High Levels Of Emotional Distress Research Articles

Health Technology Readiness Profiles Among Danish Individuals With Type 2 Diabetes: Cross-Sectional Study.

BackgroundInformation technologies (IT) are increasingly implemented in type 2 diabetes (T2D) treatment as a resource for remotely supported health care. However, possible pitfalls of introducing IT in health care are generally overlooked. Specifically, the effectiveness of IT to improve health care may depend on the user’s readiness for health technology.ObjectiveWe aim to investigate readiness for health technology in relation to mental well-being, sociodemographic, and disease-related characteristics among individuals with T2D.MethodsIndividuals with T2D (aged ≥18 years) who had been referred to self-management education, exercise, diet counseling, smoking cessation, or alcohol counseling completed a questionnaire survey covering (1) background information, (2) the 5-item World Health Organization Well-Being Index (WHO-5), (3) receptiveness to IT use in physical activity, and (4) the Readiness and Enablement Index for Health Technology (READHY), constituted by dimensions related to self-management, social support, and eHealth literacy. Individuals were divided into profiles using cluster analysis based on their READHY scores. Outcomes included differences across profiles in mental well-being, sociodemographic, and disease-related characteristics.ResultsParticipants in the study were 155 individuals with T2D with a mean age of 60.2 (SD 10.7) years, 55.5% (86/155) of which were men and 44.5% (69/155) of which were women. Participants were stratified into 5 health technology readiness profiles based on the cluster analysis: Profile 1, high health technology readiness; Profile 2, medium health technology readiness; Profile 3, medium health technology readiness and high level of emotional distress; Profile 4, medium health technology readiness and low-to-medium eHealth literacy; Profile 5, low health technology readiness. No differences in sociodemographic and disease-related characteristics were observed across profiles; however, we identified 3 vulnerable subgroups of individuals: Profile 3 (21/155, 13.5%), younger individuals (mean age of 53.4 years, SD 8.9 years) with low mental well-being (mean 42.7, SD 14.7) and emotional distress (mean 1.69, SD 0.38); Profile 4 (20/155, 12.9%), older individuals (mean age 66.3 years, SD 9.0 years) with less IT use (50.0% used IT for communication) and low-to-medium eHealth literacy; and Profile 5 (36/155, 23.2%) with low mental well-being (mean 43.4, SD 20.1) and low readiness for health technology.ConclusionsImplementation of IT in health care of individuals with T2D should be based on comprehensive consideration of mental well-being, emotional distress, and readiness for health technology rather than sociodemographic and disease-related characteristics to identify the individuals in need of social support, self-management education, and extensive IT support. A one-size-fits-all approach to IT implementation in health care will potentially increase the risk of treatment failure among the most vulnerable individuals.

Vulnerability and resilience to pandemic-related stress among U.S. women pregnant at the start of the COVID-19 pandemic.

RationaleWomen pregnant during the COVID-19 pandemic are experiencing moderate to high levels of emotional distress, which has previously been shown to be attributable to two types of pandemic-related pregnancy stress: stress associated with feeling unprepared for birth due to the pandemic (Preparedness Stress) and stress related to fears of perinatal COVID-19 infection (Perinatal Infection Stress). Objective. Given the well-documented harms associated with elevated prenatal stress and the critical importance of developing appropriately targeted interventions, we investigated factors predictive of pandemic-related pregnancy stress. Method. Between April 25 and May 15, 2020, 4,451 pregnant women in the U.S. were recruited via social media to complete an online questionnaire that included sociodemographic, medical, and COVID-19 situational factors, as well as the Pandemic-Related Pregnancy Stress Scale (PREPS). Binary logistic regression was used to calculate odds ratios for high stress. Results. Nearly 30% of participants reported high Preparedness Stress; a similar proportion reported high Perinatal Infection Stress. Abuse history, chronic illness, income loss due to the pandemic, perceived risk of having had COVID-19, alterations to prenatal appointments, high-risk pregnancy, and being a woman of color were associated with greater levels of one or both types of stress. Access to outdoor space, older age, and engagement in healthy behaviors were protective against stress. Conclusions. Practices that may alleviate pandemic-related stress such as minimizing disruptions to prenatal care, ensuring access to outdoor space, and motivating engagement in health behaviors are of vital importance. Particular attention is needed for more vulnerable populations including women of color, women with a history of abuse, and those with high-risk pregnancy. Research focused on the short and longer-term impact of pandemic-related pregnancy stress on maternal mental and physical health, perinatal outcomes, and child development is critical to identify these effects and marshal appropriate resources to reduce them.

