Higher Distress Research Articles

The relationship between frontal alpha asymmetry and self-report measurements of depression, anxiety, stress, and self-regulation

Though previous research yielded inconsistent results, studies suggest an association between frontal alpha asymmetry (FAA), mood, and self-regulation. This inconsistency may be explained by the heterogeneity of experimental protocols and sample characteristics such as the baseline level of distress. The aim of the study was to gain a better understanding of the relationship between FAA and self-report measurements of depression, anxiety, stress, and self-regulation. Using data from 130 participants (Mage = 25.2; SD = 6.8), we conducted correlation analyses and Bayesian statistics to examine these associations. The results revealed moderate-level positive correlations among depression, anxiety, and stress scores measured by the Depression Anxiety Stress Scale, with notable negative correlations observed between self-regulation and depression, as well as between self-regulation and stress. The relationship between FAA and mood was sample-dependent, and effects were restricted to the sample with moderate to extreme levels of distress, revealing consistent patterns within these subgroups. Most importantly, there was a negative correlation between FAA and anxiety. However, there was no clear association between FAA and depression. Consequently, our results show that self-regulation is associated with reduced distress, and that FAA may be a useful biomarker for anxiety in individuals with moderate to high baseline distress levels.

Lack of diversity in patients undergoing carotid artery stenting: Implications for the Distressed Community Index.

As the role of social determinants in carotid artery stenting (CAS) outcomes remains unclear, we investigated the association between the Distressed Community Index (DCI) (zip-code based) and post-CAS mortality/stroke outcomes. We analyzed patients undergoing CAS from 2015 to 2019 using the Medicare claims-linked Vascular Quality Initiative database. Patients were grouped based on high (DCI ⩾ 60) and low (DCI < 60) community distress. We analyzed 36-month mortality using Kaplan-Meier survival curves and hierarchical Cox regression, and 36-month stroke using cumulative incidence function curves and Fine-Gray models. The final cohort included 8717 patients (3032 DCI ⩾ 60), with a mean DCI score of 46.2 (± 28.5) and mean age of 74.7 (± 7.8) years. Most participants were men (64.3%), White (92.7%), and non-Hispanic/Latino (97.7%). There was no significant difference in the 36-month mortality incidence between high and low community distress groups (25.6% vs 23.5%, p = 0.22), and no significant association between high community distress and mortality (unadjusted HR: 1.04; 95% CI 0.90-1.21; adjusted HR: 1.02; 95% CI 0.89-1.17). The high community distress group experienced an elevated 36-month stroke incidence (26.8% vs 22.4%, p = 0.048), but no significant association with stroke was observed (unadjusted sub-HR: 1.12; 95% CI 1.00-1.24; adjusted sub-HR: 1.03; 95% CI 0.92-1.16). Our cohort showed underrepresentation in terms of sex, race, and ethnicity, with a skewed DCI distribution towards lower community distress. Contrary to what we know about community distress, no independent association between higher community distress and post-CAS stroke/mortality risk was found. Future work must examine whether accessibility barriers and selective CAS allocation explain our results.

Examining the Empathy Profiles and Work Outcomes of Trauma Workers

Trauma work involves intervening with others enduring acute pain and suffering, often with heavy psychological and physical health impacts. An important question is whether dispositional empathy helps or hurts trauma workers in their occupational functioning. The current study addresses this gap in the research literature by using a person-centered approach to examine the empathy profiles and professional outcomes of a broad sample of trauma workers ( n = 315). We measured their trait empathy and organizational outcomes (occupational burnout, person-job fit, turnover intentions, job performance), and found three distinct empathy profiles which differed significantly in their occupational functioning. A ‘self-focused’ empathy profile (dominated by high personal distress responding) reported the worst functioning; an ‘other-oriented’ profile (high on perspective taking and empathic concern) had more positive functioning, and an unexpected ‘low reactivity’ profile (a full SD below the general population on empathy facets) showed the lowest exhaustion. Exploratory analyses revealed that first responders (e.g., police, firefighters, EMTs, paramedics) were overrepresented in the ‘low reactivity’ profile, while psychology-related professions (e.g., psychologists, counsellors, social workers) were underrepresented in that profile. The significance of these results, as well as their implications for empathy research and vocational counselling in the field of trauma work, are discussed.

