High Levels Of Emotional Distress Research Articles

Fatigue representations in women with heart failure

Self-care management of symptoms for persons with heart failure (HF) may only be successful when their representations regarding their symptoms are accurate and linked to appropriate behavioral strategies. The purpose of this secondary data analysis (N = 169 women with HF) was to describe representations of one HF-related symptom, fatigue, and examine whether representations were related to physical health status, health care utilization, and psychological well-being and whether they differed by age. Overall, women agreed that fatigue was chronic, caused by HF, and had serious consequences. Midlife women reported more emotional distress and severe consequences from fatigue than older women. Higher levels of emotional distress due to fatigue from HF were associated with higher levels of health care utilization.

Violence against pregnant women: prevalence and characteristics. A population‐based study in Nicaragua

This study aims to estimate the prevalence and characteristics of partner abuse during pregnancy as well as to investigate associated social factors in León, Nicaragua. Cross-sectional community-based study. All pregnant women from 50 randomly selected geographical clusters out of 208 in the municipality of León, Nicaragua. A total of 478 pregnant women were included; only one woman refused to participate. The domestic violence questionnaire from the WHO-co-ordinated Multi-Country Study on Women's Health and Life Events was used with each participant being interviewed twice during pregnancy. Prevalence and characteristics of partner violence during pregnancy. The prevalence of emotional, physical and sexual abuse during pregnancy was 32.4%, 13.4% and 6.7%, respectively. Seventeen percent reported experience of all three forms of violence. Two-thirds of the victims reported repeated abuse. Half of the abused women had experienced punches and kicks directed towards the abdomen and 93% had been injured. Most women had not sought health care in relation to the abuse, but those who did were usually hospitalised. Factors such as women's age below 20 years, poor access to social resources and high levels of emotional distress were independently associated with violence during pregnancy. Violence against pregnant women in Nicaragua is common and often repeated. Although these women have poor access to social resources and high levels of emotional distress, they are rarely assisted by the health services. Innovative strategies are needed to provide support and counselling.

Emotional distress and quality of life in caregivers of patients awaiting lung transplant

Objective The aims of this study are to characterize the levels of emotional distress and quality of life among caregivers of lung transplant candidates and to examine the relation of coping styles and perceived caregiver burden to caregivers' self-reported emotional distress. Methods A consecutive series of primary caregivers of potential lung transplant candidates completed a battery of psychosocial measures, including the Beck Depression Inventory-II (BDI-II), State-Trait Anxiety Inventory, Medical Coping Modes Questionnaire (MCMQ), Scale for Caregiver Burden (SCB), and Medical Outcomes Survey, Short Form-36 (SF-36). Results Only 12 of the 82 caregivers (14.6%) who volunteered for the study reported clinically significant levels of depression (BDI-II ≥14), and only 2 caregivers (2.4%) reported clinically significant levels of anxiety (STAI ≥60). Passive coping strategies were associated with higher levels of emotional distress; specifically, resignation was associated with increased depression ( r=.27, P<.04), while avoidance was associated with increased anxiety ( r=.29, P<.04). In addition, caregivers who reported greater perceived caregiver burden experienced higher levels of depression ( r=.45, P<.001) and anxiety ( r=.43, P<.01). Moreover, the social functioning of caregivers of lung transplant patients was more than one standard deviation from a normative sample of the population (Cohen's d=1.16), indicating that caregivers of transplant patients experienced greater impairment in this area. Discussion Although most caregivers of transplant patients do not report significant impairment in functioning, assessing caregivers' coping strategies and caregiving burden may identify those caregivers who experience increased emotional distress.