Prevalence and predictors of burnout symptoms in multidisciplinary pain clinics: a mixed-methods study.

Frequent exposure to patient distress is associated with a higher prevalence of clinician distress and burnout. Patients with chronic pain often present with high levels of emotional distress. The current study examined the prevalence of burnout symptoms among a multidisciplinary sample of pain clinicians in Australia, the relationship between clinician confidence managing emotions and symptoms of burnout, and clinicians' perspectives on sources of stress and wellbeing at work. One hundred seventy-six clinicians from 58 multidisciplinary pain clinics across Australia completed a survey including the 22-item Maslach Burnout Inventory, a measure of clinician confidence managing patient emotions and their own emotions, and open-ended questions probing clinician perspectives on sources of stress and wellbeing at work. High levels of emotional exhaustion and depersonalisation were reported by 21.6% and 14.2% of respondents, respectively. These burnout symptoms were predicted by clinician confidence managing their own emotions. Low levels of personal accomplishment were reported by 18.8% of respondents and were predicted by clinician confidence managing patients' emotions. Consistent with these quantitative findings, qualitative data revealed that emotionally challenging patient encounters were common sources of stress. Working with a multidisciplinary team and supportive relationships with colleagues were commonly reported sources of clinician wellbeing. The results of this study are discussed in light of previous reports of burnout in pain medicine physicians. Implications for clinician training in pain management and the prevention of burnout in pain clinicians are discussed.

Families of COVID-19 Patients Say Goodbye on Video: A Structured Approach to Virtual End-of-Life Conversations

Journal of Palliative MedicineVol. 23, No. 12 Letters to the EditorFree AccessFamilies of COVID-19 Patients Say Goodbye on Video: A Structured Approach to Virtual End-of-Life ConversationsJulia L. Frydman, Eugene W. Choi, and Elizabeth C. LindenbergerJulia L. FrydmanAddress correspondence to: Julia L. Frydman MD, Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA E-mail Address: julia.frydman@mssm.eduBrookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.Search for more papers by this author, Eugene W. ChoiBrookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.Search for more papers by this author, and Elizabeth C. LindenbergerBrookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.Geriatric Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA.Search for more papers by this authorPublished Online:11 Nov 2020https://doi.org/10.1089/jpm.2020.0415AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail To the Editor:COVID-19 has challenged our ability to support patients and families at the end of life. Hospital policies, established to protect patients, health care workers, and family members, often dictate that no or few visitors be allowed at the bedside. Without the ability to see their loved ones in person, the emotion and disbelief of the patient's sudden serious illness are magnified leading to high levels of emotional distress. Families worry about the patient being abandoned, not having an advocate, and dying alone. Many family members have serious medical problems themselves and are precluded from leaving the house even if a visit becomes available per hospital policy; furthermore, transportation is limited. For those who do have brief visits, they are not permitted to come together and provide support to each other.In this setting of strict hospital visitation policies and the need for physical distancing, family members are often unable to say goodbye to their loved ones in person. Health care providers are being asked to play an increasing role in facilitating communication between patients with COVID-19 and their families; this work is emotionally challenging and has potential consequences for providers' mental health. Furthermore, we know that family members who have the opportunity to say goodbye at the end of life have lower rates of depression and complicated grief.1Through iterative clinical experience at the height of the pandemic, and drawing on guidelines from multiple national organizations focused on improving communication in the setting of COVID-19,2,3 we developed a novel “Video Goodbye Tool” (Fig. 1). Although many of the communication strategies used in the tool are not new, we have coupled them with the technical details of planning these meetings that we found most challenging at the start of the pandemic. How could we assess a family's readiness for a video goodbye? How could we prepare them for what they would see and what to say? What were strategies to ensure technological issues did not become a barrier to making the encounter meaningful? The “Video Goodbye Tool” is meant to be used by providers in real time to prepare for end-of-life encounters, easing the transition from in-person to virtual goodbyes.FIG. 1. Video Goodbye Tool.Given the ongoing nature of the COVID-19 pandemic and the likelihood of multiple waves over the next one to two years,4 the “Video Goodbye Tool” is a resource to support patients, families, and providers who are navigating COVID-19's impact on end-of-life care. Our hope is that coupling video technology with a structured purposeful approach to communication will make these encounters meaningful and mitigate the trauma of these unprecedented times.

