Higher Distress Research Articles

Validation of a Biopsychosocial Distress Screening Tool, SupportScreen, in a Brazilian Cancer Center.

Biopsychosocial distress is a common yet often underestimated complication in cancer care. We sought to translate and evaluate the psychometric properties of SupportScreen distress assessment tool in Brazil. A cancer cohort study was conducted at a public hospital in Brazil. The SupportScreen tool underwent transcultural translation into Portuguese. Eligible patients completed the SupportScreen, Distress Thermometer (DT), Hospital Anxiety and Depression Scale (HADS), and Functional Assessment of Cancer Therapy-General version (FACT-G). Statistical analyses included confirmatory and exploratory factor analyses (CFA and EFA), comparisons with established distress tools, and assessments of associations with patients' characteristics. A total of 302 patients were assessed (M:F 35.4%:64.6%; median age: 55). Most patients were diagnosed with breast (29.1%) and gastrointestinal cancer (20.5%), at advanced disease stage (78.8%). CFA identified optimal models for emotional and physical distress; EFA revealed two factors for the logistics of medical care: practical and medical system distress. The concurrent validity of subscales demonstrated significant correlations between distress domains. Sensitivity analyses indicated good performance of emotional and physical domains in identifying distress compared to gold standard criteria. Female patients were more likely to report high emotional distress, while younger age and late disease stage were associated with higher physical distress. Additionally, late disease stage was linked to higher practical distress. Emotional and physical domains demonstrated validity and reliability, aligning with validated measures. Logistics of medical care distress revealed practical and medical system dimensions, expanding understanding of patient challenges. The SupportScreen tool exhibited concurrent validity and sensitivity in identifying distress.

Baseline financial distress and cost-related social risks among participants in the Cancer Financial Experience (CAFÉ) trial.

172 Background: Cancer Financial Experience (CAFÉ) is a multi-site, three-arm randomized controlled trial to test the impact of a novel financial navigation intervention on financial distress among cancer patients. We compared the baseline prevalence of financial distress among CAFÉ trial participants, using two instruments (InCharge and COST), and assessed cost-related social risks. Methods: Three hundred seventy one (n=371) participants were consented and randomized between August 2021-March 2023. Eligible participants (n=2033) included adults (18+ years of age), diagnosed with invasive cancer within 120 prior to a recent visit to a CAFÉ study clinic/site, members of Kaiser Permanente Northwest or Kaiser Permanente Washington, and spoke English or Spanish. Following consent, participants were randomized to one of three trial arms: enhanced usual care; brief intervention; enhanced intervention. The two primary trial outcomes were: financial distress, measured using the InCharge Financial Distress/Financial Well-Being scale, and cancer-specific health-related quality of life, measured by the FACT-G7 scale. Additionally, we collected the COST measure and cost-related social risks. All participant-reported outcomes, demographic, and socioeconomic data were collected via telephone survey at baseline and 12 months by trained interviewers. Survey data was stored in REDCap. Descriptive statistics were used to assess participant demographic, socioeconomic, and outcome data at baseline. Results: Among randomized participants (n=371), mean age was 61 years (standard deviation=14 years), 63% were female, 11% Hispanic, 9% Asian, 8% Black , 61% married or living with partner, 31% were employed full-time, 37% retired, 44% had annual income of $20000-$74999, 45% had Medicare, and 38% had breast cancer. At baseline, InCharge scores showed 31% (n=113) of participants had high, 19% had moderate, and 50% had low financial distress. Based on COST scores, 2.2% (n=16) of participants had high, 63% had moderate, and 39% had low financial distress. Forty percent (n=148) of participants reported any cost-related social risk, including heat and electricity (15%) and housing (15%). Conclusions: Baseline findings from the CAFÉ trial indicate that nearly one-third of patients with cancer may have high financial distress around the time of diagnosis, though this may vary by screening tool. The ideal screening tool for use at diagnosis is worthy of further study. Assessing and assisting patients with social risks, including financial distress, is essential to advancing cancer health equity. Clinical trial information: NCT05018000 .

