Higher Distress Research Articles

Assessment of Incidence of Distress and Utilization of Supportive Care Services in Multiple Myeloma Patients, a Retrospective Single Center Experience

Introduction: Multiple myeloma (MM) is the second most common hematological malignancy. Current literature represents substantial underutilization of guideline-recommended supportive services (SS) in MM patients. Earlier studies have shown that most patients with MM have focal osseous lesions leading to skeletal-related events, fractures, pain, and debility. These events may negatively affect the treatment course and result in poor quality of life. Recent NCCN and ASCO guidelines recommend utilization of SS in all patients by early integration of cancer care for symptom control while being treated for primary malignancy. We evaluated the level of distress in patients (pts), SS utilization, ED visits, and hospitalization in pts with MM. Methods: We included adult patients (≥18 years) with newly diagnosed or relapsed/refractory MM at Levine Cancer Institute who had completed an electronic distress survey (EDS) within three months of diagnosis or relapse. Amyloidosis and plasma cell leukemia diagnoses were excluded. The EDS includes questions related to sociodemographic, patient-reported outcomes (PROs): distress level, physical symptoms (scale 0 - 10), screening for depression (PHQ-2, scale 0 - 6), anxiety (GAD-2, scale 0 - 6),Utilization of at least one SS (social work, palliative medicine, psych-oncology, cancer rehab, integrative medicine, and nutrition) within 6 months of EDS and emergency department visits/hospitalizations within 1 year of EDS were collected, retrospectively, from the electronic medical record. The PROs were summarized overall and compared among three distress groups [Distress score (DS) <4, 4-6, ≥7] with Wilcoxon rank sum tests for the EDS symptom scores and Fisher's exact tests for other categorical endpoints. Results: 541 MM pts were identified with an EDS within 3 months of diagnosis or relapse (assessment date range: January 2017 - May 2022), with 71.5% of those occurring near diagnosis, and 28.5% occurring around relapse. The mean age was 64.9 years, 58.6% were male, and additional patient characteristics are presented in Table 1. There were 33.8% (n=183) pts with DS<4, 30.9% (167) with DS 4-6, and 35.3% (191) with DS of ≥7. The highest scoring EDS symptoms were pain (mean score 4.7), fatigue (5.1) and sleep disturbance (3.6). Broadly, patients with higher distress scores had higher symptom scores (p<0.05 for all symptoms). There were 77.6% (420) pts with anxiety GAD-2 score of 0-2, 12.9% (70) pts with a score of 3-4 and 9.4% (51) pts with a score of 5-6. Similarly, for depression, 76.9% (416) pts reported a PHQ-2 score of 0-2, 15% (81) with a score of 3-4, and 8.1% (44) with a score of 5-6. For anxiety and depression, patients with higher DS had higher depression and anxiety screening scores (p <0.001), as shown in Table 2. 64.3% (348) pts utilized at least one SS within six months of their initial EDS assessment. The rate of utilization of at least one SS increased with DS (49.2% in DS <4, 67.1% in DS 4-6, and 76.7% in DS ≥7; p value<0.001). Numerically, more patients with high distress had at least one ED visit within a year of EDS (25.7% DS <4, 33.5% DS 4-6, 36.1% DS ≥7, p = 0.08). There was no significant difference in hospitalization within 1 year between the DS groups. There were 147 (36.8%) pts with high-risk cytogenetics, of which 43.5% had a distress score of ≥7. The rate of utilization of SS, ED visits, and hospitalizations was numerically higher in pts with newly diagnosed MM (68.5%, 34.4%, 63.1%, respectively), as compared to pts with RRMM (64.3%, 25.3%, 48.7%). Conclusion: The disease-specific symptoms predict clinically significant DS >4 on EDS. There were about 20% of pts with screening score >2 for anxiety (GAD-2) & depression (PHQ-2) that may warrant further exploration regarding the detail and nature of symptoms related to the diagnosis. There was a higher rate of utilization of SS and ED visits in pts with higher DS. Given these findings, there is a need to identify the optimal healthcare pathways for better utilization & incorporation of these EDS and PROs in the clinical care of distressed patients. Our study indicates that more work is needed to align needs with resources in order to optimize quality of life and disease outcomes for our pts.