Best practice in reducing the suicide risk in head and neck cancer patients: a structured review.

The treatment of head and neck cancer (HNC) is often radical and the patient's journey challenging, especially for individuals who are struggling with pre-existing mental health problems and who lack social support. Patients frequently suffer from high levels of emotional distress at some point before, during, or after treatment, and their risk of suicide is markedly elevated. This structured review aimed to identify the extent of the problem, appropriate interventions, and areas for future research. We found that the incidence of suicide among HNC patients was significantly elevated above that of the demographically matched general population. Furthermore, the risk was frequently higher in patients with HNC than in those with cancers in other sites. Despite the clear burden of suicide in patients with HNC, there is an absence of evidence on interventions used to reduce suicidal ideation and the risk of suicide. Recommendations for practice are made, drawing from the wider literature on the prevention of suicide.

Experiences and Illness Perceptions of Patients with Functional Symptoms Admitted to Hyperacute Stroke Wards: A Mixed-Method Study.

IntroductionA proportion of patients admitted to acute-stroke settings have not had a stroke, but have conditions mimicking a stroke. Approximately 25% of suspected stroke cases are “stroke mimics” and 2% are patients with functional symptoms — “functional stroke mimics”. This study aimed to explore experiences and illness perceptions of patients with functional symptoms admitted to hyperacute stroke wards.MethodsThis study used mixed methods. Patients with functional stroke symptoms participated in semistructured qualitative interviews immediately after admission to one of two acute-stroke units in London and again 2 months after hospital discharge. Qualitative data were assessed using thematic analysis. The Brief Illness Perception Questionnaire (Brief-IPQ) measured illness perceptions at admission and at 2-month follow-up.ResultsA total of 36 participants completed baseline interviews and 25 completed follow-up. Six themes emerged: physical symptom experience, emotional and coping responses, symptom causes, hospital experiences, views on the future, and uncertainty after hospital discharge. Mean Brief-IPQ score at admission was 49.3 (SD: 9.9), indicating a moderate–high level of perceived illness threat. Participants presented with a range of functional symptoms. At baseline, participants were highly concerned about their symptoms, but this had decreased at 2-month follow-up. Two months later, many were confused as to the cause of their admission.ConclusionThis is the first study to examine functional stroke patients’ experiences of acute-stroke admission. At admission, patients expressed confusion regarding their diagnosis, experienced high levels of emotional distress, and were concerned they were perceived as time wasting by stroke clinicians. While most participants experienced symptom recovery, there was a significant subgroup for whom symptoms persisted or worsened. A lack of care guidelines on the management of functional stroke patients may perpetuate functional symptoms.

Coping Patterns and Emotional Distress in Patients With Chronic Obstructive Lung Disease Who Are Undergoing Lung Transplant Evaluation.

Living with severe lung disease like chronic obstructive pulmonary disease (COPD) is a very stressful situation. The way patients cope may impact their symptoms of anxiety and depression and physical function as well. We studied how ways of coping are associated with levels of emotional distress and lung function in patients with COPD being evaluated for lung transplantation. Sixty-five (mean age 57 years, 46% females) patients completed the General Health Questionnaire-30 (GHQ-30) assessing emotional distress and the Ways of Coping Questionnaire. Measurements of lung function and 6-minute walk test were included. Seventeen (26%) patients had elevated emotional distress. Logistic regression of chronic GHQ score with gender, age, body mass index, lung function, and coping scales as covariates showed that escape avoidance and self-controlling coping and forced vital lung capacity were significantly associated with high emotional distress. Odds ratio of emotional distress increased with 5.2 per tertile (P = .011) in escape avoidance coping score. Moreover, we revealed that emotionally distressed patients cope with their current situation by refusing to believe the current situation and taking their distress out on other people. Among patients with COPD, a high level of emotional distress was uniquely associated with escape-avoidance coping and lung function. Future work should ascertain whether coping style predicts distress or whether distress increases the use of escape-avoidance coping. Nevertheless, our findings indicate that if either element is present, health care professionals should be attentive to the need for interventions to improve patients' well-being.

