Higher Symptom Levels Research Articles

Prevalence and predictors of persistent cognitive and psychological symptoms in non-hospitalized post-COVID-19 patients seeking care at an outpatient post-COVID-19 clinic.

There is still much uncertainty about why some people develop persistent cognitive and mental health problems after SARS-CoV-2 infection and require additional care while others do not. In this study, we investigated the cognitive and psychological outcomes of non-hospitalized post-COVID-19 patients referred to an outpatient post-COVID-19 clinic for persistent symptoms more than 3 months after infection. Additionally, we aimed to explore the influence of demographic, physical, and personal factors on these outcomes. This cross-sectional study was conducted at an outpatient post-COVID-19 clinic located at a prominent clinical teaching hospital in the Netherlands. Participants included non-hospitalized patients referred between 2020 and 2022, more than 3 months after SARS-CoV-2 infection, experiencing persistent symptoms. Main outcome measures included levels of anxiety and depression (Hospital Anxiety and Depression Scale), post-traumatic stress symptoms (PTSS) (Post-traumatic Stress Symptoms Checklist 14), and cognitive symptoms (Checklist for Cognitive and Emotional Consequences). Data analysis employed Spearman correlation and hierarchical multiple regression analyses. A total of 265 patients (61% female; mean age of 51.7 ± 13.7 years) were included in the study, with an average of 7.6 ± 4.5 months following SARS-CoV-2 infection. Among them, 104 patients (40%) reported high levels of anxiety, 111 patients (43%) showed high levels depressive symptoms, and 71 patients (31%) demonstrated high levels of PTSS. Additionally, 200 patients (79%) reported experiencing more than 2 cognitive symptoms. Bivariate analyses indicated associations between psychiatric history and increased cognitive and psychological symptoms. Multivariate analyses revealed positive associations between physical symptoms and cognitive and psychological symptoms, and catastrophizing thoughts were associated with higher anxiety levels (β = 0.217, p < 0.001). Conversely, positive refocusing was associated with lower depressive symptoms (β = -0.325, p < 0.001), PTSS (β = -0.290, p < 0.001), and cognitive symptoms (β = -0.220, p < 0.001). Among non-hospitalized COVID-19 patients seeking care for persistent symptoms, approximately one-third reported high levels of psychological symptoms, and more than three-quarter experienced cognitive symptoms. Physical symptoms, psychiatric history, and a tendency to catastrophize were identified as potential risk factors for persistent psychological and cognitive symptoms. Conversely, positive refocusing demonstrated a protective effect. These findings contribute to the understanding of long-term COVID-19 outcomes and emphasize the importance of integrating a biopsychosocial perspective into treatment approaches.

Comparison of opioid use disorder patients with and without problematic internet use in terms of impulsivity and attention deficit hyperactivity disorder.

To investigate attention deficit and hyperactivity disorder (ADHD) symptoms and impulsivity among individuals diagnosed with opioid use disorder (OUD) who also exhibit symptoms of problematic internet use (PIU). The study involved the participation of 360 patients with OUD enrolled at an alcohol and drug addiction treatment center (ADATC) from October to December 2022. Various assessment tools were administered, including Young's Internet Addiction Scale (YIAS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Barratt Impulsiveness Scale (BIS), and Adult ADHD Self-Report Scale (ASRS). PIU was identified by YIAS scores equal to or exceeding 50. Most participants diagnosed with OUD had comorbid PIU, with high levels of depression, anxiety, and ADHD symptoms. Both BDI and BAI scores were significantly increased in the PIU group compared to the non-PIU group (p < 0.001). Significant differences were observed in BIS Motor Impulsivity, Attentional Impulsivity, and total scores, indicating higher impulsivity in the PIU group (all p < 0.001). Additionally, higher ASRS scores were found in the PIU group (p < 0.001). These findings highlight the importance of addressing PIU and comorbidities in OUD treatment. Interventions targeting ADHD symptoms and emotional well-being may benefit PIU management.