The emotional burden of type 1 diabetes: A cross-sectional study to understand associations between diabetes distress and glucose metrics in adulthood.

Advancements in type 1 diabetes (T1D) management, such as continuous glucose monitoring (CGM), have helped people achieve narrower glucose ranges, but associations between CGM and diabetes distress are unclear. Although higher HbA1c is associated with higher distress, associations with other glucose metrics are unknown. To better understand this relationship, we characterized diabetes distress in a sample of CGM users and compared differences in glucose metrics (measured via CGM) between those with higher versus lower distress. CGM users with T1D from the T1D Exchange Registry completed an online survey including diabetes distress (DDS-2) and shared CGM data (N = 199). CGM metrics were computed from all available data within 3 months prior to survey completion. Participants were grouped by distress level: lower (DDS-2 < 3, n = 120) or higher (DDS-2 ≥ 3, n = 79). Welch's t-tests were used to compare mean differences in CGM metrics between groups and MANCOVA was used to further probe mean differences. Approximately 39.7% participants reported higher diabetes distress. Welch's t-tests revealed participants with higher distress spent significantly more time in higher glucose ranges (above 180 mg/dL and above 250 mg/dL), less time in target glucose ranges (between 70 and 180 mg/dL and between 70 and 140 mg/dL) and had higher glucose management index values compared to those with lower distress (p < 0.01). MANCOVA models showed similar results. CGM users continue to experience diabetes distress. Moreover, higher distress appears to be associated with hyperglycaemia. These findings provide support for broader screening efforts for diabetes distress.

Feasibility and acceptability of the Problem Management for Moms programme for improving maternal mental health in Zambia: an open-label trial

Psychological distress is common among mothers in low-income and middle-income countries, limiting their capacity to care for themselves and their children. This study aimed to test the feasibility and acceptability of an adapted psychosocial intervention for distressed mothers in low-resource settings. In this open-label trial, we enrolled women living in Lusaka, Zambia, with high mental distress (>7 score on the 20-item Self-Reporting Questionnaire [SRQ-20]) and children younger than 2 years, who had previously enrolled in the ZamCharts early childhood nutrition trial. We randomly assigned participants (1:1) to the intervention or control group using a random number draw. The intervention was a newly developed Problem Management for Moms (PM4M) programme: a ten-session treatment adapted from Problem Management Plus, which was offered by phone or in person. After randomisation, participants in the intervention group underwent pre-intervention screening, a post-intervention assessment, and a final follow-up assessment 9 months after treatment initiation (ie, final follow-up visit). The control group was assessed at the baseline of ZamCharts and at the final follow-up assessment, and these participants did not receive any intervention. The primary study outcomes were feasibility, acceptability, and participant mental distress measured using the SRQ-20. All primary and secondary outcomes were estimated in the intention-to-treat population, which included all participants who were randomised to the intervention group and attended the final follow-up assessment. Data on ethnicity were not collected. The trial is registered at ClinicalTrials.gov, NCT05627206, and has been completed. Women with lived experience of mental health symptoms were involved in this study. Between April 26, and July 14, 2021, 790 women were interviewed in the ZamCharts trial, of whom 265 had high mental distress and were randomly assigned to treatment groups in this trial (134 to the intervention group and 131 to the control group). Of the 134 women in the intervention group, 61 (46%) received the PM4M intervention and 73 (55%) were excluded; 103 in the intervention group and 106 in the control group were successfully interviewed at the final follow-up assessment. The mean age of participants was 27·6 years (SD 7·6) at ZamCharts baseline. PM4M sessions were conducted between Dec 16, 2022, and May 6, 2023. The 61 participants deemed eligible after pre-intervention screening who started the intervention completed a mean of 7·9 (SD 2·9) of ten sessions. 55 (77%) of these 61 participants were somewhat or very satisfied with the intervention. In adjusted intention-to-treat models, the intervention reduced mean SRQ-20 scores by 2·11 points (95% CI -3·50 to -0·63) at the final follow-up, and the adjusted odds ratio of having an SRQ-20 of more than 7 was 0·50 (95% CI 0·27 to 0·93). No serious adverse events were reported. The results presented here suggest that the PM4M mental health intervention is feasible and has high rates of acceptability. Further research is needed to assess the long-term efficacy of this intervention on women and their children, and its suitability for integration into routine care. The Eckenstein-Geigy Professorship.