Association between diabetes distress and sociodemographic and/or socioeconomic factors among adults: A cross-sectional study

Diabetes-related distress (DRD) is a psychological syndrome with worsened prognosis in uncontrolled diabetic patients. The current study aimed to assess the factors contributing to DRD among the Lebanese population using the Diabetes Distress Scale (DDS-17) score and its sub-scores. A cross-sectional analysis was conducted between March and September 2021 enrolling. 125 diabetic from six Lebanese governorates through an online survey. The survey included two parts: the first section gathered sociodemographic data sociodemographic and socioeconomic data and the second one focused on assessing the Diabetes Distress Scale (DDS-17) score. Participants 30 years old and above had higher emotional distress compared to younger patients, (65.2 % versus 45.5 %). Those with a primary educational level showed significantly higher emotional distress than those with a secondary and tertiary level of education (72.5 %, versus 66.7 % and 46.4 %). Participants who were treated with both insulin and non-insulin medications or had a diastolic blood pressure of more than 90 mmHg showed significantly moderate to high distress (63.6 % or 53.8 %). Participants who lived in rural areas showed higher distress (35.6 %). Obese and overweight had significant moderate to high distress (64.1 %, and 48.0 %). The same results were found in non-married (divorced or widowed) and married participants (76.9 % and 51.3 %). The association between medical history with total distress showed that participants with glycemic store HbA1c of more than 6.5 followed by those who had HbA1c between 5.7 and 6.4 showed moderate to high total distress (45.9 % and 40.0 %). It is concluded that the prevalence of DRD is high in Lebanon, more common among rural residents, and among participants high HbA1c, low educational level, unmarried and on complex treatment regimens. Screening for DRD and providing better support can optimize clinical outcomes.

Long-Term Maternal Mental Health after Spontaneous Preterm Birth.

The aim of this study is to investigate whether a history of spontaneous preterm birth (SPTB) is associated with maternal depressive and anxiety symptoms, or psychosocial distress in the fifth decade of life. This is a secondary analysis of the PreCaris-study, a prospective observational study in which we included 350 women with a history of SPTB between 220/7 and 366/7 weeks of gestation and compared them to 115 women who had a term birth. Primary outcomes were the Depression and Anxiety scores measured using the Hospital Anxiety Depression Scale and Psychosocial distress assessed with the Distress Thermometer for Parents. Secondary outcomes were self-reported impact of the birth in daily life and psychosocial support after delivery. After a median of 13 years after delivery, no significant differences were found in primary outcomes. Significantly more women with a history of SPTB reported that the birth still had impact in daily life; adjusted odds ratio: 2.46 (95% confidence interval: 1.35-4.48). A total of 57 (16.3%) women after SPTB reported to have needed professional psychosocial support after delivery but did not receive it. These women more often had a high Anxiety score (p = 0.030), psychosocial distress (p = 0.001), and influence of birth in daily life (p = 0.000). There are no long-term effects on depressive and anxiety symptoms and psychosocial distress in women who experienced SPTB compared with women who had a full-term pregnancy. A significant part of the women who delivered preterm needed psychosocial support but did not receive it and were at higher risk of anxiety, psychosocial distress, and impact in daily life. We therefore recommend offering all women after SPTB psychosocial support after delivery. · No long-term effects on depressive and anxiety symptoms and psychosocial distress after SPTB.. · A total of 16.3% of the cases needed professional psychosocial support after delivery but did not receive it.. · This subgroup was at higher risk of anxiety symptoms, psychosocial distress, and impact on daily life..

41 Predictors of Cognitive Symptoms Following Adult Civilian Mild Traumatic Brain Injury

Objective:Mild traumatic brain injury (mTBI) is an important public health problem, due to its high incidence and the failure of at least 20% of patients to successfully recover from injury. Cognitive symptoms, in particular, are an important area of research in mTBI, due to their association with return to work and referral to neuropsychological services. Understanding the predictors of cognitive symptoms may help to improve outcomes after mTBI. This study explored female sex, psychological distress, coping style and illness perceptions as potential predictors of cognitive symptoms following adult civilian mTBI.Participants and Methods:Sixty-nine premorbidly healthy adults with mTBI (mean age = 36.7, SD = 14.7, range = 18-60; 15 females) were recruited from trauma wards at two public hospitals in Australia and assessed 6-12 weeks following injury. Cognitive complaint was measured using a comprehensive 30-item scale (CCAMCHI) assessing mTBI-specific symptoms in the domains of processing speed, attention, memory and executive function. Participants additionally completed the following measures: Brief-COPE, Illness Perceptions Questionnaire-Revised, Inventory of Depressive Symptomatology, Beck Anxiety Inventory, and PTSD Checklist for DSM-5. The latter three measures were combined to create an index of psychological distress.Results:Bivariate nonparametric correlational analyses indicated that female sex (r[67] = .26, 95% CI [.14, .55], p = .03) and psychological distress (r[66] = .54, 95% CI [.40, .72], p < .001) were each significantly associated with cognitive symptom reporting following mTBI. Additionally, while none of the three coping style factors were associated with cognitive symptom reporting, seven of the eight dimensions of illness perceptions were associated with symptom reporting (|r| = .25 - .58, p < 0.05). In a linear regression model assessing the combined effects of each variable, female sex, greater psychological distress, and overall negative illness perceptions were each significant independent predictors of increased cognitive complaint (adj. R2 = .47, F[4,63] = 15.59, p < .001).Conclusions:These findings implicate female sex, psychological distress, and illness perceptions as key factors associated with cognitive symptom reporting after mTBI. This research suggests that these factors may be useful in clinical practice when considering early identification of individuals at risk of poor recovery. Specifically, this research implicates females, individuals with high psychological distress, and individuals with negative illness perceptions as important to subgroups to consider for potential intervention after mTBI. Additionally, as psychological distress and illness perceptions are both potentially modifiable, this research suggests that these factors may be useful targets for intervention.