Association between digital engagement and urban-rural disparities in Chinese women's depressive symptoms: A national-level cross-sectional study.

This study aims to investigate the impact of digital engagement on urban-rural disparities in depressive symptoms among Chinese women. Using a dataset from the China Family Panel Studies (CFPS) wave 2020, this study analyzes the impact of digital engagement on the urban-rural disparity in women's depressive symptoms using multiple linear regression and recentered influence function (RIF) models. Furthermore, the extent to which digital engagement affects the urban-rural disparity in women's depressive symptoms was calculated using the RIF decomposition method. Analysis showed that rural women had significantly higher levels of depressive symptoms compared to urban women; digital engagement significantly reduced women's depressive symptoms levels and mitigated the urban-rural disparity for women with moderate to high levels of depressive symptoms, and the mitigating effect was stronger for the highly depressed sample, but still widened the urban-rural disparity in women's depressive symptoms overall. In addition, the results of the RIF decomposition showed that digital engagement explained 28.28% of the urban-rural disparity in women's depressive symptoms. There is a significant disparity in depressive symptoms levels between urban and rural women in China. Digital engagement reduces women's depressive symptoms, but it also widens the depressive symptoms disparity between urban and rural women overall. Digital engagement is potentially positive for reducing women's depressive symptoms.

THE ASSOCIATION OF AIR POLLUTION AND CLIMATE FACTORS WITH DEPRESSIVE SYMPTOMS AMONG OLDER MEXICAN AMERICAN ADULTS

Abstract Air pollution, drought, and extreme heat are associated with elevated depressive symptoms. Older Mexican American adults experience high levels of depressive symptoms compared to other demographic groups, but little is known about the role of environmental factors in depressive symptoms for this population. Mexican American adults are resilient to the harmful health effects of socioeconomic disadvantage, but it is unclear if this resilience extends to air pollution and climate change. This study uses data from the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE) linked to air pollution and climate data from the Centers for Disease Control and Prevention, to assess the association of air pollution (PM2.5 and ozone) and climate factors (drought and extreme heat) with elevated depressive symptoms. We used data from the 2005 H-EPESE which includes Mexican American adults aged 75 and older. We used generalized estimation equations to test the association between air pollution and climate factors and depressive symptoms, adjusting for sociodemographic and health characteristics. Our sample (n=1,699) was 62.0% female with a mean age of 81.6 (standard deviation: 5.0). About 19% of participants reported elevated depressive symptoms. PM2.5 concentration was associated with higher odds of depressive symptoms (odds ratio: 1.11; 95% confidence interval: 1.04, 1.19). Ozone concentration, drought, and extreme heat were not associated with depressive symptoms. Our results suggest PM2.5 is a risk factor for elevated depressive symptoms. It is unclear if older Mexican American adults are resilient to the effects of environmental risk factors relative to other demographic groups.

Assessment the Levels of Depression among Patients with Hemodialysis at the Dialysis Centers in Mosul City

Aim: Depression is the most common psychiatric illness in patients with end-stage renal disease . Objectives: a descriptive study design, aiming to assess the levels of depression among patients with hemodialysis at two dialysis centers in Mosul City for the period 1st January to 15the Jun 2023. Material and Methods: The study used a non-probability accidental sampling method, 84 patients with Chronic Kidney Disease who were subjected to hemodialysis was enrolled in two dialysis centers at Mosul City. The study was conducted using the diagnostic poll method and standardized research tools: Part 1 collected socio-demographic characteristics of the patients. Part 2 [the Center for Epidemiologic Studies Depression Scale (CESD-R-20)], a 20-item self-report questionnaire to measure depressive symptoms. The scale had a 4-level Likert scale, and a total score was calculated by summing the 20 items. Scores equal to or above 16 indicated a person at risk for clinical depression. Data were collected through self-report questionnaires. Conclusion: The findings indicated varying levels of depression among the patients, with some experiencing high levels of depression symptoms. Recommendation: The study provides valuable insights about the need for coordination between mental health professionals and dialysis patients in dialysis centers. Keywords: Hemodialysis, depression, patient.