The Association of Migration-Related Stress with Poor Mental Health Among Recently Resettled Afghan Refugees

BackgroundThe resettlement of Afghan refugees in Oklahoma City, OK, provides a critical context for examining the mental health challenges faced by this population due to post-migration stressors. MethodsThis study utilized online surveys to recently resettled Afghan refugees in Oklahoma City, with support provided by bilingual research assistants to accommodate low literacy rates. Surveys, initially in English, were professionally translated into Dari and Pashto and validated through back-translation. ResultsParticipants (N= 348) were majority of Pashtun ethnicity. High rates of mental health issues were evident, with 62.1% of participants screening positive for depression and 20.1% for probable GAD. Logistic regression analysis revealed that lower pre-migration socioeconomic status (SES) and high post-migration stressors such as discrimination and loss of homeland were significantly associated with increased mental health problems. Stress related to the worry for and loss of their homeland was a substantial predictor of high distress (AOR= 2.71, p <.001), anxiety (AOR= 1.99, p =.001) and depression (AOR= 2.65, p<.001). Experiences of discrimination post-resettlement was also associated with anxiety (AOR 4.92, p <.001). DiscussionThe findings highlight the profound impact of post-migration stressors on the mental health of Afghan refugees. This study underscores the need for targeted interventions to address the specific challenges faced by refugees, such as language barriers, employment, legal support, and anti-discrimination measures, to facilitate better integration and improve mental health outcomes. ConclusionEnhanced community integration programs and comprehensive support services are essential to mitigate the mental health challenges faced by Afghan refugees, suggesting a broader application for such approaches in similar resettlement contexts globally.

Within-couple comparison of maternal and paternal distress in an Italian birth cohort

ObjectiveThis study compared parental distress in 166 couples, using the Parenting Stress Index–Short Form (PSI-SF), in the Italian NASCITA cohort at the two-year well-child visits. The study explored the concordance of distress levels within couples (aim 1) and their correlation with child-related stressors (aim 2).BackgroundPrevious studies focused on maternal distress or considered maternal and paternal experiences separately, without addressing differences within couples.MethodData on parental distress were collected from the PSI-SF completed separately by parents. The total score was derived from three subscales, with high distress defined by a score above 85. The Wilcoxon signed-rank test compared the total PSI-SF scores of mothers and fathers. The prevalence of high distress was assessed using chi-square tests, and concordance between parents within the same couple was estimated using Cohen’s K statistic. Chi-square tests were also used to compare distress levels in parents exposed to potential child-related stressors versus those not exposed.ResultsA slightly higher total score (z = -2.45; p = 0.01) was observed in mothers versus fathers, although the prevalence of distress was similar (15.1% vs. 13.9%, respectively; p = 0.76). Nine children (5.4%) had both parents distressed. Agreement in the high level of distress was observed for 81.9% of the couples, with a fair agreement on the total score (Cohen’s K = 0.27).The percentage of children with both distressed parents was slightly higher in the group exposed to potential stressors (6.6% vs. 4%, p = 0.49).ConclusionsIt is essential to evaluate distress in parents exposed to potential stressors related to child characteristics early. This assessment should be part of the pediatric family practice to prevent adverse outcomes in both child and parental wellbeing.