Baseline characteristics of parents enrolled in ACCL20N1CD: Financial distress during treatment for pediatric acute lymphoblastic leukemia (ALL) in the US.

220 Background: Personal costs of childhood cancer can contribute to disparities in health outcomes. The purpose of ACCL20N1CD is to examine trajectories of parental costs and the associated financial distress, cost coping behaviors, and household material hardships (HMH) during treatment for pediatric ALL. Objective is to report baseline characteristics of the parents and their households. Methods: The study used a prospective cohort design with repeated measures. Setting was Children’s Oncology Group (COG) practices at National Cancer Institute Community Oncology Research Program (NCORP) institutions. Parents who use English or Spanish, and have children newly diagnosed with ALL treated at COG NCORP practices were eligible. Parents were asked to complete surveys at 3 time points, including baseline (T1; during induction and <7 days after planned induction remission evaluation). Surveys included items about (a) parent socio‐economic status, financial distress measured by 8-item Personal Wellness Scale (PFWS), and cost coping behaviors, and (b) HMH. Factors related to high PFWS scores were evaluated by logistic regression. Results: Of 104 evaluable parents, most were female (83.7%), white (65.4%), non-Hispanic (48.1%), partnered (79.8%), > high school diploma (93.3%), used English (84.6%), worked full (48.1%) or part (5.8%) time, and paid for their child’s care with public insurance (57.7%). Median household income=$50,000 (Inter-Quartile Range/IQR 20,000-100,000) for 4 (IQR 4-5) people. Not including wages lost due to caregiving, out of pocket payments for medical care + other ALL-related costs in the prior month >15% of monthly income for 51.9% of households, which is considered financially catastrophic. 24.0% of households lacked food stability; 21% had housing insecurity. Conclusions: At baseline, sizeable proportions of parents exhibit high out of pocket costs, high financial distress level, and multiple cost coping behaviors with implications for future health and individual and household quality of life.

The Effect of Emotional Techniques in Reducing Psychological Distress among Orphan Female Secondary School Students

The current research aims to verify the ineffective effects in removing psychological distress among orphan female secondary school students in schools in Basrah Governorate. In order to apply these goals to the field of study and application, and to achieve the objectives of this study, the two researchers built a scale of psychological distress based on the definition of Pearlin (1983) and built a counseling program based on emotional techniques to reduce psychological distress, taking into account the scientific steps to build measurement tools and verify the face validity and construct validity as well as the validity of the confirmatory factor analysis and extracting psychometric properties and calculating reliability in two ways. It was found that the value of the Cronbach’s alpha reliability coefficient was (0.72) and by the retest method was (0.84).After applying the scale to the final sample of (267) and analyzing the data using the statistical package (SPSS), the results of the study showed that there was high psychological distress among the research sample. Based on this result, a purposive sample of (20) female students who obtained the highest scores on the scale was drawn. And according to the type of experimental design adopted in the research, the experiment sample was distributed into two groups, experimental and control, in a random manner, with (10) female students in each group. The experimental group was then subjected to treatment using emotional techniques, and the treatment was withheld from the control group. After the end of the experiment period, (14) sessions were provided, two sessions per week. The researchers processed the pre- and post-measurement data for the two groups by adopting the Wilcoxon rank-sum test for two correlated samples and the Kruskal-Wallis test. The results of the post-measurement for the experimental group showed a noticeable decline compared to the results of the pre-measurement for the same group and the results of the post-measurement for the control group whereas the control group maintained a high level of psychological distress in the pre- and post-measurements. The results of the scientific experiment demonstrated the effect of emotional techniques in making change in reducing psychological distress among the experimental group, achieving the general goal of the program. In light of these results, the research concluded with a set of recommendations and suggestions.

Feasibility of Early Assessment for Psychological Distress: HRV-Based Evaluation Using IR-UWB Radar.