The Effects of Cognitive Ability, Mental Health, and Self-Quarantining on Functional Ability of Older Adults During the COVID-19 Pandemic: Results From the Canadian Longitudinal Study on Aging.

Determine whether levels of anxiety and depression, cognitive ability, and self-quarantining during and prior to the pandemic predict decreases in perceived functional ability. Longitudinal data collected from the Canadian Longitudinal Study on Aging (CLSA) COVID-19 Questionnaire Study (2020) and core CLSA study (Follow-Up 1; 2014-2018). 17541 CLSA participants. Self-quarantining behaviours from questionnaires administered at Baseline (April 2020), Monthly, and Exit (December 2020) time points of the CLSA COVID-19 Questionnaire Study, levels of anxiety and depression at Baseline, perceived change in functional ability at Exit, and performance on neuropsychological tests (Rey Auditory Verbal Learning Task, Mental Alternation Task, Animal Fluency Test) and functional ability (Older Americans Resources and Services [OARS] Multidimensional Assessment Questionnaire) from the core CLSA study. Greater cognitive ability pre-pandemic (B = -.003, P < .01), higher levels of anxiety (B = -.024, P < .01) and depressive symptoms (B = -.110, P < .01) at Baseline, and higher frequency of engaging in self-quarantining throughout the COVID-19 survey period (B = -.098, P < .01) were associated with perceived loss in functional ability at Exit. Self-quarantining behaviour was associated with perceived loss in functional ability only at average and high levels of depressive symptoms (B = -.013, P < .01). Older adults with higher cognitive and lower functional ability prior to the pandemic were at greater risk of decreased perceived functional ability during the first year of the pandemic, as were those who experienced greater levels of anxiety and depressive symptoms during the pandemic. Strategies/interventions to preserve functional ability in older adults with cognitive independence prior to future pandemics are warranted.

Risk factors for sexual harassment and abuse victimization among adolescent athletes and non-athletes: A one-year follow-up study

BackgroundThe association between SHA and negative mental health increases the need to understand risk factors for SHA victimization, which is important for future development of prevention programs. ObjectiveTo examine which combinations of demographic- and mental health factors were associated with subsequent SHA victimization, and the prevalence of elite athletes, recreational athletes, and reference students who experienced sexual revictimization. Participants and settingNorwegian elite athletes and recreational athletes attending sport high schools, and reference students attending non-sport high schools (mean age: 17.1 years) were eligible for participation. MethodsThe participants answered an online questionnaire at two measurement points one year apart, T1 and T2 (n = 1139, 51.1 % girls). After testing for measurement invariance, data were analyzed with Classification and Regression Tree analysis (CRT) using demographic- and mental health variables from T1 as independent variables, and SHA at T2 as outcome. ResultsThe combination of being a girl with high level of symptoms of eating disorders and other psychological symptoms was associated with subsequent reporting of SHA. Among the students with lifetime experience of SHA at T1 (n = 533, 58.3 %), 49.5 % reported revictimization at T2 (60.9 % girls, 32.2 % boys, p ≤ .001). The prevalence of SHA revictimization was lower among elite athletes (44.3 %) compared with recreational athletes (49.1 %) and reference students (59.4 %, p = .019). ConclusionThe combination of female gender and mental health symptoms are risk factors for subsequent SHA victimization. These findings, and the high prevalence of SHA revictimization is important knowledge for developing preventive programs targeting elite athletes, recreational athletes, and reference students.