A Mindfulness-Integrated Therapeutic Approach to Enhance Client Engagement with Prolonged Exposure and Habit Reversal Therapy and Bolster Therapist Trainee Self-Efficacy and Distress Tolerance

Despite the established efficacy of exposure-based trauma treatments, such as prolonged exposure (PE), clinicians’ and clients’ concerns about these therapies hinder their widespread implementation. Clinicians report experiencing low self-efficacy and high distress when delivering PE, while patients doubt the credibility of this treatment, contributing to patient dropout. To tackle such challenges, mindfulness-based therapeutic approaches have been used. In the current case involving PTSD due to childhood sexual abuse (CSA) and coercive sex, trichotillomania, excoriation disorder, and depression, mindfulness practices and principles were woven into PE and habit reversal therapy (HRT). The therapist, a trainee with no prior trauma treatment experience, felt that her ability to manage the client’s distress during treatment and her confidence in delivering therapy was enhanced by her own mindfulness practice, and further reinforced by the pervasive integration of mindfulness throughout treatment. Likewise, the client attributed her capacity to engage in PE and HRT to the mindfulness practices and principles woven into treatment. Mindfulness also assisted in coalescing the concomitant delivery of PE and HRT. Following 21 sessions of mindfulness-integrated PE and 17 sessions of mindfulness-integrated HRT, the client no longer met criteria for PTSD and depression, eradicated her body-focused repetitive behaviors (BFRBs), and disclosed her index trauma with loved ones. These improvements were maintained at one-year follow-up, underscoring the potency of mindfulness therapeutic integration to enhance therapists’ distress tolerance and self-efficacy, clients’ treatment engagement, and overall therapeutic outcomes in complex cases.

Client characteristics and early working alliance development: A person-centered research approach

Objective Certain client characteristics are associated with early working alliance difficulties in psychotherapy. However, there is limited quantitative evidence on whether combinations of these characteristics (e.g., intersectional identities, prior treatment experiences) are related to alliance development. The present study leveraged a person-centered research approach to examine profiles of early alliance development and differences in the latent class structure of client characteristics among alliance development profiles. Method Individual psychotherapy clients (N = 2,579) rated the working alliance for their first four sessions and self-reported demographics, treatment history, and psychological distress. Therapists provided their assessment of clients’ primary presenting concerns at baseline. Results Latent profile analysis revealed three profiles of working alliance development: high and stable, moderate and increasing, and low and stable. Follow-up person-centered analyses (multigroup confirmatory latent class analysis) indicated that clients in the alliance profiles differed in their combinations of clinical and demographic characteristics. For example, women of color with high baseline distress and a history of prior psychotherapy were over-represented in the low and stable alliance profile. Conclusion These results are consistent with recommendations to holistically consider how clients’ characteristics and experiences shape psychotherapy processes. Results also highlight the utility of person-centered quantitative methods in psychotherapy research.

The Supportive Care Needs of Individuals Living With Advanced or Metastatic Lung Cancer Receiving Targeted or Immunotherapies.

Lung cancer is associated with the highest incidence and mortality of all cancers. New treatments, called targeted therapies (TT) and immunotherapies (IO), offer higher treatment efficacy and fewer side effects compared to traditional treatments but are accompanied by uncertainty and an unpredictable treatment course. There is a paucity of research on the experiences of individuals living with advanced or metastatic lung cancer receiving TT/IO, and even less is known about the supportive care needs of this population. Twenty four participants from across Canada participated in semi-structured interviews regarding their supportive care needs. Thematic analysis was utilized to identify their supportive care needs. Qualitative coding identified unmet needs and challenges. All participants indicated difficulties with unmet supportive care needs, including psychological, informational, and practical needs. The exploration of supportive care experiences of patients receiving TT/IO exposes high distress and unmet needs. Results indicate the need for timely and accessible supportive cancer care. Results can inform patient advocacy efforts and the development of new services.

Understanding the interplay of compassion fatigue and moral resilience on moral distress in ICU nurses: a cross-sectional study.

