was associated with greater emotional distress. These results highlight the importance of safe and caring environments, and culturally sensitive support for Asian-American sexual minority adolescents.

Getting Attica Out of Her Mind: A Psychoanalytic Memoir

This psychoanalytic memoir of trauma, treatment, and creative growth begins when Rosie was admitted to the Masters Children's Center in 1960, at the age of three, to participate in a project on autism designed by Dr. Manuel Furer and Margaret Mahler in which Anni Bergman was a participating analyst. Mahler was experimenting with a tripartite treatment design, which was built on the premise that autistic children had "never formed a symbiotic relationship with their mothers from which the process of separation-individuation, culminating in the achievement of object constancy, could evolve" (Bergman 1989). Mahler believed that by working with the mother separately, with the mother and child together, and with the child separately an autistic child could be lured from a cocoon of fantasy and self-protection by the therapist; only then might the mother's initial visceral connection to the child (and hers to the mother) be reestablished, allowing normal development to resume. Rosie's parents were hopeful that the Masters Program would help with Rosie's failure to speak, her wild behavior, and her sleepless nights, all of which caused them great emotional distress and created a chaotic atmosphere in the home. They were willing to bring Rosie to the center four times per week, and to remain in the two-and-a-half-hour sessions with Rosie. The treatment largely involved Rosie and her mother, although her father was very supportive to the process. Rosie was in treatment for a period of sixteen years. She then married, moved to Asia, and raised two children. When she lived abroad, she kept in contact with Bergman via telephone calls, letters, paintings, and diaries, and also scheduled analytic sessions during her yearly vacations. When Rosie [End Page 315] returned to New York after her children were grown, she re-entered therapy with Bergman, and this arrangement continues to the present. A professional painter and occasional writer, Rosie is beginning to work on a memoir about her experiences. When I met Anni Bergman in 2001, she was searching for a professional writer to help her sort through over 2,000 pages of materials documenting Rosie's story. The data include the therapeutic notes and reports, analytic papers published about the case, Rosie's diaries, stories, drawings, paintings, letters, and two novels, as well as hours of videotape and film about her analysis. Bergman always had Rosie's consent to publish therapeutic texts about her analysis because Rosie was hopeful that her story could help others like her, but publication for a more popular audience had become a recent goal. At the time that I first heard about Rosie's story, I already knew Bergman to be a Viennese-born analyst who had worked closely with Margaret Mahler. An Associate Professor and Supervisor at New York University Post-Doctoral Program in Psychotherapy and Psychoanalysis, a Training and Supervising Analyst at the New York Freudian Society (where she directs a three-year program in infant studies), and a Training and Supervising Analyst at the Institute for Psychoanalytic Training and Research, Bergman is famous for her sensitive and creative approach to therapy with severely mentally-ill and traumatized children. Once we decided to work together, I visited her many times in her home in New York to conduct interviews. Bergman gave me all the data related to the project, which I compiled with the help of my tireless assistant, Jessie Janushek. When little Rosie met Bergman, she was mute, making no eye contact or other response to people, neither to parents nor others, and she was prone to violent outbursts of temper. After five years of treatment she began to speak and write. Eventually she completed high school and, as I have noted, married, moved to Asia, and successfully raised two children. How did 5Rosie emerge from her position as a mute, violent, withdrawn child to become a writer...