Mental distress-induced imbalances in autonomic nervous system activities adversely affect the electrical stability of the cardiac system, with heart rate variability (HRV) identified as a related indicator. Traditional HRV measurements use electrocardiography (ECG), but impulse radio ultra-wideband (IR-UWB) radar has shown potential in HRV measurement, although it is rarely applied to psychological studies. This study aimed to assess early high levels of mental distress using HRV indices obtained using radar through modified signal processing tailored to reduce phase noise and improve positional accuracy. We conducted 120 evaluations on 15 office workers from a software startup, with each 5 min evaluation using both radar and ECG. Visual analog scale (VAS) scores were collected to assess mental distress, with evaluations scoring 7.5 or higher classified as high-mental distress group, while the remainder formed the control group. Evaluations indicating high levels of mental distress showed significantly lower HRV compared to the control group, with radar-derived indices correlating strongly with ECG results. The radar-based analysis demonstrated a significant ability to differentiate high mental distress, supported by receiver operating characteristic (ROC) analysis. These findings suggest that IR-UWB radar could be a supportive tool for distinguishing high levels of mental stress, offering clinicians complementary diagnostic insights.

False High Respiratory Distress Index Due to Mask Leak During Continuous Positive Airway Pressure Titration

ABSTRACT The treatment of choice for moderate-to-severe obstructive sleep apnea (OSA) is continuous positive airway pressure therapy (CPAP), and the optimal pressure for the elimination of obstructive events is set on the basis of titration study. Treatment-emergent central sleep apnea (TECSA) is characterized by new onset of central apneas in a patient with OSA, while on CPAP therapy. Many risk factors, including some polysomnographic parameters, have an association with TECSA. One such easily correctable factor is mask leak. Mask fitting during CPAP titration is a very important consideration and loose masks can lead to air leaks, causing redness of the eyes, and in some cases, arousal and even central sleep apneas.

A comparison of challenging and positive caregiving experiences for caregivers of individuals with schizophrenia spectrum and bipolar disorders

BackgroundCaregivers of people with serious mental illness experience challenges that may affect their mental health. Few researchers have explored whether positive or negative caregiver experiences differ due to disorder characteristics of the person receiving care. We aimed to determine whether caregiver appraisals and psychological functioning differed between caregivers of those diagnosed with schizophrenia spectrum (SSD) and bipolar disorder (BD). MethodsCaregivers of people with SSD and BD participated in an online self-report survey assessing appraisals, distress, anxiety, depression, and psychological wellbeing. Independent samples t-tests and multivariate generalised linear models determined group differences, and Pearson correlation coefficients and Fisher z-score transformations determined differences in the strength of correlations between groups. Results108 caregivers participated in the study. Caregivers of people with SSD reported significantly greater negative appraisals of the care recipient's negative symptoms and dependency. Caregivers did not differ on positive appraisals. Both groups reported moderate distress, mild anxiety and depression, and moderate psychological wellbeing, but did not differ. Higher negative caregiver appraisals were more strongly associated with higher distress, anxiety and depression, and lower psychological wellbeing, for caregivers of those with SSD than BD. LimitationsSmall between group sample sizes, and analyses may have been moderated by significant demographic differences between groups. ConclusionsCaregivers can experience difficulties associated with their role, and some differences may be attributed to the care recipient's disorder. Future research and interventions should consider specific disorder characteristics, such as symptom profiles, to better support caregivers in having their specific needs addressed whilst themselves providing care.

Factors Affecting Sleep Quality and Prenatal Distress Among Rural and Urban Women During Early Pregnancy.