Intensive Care Unit (ICU) nurses frequently confront significant psychological challenges, including compassion fatigue, moral distress, and diminished moral resilience. These issues not only affect their well-being but also impact the quality of care provided to patients. The interplay of these factors is complex and not fully understood, particularly how compassion fatigue influences the relationship between moral resilience and moral distress. To explore the complex interplay between compassion fatigue and moral distress among ICU nurses, and to elucidate how compassion fatigue influences the protective role of moral resilience against moral distress. A cross-sectional study was conducted using a nationwide random sample of ICU nurses in China. Latent profile analysis identified subgroups based on levels of compassion fatigue. Moderation analysis examined whether compassion fatigue moderated the association between moral resilience and moral distress. Among 612 ICU nurses, latent profile analysis revealed three distinct groups with high, moderate, and low levels of compassion fatigue. Being female was protective against high compassion fatigue, while ages 30-49 yrs., lack of bachelor's degree, and dissatisfaction with salary increased compassion fatigue risk. Moderation analysis showed compassion fatigue significantly moderated the relationship between moral resilience and moral distress. Nurses with higher compassion fatigue exhibited a stronger association between low moral resilience and high moral distress. Compassion fatigue and moral distress are interconnected phenomena among ICU nurses. Demographic factors like gender, age, education, and income satisfaction impact compassion fatigue risk. High compassion fatigue impairs moral resilience, exacerbating moral distress. Comprehensive interventions targeting both compassion fatigue and moral resilience, tailored to nurses' demographic profiles, are needed to support this workforce.

Perceived distress and relational boredom during the COVID-19 pandemic: The role of shared leisure time

The COVID-19 pandemic was a time of heightened distress that may have informed couples’ time engaging in shared leisure and, ultimately, negative relational outcomes. A growth-security framework was used to classify shared leisure time into security-restorative (i.e., familiar and comfortable) and growth-enhancing (i.e., novel and exciting). We followed a community sample (N = 257) of people in intimate relationships over six-weeks during the lockdown. Each week we measured perceived distress, subjective shared leisure time, and relational boredom. Multilevel modeling revealed a lack of evidence to support distress increasing shared security-restorative leisure time. However, perceived distress was positively related to relational boredom. Specifically, people who were more distressed than others reduced their time spent engaging in growth-enhancing activities with their partner which, in turn, was associated with relational boredom. Therefore, in the long-term, high environmental distress resulted in less time spent on growth-enhancing shared leisure, likely resulting in more relational boredom.

Psychological Factors and Blood Pressure Responses to Acute Stress in Women with Takotsubo Syndrome: An Exploratory Study.

This secondary analysis aimed to: 1) describe psychological resources and distress in women with Takotsubo Syndrome (TS), and 2) explore whether such factors affect blood pressure (BP) responses to acute mental stress. Participants were 47 women consecutively enrolled in an ongoing study examining the prognostic significance of stress reactivity in TS. Psychological resources (resilience, adaptive coping) and distress (depression, anxiety, PTSD, perceived stress) were self-reported using validated questionnaires <12 weeks after TS. Using a standardized protocol, systolic BP (SBP) and diastolic BP (DBP) (mmHg) were measured every 5 minutes during baseline (10 min), mental stress (10 min), and recovery (20 min). Associations of psychological resources and distress (high vs. low composite scores), respectively, with BP during mental stress and recovery (change from baseline) were examined using one-way ANCOVAs (covariates: age, anti-hypertensive medications). Given the study's exploratory nature, results are shown as effect sizes.On average, women (Mage= 64.3 years) had high perceived stress, anxiety, and PTSD symptoms and low resilience. Women with high (vs. low) psychological distress displayed less complete SBP (d=.57) and DBP (d=.33) recovery to baseline. Women with low (vs. high) psychological resources demonstrated lower SBP responses during mental stress (d=-.26) alongside a more complete SBP recovery (d=.30). Female survivors of TS with high psychological distress exhibited impaired BP recovery following acute mental stress. While the prognostic significance of impaired BP recovery from mental stress remains to be determined in longitudinal studies, this finding could help identify TS survivors at risk for recurrence.

Using a Patient-Reported Outcome Measure to Assess Physical, Psychosocial, and Existential Issues in COPD.