1102 Relationship Between Emotional Distress And Sleep Duration Among Hispanics Using The 2018 National Health Interview Survey Dataset

Abstract Introduction Although Hispanics experience a high level of shorter sleep duration (< 7 hrs./24 period), a clear mechanism or cause is lacking. Previous research indicate that emotional distress may explain the burden of shorter sleep among blacks. Applying these findings to Hispanics, we investigated whether emotional distress explains the burden of short sleep duration (< 7 hrs.) among Hispanics and if this relationship varies by sex Methods We used data from the 2018 National Health Interview Survey (NHIS) dataset, a nationally representative sample, in which only Hispanic ethnicity participants (N=3,091) were analyzed. Average sleep duration was self-reported and measured in hours. Emotional distress was measured using Kessler 6, which measures how an individual felt over the past 30 days: nervous, hopeless, restless/fidgety, depressed, effortful and worthless. To assess the association between short sleep duration and emotional distress, we performed Pearson correlation, hierarchical regression analyses, and stratified this relationship by sex to determine if this relationship differed between males and females, adjusting for covariates. Results Of the total sample of 3,091 Hispanics, 1,762 were female, and 1,329 were male. Sleep duration and emotional distress were negatively correlated among females (r = -.27, p <.001) and males (r=-.18, p <.001). Among Hispanic females, sleep duration significantly predicted emotional distress, β = -.27, t = -11.60, p <.001, and explained a significant portion of variance in emotional distress, R2 = .07, F= 134.63, p <.001. While, among Hispanic males, sleep significantly predicted emotional distress (β = -.18, t =-6.5, p <.001) and explained a significant portion of the variance in emotional distress (R2 = .03, F= 42.37, p <.001). Conclusion Our findings indicate that a negative sleep-ED relationship, suggesting that shorter sleep was predictive of higher levels of emotional distress among Hispanics and that this relationship is greater among Hispanic females, compared males. Support K01HL135452, R01MD007716, R01HL142066, and K07AG052685

Web-Based Self-Management for Patients With Lymphoma: Assessment of the Reach of Intervention of a Randomized Controlled Trial.

BackgroundRandomized controlled trials (RCTs) often provide accurate estimates of the internal validity of an intervention but lack information on external validity (generalizability). We conducted an RCT on the effectiveness of a self-management intervention among patients with lymphoma in a population-based setting.ObjectiveThe objectives of the current study were to describe the proportion of RCT participants compared to all patients invited to participate, and compare sociodemographic and clinical characteristics of RCT participants with all respondents, all patients invited to participate, and all patients selected from the Netherlands Cancer Registry (NCR) to determine the reach of the intervention. An additional objective was to assess differences on RCT outcome variables between RCT and paper respondents.MethodsPatients with lymphoma or chronic lymphocytic leukemia ≥18 years old at diagnosis from 13 hospitals in the Netherlands were selected from the population-based NCR, which routinely collects data on sociodemographic and clinical characteristics. Eligible patients were invited to participate in an RCT and complete a questionnaire. Web-based completion determined RCT enrollment, whereas paper respondents were followed observationally.ResultsA total of 1193 patients were selected from the NCR, 892 (74.77%) of whom were invited to participate in the trial by their hematologist after verifying eligibility. Among those invited, 25.4% (227/892) completed the web-based questionnaire and were enrolled in the RCT. The RCT participants were younger and there was a higher proportion of men than nonparticipants (P<.001). In addition, 25.7% (229/892) of those invited opted to participate in the paper-based observational follow-up study. Compared with paper respondents, RCT participants were younger (P<.001), with a higher proportion of men (P=.002), and had higher education levels (P=.02). RCT participants more often wanted to receive all available information on their disease (P<.001), whereas paper respondents reported higher levels of emotional distress (P=.009).ConclusionsFrom a population-based sample of eligible patients, the participation rate in the RCT was approximately 25%. RCT participants may not be representative of the target population because of different sociodemographic and clinical characteristics. Since RCT participants represent a minority of the target population, RCT results should be interpreted with caution as patients in the RCT may be those least in need of a self-management intervention.Trial RegistrationNetherlands Trial Register NTR5953; https://www.trialregister.nl/trial/5790

A Step Towards a Better Understanding of Pain Phenotypes: Latent Class Analysis in Chronic Pain Patients Receiving Multimodal Inpatient Treatment.