Psychosocial Risk Associated With Newborn Screening for Cystic Fibrosis: Parents’ Experience While Awaiting the Sweat-Test Appointment

The psychosocial effects on parents of infants with abnormal results in cystic fibrosis (CF) newborn screening (NBS) that uses genetic testing remain unclear. Twenty-eight individuals representing 14 families participated in grounded theory interviews approximately 6 months after their child's positive NBS results for CF. Participants also completed the Center for Epidemiologic Studies Depression Scales (CES-D) at their infant's sweat-test appointment (n = 51) and/or approximately 6 months after the sweat test (n = 35). Most parents experienced high levels of emotional distress during their wait for the sweat-test appointment (CES-D score, mean +/- SD: 16.5 +/- 6.7; 43.1% in the clinical range; median wait: 7 days; range: 3-35 days). CES-D scores of these parents were also significantly higher than those of comparison parents. Interviews showed that parental cognitive uncertainty and emotional distress were influenced by the parents' prior knowledge of NBS, CF, and their carrier status; parents' adjustment to their new baby; and the physicians' approach to informing parents. Parents' coping strategies involved requesting a sweat test as soon as possible, searching for information, assessing the infant's risk/health, seeking support, praying, or not talking with others. The waiting period from notification regarding positive NBS results to diagnostic test results can be psychologically distressing to parents, causing depressive symptoms that vary depending on their perceptions about the likelihood that their infant has CF. Implications for future research examining psychosocial interventions for NBS are discussed.

Family caregiving and congestive heart failure. Review and analysis

There is increasing evidence that discharge planning and post-discharge support for CHF patients can contribute greatly to the medical management of heart failure (CHF) in the community and that the quality of the CHF patient's close personal relationships can influence outcome in CHF. However, there has been little research on the impact of CHF on the family or the role of the family in the management of the condition. In this paper, we provide a review and analysis of studies that have explicitly investigated these issues in the informal carers of CHF patients. Sixteen papers were identified that examined the role and/or impact of informal caregiving for CHF patients. Our main findings were: demands specific to CHF caregiving were identified, e.g., monitoring complex medical and self-care regimen, disturbed sleep and frequent hospitalisation of patients. Relatively high levels of emotional distress were identified in CHF caregivers. Few studies explicitly investigated the role of informal carers in the management of CHF. Studies were limited in number, scope and quality. Caring for a family member with CHF can affect the well-being of those responsible for care, which may have consequences for the CHF patient's health. Further studies are needed to clarify these issues and to examine the role of informal caregivers in the management of CHF in the community.

Optimism, Satisfaction With Needs Met, Interpersonal Perceptions of the Healthcare Team, and Emotional Distress in Patients’ Family Members During Critical Care Hospitalization

Families of critical care patients experience high levels of emotional distress. Access to information about patients' medical conditions and quality relationships with healthcare staff are high-priority needs for these families. To assess satisfaction with needs met, signs and symptoms of acute stress disorder, interpersonal perception of healthcare staff, level of optimism, and the relationships among these variables in patients' family members. Family representatives of 40 patients were administered a brief version of the Critical Care Family Needs Inventory, the Acute Stress Disorder Scale, the Brief Symptom Inventory, the Impact Message Inventory, and the Life Orientation Test shortly after admission of the patients to the intensive care unit and after discharge. Levels of dissociative symptoms associated with acute stress disorder were elevated in family members just after admission but decreased significantly after discharge. Needs the families thought were least satisfactorily cared for after admission involved lack of information. Interpersonally, attending physicians were viewed as more controlling than bedside nurses at admission; nurses were viewed as more affiliative than physicians both at admission and after discharge. At admission, higher optimism of the family members was strongly related to greater satisfaction with needs met, to perceptions of affiliation from physicians, and to perceptions of not being controlled by physicians. More interpersonal contact with medical staff can help meet the information needs of patients' families. Nurses may aid in families' adjustment by fostering a sense of optimism in family members and encouraging them to participate in the patients' care.