Background Early pregnancy is characterized by the initiation of physiological and psychological changes, which places pregnant women at risk of psychological distress and poor sleep, which is known to cause adverse maternal and neonatal outcomes. This study aimed to assess the prevalence of prenatal distress and sleep quality during early pregnancy and identify factors associated with prenatal distress among pregnant women from urban and rural settings. Methods The study was conducted with 325 pregnant women (175 rural, 150 urban) as a baseline assessment of theMAI (Mother and Infant) cohort, a longitudinal observational study in Pune, India. Data on sociodemography, anthropometry, clinical history, prenatal distress, and sleep quality were collected between August 2020 and March 2023. Mann Whitney U test and regression were used to assess correlates of sleep quality and prenatal distress. Results Over one-third (37.5%) (n=122) of women experienced prenatal distress. Women from rural areas reported a higher prevalence (40%) (n=70) of distress, and poorer sleep quality than urban women (51.4% (n=90) vs 38.7% (n=58)). High prenatal distress was moderately associated with poor sleep quality (ρ = 0.308, p = 0.001). After controlling for sociodemographic and clinical factors, high prenatal distress (B=2.63, 95% CI: 1.47-4.69) predicted poor sleep quality. Rural residence (OR: 6.37, 2.46-16.51), underweight BMI status (OR: 2.21, 0.97-5.05), presence of episodes of vomiting (OR: 1.70, 0.93-3.13), and poor sleep quality (OR: 0.74, 0.40-1.38) significantly (p<0.05) contributed to prenatal distress. Conclusion Prenatal distress and poor sleep quality are significant concerns for pregnant mothers globally and require early screening and management strategies to avoid adverse maternal and fetal outcomes.

The prevalence of psychological distress and its associated sociodemographic factors in the Australian adults aged 18–64 years during COVID-19: Data from the Australian National Health Survey

ObjectiveCOVID-19 significantly contributed to an increase in psychological distress and may have disproportionally impacted certain sociodemographic groups. This study aimed to assess the prevalence of psychological distress among Australian adults aged 18–64 years and identify sociodemographic factors associated with psychological distress during the COVID-19 pandemic. MethodsSecondary analyses were conducted using data from the National Health Survey 2020–21 to calculate weighted national estimates of the prevalence of psychological distress using the Kessler Psychological Distress scale (K10). The association between sociodemographic factors and psychological distress was analysed using multivariable logistic regression, with adjustments for complex survey design. ResultsThe average of K10 score was 16.94, with a prevalence of combined high/very high distress reported at 21.13 % among Australian adults. Young women aged 18–25 reported the highest average scores (M = 20.44) across all sex and age groups. Risk factors associated with psychological distress included lower personal income, marital status (never married; widowed/divorced/separated) and being ‘born in Australia’. Protective factors included homeownership and having children in the household. Additionally, among women, being aged ≥56 was significantly associated with lower odds of psychological distress. LimitationsData collection relied on self-completed online form, and a cross-sectional design limits the inference of a causal relationship. DiscussionDuring COVID-19 pandemic, lower personal income and being female have consistently been identified as risk factors for psychological distress. Targeted and tailored interventions based on age, sex and disadvantage are warranted, particularly focusing on younger women, to alleviate the adverse effect of the pandemic on the population's mental health.

Associations between mental health profiles and later school outcomes

The dual-factor model of mental health proposes that high wellbeing and low distress are necessary to define mental health. This study used latent profile analysis to identify mental health profiles in a sample of 3,587 Australian grade 6 students and explored the association between mental health profiles and school outcomes measured in grades 7 and 9. Six mental health profiles were identified: complete mental health (i.e. high wellbeing and low distress; 30%), moderately mentally healthy (i.e. average wellbeing and low distress; 18%), symptomatic but content (i.e. high wellbeing and above-average distress; 19%), vulnerable (i.e. low wellbeing and below-average distress; 6%), moderately troubled (i.e. below-average wellbeing and high distress; 19%), and troubled (i.e. low wellbeing and high distress; 8%). After statistical adjustment for potential confounders (gender, language background, socio-economic status, and geographical remoteness), students with complete mental health showed significantly higher academic achievement and school engagement one and three years later compared with students with all other mental health profiles. Students with vulnerable and troubled profiles experienced the poorest school outcomes sustained over time (grade 7 and grade 9). Implications for school-based interventions to support the mental health and wellbeing of students are discussed.

Active Engagement: The Impact of Group-Based Physical Activities on the Resilience of Israeli Adolescents with ADHD.

