High Risk For Emotional Distress Research Articles

Technology in the service of caregiver well‐being: an online psycho‐educational intervention combined with virtual reality

AbstractBackgroundCare for community‐dwelling people with dementia (PwD) is frequently delegated to relatives, who find themselves in the role of informal caregivers (iCGs) with no practical knowledge to manage their loved ones. This situation puts iCGs at high risk for emotional distress. We will assess the efficacy of an online psycho‐educational program combined with an immersive virtual reality (VR) experience to reduce iCGs perceived stress by acting on the cognitive and affective components of empathy.MethodUsing covariate‐adaptive (by sex and baseline level of perceived stress) randomization, 100 iCGs of mild‐to‐moderate Alzheimer’s disease patients will be assigned to i) an online 6‐week psycho‐educational program (control arm); or ii) the same psycho‐educational program integrated with VR (experimental arm). VR consists of 360‐degree videos and allows caregivers to experience dementia symptoms from the patient’s perspective. The primary outcome will be a change in emotional distress, assessed with the Zarit Burden Inventory and the State‐Trait Anxiety Inventory. In addition, changes in brain activity while reading emotional stories (protocol modified from Ashar, 2017) will be assessed as a secondary outcome in a subsample of 50 participants who will undergo magnetic resonance imaging. Primary and secondary outcomes will be measured before and after the intervention. A 2‐month clinical follow‐up is also scheduled.ResultTo date, 20 iCGs (mean age: 58; range 30‐79; female: 75%; children: 55%) have been randomized to the 2 arms. The psycho‐educational program provides support for the home management of PwD, by offering knowledge on symptom management and enhancing strategies based on the cognitive component of empathy. During each session, iCGs are exposed to 30 minutes of empathy training with i) imagery exercises or ii) VR. The experimental intervention is expected to result in deeper disease comprehension and strengthen empathy’s cognitive component. At the network level, we expect to observe a greater activation of cognitive empathy circuits and a lower activation of affective empathy circuits in the experimental group.ConclusionTo our knowledge, this will be the first randomized controlled trial assessing the synergistic effect of combining traditional psycho‐educational intervention with VR in iCGs and measuring both clinical and imaging markers.

Technology in the service of caregiver well‐being: an online psycho‐educational intervention combined with virtual reality

AbstractBackgroundCare for community‐dwelling people with dementia (PwD) is frequently delegated to relatives, who find themselves in the role of informal caregivers (iCGs) with no practical knowledge to manage their loved ones. This situation puts iCGs at high risk for emotional distress. We will assess the efficacy of an online psycho‐educational program combined with an immersive virtual reality (VR) experience to reduce iCGs perceived stress by acting on the cognitive and affective components of empathy.MethodUsing covariate‐adaptive (by sex and baseline level of perceived stress) randomization, 100 iCGs of mild‐to‐moderate Alzheimer’s disease patients will be assigned to i) an online 6‐week psycho‐educational program (control arm); or ii) the same psycho‐educational program integrated with VR (experimental arm). VR consists of 360‐degree videos and allows caregivers to experience dementia symptoms from the patient’s perspective. The primary outcome will be a change in emotional distress, assessed with the Zarit Burden Inventory and the State‐Trait Anxiety Inventory. In addition, changes in brain activity while reading emotional stories (protocol modified from Ashar, 2017) will be assessed as a secondary outcome in a subsample of 50 participants who will undergo magnetic resonance imaging. Primary and secondary outcomes will be measured before and after the intervention. A 2‐month clinical follow‐up is also scheduled.ResultTo date, 20 iCGs (mean age: 58; range 30‐79; female: 75%; children: 55%) have been randomized to the 2 arms. The psycho‐educational program provides support for the home management of PwD, by offering knowledge on symptom management and enhancing strategies based on the cognitive component of empathy. During each session, iCGs are exposed to 30 minutes of empathy training with i) imagery exercises or ii) VR. The experimental intervention is expected to result in deeper disease comprehension and strengthen empathy’s cognitive component. At the network level, we expect to observe a greater activation of cognitive empathy circuits and a lower activation of affective empathy circuits in the experimental group.ConclusionTo our knowledge, this will be the first randomized controlled trial assessing the synergistic effect of combining traditional psycho‐educational intervention with VR in iCGs and measuring both clinical and imaging markers.