Personality Traits Related to Chronic Pain Location

Previous research has yielded inconsistent findings on the relationship between personality characteristics and chronic pain. The present study examines measures of alexithymia, somatosensory amplification, attachment, counterdependency, and emotional distress in 140 consecutive general medical outpatients seen in psychiatric consultation. Forty-five subjects having no chronic pain (NP) were compared to 49 subjects with chronic pain restricted to their back and/or extremities (BE) and with 46 subjects having pain involving other regions of the body (OP). Findings demonstrated marked counterdependency traits in the BE group relative to the other two groups. By contrast, traits of alexithymia and somatosensory amplification, insecure attachment, and a high level of emotional distress characterized the OP group. A multiple logistic regression model combining counterdependency and secure attachment was 86% accurate in predicting BE (c = 0.86). The study's findings suggest that personality traits vary according to chronic pain location, although the nature of the relationship still needs to be determined.

Emotional distress and marital adjustment of caregivers: contribution of level of impairment and appraised burden

The study examined the relative contribution of both the husband's impairment and the caregiver's sense of burden to the caregiver level of emotional distress and marital adjustment. Two hundred and fifteen veterans with posttraumatic stress disorder (PTSD) and their wives participated in the study. Data were collected using self-report questionnaires and a series of clinical interviews with the veterans and their wives. Results indicated that spouses of PTSD veterans suffer from a higher level of emotional distress and a lower level of marital adjustment than the general population. Their level of distress is more closely associated with perceived caregiver burden than with the level of the veterans’ impairment. The discussion highlights some cross-cultural similarities of the findings and the clinical and empirical implications of the study.

Anxiety, Emotional Suppression, and Psychological Distress Before and After Breast Cancer Diagnosis

The authors examined the influence of anxiety and emotional suppression on psychological distress in 21 patients with breast cancer and 72 patients with benign breast tumor. The patients with breast cancer who suppressed emotion and had chronically high levels of anxiety felt higher levels of emotional distress both before and after the diagnosis. Such patients need psychological interventions, including encouragement to express and communicate their emotions, immediately after disclosure of the diagnosis to help maintain psychological adjustment in the face of the disease.

Help-seeking for mental health problems among young physicians: is it the most ill that seeks help?

The aims of this study were to assess the prevalence of self-reported mental health problems and help-seeking among young physicians, and identify predictors of seeking help. A prospective cohort sample of Norwegian medical students (N = 631) were assessed in their final semester (T1), and in the first (T2) and fourth (T3) postgraduate year. The average observation period was 3.6 years. The prevalence of mental health problems that needed treatment over the preceding year was observed to have increased from 11% at T2 to 17% at T3. There was no increase in help-seeking. Longitudinally, 34% reported that they needed treatment on one or several occasions. Adjusted predictors of help-seeking were perceived level of mental health problems and a reality weakness personality trait. Those who sought help had higher levels of emotional distress than those who did not. However, higher reality weakness scores predicted lower help-seeking and, therefore, may be a risk factor for avoiding necessary care.

Family experience with palliative sedation therapy for terminally ill cancer patients

Symptomatic sedation is often required in terminally ill cancer patients, and could cause significant distress to their family. The aims of this study were to clarify the family experience during palliative sedation therapy, including their satisfaction and distress levels, and the determinants of family dissatisfaction and high-level distress. A multicenter questionnaire survey assessed 280 bereaved families of cancer patients who received sedation in 7 palliative care units in Japan. A total of 185 responses were analyzed (response rate, 73%). The families reported that 69% of the patients were considerably or very distressed before sedation. Fifty-five percent of the patients expressed an explicit wish for sedation, and 89% of families were clearly informed. Overall, 78% of the families were satisfied with the treatment, whereas 25% expressed a high level of emotional distress. The independent determinants of low levels of family satisfaction were: poor symptom palliation after sedation, insufficient information-giving, concerns that sedation might shorten the patient's life, and feelings that there might be other ways to achieve symptom relief. The independent determinants of high levels of family distress were: poor symptom palliation after sedation, feeling the burden of responsibility for the decision, feeling unprepared for changes in the patient's condition, feeling that the physicians and nurses were not sufficiently compassionate, and shorter interval to patient death. Palliative sedation therapy was principally performed to relieve severe suffering based on family and patient consent. Although the majority of families were comfortable with this practice, clinicians should minimize family distress by regular monitoring of patient distress and timely modification of sedation protocols, providing sufficient information, sharing the responsibility of the decision, facilitating grief, and providing emotional support.