Background: Attention Deficit Hyperactivity Disorder (ADHD) is a pressing concern in pediatric public health, with its prevalence rising among children and teenagers. This study explored the relationship between group-based physical activity and the well-being, resilience, and distress levels of Israeli youth, with a specific focus on those with ADHD symptoms. Methods: This cross-sectional study surveyed 699 Israeli teenagers, assessing their participation in three types of physical activities: unorganized, structured, and the "Five Fingers" program. Data were collected through an online platform and analyzed using ANOVA, t-tests, and multivariable regression models to identify predictors of resilience. Results: Structured, group-based sport activities are associated with higher resilience (p < 0.01) and lower distress (p < 0.01) in adolescents. Adolescents with ADHD symptoms exhibited lower resilience (p < 0.001) and well-being (p < 0.001), and higher distress (p < 0.001). However, those with ADHD symptoms who participated in group-based activities fared better in terms of distress (p < 0.01) and well-being (p = 0.018) than those who did not. Participation in any sport activity, older age, male gender, and a higher socio-economic status predicted greater resilience in youth, generally. Conclusions: This study presents the potential of structured physical activities that involve psychosocial and group integration training to improve the mental health of adolescents, especially in the context of ADHD symptoms.

Death attitudes in Chronic Obstructive Pulmonary Disease (COPD) patients: A mixed-methods study

Research shows the significance of death attitudes for the mental health of somatically ill people, but findings that focus on multidimensionality in processing death are scarce. Patients with Chronic Obstructive Pulmonary Disease (COPD) report shortness of breath, pain and anxiety about suffocation and high mental distress. Utilizing a mixed-methods approach from 64 hospitalized COPD patients, we examined how they cope with mortality. We conducted a narrative interview with two questions. Patients completed the Multidimensional Orientation Toward Dying and Death Inventory (MODDI-F). Findings reveal a spectrum of death-related narratives, with most patients reporting at least 3 different attitudes. The sample showed below average scores in the Rejection of One’s Own Death and Dying subscale of the MODDI-F. Assessing death attitudes using two simple questions proved highly applicable in this population and may serve as a potential approach to engage patients in discussions about existential matters, as suggested in the literature.

Clinician Experiences of and Responses to the Challenges of Working with Patients in the Australian Compensation Setting.

Previous research indicates that the compensation process is stressful for people with a compensable injury, contributing to poorer recovery. However, little is known about the challenges faced by clinicians who work in this setting. This study aims to qualitatively explore the experiences of clinicians delivering care to patients with compensable injuries in Australia. Semi-structured interviews were conducted with 26 experienced clinicians providing care to compensable patients in Australia. The interviews were transcribed, and data were analysed using reflective thematic analysis. Participants described their work as challenging due to factors such as high patient distress, poor clinical outcomes, and high administrative load. However, they responded to these challenges in varying ways. While some reported feelings of vicarious injustice, emotional exhaustion, and self-doubt, others derived a sense of meaning, purpose, and mastery from these challenges. Clinician responses to the challenge of working with people with a compensation claim were associated with access to mentoring, continuous education and training, and a supportive workplace culture. Clinicians reported both positive and negative responses to the challenges of working with people with a compensable injury. Coping strategies that were associated with more positive reactions included seeking further education, mentoring, peer support. Prioritising these support systems is important for clinician wellbeing and patient outcomes.

Depression, anxiety, and stress in young adult gamers and their relationship with addictive behaviors: A latent profile analysis