Mental health and stress level of Ukrainians seeking psychological help online

Due to the Russian invasion of Ukraine on February 24th, 2022, more than 8 million Ukrainians have been displaced from their homes. Ukrainians exposed to armed conflict and migration are likely to have low levels of mental health status and seek help. We provide a uniform quantitative assessment of the mental health conditions of Ukrainians seeking help soon after the invasion and resettlement. We screen the mental well-being and psychological distress of 1165 refugees, migrants, internally displaced, and non-displaced individuals from Ukraine who seek psychological help online in Ukraine and across 24 countries of the European Union. We surveyed participants in the study as a part of our online program for adult Ukrainians from June 22nd to July 6th, 2022. We report descriptive results of mental-health status for the aggregate sample and the sub-groups. More than half of the respondents exhibit low levels of mental well-being and high psychological distress, with 81 % being at risk of depression; 57 % having severe psychological distress. Refugees and internally displaced participants show a particularly high risk of depression and severe psychological distress in our sample. Many Ukrainians seeking psychological help work, study, or volunteer, and those who engage in these activities have relatively alleviated mental well-being. Our results indicate a considerable psychological burden on Ukrainians. Although our analysis focuses on Ukrainians seeking help, it shows that the displaced soon after resettlement require particular attention and can be reached in a short time across borders, irrespective of their (officially documented) migration status.

Yoga-based supportive care for patients with head and neck cancer undergoing radiotherapy: Results of a three-arm randomized controlled trial.

292 Background: Radiotherapy (RT) to treat head and neck cancer (HNC) may result in debilitating toxicities and functional problems. Targeted yoga therapy delivered concurrently to RT may buffer against treatment-related sequelae. Given the high distress rates in spouses and interdependence of distress in couples, involving a spousal caregiver in the intervention may have additional benefits. Thus, we randomized patient-caregiver dyads to either a dyadic yoga (DY), patient yoga (PY) or usual care (UC) control arm. We hypothesized that both yoga arms are better than the UC arm regarding functional outcomes and healthcare utilization (i.e., feeding tube (FT) placements, emergency department (ED) and hospital admissions (HA) across the standard RT period. The comparison between the DY vs PY group was considered exploratory. Methods: HNC patients planned to receive ≥25 fractions of RT and their caregivers completed baseline assessments and were then randomized to the DY, PY or UC arm. Both yoga programs consisted of 15 sessions delivered parallel to the RT schedule. Sessions were either in person or via videoconference. Patients completed the self-report part of the PG-SGA on a weekly basis during the RT period (5-6 weeks). We extracted FT, ED and HA as healthcare utilization metrics from patients’ electronic medical records as binary variables (yes/no). Results: 100 patients (mean age: 60.3 yrs., 85% male, 79% NHW, 67% early stage, 54% chemo-RT) and caregivers (mean age: 54.9 yrs., 83% female, 78% NHW) were randomized (DY: n=34; PY: n=33, UC: n=33). Session attendance was high for both yoga arms (88% attended ≥ 10 session) with mean of 13.13 sessions in the DY and 13.30 sessions in the PY group. Intent to treat analyses using multi-level modeling controlling for patient age, sex, disease stage and treatment (RT vs CRT) revealed a significant effect between the DY and UC group for the physical function (F=5.27, p=.03) and the nutrition intake (F=4.97, p=.03) PG-SGA subscales favoring the DY group. The other comparisons (PY vs UC and DY vs PY) were not significant. None of the comparisons for the symptom and weight subscales were significant. Logistic regression analyses revealed a significant effect for FT placement so that both DY (p=.05) and PY (p=.02) groups had significantly fewer FTs than the UC group. The effect for ED visits was marginally significant and the effect for HA was not significant. Conclusions: Yoga therapy, particularly when delivered to patient-caregiver dyads, appears to be a beneficial behavioral supportive care strategy for HNC patients undergoing RT. We revealed significantly improved physical function and nutrition intake and fewer FTs relative to a UC comparison group. A larger comparative effectiveness trial is warranted. Clinical trial information: NCT04607590 .