Persistence of Emotional Distress in Unaccompanied Migrant Children and Adolescents Primarily From the Northern Triangle of Central America

In the US, unaccompanied migrant children and adolescents (hereinafter referred to as children) are predominantly from Central America's Northern Triangle. While unaccompanied migrant children are at high risk for psychiatric sequelae due to complex traumatic exposures, longitudinal investigations of psychiatric distress after resettlement are lacking. To identify factors associated with emotional distress and longitudinal changes in emotional distress among unaccompanied migrant children in the US. For this retrospective cohort study, the 15-item Refugee Health Screener (RHS-15) was administered between January 1, 2015, and December 31, 2019, to unaccompanied migrant children as part of their medical care to detect emotional distress. Follow-up RHS-15 results were included if they were completed before February 29, 2020. Median follow-up interval was 203 days (IQR, 113-375 days). The study was conducted in a federally qualified health center that provides medical, mental health, and legal services. Unaccompanied migrant children who completed the initial RHS-15 were eligible for analysis. Data were analyzed from April 18, 2022, to April 23, 2023. Traumatic events before migration, during migration, during detention, and after resettlement in the US. Emotional distress, including symptoms of posttraumatic stress disorder, anxiety, and depressive symptoms, as indicated by the RHS-15 (ie, score ≥12 on items 1-14 or ≥5 on item 15). In total, 176 unaccompanied migrant children completed an initial RHS-15. They were primarily from Central America's Northern Triangle (153 [86.9%]), were mostly male (126 [71.6%]), and had a mean (SD) age of 16.9 (2.1) years. Of the 176 unaccompanied migrant children, 101 (57.4%) had screen results above the positive cutoff. Girls were more likely to have positive screen results than boys (odds ratio, 2.48 [95% CI, 1.15-5.34]; P = .02). Follow-up scores were available for 68 unaccompanied migrant children (38.6%). On the follow-up RHS-15, most scored above the positive cutoff (44 [64.7%]). Three-quarters of unaccompanied migrant children who scored above the positive cutoff initially continued to have positive scores at follow-up (30 of 40), and half of those with negative screen scores initially had positive scores at follow-up (14 of 28). Female vs male unaccompanied migrant children (unstandardized β = 5.14 [95% CI, 0.23-10.06]; P = .04) and initial total score (unstandardized β = 0.41 [95% CI, 0.18-0.64]; P = .001) were independently associated with increased follow-up RHS-15 total score. The findings suggest that unaccompanied migrant children are at high risk for emotional distress, including symptoms of depression, anxiety, and posttraumatic stress. The persistence of emotional distress suggests that unaccompanied migrant children would benefit from ongoing psychosocial and material support after resettlement.

Sociodemographic Factors Associated with Emotional Distress, Transactional Sex and Psychoactive Substance Use during the First Wave of the COVID-19 Pandemic

The aim of this study was to identify the sociodemographic factors associated with emotional distress and determine if the quality of family relationships and the perception of social isolation can protect those who transacted sex or used psychoactive substances from emotional distress during the COVID-19 pandemic. Data for 426 people who transacted sex and 630 persons who used psychoactive drugs during the COVID-19 pandemic were extracted from a database of participants recruited from 152 countries. The extracted data were the dependent (emotional distress), independent (age, sex, education status, employment status, HIV status, the perception of social isolation, and the quality of family relationships), and confounding (country income level) variables. Multivariable logistic regression analyses were conducted to determine the associations between the dependent and independent variables after adjusting for confounders. Students who transacted sex (AOR:2.800) and who used psychoactive substances (AOR:2.270) had significantly higher odds of emotional distress. Participants who transacted sex, lived with HIV (AOR:2.582), or had the same/better quality of family relationships (AOR:1.829) had significantly higher odds of emotional distress. The participants who used psychoactive substances, had tertiary education (AOR:1.979), were retired (AOR:2.772), were unemployed (AOR:2.263), or felt socially isolated (AOR:2.069) had significantly higher odds of emotional distress. Being a student was the only sociodemographic risk indicator common to both populations. The risk indicators and protective factors for emotional distress differed for both populations despite both being at high risk for emotional distress.

The Relationship of Adverse Childhood Experiences and Emotional Distress in Young Adults.

Emerging evidence notes increased depression, anxiety, and stress among the general population during the COVID-19 pandemic. However, little is known about populations at increased risk for emotional distress as the pandemic continues. Persons with adverse childhood experiences (ACE) are one group that may be at higher risk for emotional distress. The aim of this study is to examine whether young adults, particularly Black young adults, with histories of ACEs report more emotional distress during the pandemic than those with no ACE exposure. Using a cross-sectional, quota sampling approach, 100 Black and 100 White young adults were recruited using online sources (e.g., University website, Facebook). Due to the pandemic, participants were screened via Zoom and, if eligible, completed a demographic questionnaire, emotional distress measures (i.e., anxiety, depression, stress), and the ACE Questionnaire online via a Qualtrics survey. Structural equation modeling (SEM) analysis examined the ACE and emotional distress relationship, and multigroup SEM assessed racial differences. High levels of both emotional distress and ACEs were observed. Black young adults reported significantly more ACEs than Whites. ACEs were significantly associated with each measure of emotional distress regardless of race or other covariates. Findings reveal that during the pandemic, persons exposed to ACEs reported greater emotional distress than those with no ACE exposure. Nurses must screen patients for both emotional distress and ACE to target those at higher risk for early intervention and initiate treatment as needed to mitigate long-term mental health consequences.