Background: Chronic obstructive pulmonary disease (COPD) is marked by severe physical symptoms, impaired quality of life, and high psychological distress. Despite its impact, the identification of not only physical but also psychosocial and existential issues in the clinic lags behind that of other patient groups. Methods: This study aimed to assess physical, psychosocial, and existential issues among patients with COPD using a patient-reported outcome measure for general palliative care (the 'PRO-Pall') in a Danish outpatient clinic. We included 115 adults with COPD who completed the PRO-Pall either electronically or in the clinic. Sociodemographic and illness-related data were retrieved from their electronic health records. Results: We found that shortness of breath, tiredness, and difficulty walking were predominant physical issues. Worry about change in social roles was the most frequently reported psychosocial issue, while existential issues were reported by approximately one in ten patients. Most patients (44.5%) felt able to share their feelings with family or friends, and a majority (62.2%) felt their illness-related issues were addressed satisfactorily. Females expressed a greater need for rest and males more frequently reported intimacy issues. Higher COPD-impact on life measured by the COPD Assessment Test was associated with lower ratings on the quality-of-life item of the PRO-Pall independent of age, gender, lung function, and smoking status. Conclusions: Patients reported issues in physical, psychosocial, and existential dimensions of the PRO-Pall. The PRO-Pall shows potential as a broader alternative to measures that focus mainly on physical issues.

The social process linking neighborhood social fragmentation and individual psychological distress

The current study assessed the social process linking neighborhood social fragmentation with individual psychological distress. Social fragmentation was operationalized as a perception of limited social cohesion within a neighborhood. Data were collected from two waves in the United Kingdom (T1 N = 705; T2 N = 534). Participants completed an online survey with measures of perceived social cohesion, social support, perceived social isolation at Time 1 and completed a follow up survey six months later with measures of psychological distress. Structural equation modeling was used to test a serial mediation model. The results support the hypothesis that social support and isolation mediate the relationship between limited social cohesion (i.e., social fragmentation) and psychological distress. Living in neighborhoods marked by social fragmentation is predictive of decreased social support that in turn predicts greater perceptions of social isolation, and ultimately predicts high psychological distress.

A Study of Diabetes Correlated Emotional Distress among Patients with Type 2 Diabetes Mellitus: A cross Sectional Study

Background: Diabetes distress (DD) is a significant concern for individuals with type 2 diabetes, marked by emotional strain related to disease management and support, distinct from general psychological distress. Specific Background: Addressing DD can improve self-care practices and glycemic control, yet limited research exists on the relationship between emotional distress and sociodemographic factors in this population. Knowledge Gap: This study aims to fill this gap by exploring how sociodemographic traits influence emotional distress among type 2 diabetes patients. Aims: The primary objectives are to identify the correlation between emotional distress and diabetes and to determine the impact of sociodemographic characteristics on this distress. Results: A descriptive cross-sectional study conducted at the Endocrinology and Diabetes Center in Al-Basrah City included 150 patients aged 50–65 years, with a significant proportion of men (63.3%). The findings revealed a mean emotional distress score of 3.81, indicating high distress levels, with physician-associated distress at 3.32 and regimen-related distress at 3.48. Novelty: This research highlights the strong correlation between emotional and diabetes-related distress, particularly across different age and gender demographics, thus emphasizing the need for tailored interventions. Implications: The study emphasizes the importance of incorporating psychological assessments into diabetes management and policymakers' consideration of emotional dimensions in health program designs to improve patient self-management and quality of life. Highlights: Diabetes distress impacts self-care and glycemic control. Socio-demographics influence emotional distress levels in patients. Psychological assessments are crucial in diabetes management strategies. Keywords: diabetes distress, emotional distress, type 2 diabetes, sociodemographic factors, healthcare interventions

The association of resilience with HbA1c and key psychosocial factors in emerging adults with type 1 diabetes.