Communication about the ending of anticancer treatment and transition to palliative care

Communication about the ending of anticancer treatment and transition to palliative care is a difficult task for oncologists. The primary aims of this study were to clarify family-reported degree of emotional distress and the necessity for improvement in communication methods when communicating about the ending of anticancer treatment, and to identify factors contributing to the levels of emotional distress and the necessity for improvement. A multi-center questionnaire survey was conducted on 630 bereaved family members of cancer patents who received specialized palliative care in Japan. A total of 318 responses were analyzed (effective response rate, 62%). Thirty-nine percent of the bereaved family members reported that they were 'very distressed' in receiving information about the ending of anticancer treatment, and 19% reported 'considerable' or 'much' improvement was necessary in the communication methods. High-level emotional distress was significantly associated with younger patient age, female family gender, the experience of the physician stating she/he could do nothing for the patient, the physician's unwillingness to explore their feelings, and prognostic disclosure of definite survival periods without probabilities or ranges. High levels of perceived necessity for improvement in the communication methods were significantly associated with the experience of the physician stating she/he could do nothing for the patient, physicians not explaining treatment goals in specific terms, physicians not pacing the explanation with the state of family preparation, physicians not being knowledgeable about the most advanced treatments, and the atmosphere not being relaxing enough to ask questions. In receiving the information about ending anticancer treatment, a considerable number of families experienced high levels of emotional distress and felt a need for improvement of the communication methods. The strategies to alleviate family distress could include: (i) assuring that physicians will do their best to achieve specific goals, without saying that they can do nothing for the patient; (ii) providing information, including estimated prognosis, in careful consideration of families' preparation and the uncertainty for each patient; (iii) exploring families' emotions and providing emotional support; (iv) acquiring knowledge about advanced treatments; and (v) making the atmosphere relaxing enough to allow families to ask questions.

Increased depression and anxiety in infertile Japanese women resulting from lack of husband's support and feelings of stress

We report that infertile women in Japan as well as in the Western world have high levels of emotional distress, anxiety, and depression. The reasons for anxiety and depression in infertile women are easy to presume but remain unclear. We conducted the present study to assess the relationship between the anxiety and depression of infertile Japanese women and their thought processes and emotional well-being with regard to their infertility. A cross-sectional questionnaire was administered to 101 infertile Japanese women who visited the infertility clinic at Tokai University. Inventories included the Hospital Anxiety and Depression Scale (HADS) and our original infertility questionnaire, which is composed of 22 questions to assess attitudes and emotional status in facing the stigma of infertility. After factor analysis, comparison between the HADS and the infertility questionnaire was made with simultaneous multiple regression analyses. Anxiety and depression in childless Japanese women were significantly associated with lack of husband's support and feeling stress. Our findings should prove useful in designing and implementing psychological support programs for infertile Japanese women. Psychological interventions to relieve or diminish these conditions might have significant therapeutic benefits for women attending infertility clinics in Japan.

Long-term adjustment among Israeli war veterans: the role of attachment style

This study examines the role of attachment in the long-term adjustment of Israeli veterans. The sample of participants comprised three groups of Israeli veterans who fought in the 1973 Yom Kippur War: 112 combat stress reaction (CSR) casualties, 98 veterans who received medals for bravery, and 189 controls. The CSR casualties reported higher levels of emotional distress than did participants in the two other groups. CSR veterans also showed the lowest levels of secure attachment characteristics. Additionally, the findings revealed different relationships between the avoidant style of attachment and emotional distress measures across the research groups. The implications of these findings are discussed according to two theoretical models of attachment.