Caregiver Burden, Stress, and Relationship Cohesion Among Self-Identified Caregivers of Children with Pediatric Acute-Onset Neuropsychiatric Syndrome.

Objective: Children with Pediatric Acute-onset Neuropsychiatric Syndrome (PANS) experience sudden onset neuropsychiatric symptoms after infection or other triggers. Symptoms range from mild to severe, potentially lasting days, weeks, months, or longer. Exacerbation-related functional decline presents in many aspects of daily life, generally accompanied by family stress and caregiver burden. We sought to investigate the relationship between severity of PANS symptoms and caregiver burden/stress and the relationship between severity of PANS symptoms and degree of caregiver/child cohesion. Methods: This cross-sectional online study surveyed caregivers recruited from PANS-related social media support sites. The Pediatric Acute Neuropsychiatric Symptom Scale - Parent Version (PNSS) measured current severity. Caregiver Burden Inventory (CBI) and Caregiver Self-Assessment Questionnaire (CSAQ) assessed caregiver burden/stress. Inclusion of Other in the Self (IOS) scale determined caregiver-perceived current and desired cohesion with their child(ren) with PANS. Results: Of the 216 respondents 79.6% exceeded CBI threshold indicating need for respite in adult care receiver populations. On the CSAQ, 72.9% expressed high distress, 80.5% reported feeling overwhelmed, and 58.1% reported crying spells, meeting cutoffs for support/respite used in adult care receiver populations. Most caregivers reported not having the desired degree of cohesion with their child on the IOS (85.5%). Parents of children with more severe PNSS symptoms fared significantly worse on all measures (CBI: H = 57.83; CSAQ: F = 29.26; IOS: H = 38.04; p < 0.001 for all). Content analysis of comments revealed five themes: (1) severe caregiver and/or family emotional distress and trauma; (2) caregivers wondering what happened to their child; (3) lack of awareness and support among health and education professionals; (4) relationship strain with family, friends, and significant others; and (5) financial and/or legal struggles because of their child's diagnosis. Conclusion: There is strong need for support and respite for children with PANS and their families. Long-term effects including posttraumatic stress symptoms among family members should be studied.

Prevalence and predictors for fertility-related distress among 1010 young adults 1.5 years following cancer diagnosis – results from the population-based Fex-Can Cohort study

Background Cancer treatment during reproductive ages may negatively impact fertility and there is a need of firm knowledge about the prevalence and predictors of fertility-related distress. The aim was to examine fertility-related distress in a population-based sample of young women and men recently treated for cancer and to identify predictors for this outcome. Material and methods This nationwide cohort study included 1010 individuals (694 women and 316 men), mean age 34.5 ± 4.9 and 32.1 ± 5.5, respectively, diagnosed with breast, cervical, ovarian, testicular cancers, brain tumors or lymphoma at ages 18–39 in Sweden. Participants completed a survey 1.5-year post-diagnosis to assess fertility-related distress (RCAC), emotional distress (HADS) and self-efficacy, as well as sociodemographic and clinical factors and fertility preservation. Logistic regression was used to examine associations between explanatory factors and high fertility-related distress (RCAC subscale mean >4). Results Many participants (69% of women and 47% of men) had previous children and about half reported a wish for future children. High fertility-related distress was more prevalent among women (54%) than men (27%), and women were more likely than men to report distress concerning all but one RCAC dimension after adjustment for sociodemographic factors. Use of fertility preservation was unevenly distributed (15% of women and 71% of men) and was not associated with decreased fertility-related distress. In multivariable logistic regression models, a wish for future children, being single, not having previous children, symptoms of anxiety and low self-efficacy regarding one’s ability to handle threats of infertility were associated with high fertility-related distress. Conclusion This nationwide study found a high prevalence of fertility-related distress in young women and men recently treated for cancer and identified sociodemographic and psychological predictors. Fertility preservation was not found to act as a buffer against fertility-related distress, indicating the continuous need to identify strategies to alleviate fertility distress following cancer.

Firm-level political risk and intellectual capital investment: Does managerial ability matter?

This paper examines the impacts of firm-level political risks on intellectual capital investment decisions and how managerial ability adjusts this relationship. Using a broad sample of U.S firms from 2002 to 2021, our results show that firms with higher political risks reduce their investment in intellectual capital. This impact is more prominent for high-tech firms and firms with high financial distress, external financial dependence, and lower institutional ownership. Further, we find supportive evidence that managerial ability can prevent a substantial dimension (around 20%–40%) of the destructive impact of political risk on intellectual capital investment, which is also driven by firm-specific characteristics. These findings hold after a battery of robustness tests.