BackgroundThere is limited research examining latent profiles of gamers based on emotional variables, which has implications for prevention efforts. The study sought to identify young adult gamer profiles based on depression, anxiety, and stress, and to examine differences between the latent profiles in other addictive behaviors (i.e., tobacco, alcohol, cannabis, illegal substance use, gaming, and gambling). MethodsA total of 1209 young adults (Mage = 19.37, SD = 1.62; 55.3%males) reported past-year gaming. A latent profile analysis (LPA) was performed to identify distinct profiles, and a set of ANOVA and chi-square analyses characterized the profiles in terms of sociodemographic, addictive behaviors, and emotional variables. ResultsLPA suggested a three-profile solution: profile 1 (n = 660, ‘low emotional distress’), profile 2 (n = 377, ‘moderate emotional distress’), and profile 3 (n = 172, ‘high emotional distress’). Participants with ‘moderate’ and ‘high emotional distress’ were mostly women, showed greater gaming severity, higher prevalence of past-month substance use (i.e., tobacco and illegal drugs), and greater consequences of alcohol use. LimitationsThe cross-sectional nature of the study and sample being university students. ConclusionFindings revealed three distinct profiles of gamers, which differed in emotional, gaming, and substance use severity. Transdiagnostic prevention programs have the potential to provide significant benefits to college students by addressing the core processes (e.g., emotion regulation) that underlie substance use and gaming.

Is the feeling of 'weakness' associated with unhelpful thoughts or distress regarding symptoms?

This cross-sectional study looked for factors associated with feelings of weakness, level of capability and pain intensity in people seeking musculoskeletal speciality care for non-traumatic upper extremity conditions. A survey was conducted in 139 English-speaking adults, with 135 participants completing it. We found that greater intensity of feelings of weakness correlated with higher distress regarding symptoms and with older age. Lower level of capability was associated with greater intensity of feelings of weakness, greater distress regarding symptoms and older age. Higher pain intensity was associated with greater distress regarding symptoms and greater intensity of feelings of weakness. These findings suggest that the symptom of weakness may be a cue to explore potential distress about symptoms in addition to examining for actual weakness. This understanding could be a guide to a more compassionate approach to alleviate distress rather than focusing on neuromuscular pathophysiology alone, with the potential to reduce unnecessary tests and treatments.Level of evidence: IV.

COVID-19 and speeding: Results of population-based survey of ontario drivers

Introduction: During COVID-19, increased speeding was observed in many jurisdictions. Yet, evidence is limited on what factors predicted increased speeding during the pandemic. This study’s purpose was to examine speeding, and person and situation factors associated with increased speeding since the start of the pandemic. Methods: An online panel survey sampled 1,595 drivers using sex, age, and region quota sampling and weighting to approximate the Ontario, Canada adult population. Measures included: (1) person factors: socio-demographics (age, sex, region); psychological trait of risk propensity (Competitive Attitudes Toward Driving Scale (CATDS)); psychological states (distress - general and COVID-19-related); and behaviors (kilometers driven, alcohol use, police stops and collisions); and (2) COVID-19-related situation factors: perceived changes in (traffic volume, police enforcement). Results: 67.2% of respondents reported speeding; 7.2% reported increased speeding since the start of the pandemic. Bivariate analyses indicated that person factors of younger age, male sex, higher CATDS, higher distress, more alcohol use, more kilometers traveled, police stops, and collisions since the start of the pandemic were associated with increased speeding. Situation factor of perceived less traffic volume since the start of the pandemic was associated with increased speeding. Logistic regression analysis identified odds of reported increased speeding during the pandemic was significantly higher for drivers with higher scores on the CATDS, higher kilometers traveled, and more alcohol use during the pandemic. Conclusions: These findings suggest that higher risk propensity as well as the more kilometers driven and increased alcohol consumption were risk factors for increased speeding. Practical Applications: COVID-19-related factors of lower traffic volume and enforcement are less predictive of increased speeding than driver personality and pandemic-related behaviors of more driving and drinking. Interventions to reduce speeding still need to focus on these person factors through education, enforcement, and strong sanctions for speeding.

Evaluating pre-consult patient education videos for patients with newly-diagnosed anal squamous cell carcinoma: Impact on patient comprehension, satisfaction and distress

We hypothesized that pre-consult patient education videos can improve patient understanding about their diagnosis, lead to high satisfaction and low distress. In this pilot study, we developed a patient education video curriculum for patients with newly-diagnosed anal cancer. Comprehension of key content was evaluated by comparing pre- and post-test scores. Patient satisfaction scores were collected. Patient distress scores (0–10) were collected at the beginning of their consult visit prior to seeing the physician. We found that patient education videos prior to consult improved patient understanding, resulted in high patient satisfaction, and low patient distress at the time of consult.