PurposeThe number of non-responders to treatment among patients with chronic pain (CP) is high, although intensive multimodal treatment is broadly accessible. One reason is the large variability in manifestations of CP. To facilitate the development of tailored treatment approaches, phenotypes of CP must be identified. In this study, we aim to identify subgroups in patients with CP based on several aspects of self-reported health.Patients and MethodsA latent class analysis (LCA) was carried out in retrospective data from 411 patients with CP of different origins. All patients experienced severe physical and psychosocial consequences and were therefore undergoing multimodal inpatient pain treatment. Self-reported measures of pain (visual analogue scales for pain intensity, frequency, and impairment; Pain Perception Scale), emotional distress (Patient Health Questionnaire, PHQ-9; Generalized Anxiety Disorder Scale, GAD-7) and physical health (Short Form Health Survey; SF-8) were collected immediately after admission and before discharge. Instruments assessed at admission were used as input to the LCA. Resulting classes were compared in terms of patient characteristics and treatment outcome.ResultsA model with four latent classes demonstrated the best model fit and interpretability. Classes 1 to 4 included patients with high (54.7%), extreme (17.0%), moderate (15.6%), and low (12.7%) pain burden, respectively. Patients in class 4 showed high levels of emotional distress, whereas emotional distress in the other classes corresponded to the levels of pain burden. While pain as well as physical and mental health improved in class 1, only the levels of depression and anxiety improved in patients in the other groups during multimodal treatment.ConclusionThe specific needs of these subgroups should be taken into account when developing individualized treatment programs. However, the retrospective design limits the significance of the results and replication in prospective studies is desirable.

Intimate partner violence and postpartum emotional distress among South African women: Moderating effects of resilience and vulnerability factors

ABSTRACT In this study we aimed to identify factors that condition (i.e. buffer or exacerbate) the impact of exposure to intimate partner violence (IPV) on postpartum emotional distress among South African women. Hypothesised buffering factors included: socioeconomic status, family social support, and religiosity. Hypothesised exacerbating factors included: baseline distress, HIV status, and childhood abuse. Longitudinal analyses examined interactions between putative buffering and exacerbating factors and exposure to physical or sexual IPV, assessed during pregnancy (T1), as predictors of emotional distress, measured at 14 weeks (T2) and 9 months postpartum (T3). Consistent with hypotheses, at both T2 and T3 the impact of IPV exposure on emotional distress was significantly stronger among women who reported greater baseline distress and weaker among women of greater socioeconomic status. At T3, an interaction emerged with HIV status; the impact of IPV exposure on emotional distress was stronger for women who were diagnosed as HIV-positive during pregnancy. Findings support the need for targeted mental health promotion interventions for IPV-exposed women who are newly diagnosed with HIV and/or report high levels of emotional distress during pregnancy. Although more research is needed, findings also suggest that strengthening socioeconomic supports for IPV-exposed women may buffer impacts on postpartum mental health.

Diabetes-Specific Self-Compassion: A New Measure for Parents of Youth With Type 1 Diabetes.

Given the high daily demands of managing type 1 diabetes (T1D), parents of youth with T1D can experience high levels of emotional distress, burden, and self-criticism, with implications for parent and child well-being and parent self-efficacy for managing diabetes. Diabetes-specific self-compassion (SC), or being kind to oneself when facing challenges related to managing diabetes, may serve as protective for parents. This study aimed to create and assess the psychometric properties of a new tool, the diabetes-specific Self-Compassion Scale (SCS-Dp), to assess diabetes-specific SC in parents of youth with T1D. We adapted a parent diabetes-specific SC measure; surveyed parents (N = 198; parent: 88% female; 95% non-Hispanic White; M age = 44 ± 8.9; child: 46% female; M age = 13 ± 3.4, range 2-18 years; 83% insulin pump users; 40% continuous glucose monitor (CGM) users; HbA1c from clinic data available for 76 participants: M HbA1c = 8.1 ± 1.3%) and conducted confirmatory factor analysis, and reliability and construct validity analyses. Validity measures included diabetes distress, diabetes empowerment, diabetes numeracy, and HbA1c. A bifactor structure provided the best fit, with one general factor and two wording-related group factors (positively and negatively worded items). The final 19-item SCS-Dp demonstrated excellent internal consistency (α =.94; range of item-total correlations: .52-.81) and good construct validity. As predicted, greater SC was associated with lower distress (r = -.68, p < .001) and greater empowerment (r = .43, p < .001) and was not associated with diabetes numeracy (p = .61). Diabetes-specific Self-Compassion Scale was not associated with HbA1c (p = .28). Results provide initial evidence of good reliability and validity of the SCS-Dp to assess diabetes-specific SC in parents.