Market reactions to drugs price reduction during COVID-19 distress in an emerging economy: value creation through CSR

PurposeThe coronavirus (COVID-19) is the worst pandemic in recent memory in terms of its economic and social impacts. Deadly second wave of COVID-19 in India shook the country and reshaped the ways organizations functions and societies behave. Medical infrastructure was unaffordable and unsupportive which created high distress in the Indian society, especially for poor. At this juncture, some pharmaceutical firms made a unique social investment when they reduced price of drugs used to treat COVID-19 patients. This study aims to examine how the market and the society respond to the price reduction announcement during the psychological distress of COVID-19.Design/methodology/approachMarket reactions have been analyzed by conducting an event study on stock market data and visual analytics-based sentiment analysis on Twitter data.FindingsOverall, this study finds positive abnormal returns on the day and around the day of event. Interestingly, this study finds that returns during the time of high distress are significantly higher. Sentiment analysis conveys that net sentiment is favorable to the pharmaceutical firms around the day of event and it sustains more during the time of high distress.Originality/valueThis study is unique in contributing to the business and industrial management literature by highlighting market reactions to social responsibility of business during the time of psychological distress in emerging economies.

Emotional burden among MS patients: associations between specific chronic pain diagnoses and psychological features.

Central neuropathic pain (CNP) and musculoskeletal pain (MSP) are often comorbid with multiple sclerosis (MS), yet data on the emotional burden entailed by this comorbidity are very limited. We studied whether MS patients with CNP exhibited greater emotional burden and pain severity than those with MSP and whether this emotional burden was attributed to the MS, the chronic pain, or both. Participants were 125 MS patients (55 with CNP; 30 with MSP; 40 MS pain-free) and 30 healthy controls (HCs). Participants completed questionnaires assessing pain interference, pain catastrophizing, depression, anxiety, stress, hypervigilance, and chronic pain. Group comparisons and a two-step cluster analysis were performed, and the association between cluster membership and clinical group membership was evaluated. Chronic pain was stronger and more widespread in the CNP group than in the MSP group. Both pain groups had higher pain interference, pain catastrophizing, and stress compared to MS pain-free and HC groups. All MS groups had greater depression levels compared to HCs, and the CNP group had the highest anxiety level. The "high psychological distress" cluster comprised mainly participants with CNP (57%), and the "minimal psychological distress" cluster comprised mainly the MS pain-free and HC groups. In conclusion, CNP seems to induce greater emotional burden and pain severity than does MSP. Whereas depression may be attributed to MS, and anxiety to CNP, enhanced pain interference, catastrophizing, and stress may be attributed to the comorbidity of MS and chronic pain. Identifying these traits among MS patients and targeting them in management programs may contribute to more effective, individually based care.

Relationship between Telework Jetlag and Perceived Psychological Distress among Japanese Hybrid Workers.

Social jetlag is associated with physical and mental health problems. With the increased popularity of telework, we investigated a specific form of social jetlag that we termed "telework jetlag". This study aimed to clarify the relationship between telework jetlag-the difference in sleep and wake-up times between in-office and telework days-and mental health problems among Japanese hybrid workers. A cross-sectional study was conducted with 1789 participants from October to December 2021 using an online-based questionnaire. Telework jetlag, defined as the difference in the midsleep point between in-office and telework days, was investigated using two groups according to telework jetlag-those lagging <1 h versus ≥1 h. We used the six-item Kessler Scale as a nonspecific psychological distress scale for the outcome. Telework jetlag was significantly associated with psychological distress, and the ≥1 h group had a higher risk (odds ratio: 1.80) of developing high psychological distress (HPD) than the <1 h group in the multivariate analysis. Since most teleworkers are forced to have a hybrid work style that mixes going to work and teleworking, telework jetlag must be addressed to maintain the health of teleworkers.

Hepatic mesenchymal hamartoma masquerading as neonatal unconjugated hyperbilirubinemia: a case report