A Large Scale of Nurses Participated in Beating down COVID-19 in China: The Physical and Psychological Distress.

The outbreak of coronavirus disease 2019 (COVID-19) posed an unprecedented threat to health care providers (HCPs) in Wuhan, China, especially for nurses who were frequently exposed to infected or suspected patients. Limited information was available about the working experience of nurses in fighting against the pandemic. To learn the physical and psychological responses of nurses during the pandemic and explore the potential determinants, we conducted a large-scale survey in Wuhan. This multicenter cross-sectional study enrolled 5521 nurses who worked in designated hospitals, mobile cabins, or shelters during the pandemic. A structured online questionnaire was distributed to assess the physical discomforts, emotional distress and cognitive reactions of nurses at work, and the log-binomial regression analysis was performed to explore potential determinants. A considerable proportion of nurses had symptoms of physical discomforts [3677 (66.6%)] and emotional distress [4721 (85.5%)]. Nurses who were directly involved in the care of patients (i.e., care for severe patients: RR, 2.35; 95% CI, 1.95–2.84), with irregular work schedules (RR, 2.36; 95% CI, 1.95–2.87), and working overtime (RR, 1.34; 95% CI, 1.08–1.65) were at a higher risk for physical discomforts. Nurses who were directly involved in the care of patients (i.e., care for severe patients: RR, 1.78; 95% CI, 1.40–2.29), with irregular work schedules (RR, 3.39; 95% CI, 2.43–4.73), and working overtime (RR, 1.51; 95% CI, 1.12–2.04) were at a higher risk for emotional distress. Therefore, formulating reasonable work schedules and improving workforce systems are necessary to alleviate the physical and emotional distress of nurses during the pandemic.

Emotional Distress Correlates Among Patients With Chronic Nonspecific Low Back Pain: A Hierarchical Linear Regression Analysis.

Chronic low back pain (CLBP) has become a worldwide health concern, and emotional distress is an important issue for CLBP management. However, it remains poorly understood how emotional distress happens and develops. This study aimed to systematically explore the correlates of emotional distress in patients with CLBP. The study was a multisite, cross-sectional survey with a sample of 252 patients with CLBP in urban communities. A battery of questionnaires was used to collect data. Univariate analysis, Pearson correlation analysis, and hierarchical linear regression analysis were performed. The mean score of emotional distress among 252 patients with CLBP was 13.85 ± 6.50. Hierarchical regression analysis indicated that the demographic factors, psychobehavioral factors, and social support of patients with CLBP were associated with their emotional distress, uniquely explaining 16.5%, 18.4%, and 6.2% of the variance, respectively. Five factors were found to be associated with patients' emotional distress: pain intensity (β = 0.257, P < 0.001), passive coping (β = 0.297, P < 0.001), active coping (β = -0.254, P < 0.001), self-efficacy (β = -0.155, P = 0.005), and social support (β = -0.268, P < 0.001). Patients with CLBP suffered from clinically significant emotional distress. Patients' demographics, psychobehavioral factors, and social support were all related to emotional distress. The findings help us to identify the characteristics of patients with CLBP at high risk for emotional distress and to formulate corresponding countermeasures. This study aimed to explored the correlates of emotional distress of patients with chronic low back pain (CLBP) by hierarchical linear regression analysis. The study found that patients' demographic factors, psycho-behavioral factors, and social support were associated with their emotional distress, uniquely explaining 16.5%, 18.4%, and 6.2% of the variance, respectively. Pain intensity, passive coping, active coping, self-efficacy, and social support were detected as significant correlates.

Risk Factors for Post-Traumatic Stress Disorder Symptoms in Surrogate Decision-Makers of Patients with Chronic Critical Illness.