Anxiety and food allergy: A review of the last two decades.

Food allergy (FA) is recognized as a growing public health burden affecting 5%-10% of children worldwide. Several unique features specific to FA elicit high levels of emotional distress and anxiety in patients and caregivers, the first among all the possibility of a life-threatening reaction. Anxiety disorders are highly prevalent in patients with chronic disease, but remain undertreated despite significant negative consequences on patient health. This review aimed to offer a comprehensive overview of literature data on FA and anxiety of the last two decades. A review of the medical and psychological literature from the year 2000 (MEDLINE, PubMed and PsycINFO) was done using the keywords "anxiety" and "food allergy." Clinical implications for disease management, various manifestations in different target groups, proper interventions and possible explanations on the nature of the association between FA and anxiety have been discussed, as well as limitations and further research directions. The relationship between FA and anxiety is attributed to FA-specific fears and anxiety, rather than a general propensity towards anxiety. Some anxiety-short-lived and related to key events-is to be expected and may even be helpful if it sustains allergen avoidance and preparedness to emergency. However, some data reported that increased anxiety did not improve adherence. Rather, high levels of anxiety have been demonstrated counterproductive and related to maladaptive coping. Further research is needed to elucidate the association between FA and anxiety, especially to understand biopsychosocial directions of the underlying mechanisms and to build proper, effective, standardized protocols of intervention. Clinicians must be aware of the association between FA and anxiety, understand their role in recognizing maladaptive anxiety and encouraging to seek psychological support when needed.

Tugovanje nakon raskida - razlika između inicijatora i neinicijatora u zavisnosti od strategija prevladavanja i afektivne vezanosti

The aim of this paper is to examine the difference in the intensity of the breakup distress between the initiator and the non-initiator, as well as whether this difference is moderated by coping strategies and inner working models according to the attachment theory. The sample used in the research is convenient and consists of 387 respondents. The age range is between 18-40 (M=23.90; SD=4.22). We used the Close Relationship Experience Questionnaire (Brenan, Clark, &amp; Shaver, 1995), the Brief COPE (Carver, 1997) and the Breakup Distress Scale (Field &amp; al., 2010). The t-test was performed for the independent samples to test the difference between the breakup initiators and non-initiators in the variable of grief after a breakup (t(365)=4.62; p&lt;.01). Within the constructed prediction model, a total of four predictors showed an independent contribution to the explanation of experienced grief after a breakup: the status of the initiator of the breakup, coping aimed at solving problems, coping with avoidance and anxiety. Later, by testing the contribution of the predictor and the variable, the status of the initiator was obtained as a statistically significant interaction with anxiety. Respondents who have low anxiety do not experience a high level of distress after a breakup and do not differ from each other depending on whether the initiators of the relationship were them or their partner. Respondents who have high anxiety experience a noticeably higher level of emotional distress after the breakup, but there are also differences in that level depending on who initiated the breakup. If the partner initiated the termination, the level of experienced distress will be significantly higher. It seems that presenting as a stressor can be a trigger of an intense emotional reaction, considering that such people are sensitive to rejection by others.

Prevalence of DSM-5 somatic symptom disorder in Chinese outpatients from general hospital care

ObjectiveWe aimed to explore the prevalence of somatic symptom disorder (SSD) according to DSM-5 criteria in Chinese outpatients from general hospital departments. MethodsThis multicentre cross-sectional study enrolled 699 patients from outpatient departments, including the neurology, gastroenterology, Traditional Chinese Medicine [TCM] and psychosomatic medicine departments, in five cities in China. The structured clinical interview for DSM-5 (SCID-5) for SSD was administered by trained clinical professionals to diagnose SSD. ResultsSSD was diagnosed in 33.8% (236/697) of all enrolled patients. The prevalence of SSD differed significantly among the departments (χ2 = 34.049, df = 2, p ≤0.001). No differences were found between SSD patients and non-SSD patients in terms of gender, residence, marital and living statuses, family income, education, employment status and lifestyle factors. However, patients with SSD reported higher levels of depression, health-related and general anxiety, lower physical and mental quality of life, higher frequency of doctor visits, increased time devoted to physical symptoms and longer duration of somatic symptoms. In a binary linear regression analysis, SSD was significantly associated with an increase in health-related anxiety, time devoted to symptoms and impact of somatic symptoms on daily life. The explained variance was Nagelkerke R2 = 0.45. ConclusionThere is a high prevalence of SSD in Chinese general hospital outpatient clinics. The diagnosis is associated with high levels of emotional distress and low quality of life. There is a danger of over-diagnosis if we include the mild and moderate forms of SSD. Future studies are warranted to investigate the prevalence of SSD in inpatient departments and the development of psychological interventions for these patients.