Other psychological approaches: A qualitative investigation of parents' experiences of caring for an adolescent with chronic pain

Previous quantitative research has shown that parents/carers of adolescents with chronic pain report high levels of emotional distress, severe limitations in social and family functioning, increased financial hardship, and increased use of health care resources. This study aimed to further explore this parental impact by employing qualitative methodology to investigate parents' experiences of caring for an adolescent with chronic pain. A sample of 18 parents/carers of adolescents with chronic pain were selected from two clinic sites. Participants comprised of 11 mothers, 5 fathers, 1 grandmother and 1 family friend. Four focus groups with parents/carers were conducted to discuss the impact of caring for an adolescent with chronic pain on the parent/carer. Group discussions were tape-recorded, anonymised and transcribed verbatim. Transcripts were analysed using interpretative phenomenological analysis (IPA). Additional analyses were conducted to account for the dynamics of group interaction. A number of themes emerged from the IPA including ‘struggle’, ‘challenge of the parental role’, ‘parental distress’, ‘shift in familial relationships’ and ‘salience of medical knowledge and services’. Parents were highly distressed by their inability to alleviate their child's pain and felt that this contradicted their view of a parent as someone who can ‘make things better’. Participants emphasized that caring for an adolescent with chronic pain is a constant ‘struggle’, consuming vast amounts of energy, time and financial resources. Parents also discussed practical ways in which they have adapted their lives and those of their family members to care for an adolescent with chronic pain. Understanding of others, particularly medical professionals dominated the lives of participants. In addition to providing an understanding of parental experiences of caring for an adolescent with chronic pain, these research findings will also be used to inform the development of an inventory to measure the parental impact of caring for an adolescent with chronic pain. Previous quantitative research has shown that parents/carers of adolescents with chronic pain report high levels of emotional distress, severe limitations in social and family functioning, increased financial hardship, and increased use of health care resources. This study aimed to further explore this parental impact by employing qualitative methodology to investigate parents' experiences of caring for an adolescent with chronic pain. A sample of 18 parents/carers of adolescents with chronic pain were selected from two clinic sites. Participants comprised of 11 mothers, 5 fathers, 1 grandmother and 1 family friend. Four focus groups with parents/carers were conducted to discuss the impact of caring for an adolescent with chronic pain on the parent/carer. Group discussions were tape-recorded, anonymised and transcribed verbatim. Transcripts were analysed using interpretative phenomenological analysis (IPA). Additional analyses were conducted to account for the dynamics of group interaction. A number of themes emerged from the IPA including ‘struggle’, ‘challenge of the parental role’, ‘parental distress’, ‘shift in familial relationships’ and ‘salience of medical knowledge and services’. Parents were highly distressed by their inability to alleviate their child's pain and felt that this contradicted their view of a parent as someone who can ‘make things better’. Participants emphasized that caring for an adolescent with chronic pain is a constant ‘struggle’, consuming vast amounts of energy, time and financial resources. Parents also discussed practical ways in which they have adapted their lives and those of their family members to care for an adolescent with chronic pain. Understanding of others, particularly medical professionals dominated the lives of participants. In addition to providing an understanding of parental experiences of caring for an adolescent with chronic pain, these research findings will also be used to inform the development of an inventory to measure the parental impact of caring for an adolescent with chronic pain.

Psychological responses to drought in northeastern Brazil

This study of cumulative effects of drought in Northeast Brazil assessed the psychological responses (anxiety, emotional distress, and PTSD) of 102 individuals living in a city (Queimadas) in a drought-prone area compared to the responses of 102 persons living in a drought-free control city (Areia) of comparable size. As predicted, the findings revealed that residents in the drought area (Queimadas) had significantly higher levels of anxiety and emotional distress than residents in the no-drought area (Areia). In the drought area, women had significantly higher levels of anxiety and men had significantly higher levels of emotional distress than women and men, respectively, in the no-drought area. Likely because of their role vulnerability, women had significantly higher levels of anxiety and emotional distress than men. As predicted, Post-traumatic Stress Disorder (PTSD) was unrelated to the drought. Although descriptive, the results provide baseline data for comparisons as the drought deepens and offer insights and suggestions for further research into the psychological consequences of drought.