Emerging adults (EAs) with type 1 diabetes (T1D) have difficulty meeting glycemic targets and have a high prevalence of mental health comorbidities. Resilience, the ability to harness resources needed to sustain one's emotional and physical well-being, may be a key factor impacting poor mental health and glycemic outcomes. We aimed to (a) evaluate the association between resilience, HbA1c, and key psychosocial factors and (b) explore whether resilience moderates the relationship between psychosocial factors (depression, diabetes-related distress, anxiety) and HbA1c in EAs with T1D. EAs with T1D (N = 233) (mean age = 19.9 years (SD = 1.6), range 16.8-24.7) seen at an EA-specific diabetes clinic completed resilience, diabetes-related distress, depression, and anxiety measures and had their HbA1c level evaluated. We used linear regression models and conducted moderation analyses for the resilience factor. Resilience was strongly associated with HbA1c, depression, diabetes-related distress, and anxiety in EAs with T1D. We did not find evidence that resilience moderates the relationship between depression, anxiety, or diabetes-related distress and HbA1c. This study found that resilience is a highly relevant psychological factor associated with HbA1c and a key mental health factor for EAs with T1D. Novel interventions are needed to ameliorate high diabetes-related distress and HbA1c, and bolstering resilience may be one avenue to explore. Future research on resilience should longitudinally characterize and evaluate whether resilience may be a mechanism underlying the relationship between poor psychosocial outcomes and not meeting glycemic targets in EAs with T1D.

Changes in sleep patterns in people with a history of depression during the COVID-19 pandemic: a natural experiment

BackgroundThe COVID-19 pandemic, while a major stressor, increased flexibility in sleep–wake schedules.ObjectivesTo investigate the impact of the pandemic on sleep patterns in people with a history of depression and identify...

Psychological distress and trajectories of sleep duration among Australian adolescents: a prospective cohort study

ObjectivesThis study investigated the association between indicators of psychological distress and well-being and trajectories of sleep duration among a cohort of Australian adolescents.DesignA prospective cohort of adolescents was followed over...

Impact of Cancer Care Financial Assistance Program on client financial toxicity and emotional distress.

204 Background: The financial impact of cancer can include high out-of-pocket costs, compensatory trade-offs (e.g., postponing treatment), and emotional distress. Cancer Care developed its Financial Assistance (FA) Program to assist with cancer-related costs and reduce client financial and emotional burden. We examined the impact of Cancer Care ’s FA Program on financial toxicity and emotional distress in clients undergoing cancer treatment. Methods: 731 patients enrolled in Cancer Care ’s FA Program (1/23-12/23) completed an evaluation survey. Clients were primarily women (71%); mean age=58 ( SD =13); 47% were non-Hispanic White, 33% non-Hispanic Black, 12% Hispanic. 84% were not employed; median household income $20K; 98% insured. Most frequent diagnoses: breast (26%), multiple myeloma (8%), and colon (5%) cancers; mean years since diagnosis=3 ( SD =6). All were on treatment (85% chemo; 38% radiation; 13% hormone; 11% immunotherapy). We used descriptive and multivariable regression analyses to examine the impact of FA and the correlates of reduced financial stress (yes/no) and emotional distress (not at all–extremely), controlling for socio-demographics. Results: The median grant award was $300 (max: $3000). FA was most often used for transportation (48%), household costs (43%), food (40%), and medical costs (30%). Only 38% of clients were aware of non-insurance financial resources during treatment. Financial compensatory trade-offs included delaying treatment (19%), choosing a less expensive treatment (7%), and stopping treatment (5%). Regarding financial toxicity, 61% reported that FA reduced their financial stress. In logistic regression, factors associated with greater likelihood of reduced financial stress after FA were larger grant amounts ( OR =1.05; p =.04), using FA for transportation ( OR =1.59; p =.00) or medical costs ( OR =1.44; p =.04), and unemployment ( OR =1.69; p =.02). Regarding emotional distress, 67% were distressed/extremely distressed before FA, vs. 25% after FA ( t =-21.72; p =.00). In linear regression, using FA for medical costs was associated with lower distress ( B =-.29; p =.00), and stopping treatment due to finances was associated with higher distress ( B =.52; p =.00), controlling for baseline distress. Using FA for other needs was not significantly associated with reduced financial/emotional distress. 50% said FA met their needs well/very well; 78% were satisfied/very satisfied with the program. Conclusions: Our results show the impact of Cancer Care ’s FA Program on reducing client financial toxicity and emotional distress, known factors in treatment adherence, quality of life, and survival. Notably, use of FA for medical and transportation costs, and grant amount, were significantly associated with improved client outcomes. Clients using funds for other basic needs may have multiple stressors requiring comprehensive multilevel support beyond FA alone.