Chronically critically ill patients are often dependent on family members for surrogate decision-making, and these surrogates are at high risk for emotional distress. We hypothesized that patient- and surrogate-specific risk factors for surrogate post-traumatic stress disorder (PTSD) symptoms can be identified early in the course of chronic critical illness. To identify risk factors for PTSD symptoms in surrogate decision-makers of chronically critically ill patients. We performed a secondary analysis of the database from a multicenter randomized trial of a communication intervention for chronic critical illness patients and surrogates. Variables preselected for plausible mechanism for increasing PTSD symptoms and identifiable by Day 10 of mechanical ventilation were included in the analysis for association with surrogate PTSD symptoms at 90 days, as measured by the Impact of Events Score-Revised (IES-R). Patient factors included demographics, insurance status, baseline functional status, chronic comorbidities, illness severity, and presence of advance directive. Surrogate variables included demographics, education level and employment, religion, relationship to patient, and Hospital Anxiety and Depression Scale score measured at enrollment. Multivariable linear regression models were then constructed for 26 potential risk factors, including biologically or mechanistically plausible confounders for each, with IES-R score as the outcome. All models were adjusted for multiple respondents, using a mixed model, considering the patients as a random factor. Our analysis included 306 surrogates for 224 patients. A total of 49% of patients were female, and mean age was 59 years (95% confidence interval [CI], 56.4-60.7). A total of 71% of surrogates were female, and mean age was 51 years (95% CI, 49.3-52.4). After examining each potential risk factor in a separate multivariable model, only Day-10 surrogate Hospital Anxiety and Depression Scale score (β coefficient = 1.02; 95% CI, 0.73-1.30) and patient unresponsiveness (β coefficient = 8.39; 95% CI, 0.83-15.95) were associated with higher IES-R scores. Among surrogate decision-makers for chronically critically ill patients, high anxiety and depression scores and patient unresponsiveness on or near Day 10 of mechanical ventilation are risk factors for PTSD symptoms at 90 days.

Perceptions of Mental Health Among Hispanic Older Adults: Findings Among Immigrants from the Dominican Republic, Colombia, and Guatemala.

Disparities exist in the recognition and treatment of mental health issues among Hispanic community-dwelling older adults. Previous researchers have focused on accessing mental health services, with limited attention to older Hispanic immigrants' perceptions of mental health issues. A qualitative descriptive research design was used to understand older Hispanic immigrants' perceptions of mental health issues, especially those related to stress, anxiety, and depression. Seventeen older adults from the Dominican Republic, Colombia, and Guatemala were interviewed. Despite having experienced significant personal tragedies, participants did not initially describe emotional distress or any mental health issues. When specifically questioned, depression was the most recognized illness. Depression was commonly described as sadness, whereas stress and anxiety had multiple definitions among participants. Understanding older Hispanic immigrants' perceptions of mental health issues and establishing a therapeutic relationship between the health care provider and patient may be helpful in recognizing and treating individuals who may be at high risk for emotional distress, anxiety, and depression. [Journal of Gerontological Nursing, 44(11), 44-50.].

Validation of PROMIS emotional distress short form scales for cervical cancer

ObjectivesCervical cancer patients are at high risk for emotional distress. In this study we evaluate the PROMIS emotional distress-Depression and -Anxiety Short Forms for assessing depression and anxiety in a cervical cancer population. MethodsA 15-item questionnaire was used in a cervical cancer biobehavioral randomized clinical trial, testing psychosocial telephone counseling (PTC) against usual care (UC). It was administered to 204 patients prior to randomization, four months post-enrollment, and nine months post-enrollment, together with legacy measures of depression. The short forms were evaluated in patients participating in this study over three time points for internal consistency, convergent validity, and responsiveness to change over time. ResultsOverall, 45% and 47% of patients scored in the moderate to severe range for anxiety and depression, respectively. Internal consistency coefficients were ≥ 0.95 at baseline, 4 months, and 9 months for depression and anxiety. The average inter-item correlation was 0.65 and 0.73 at baseline assessment for depression and anxiety, respectively. The depression short form T-score was correlated with legacy distress scales ranging from 0.44–0.76, and the anxiety short form ranging from 0.45–0.78. The depression short form demonstrated sensitivity to change as patients randomized to the counseling intervention reported greater improvement over time in depression (p = 0.014), and a nonsignificant improvement in anxiety, compared to the patients receiving usual care. ConclusionsThe PROMIS depression and anxiety short forms reliably and validly assess cervical cancer-specific emotional distress, capture salient features of distress in this population, and perform as well or better than legacy measures.

Breast Cancer Surgery Decision-Making and African-American Women.