BackgroundHepatic mesenchymal hamartoma (HMH) is the second most common benign hepatic tumor in the pediatric age group. The etiology of HMH is unclear. Theories include abnormal hepatic mesenchyme, a reactive change or a proliferative lesion. The condition can present prenatally in USG as a mass, high output cardiac failure, pulmonary hypertension, respiratory distress, and abdominal distension or mass in older children. We present this case to discuss an extremely rare presentation of a comparatively rare disease and to emphasise the need for a high index of suspicion even if the patient presents with symptoms common for that age.Case presentationA 7-day-old male baby with an uneventful antenatal period, born by vaginal delivery, with a birth weight of 3.1 kg and normal APGAR scores, presented with jaundice, poor feeding, and labored breathing noticed on the same day itself. Examination revealed a grossly distended abdomen with a mass of size 8 × 7 cm occupying the right side down to the right iliac fossa, crossing midline and dullness continuous with liver dullness. On investigation an abnormal liver function test with unconjugated hyperbilirubinemia was seen. USG and CECT abdomen were suggestive of HMH with close proximity to hepatic vessels. Exploratory laparotomy and near total excision with marsupialisation was done. Histopathology report was suggestive of HMH. A 2-year follow-up was normal.ConclusionThis case of HMH presented as neonatal jaundice with unconjugated hyperbilirubinemia which is a rarity. We had to limit our surgery to near total excision and marsupialisation due to its proximity to vascular structures.

Does Psychological Flourishing Have the Potential to Mitigate Self-Injurious Thoughts and Behaviors? A Preliminary Analysis of the Protective Influence of Flourishing

Aim The purpose of this article was to examine whether psychological flourishing, a multi-dimensional construct of well-being, has the potential to play a preventative role in suicidal and nonsuicidal thoughts and actions. Methods This two-part study utilized cross-sectional survey data from college students across the United States, assessing levels of psychological distress, loneliness, and psychological flourishing. Frequencies of suicidal ideation, intent, previous suicidal attempts, and nonsuicidal self-injury (NSSI) were also assessed. Data collected in 2019 were used for Study 1 (n = 38,679) and data collected in 2020 were used for Study 2 (n = 50,307). Results Psychological flourishing is significantly inversely related to suicide and NSSI risk when controlling for loneliness and psychological distress. There were two-way interactions between flourishing and distress, whereby under conditions of high distress, the inverse effect of flourishing on suicidal ideation, intent, and attempts and NSSI was more pronounced. These results were consistent across both studies. Subgroup analyses revealed similar results regardless of participants’ race, sexual orientation, and gender identity. Conclusion Inverse associations between flourishing and self-injurious thoughts and behaviors suggest that flourishing may buffer risk of suicide and NSSI, and these findings may have important implications for developing evidence-based therapeutic interventions. Additional research, including longitudinal and clinical work, is warranted.

A Brief Wellbeing Training Session Delivered by a Humanoid Social Robot: A Pilot Randomized Controlled Trial

Mental health and psychological distress are rising in adults, showing the importance of wellbeing promotion, support, and technique practice that is effective and accessible. Interactive social robots have been tested to deliver health programs but have not been explored to deliver wellbeing technique training in detail. A pilot randomised controlled trial was conducted to explore the feasibility of an autonomous humanoid social robot to deliver a brief mindful breathing technique to promote information around wellbeing. It contained two conditions: brief technique training (‘Technique’) and control designed to represent a simple wait-list activity to represent a relationship-building discussion (‘Simple Rapport’). This trial also explored willingness to discuss health-related topics with a robot. Recruitment uptake rate through convenience sampling was high (53%). A total of 230 participants took part (mean age = 29 years) with 71% being higher education students. There were moderate ratings of technique enjoyment, perceived usefulness, and likelihood to repeat the technique again. Interaction effects were found across measures with scores varying across gender and distress levels. Males with high distress and females with low distress who received the simple rapport activity reported greater comfort to discuss non-health topics than males with low distress and females with high distress. This trial marks a notable step towards the design and deployment of an autonomous wellbeing intervention to investigate the impact of a brief robot-delivered mindfulness training program for a sub-clinical population.

The relationship between social support, coping strategies and psychological distress and positive mental well-being in carers of people with borderline personality disorder

BackgroundInformal carers of people with BPD experience high levels of burden and psychological distress relative to other populations. There is a scarcity of research evidencing the influence of modifiable factors on carer outcomes to inform interventions. This study aimed to investigate the relationship between social support, coping strategies and psychological distress and positive mental well-being in this carer population.MethodsIn this cross-sectional study, 1207 carers completed the McLean Screening Instrument for BPD-Carer Version, the Brief COPE, the Multidimensional Scale of Perceived Social Support, the Kessler Psychological Distress scale, the WHO-5 Well-being Index, and the Coronavirus Anxiety Scale. Data for 863 participants who met the inclusion criteria were analysed.ResultsCarers reported low positive mental well-being and high psychological distress. Perceived social support and several coping strategies were significant unique predictors of psychological distress and positive mental well-being. Perceived social support and positive reframing were the strongest predictors of higher positive mental well-being and lower psychological distress. Self-blame, behavioural disengagement and substance use were the strongest predictors of adverse outcomes.ConclusionsThe findings evidence modifiable factors that may be used to improve informal carer outcomes and indicate that carer interventions may be improved by focusing on reducing the use of self-blame, behavioural disengagement and substance use, and development of quality social support and skills to positively reframe caregiving situations.