Emotional distress and psychosocial needs in patients with breast cancer in British Columbia: younger versus older adults.

This study evaluates the prevalence of emotional distress and psychosocial needs in young adult (YA, age 18-39) patients at the time of their breast cancer diagnosis compared to older patients. Through a province-wide program, BC Cancer patients complete the PsychoSocial Scan for CANcer-Revised (PSSCAN-R) questionnaire, which screens for the presence of symptoms of anxiety and depression and assesses psychosocial needs using the Canadian Problem Checklist (CPC). The study population comprised all breast cancer patients who completed the questionnaire within 6months of their cancer diagnosis between 2011 and 2016. Clinical information was retrospectively collected from electronic health records. Univariate and multivariate analyses using the X2, Fisher's exact test, and logistical regression were used to compare patient age groups. The cohort included 10,734 breast cancer patients: median age 62, 4% YA, 99% female, and 96% presented with non-metastatic disease. After adjusting for clinical and demographic variables, YA patients were more likely to report depression (33.6% vs. 25.5%, OR 1.47, p = 0.001) and anxiety symptoms (58.6% vs. 35.7%, OR 2.49, p < 0.001) than older patients. Psychosocial needs regarding work/school (OR 3.79, p < 0.001), intimacy/sexuality (OR 2.82, p < 0.001), and finances (OR 2.78, p < 0.001) were more common among YA than older adults. After a breast cancer diagnosis, YAs have higher levels of emotional distress compared to older patients. Differences in specific psychosocial needs likely reflect differences in life stage between these age groups. The data suggest that YAs warrant specific attention with respect to early psychosocial assessment and tailored intervention.

Prevalence of DSM-5 Somatic Symptom Disorder in Chinese Outpatients from General Hospital Care

Objective: We aimed to explore the prevalence of somatic symptom disorder (SSD) according to DSM-5 criteria in Chinese outpatients from general hospital departments. Methods: This multicentre cross-sectional study enrolled 699 patients from outpatient departments, including the neurology, gastroenterology, Traditional Chinese Medicine [TCM] and psychosomatic medicine departments, in five cities in China. The structured clinical interview for DSM-5 (SCID-5) for SSD was administered by trained clinical professionals to diagnose SSD. Results: SSD was diagnosed in 33.8% (236/697) of all enrolled patients. The prevalence of SSD differed significantly among the departments (X2 = 34.049, df=2, p=<0.001). No differences were found between SSD patients and non-SSD patients in terms of gender, residence, marital and living statuses, family income, education, employment status and lifestyle factors. However, patients with SSD reported higher levels of depression, health-related and general anxiety, lower physical and mental quality of life, higher frequency of doctor visits, increased time devoted to physical symptoms and longer duration of somatic symptoms. In a binary linear regression analysis, SSD was significantly associated with an increase in health-related anxiety, time devoted to symptoms and impact of somatic symptoms on daily life. The explained variance was Nagelkerke R2 = .45. Conclusion: Patients with SSD have a high prevalence in Chinese general hospital outpatient clinics. The diagnosis is associated with high levels of emotional distress and low quality of life. There is a danger of over-diagnosis if we include the mild and moderate forms of SSD. Future studies are warranted to investigate the prevalence of SSD in inpatient departments and the development of psychological interventions for these patients. Funding Statement: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Declaration of Interests: The authors have no competing interests to report. Ethical Approval Statement: The study was approved by the ethics committees of Peking Union Medical College Hospital (PUMCH) and the University Medical Centre Freiburg, Germany.