A prospective cohort study to assess the prevalence and risk factors of antepartum depression and its effect on maternal and fetal outcome

Antepartum depression (APD) is a public health issue has negative repercussions on the health of the mother, child, and family. Early screening for APD will help in early detection and further prevention of postpartum depression and adverse maternal and fetal outcomes. This study was designed to determine i) the prevalence rate of APD in the Indian population and its associated risk factors, ii) the impact of APD on maternal and fetal outcomes. A retrospective cohort study was conducted among antenatal women in the third trimester and screened for antepartum depression between October 2021 and March 2022 by adopting the Edinburgh Postnatal Depression Scale (EPDS). In the study population, 36.6 % had mild to moderate level of depressive symptoms (EPDS score of 8–12) and 28 % had high levels of depressive symptoms (EPDS score of ≥13). An unplanned pregnancy, a history of abortion, and a history of any pregnancy complications were the likely maternal risk factors for developing antepartum depression. The APD risk was also likely to be increased by sociodemographic and personal factors such as insufficient family support, a history of domestic violence, marital dissatisfaction, and a partner with a poor level of education (P < 0.05). Women screened with antepartum depression had 58.34 times the likelihood of developing postpartum depression and a threefold greater risk of having premature delivery. These findings may help to improve pregnancy outcomes by early identification, referral for early treatment of antepartum depression, also inform maternal mental health service development and utilization for boosting women's mental wellbeing.

Depressive symptoms, gender equality and belongingness among older partnered individuals in Sweden

ABSTRACT Approximately one-third of all older adults in Sweden report periods with depressive symptoms. The study aims to find explanations for older partnered individuals’ depressive symptoms by focusing on their gender attitudes, household division of labor and conformity to younger partnered individuals’ commonly held gender attitudes and household division of labor. Analyses are based on a subsample (n respondents 1764) from the Swedish Generations and Gender Survey (2012/2013) including individuals aged 60–80. The analytical strategy is logistic regression. The findings show that individuals with traditional gender attitudes are more likely to report a high level of depressive symptoms than individuals with transitional (i.e. attitudes in between traditional and egalitarian attitudes) and individuals with egalitarian gender attitudes. Lower conformity to commonly held gender attitudes is also associated with a high level of depressive symptoms. However, neither the household division of labor nor conformity to common household division was associated with depressive symptoms. In later life, gender attitudes thus seem more important for depressive symptoms than the actual household division of labor. It may be that attitudes are more important than behavior among older couples, and a reason for this may be that behavior is likely more restricted by practical circumstances.

The impact of firm downsizing on workers: Evidence from Ethiopia’s ready-made garment industry

We analyze matched employee–employer data from Ethiopia’s largest special economic zone during a period of downsizing pressure from the COVID-19 world import demand shock. We observe substantial job displacement during the shock peak, particularly for new hires. These largely female and rural-to-urban migrants persistently “fall off the employment ladder”, remaining unemployed both within and outside the zone even after employers have recovered from the shock. We observe high levels of urban-centered food insecurity and depression symptoms during the crisis peak, regardless of employment status. Our findings highlight the importance of social protection policies within export-oriented development strategies.

A potential role for chlamydial infection in rheumatoid arthritis development.

To assess the relationship between self-reported and serologic evidence of prior chlamydial infection, rheumatoid arthritis (RA)-related autoantibodies and risk of RA-development. This is a nested study within a prospective Swiss-based cohort including all first-degree relatives of RA patients (RA-FDR) who answered a question on past chlamydial infections. Primary outcome was systemic autoimmunity associated with RA (RA-autoimmunity) defined as positivity for anti-citrullinated peptide antibodies (ACPA) and/or rheumatoid factor (RF). Secondary outcomes were high levels of RA-autoimmunity, RA-associated symptoms and RA-autoimmunity, and subsequent seropositive RA diagnosis. We conducted a nested case-control analysis by measuring the serological status against Chlamydia trachomatis' major outer membrane protein. We replicated our analysis in an independent United States-based RA-FDR cohort. Among 1231 RA-FDRs, 168 (13.6%) developed RA-autoimmunity. Prevalence of self-reported chlamydial infection was significantly higher in individuals with RA-autoimmunity compared with controls (17.9% vs 9.8%, OR = 2.00, 95%CI: 1.27-3.09, p < 0.01). This association remained significant after adjustments (OR = 1.91, 95%CI: 1.20-2.95). Stronger effect sizes were observed in later stages of RA development. There was a similar trend between a positive C. trachomatis serology and high levels of RA-autoimmunity (OR = 3.05, 95% CI: 1.10-8.46, p= 0.032). In the replication cohort, there were significant associations between chlamydial infection and RF positivity and incident RA, but not anti-CCP positivity. Self-reported chlamydial infections are associated with elevated RA-autoimmunity in at risk individuals. The differing association of chlamydial infections and ACPA/RF between cohorts will need to be explored in future studies but is consistent with a role of mucosal origin of RA-related autoimmunity.