Trajectories of financial distress during the COVID-19 pandemic and their associations with mental health and substance use outcomes in a cohort of young adults.

The COVID-19 pandemic has led to unprecedented life disruptions among young adults, including increased job insecurity and financial strain. Mental health problems and substance use have also increased during the pandemic, with young adults particularly vulnerable to experiencing these challenges. This study examines trajectories of financial distress among young adults during the pandemic and their associations with depression, anxiety, and hazardous alcohol and cannabis use. Data from 473 young adults (ages 22-29) recruited in the Northwest United States were collected from April/May 2020 to July/August 2021. Financial distress trajectories were identified using growth mixture modeling. Negative binomial models were used to examine associations between financial distress trajectories and distal outcomes of depression, anxiety, alcohol, and cannabis use. Three distinct trajectories were identified, revealing Low, Moderate, and High financial distress experiences. Individuals with "Moderate" and "High" trajectories showed significantly greater depressive and anxiety symptom scores compared with those in the "Low" financial distress trajectory group. Trajectories were not associated with subsequent levels of alcohol or cannabis use. Young adult mental health remains a priority during periods of economic downturn. Providers must be aware of the psychological challenges imposed by financial distress among young adults to address worsening mental health symptoms.

Research on the association between overweight and obesity mediated by Chinese children and adolescent aged 13-18 years physical exercise and psychological distress

Objective: To analyze the association between overweight and obesity, psychological distress, and the influence of physical exercise among Chinese children and adolescents. Methods: The study used data from the 2019 Chinese National Survey on Students' Constitution and Health. A total of 95 280 Han Chinese children and adolescents aged 13 to 18 years were included in the study based on complete information on overweight and obesity, psychological distress assessment, and physical exercise variables. The Kessler Psychological Distress Scale was used to measure their psychological distress, with scores above 25 indicating high psychological distress. The BMI group of the adolescents was evaluated according to the Chinese standard "WS/T 586-2018 Screening for Overweight and Obesity in School-age Children and Adolescents", including underweight, normal weight, overweight, and obesity. The individual's BMI Z-score (BMIZ) was evaluated using the WHO standard and divided into ten groups based on the population percentile distribution. The survey collected the subjects' average daily physical exercise time and divided them into two groups: less than 1 hour and greater than or equal to 1 hour. Logistic regression analysis was used to analyze the relationship between overweight and obesity and high psychological distress among children and adolescents and the differences in association between different physical exercise groups. Results: The detection rates of overweight and obesity among Han Chinese children and adolescents aged 13 to 18 years in 2019 were 14.5%, and 7.6%, respectively. The rate of high psychological distress was 37.6%, and the rate of average daily physical exercise time exceeding 1 hour was 17.1%. Using the population with a BMIZ P10 below as a reference, the association strength between high psychological distress and the population gradually increased, with an OR (95%CI) value of 1.08 (1.02-1.14), 1.09 (1.02-1.14), 1.10 (1.03-1.16), and 1.16 (1.09-1.23) for BMIZ in the P60-, P70-, P80-, >P90 groups. Compared to normal weight, both overweight and obesity were positively associated with high psychological distress in children and adolescents, with obesity showing a more significant correlation, while underweight was negatively associated with high psychological distress. The detection rates of high psychological distress in normal weight, underweight, overweight, and obese groups were 37.6%, 37.0%, 38.2%, and 38.7%, respectively, with an OR (95%CI) value of 0.93 (0.88-0.98) for the underweight group and 1.05 (1.01-1.10) and 1.13 (1.07-1.19) for the overweight and obese groups, respectively. The positive correlation between BMIZ, overweight, and obesity with high psychological distress was significant only in adolescents who exercised less than 1 hour per day on average. Conclusions: Chinese children and adolescents face the problem of obesity and high psychological distress, with a positive correlation between these two problems. Physical activity may moderate the association between obesity and psychological distress in children and adolescents. Adequate physical exercise may offset the potential high psychological distress caused by obesity in children and adolescents. Thus, strengthening physical exercise among children and adolescents reduces the risks of both obesity and psychological health problems effectively.