808-P: A New Measure of Diabetes-Specific Self-Compassion for Parents of Youth with Type 1 Diabetes (T1D)

Managing T1D is highly demanding while offering little in terms of rewards or positive reinforcement. Parents often experience high levels of emotional distress and burden, with implications for parent and child wellbeing and parent self-efficacy for managing diabetes. Parents may also experience self-criticism regarding their management of T1D. Diabetes-specific self-compassion (SC), or being kind to oneself in the face of challenges that arise in managing diabetes, has the potential to buffer against the negative impact of diabetes distress. The purpose of this study was to create a new tool, the Diabetes-Specific Self-Compassion Scale (SCS-Dp), to assess diabetes-specific SC in parents of youth with T1D. We adapted a previously validated measure for adults with T1D; surveyed parents (N=198; parent: 88% female; 95% non-Hispanic white; M age=44±8.9; child: 46% female; M age=13±3.4, range 2-18 years; 83% insulin pump users; 40% CGM users; A1c from clinic data available for 76 participants: M A1c=8.1±1.3%) and conducted confirmatory factor analysis (CFA), reliability and construct validity analyses. The 19-item SCS-Dp had excellent internal consistency (ɑ=.94; range of item-total correlations: .52-.81). The CFA model showed evidence of good fit: SRMR=0.04; RMSEA=0.05; CFI=0.95; χ2(171)=1637.02, p&amp;lt;0.0001. Validity measures included diabetes distress, diabetes empowerment, diabetes numeracy, and A1c. As predicted, greater SC was associated with lower distress (r=-.68, p&amp;lt;.001) and greater empowerment (r=.43, p&amp;lt;.001) and was not associated with diabetes numeracy (p=.61). SCS-Dp was not associated with A1c (p=.28). Results suggest that the SCS-Dp is a reliable, valid measure of diabetes-specific SC in parents and may help determine points of intervention for this population. Interventions to increase diabetes-specific SC in parents may aid in ameliorating diabetes distress through increasing self-kindness in the context of diabetes-related challenges. Disclosure M.L. Tanenbaum: None. J.J. Wong: None. S. Hanes: None. K.K. Hood: Consultant; Self; Lilly Diabetes. Research Support; Self; Dexcom, Inc. Speaker's Bureau; Self; Johnson &amp; Johnson Diabetes Institute.

Emergency department visits involving opioids in Connecticut, 2011–2015

ABSTRACTBackground: Opioid abuse has demonstrated an unwavering elevation in the past decade. This study examined emergency department (ED) utilization for this growing public health problem in the state of Connecticut.Methods: We evaluated the ED discharges involving opioids in individuals treated in Connecticut EDs from 2011 to 2015. International Classification of Disease, 9th Revision, Clinical Modification and external cause of injury codes were used to identify cases.Results: There were 38,003 ED visits involving opioids during the study period. Visits were most prevalent in males (63.4%) and in those aged 18–44 years (71.8%). The rate of visits (per 10,000 ED visits) in whites (72.7) was more than three times that of blacks (24.7) and nearly double that of individuals of Hispanic ethnicity (37.7). The rate of visits for females under the age of 18 was slightly greater than that for males in the same age groups (2.7 vs. 2.4/10,000 ED visits, respectively).Conclusion: Manual labor work and racial stereotyping are possible causal factors for higher rates of opioid-related ED visits among white males between the ages of 18 and 44, while higher levels of emotional distress may be contributing to similar rates among females under the age of 18 and over the age of 65.

Can Occupational Therapy Address the Occupational Implications of Hoarding?

Hoarding is often described as a medical disorder, defined by a persistent difficulty in discarding possessions and associated high levels of emotional distress when forced to part with these. This article will discuss how having a different view of hoarding, seeing hoarding as a daily occupation which provides value, purpose, and meaning and with a relationship to self-identity and life purpose, could offer alternate interventions to support an individual who hoards. The article will consider the components of hoarding activity and how these relate to health and wellbeing and doing, being, belonging, and becoming as understood by occupational therapists. The article will consider what occupational therapy, a profession which considers a person's daily occupations, the things that occupy their time and which give meaning to their existence, could offer as an alternative to current hoarding interventions. Proposals for occupational therapy interventions will be suggested which would support occupational choice, support engagement in activities which have more positive outcomes on a person's health, and seek to address barriers which limit engagement and occupational performance in activities within the person's home environment.