Mothers' depressive symptoms and children's behavioral adjustment: The role of negative parental emotional states.

The contribution of fathers and family dynamics to the deleterious effects of mothers' depressive symptoms on children's behavioral adjustment has been evaluated in this study. Using longitudinal data spanning from toddlerhood to grade school (N = 1,311), this study examined whether negative emotional states in both parents related to mothers' cumulative depressive symptoms during the early years of children were associated with children's later internalizing and externalizing problems in grade school. A random intercept cross-lagged panel model was used to segregate between- and within-individual effects. The results demonstrated that, independent of fathers' depressive symptoms, high levels of maternal cumulative depressive symptoms were positively associated with negative emotional states in both parents over time, which then independently mediated the longitudinal associations between mothers' depressive symptoms and children's subsequent behavioral maladjustment, particularly internalizing problems, at the between-individual trait level. The findings highlight the interdependence of family members from a longitudinal perspective and support the unique contributions of both parents' negative emotional states to better understand children's behavioral adjustment in the context of maternal depressive symptoms. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Psychological Analysis of Healthcare Workers During Covid-19 in Indonesia; Systematic Review and Meta-Synthesis

Healthcare workers (HCw) are at the forefront of treating infectious diseases. The excessive workload on Covid-19 HCw adds to the level of fatigue and psychological burden that existed before the Covid-19 pandemic. HCw knowledge of the likelihood of infection can affect their mental and physical stress levels, so they will experience common symptoms including trauma, fear, anxiety, and insomnia caused by excessive fear of infection. This study aims to summarize most research articles that discuss the description and influence of psychology on health workers throughout Indonesia during the Covid-19 pandemic. This study uses a systematic method of qualitative review (meta-synthesis). High levels of stress, depression, anxiety, and insomnia symptoms were found in Indonesia. The results also showed the influence of gender, education, and contact with patients on the incidence of psychological problems in health workers. Providing positive support and preparing psychiatric personnel in hospitals and/or other healthcare settings can reduce the impact of psychology on healthcare workers.

Relationship between Fear of COVID-19, Intolerance of Uncertainty, and Coping Strategies on University Students’ Mental Health

Background: the mental health of students was particularly affected by the COVID-19 pandemic. The present study therefore examined the relationships between anxiety and depressive symptoms, eating-related problems, coping, fear of COVID-19, and intolerance of uncertainty. Methods: 2139 French students of 54 universities were recruited in the different regions of France during a French lockdown (between 21 April and 3 May 2021). Six variables were measured: fear of COVID-19, intolerance of uncertainty, coping, anxiety and depressive symptoms, and eating-related problems. To explore the directions of the relationships between our variables of interest, we calculated a directed acyclic graph. Results: our data highlighted the central roles of intolerance of uncertainty in students’ anxiety and depressive symptoms, and the direct role of prospective intolerance of uncertainty on eating-related problems. Conclusions: these findings indicate that intolerance of uncertainty should be targeted by interventions designed to help students with high levels of anxiety, depressive symptoms, and/or eating-related problems.