The struggle for systematic ‘adulthood’ for Aboriginal Mental Health in the mainstream: The Djirruwang Aboriginal and Torres Strait Islander Mental Health Program

The title of this paper refers to issues of growth, development and maturity in Aboriginal Mental Health as it emerges as a specialised profession in the mainstream mental health system. The paper raises many challenges to the existing mental health structures. It asks a number of key questions regarding the professional status of Aboriginal Mental Health Professionals operating in the mainstream mental health industry. The paper describes the approach the Djirruwang Aboriginal and Torres Strait Islander Mental Health Program is taking to ensure that its students graduate with all the necessary skills, attitudes, knowledge and values to be effective professionals in their own right. It highlights the collaboration required by the mental health industry to ensure that the entire mental health workforce and the services in which they operate create a supportive environment for the development of the Aboriginal and Torres Strait Islander mental health workforce. Finally it seeks the support of the mental health industry and professional organisations to move towards systematic adulthood with respect to 1) the professional recognition of students and graduates of the program, and 2) the need for professional organisations, and service management and staff to take responsibility in their responses to Aboriginal mental health issues. The need to effectively deal with the above workforce issues is based on the evidence that Aboriginal and Torres Strait Islander people suffer from higher levels of emotional distress and possible mental illness than that of the wider community. Suicide and self-harm rates are also considerably higher in comparison to that of the broader population (AIHW, 2001). Surely, if there is a higher level of identified need there must also be a higher level of orchestrated effort required.

Emotional distress: adequacy of treatment for lung cancer patients

Lung cancer is the most common cause of cancer-related death in the United States. These patients report higher levels of emotional distress than any other population of cancer patients. It is not clear whether lung cancer patients receive adequate treatment for their psychological symptoms. We conducted exploratory analysis to examine the adequacy of treatment for emotional distress. We recruited 29 patients with lung cancer (59% females, 41% males, mean age=66) and assessed their current use of mood altering medications, symptom distress, cancer-specific anxiety, and generalized anxiety. Independent samples t tests were used to compare measures of adjustment for cancer patients currently taking mood-altering medications to those not on such medications. The analysis showed that subjects on mood altering medications reported higher symptom distress, higher cancerspecific anxiety, and higher general anxiety than the comparison group. When subjects on antidepressants and anxiolytics were examined separately, we found elevated levels of symptom distress and cancerspecific anxiety in subjects on antidepressants. These data suggest that mood disturbance may not be adequately addressed even when treated with mood-altering medications. Psychotherapeutic intervention may be beneficial for lung cancer patients.

Working with Bangladeshi young women

The author describes once-weekly psychoanalytically informed work in a child mental health setting with young Bangladeshi women making the transition to adulthood. She argues that the prevalent notion of 'culture conflict' used to account for patterns of emotional disturbance and self-harm in these young women is reductionist and represents a denial of severe family dysfunction and individual psychic pain. She shows how, despite cultural differences, psychoanalytically informed thinking can provide a basis for understanding these young women's experience and facilitate their emotional growth. However, faced with complex unconscious processes, the worker has to remain alert to her countertransference in order not to be drawn into an unhelpful collusion or denial of reality. Organizational defences may also operate to protect staff and their institutions from awareness of such high levels of emotional distress, which therefore remain hidden. The author is grateful to the two young women who consented to publication in the hope that it might help others. Details have been changed to protect their anonymity.

Rapid assessment of quality of life in patients with advanced heart failure

prior to HT tended to be more hostile ( -.243, p .07). Number of rejections contributed to anxiety ( .389, p .02) and depression ( .292, p .03). Those receiving cyclosporine had more anxiety ( -.301, p .02), depression ( -.338, p .01), and hostility ( -.392, p .004) than those receiving tacrolimus. Conclusion: Many women are likely to experience emotional distress at levels above normative values after HT. Cyclosporine’s cosmetic side effects (hirsutism and gingival hyperplasia) may contribute to higher levels of emotional distress. Annual psychological assessment should be part of post transplant evaluation.