Prevalence of psychological distress among Chinese children and adolescents aged 9-18 years

Objective: To describe the prevalence of psychological distress and to analyze its influencing factors among Chinese children and adolescents aged 9-18 years in 2019. Methods: Data was from the 2019 Chinese National Survey on Students' Constitution and Health, and 148 892 children and adolescents were included. Psychological distress was measured using the Kessler Psychological Distress Scale (K10): scores ≤19 were defined as no psychological distress, scores between 20-24 were defined as mild psychological distress, scores between 25-29 were defined as moderate psychological distress, and scores ≥30 were defined as severe psychological distress (moderate to severe psychological distress were defined as high psychological distress). The ANOVA, t test, and χ2 test were used to compare the differences in K10 scores and high psychological distress rates among children and adolescents with different characteristics. The ANOVA and trend χ2 test were used to analyze the trends. Modified-Poisson regression models were used to determine influencing factors of high psychological distress. Results: The K10 scores for Chinese children and adolescents aged 9-18 years in 2019 was 21.5±9.2, and their rate of high psychological distress was 31.6%. The rates of high psychological distress among children and adolescents aged 9-12, 13-15, and 16-18 years were 22.3%, 35.9%, and 38.8%. K10 scores and rates of high psychological distress showed an increasing trend as age increased (trends test all P<0.001). K10 scores and rates of high psychological distress were higher among children and adolescents who were older, female, rural, in areas with medium to low GDP per capita level, and with lower parental education (all P<0.001). Multifactorial modified-Poisson regression analysis showed that children and adolescents aged 13-15 years, 16-18 years, female, rural, and in areas with low to moderate GDP per capita level were at higher risk of high psychological distress (all P<0.05), with aOR (95%CI) of 1.55 (1.52-1.58), 1.66 (1.63-1.69), 1.07 (1.05-1.09), 1.02 (1.01-1.04), 1.10 (1.07-1.12). Children and adolescents in areas with medium to high GDP per capita level, whose father had a secondary or high school degree, whose father had a college degree or above, whose mother had a secondary or high school degree, and whose mother had a college degree or above were at lower risk of high psychological distress (all P<0.05), with aOR (95%CI) of 0.96 (0.94-0.98), 0.92 (0.90-0.93), 0.84 (0.82-0.86), 0.95 (0.93-0.97), 0.86 (0.83-0.88). Conclusions: The prevalence of psychological distress was high among Chinese children and adolescents aged 9-18 years in 2019, which is a vital problem. Mental health interventions need to be implemented among children and adolescents that were older, girls, rural, live in areas with lower economic levels, and whose parents have a lower education level.

Research on the association between the occurrence of spermarche and menarche and psychological distress among Chinese children and adolescents aged 9-18 years

Objective: To analyze the association between the occurrence of spermarche and menarche and psychological distress among Chinese Han children and adolescents aged 9 to 18 years. Methods: Data were drawn from the 2019 Chinese National Survey on Students' Constitution and Health, and a total of 54 438 boys aged 11 to 18 years and 76 376 girls aged 9 to 18 years with psychological distress, spermarche/menarche records were included in the final analysis. The occurrence of spermarche/menarche was recorded by physicians, and psychological distress was classified according to the Kessler Psychological Distress Scale scores. The chi-square test was used to compare the difference between groups in the occurrence of spermarche/menarche, and the multinomial logistic regression model and stratification analysis was established to analyze the association between psychological distress and spermarche/menarche. Results: The incidence of spermarche/menarche in 2019 ranged from 6.3% to 96.5% for eight age groups of Chinese boys and 2.8% to 99.0% for ten age groups of girls. The rates of high psychological distress among boys and girls were 32.5% and 32.7%. Among boys aged 11 to 18 years, the rate of high psychological distress increased with age, with a trend test P<0.001, and the difference in the rate of high psychological distress between those who had and had not had their spermarche was not statistically significant in all age groups. Among girls aged 9 to 18 years, the rate of high psychological distress increased with age, with a trend P<0.001; the rate of high psychological distress was higher in the group with menarche at age 10 and 12 than in the group without menarche (all P<0.05). High psychological distress was positively correlated with spermarche among boys aged 13-15 years living in urban areas and hight level economic development areas (OR=1.11, 95%CI: 1.02-1.21;OR=1.18, 95%CI: 1.06-1.32). Overall, high psychological distress was positively correlated with menarche in girls aged 9-12 and 13-15 years (OR=1.33, 95%CI: 1.25-1.42; OR=1.22, 95%CI: 1.07-1.39). High psychological distress was positively correlated with menarche among girls aged 9-12 years living in different regions except for the Northeast region, in areas with different levels of economic development, and in urban and rural areas, in girls aged 13-15 years living in urban, central, and western regions, and in girls aged 16-18 years residing in the central region. Conclusions: This study found an association between the occurrence of spermarche/menarche and psychological distress among Chinese Han children and adolescents aged 9 to 18 years in 2019, which was particularly significant among girls aged 9 to 12 years and boys aged 13 to 15 years living in areas with higher levels of socioeconomic development.