The efficacy of an evidence-based parenting program in preventing child maltreatment in mainland China

BackgroundThere is limited evidence regarding the effectiveness of online parenting programs for preventing child maltreatment in low- and middle-income countries. Therefore, this study aimed to examine the effectiveness of the online Parenting for Lifelong Health for Young Children (PLH-YC) program in preventing child maltreatment among Chinese families specifically. MethodsA quasi-experiment was conducted, wherein 274 parents with children aged 2–9 years were assigned to either the online PLH-YC group (n = 135) or a waitlist control group (n = 139). Data were collected at baseline and one week after intervention. A difference-in-differences (DiD) design with propensity score weighting was used to estimate the between-group difference for child maltreatment as well as the associated risk and protective factors. ResultsCompared to the parents in the control group, parents in the online PLH-YC intervention reported a significant reduction in the occurrence of corporal punishment (b = −1.21; 95 % CI [−2.37, −0.03]), emotional abuse (b = −3.09; 95 % CI [−5.36, −0.82]), and general maltreatment (b = −4.94; 95 % CI [−8.86, −1.02]) as well as an increased frequency of positive parenting strategies (b = 6.46; 95 % CI [2.21, 10.72]). Additionally, parents with high levels of depressive symptoms were significantly more likely to drop out of the program, and those with lower education levels engaged in fewer sessions. ConclusionThe online PLH-YC program can benefit families with young children by reducing the incidence of child maltreatment through improved positive parenting strategies. More randomized controlled trials with long-term follow-ups are required to further verify the accuracy of the results obtained in this study.

Violence, Discrimination, and High Levels of Symptoms of Depression Among Adolescent Men Who Have Sex With Men and Transgender Women in Brazil

PurposeThis study aimed at describing the prevalence of symptoms of depression among 15–19 year old adolescent men who have sex with men (aMSM) and transgender women (aTGW), who were recruited in an HIV pre-exposure prophylaxis cohort study in three Brazilian capital cities. The study also examined potential associations, including violence and discrimination, with severe symptoms of depression among aMSM. MethodsThis is a cross-sectional study of baseline data among 730 aMSM and 56 aTGW recruited between February 2019 and February 2021. Sociodemographic and behavioral data were collected. The 20-item Center for Epidemiologic Studies Depression scale was used to screen for symptoms of depression. Scores of ≥22 points indicate the presence of severe symptoms associated with major depression. Logistic regression was used to assess independent associations among aMSM, adjusting for sociodemographic variables. ResultsOur findings indicate a high prevalence of symptoms of depression (overall prevalence = 58.5% and 69.6%; 21.2% and 25.0% for mild/moderate, and 37.3% and 44.6% for severe) among these aMSM and aTGW, respectively. Psychological violence (aOR = 1.74; 95% CI = 1.12–2.70), sexual violence (aOR = 1.79; 95% CI = 1.07–2.98), and discrimination due to sexual orientation (aOR = 1.71; 95% CI = 1.23–2.38) were independently associated with severe symptoms of depression in aMSM. DiscussionThe high prevalence of severe symptoms of depression and its association with psychological and sexual violence and discrimination creates cycles of vulnerability and carries important public health implications. Thus, our findings indicate public policies should consider assessing depression, psychological and sexual violence, as well as discrimination, especially in populations that will be targeted by interventions, such as the use of pre-exposure prophylaxis.

Grief trajectories after loss in pregnancy and during the neonatal period

Distinguishing patterns of grief over time in parents with a loss in pregnancy or during the neonatal period is important for identification of parents with severe grief symptoms, who may need additional support. Our aim was to describe grief in this population and to examine variations by type of loss in a large prospective cohort. We used questionnaire data from the Danish longitudinal cohort, Life After the Loss, which contains information on parents with a loss in pregnancy (from 14 weeks) or during the neonatal period. Parents completed the Prolonged Grief-13 scale at 1, 7, and 13 months after their loss. We applied Latent Growth Mixture Modelling to identify prolonged grief trajectories and used multinomial regression models to assess factors associated with class membership. Three distinct trajectories were identified in 676 parents: resilience (73.1%), recovery (16.9%), and chronic (10%). The distribution varied by type of loss, and the chronic group were overrepresented by parents with stillbirths (16.2%) and neonatal deaths (16.1%) in contrast to parents with spontaneous abortions (8.2%) and termination of pregnancy due to fetal anomalies (6.2%). Furthermore, not having a living child or being a woman was associated with following the chronic trajectory. These results underline that, while most bereaved parents are resilient, 10% experience consistently high levels of grief symptoms during the first year after the loss. Information on type of loss, gender, and whether the parent has living children are meaningful indicators of grief class membership.