Identity Distress, Confusion, Synthesis, and Social Media Use for Coping: Implications for Identity Development

ABSTRACT How do emerging adults undergoing identity distress during an adverse collective life event such as the COVID-19 pandemic use social media for coping? This study addressed this question by examining the associations of identity distress, confusion, and synthesis with social media use for coping with a national, multisite undergraduate sample of university students (N = 1257; M age = 20; 908 women) in the United States. Results indicated that emerging adult college students undergoing increased identity distress during the pandemic reported utilizing social media frequently for coping, such as socially connecting with others and alleviating negative emotions. Similarly, emerging adult college students experiencing increased identity uncertainty (marked by greater identity confusion and lower identity synthesis) during the pandemic reported using social media frequently for coping. Moreover, findings implied that emerging adult college students experiencing high identity distress severity, interference, and duration were almost two times more likely than their peers undergoing a lesser degree of distress to use social media to alleviate negative emotions. Implications for mental health practitioners working with emerging adults during an adverse collective life event are discussed.

Financial distress and medical financial hardship among young adult survivors of blood cancer.

The long-term financial impact of cancer care has not been adequately addressed in young adults. As part of a remote intervention study, we describe medical financial distress and hardship among young adult survivors of blood cancer at study entry. Young adults were recruited from 6 US hospitals. Using a Research Electronic Data Capture link, young adults confirmed their eligibility-namely, currently 18 to 39 years of age, blood cancer diagnosis 3 or more years ago, off active treatment, and not on parent's insurance. Following consent, the baseline assessment was sent. The primary outcome measure, the Personal Financial Wellness Scale, measured financial distress (scored as severe, 1-2; high, 3-4; average, 5-6; and low to no, 7-10). Medical financial hardship encompassed material hardship, psychological impact, and coping behaviors. Descriptive summary statistics and linear regression were used. Among the 126 participants, 54.5% came from minority racial or ethnic groups. Median time since diagnosis was 10 years (interquartile range = 6-16 years), with 56% having received a diagnosis when they were between 18 and 39 years of age. The overall mean (standard deviation) Personal Financial Wellness Scale score was 5.1 (2.4), but 49% reported severe or high distress. In multivariable analysis, female sex, Hispanic ethnicity, and lower income were strongly associated with worse Personal Financial Wellness Scale scores. Among participants with severe financial distress (n = 26), 72% reported 2 or more household material hardships, had worse scores across all psychological domains, and altered survivorship care because of cost (68%). Nearly half of long-term young adult cancer survivors reported severe or high levels of financial distress. Individuals with severe or high distress also reported more medical financial hardship than other participants. This finding highlights the need for ongoing financial intervention in this vulnerable population. NCT05620979.

Effect of Stress on Sleep Quality among Medical Students: A Cross-sectional Study at Jazan University, Saudi Arabia.

It has long been understood that sleep is a necessary therapeutic element of human physiology and is crucial for healthy functioning, mental health, and quality of life. Medical students frequently minimize their sleep and habits to cope with their workload and their stressful lives, which has a negative influence on both mental health and academic performance. The purpose of this study was to evaluate the prevalence of stress and its effect on sleep quality among medical students (in both the preclinical and clinical years) at Jazan University in Saudi Arabia. A cross-sectional research design was applied in this study. The sample constituted medical students at Jazan University, Jazan region, Saudi Arabia. A self-administered online survey was distributed actively to measure the variables of interest. This study examined the sleep quality and psychological distress among 347 students. The findings revealed that a significant proportion of students experienced sleep difficulties, with 52.8% reporting mild sleep problems and 46.6% reporting moderate sleep difficulties. In addition, a notable percentage of participants (28.2%) reported very high psychological distress, while 27.4% experienced severe psychological distress. This study found that medical students had a high level of stress and poor sleep quality, which led to unhealthy habits, such as consuming many energy drinks. Hence, it is recommended that concerns should be addressed to minimize the risk of developing chronic illnesses.