Prior research has used focus group methodology to investigate cultural factors impacting the breast cancer experience of women of various ethnicities including African-Americans; however, this work has not specifically addressed treatment decision-making. This study identifies key issues faced by African-American women diagnosed with breast cancer regarding treatment decisions. We used an interpretive-descriptive study design based on qualitative data from three focus groups (n = 14) representing a population of African-American women in central Pennsylvania. Participants were asked to think back to when they were diagnosed with breast cancer and their visit with the breast surgeon. Questions were asked about the actual visit, treatment choices offered, sources of information, and whether the women felt prepared for the surgery and subsequent treatments. The prompts triggered memories and encouraged open discussion. The most important themes identified were fear across the breast cancer disease trajectory, a preference for visual information for understanding the diagnosis and surgical treatment, and support systems relying on family and friends, rather than the formal health-care system. Our results have implications for practice strategies and development of educational interventions that will help breast cancer patients better understand their diagnosis and treatment options, encourage their participation in treatment decision-making, and provide psychosocial support for those at high risk for emotional distress.

Sexual Self Schema as a Moderator of Sexual and Psychological Outcomes for Gynecologic Cancer Survivors

Gynecologic cancer patients are at high risk for emotional distress and sexual dysfunction. The present study tested sexual self schema as an individual difference variable that might be useful in identifying those at risk for unfavorable outcomes. First, we tested schema as a predictor of sexual outcomes, including body change stress. Second, we examined schema as a contributor to broader quality of life outcomes, specifically as a moderator of the relationship between sexual satisfaction and psychological statue (depressive symptoms and quality of life). A cross-sectional design was used. Gynecologic cancer survivors (N = 175) 2-10 years post treatment were assessed during routine follow up. In regression analyses controlling for sociodemographic variables, patients' physical symptoms/signs as evaluated by nurses, health status, and extent of partner sexual difficulties, sexual self schema accounted for significant variance in the prediction of current sexual behavior, responsiveness, and satisfaction. Moreover, schema moderated the relationship between sexual satisfaction and psychological outcomes, suggesting that a positive sexual self schema might "buffer" patients from depressive symptoms when their sexual satisfaction is low. Furthermore, the combination of a negative sexual self schema and low sexual satisfaction might heighten survivors' risk for psychological distress, including depressive symptomatology. These data support the consideration of sexual self schema as a predictor of sexual morbidity among gynecologic cancer survivors.

Brazilian version of the Problem Areas in Diabetes Scale (B-PAID): Validation and identification of individuals at high risk for emotional distress

The purpose of this study was to validate the Brazilian version of the Problem Areas in Diabetes Scale (B-PAID) in a sample of outpatients with type 2 diabetes (DM2) and to identify the characteristics of individuals at high risk for emotional distress. A cross-sectional study was conducted in a sample of 146 patients randomly selected among those attending outpatient clinics at a University Hospital in Porto Alegre, Brazil. Information was collected regarding age, gender, known duration of diabetes, type of treatment and level of schooling, and a blood sample was taken to measure HbA1c. B-PAID was compared with the already validated Brazilian versions of Satisfaction with Life (SWL) and WHO Quality of Life-Brief (WHOQOL) Scales. One-hundred forty-six DM2 patients (48% males, 59.7 ± 9 years, BMI: 29.7 ± 5.2 kg/m 2, mean duration: 8.63 ± 8 years, HbA 1c: 7.2 ± 1.7%) were included. There were significant correlations between B-PAID and SWL ( r p = 0.55, p < 0.001) and WHOQOL ( r p = −0.33, p < 0.05) Scales. In a multiple regression analysis the B-PAID Scale was associated with younger age ( p = 0.006) and lower education level (p = 0.05). In conclusion, B-PAID is a reliable, valid outcome measure for Brazilian DM2 patients and identifies patients at increased risk for emotional distress who should be prioritized in psychosocial intervention.

HIV-Risk Behaviors and Mental Health Characteristics Among Homeless or Drug-Recovering Women and Their Closest Sources of Social Support

This article describes risky drug and sexual behavior and mental health characteristics in a sample of 240 homeless or drug-recovering women and their most immediate sources of social support. Women and their closest support sources both reported a great deal of recent noninjection drug use (56% and 52%, respectively) and lesser, though similar amounts of recent injection drug use (12% and 14%, respectively). More than one third of both groups reported a history of sexually transmitted disease and sexual activity with multiple partners. Fifty-one percent of the women and 31% of their support sources had Center for Epidemiological Studies Depression Scale (CES-D) scores of 27 or greater, suggesting a high level of depressive disorders in both samples. Similarly, 76% of the women and 59% of their support sources had psychological well-being scores below a standard clinical cutoff point. These data suggest that homeless and impoverished women turn to individuals who are themselves at high risk for emotional distress and risky behaviors as their main sources of support.