The impact of COVID-19 and the confinement on the secondary level students of the Eastern region of Morocco.

In March 2020, Morocco announced the first COVID-19 case and implemented preventive measures, including home confinement. Monitoring the psychological effects and prevalence among high- and middle-school students. This study is cross-sectional, carried online. The survey was conducted by publishing an online questionnaire between May 14, 2020 and June 14, 2020, which included inquiries about socio-demographic data, the conditions of home confinement, activities carried out during confinement, and medical history and sleep patterns. To assess depressive disorder, anxiety disorders, and stress, the survey employed the "DSRS-c," "SCARED," and "PSS10" scales, respectively. Data were received on Google forms coded by Excel 2010 and analyzed by IBM SPSS Statistics 22. Out of the 689 participants, 73.7% were females; the mean age was 16.08 years (standard deviation 1.48). 94.8% of subjects reported changes in sleep habits, and 41.4% of adolescents had high levels of depressive symptoms, while 50.7% had high levels of anxiety symptoms. Several factors were significantly associated with anxiety and depressive symptoms, including being a girl (P = 0.000), being a high-school student (P = 0.011), economic struggles during the pandemic (P = 0.003), doubting the necessity of home confinement (P = 0.000), spending over 3 hours a day on social networks and video games (P = 0.000), dropping out of remote learning (P = 0.000), having a psychiatric history (P = 0.000), having chronic illnesses in the family (P = 0.002), and changes in sleep habits (P = 0.000). The study found high prevalence of depression, anxiety, and stress symptoms among students during the pandemic, emphasizing the need for mental health awareness and support.

PRO-SHOUT: Patient reported outcome supportive health in oncology utilizing technology.

578 Background: High levels of symptoms and distress in cancer patients are linked to negative outcomes related to treatment adherence, healthcare utilization, quality of life, and survival. As such, psychosocial distress screening is now mandated in the American College of Surgeons Commission on Cancer accreditation standards. A growing body of evidence supports usage of electronic patient-reported outcomes (ePROs) for screening, with ePRO added as a quality metric in CMS’s Oncology Care First Model. However, some concerns related to uptake, accessibility, and clinician buy-in remain. In 2020, our palliative oncology (PO) team’s provider-driven (PD) screening workflow transitioned from a qualitative to quantitative approach, using four research-validated tools to assess mental distress (PHQ-9, GAD-7), symptoms (ESAS), and spirituality (FICA). In 2021, we initiated an ePRO workflow in which patients were prompted to complete all tools via the EHR patient portal before each visit, defaulting to PD workflow when not utilized. The aim of this project was to uncover the team’s perception of this workflow evolution and assess ePRO utilization. Methods: We collected EHR data from July 2020 to January 2023 for encounters in our PO clinic within a community-based cancer institute in the Midwest United States. We included in-office and virtual encounters with 13 providers where at least one tool was used (ePRO or PD). We conducted 45-minute semi-structured interviews and 2 usability surveys with 7 of these providers to assess their perspectives of ePRO tools. The IRB determined this to be a quality improvement project. Results: A total of 16,923 encounters with 3,101 patients (54.4% male, 89.3% white, average age 64.8) were analyzed. Post-ePRO initiation, 30.4% of encounters (primarily virtual) utilized ePRO; as expected, most of these included all four questionnaires (96.1%). In contrast, providers often completed only the ESAS in the PD workflow, particularly for established patients. Clinicians rated the workflow positively on surveys and described advantages such as improved visit preparation, flow, and efficiency. Validated tools overall were credited with greater standardization and improved data tracking and usage. Disadvantages of our ePRO workflow included excessive repetition of tools compared to PD and concerns with accuracy and patient misinterpretation. Suggested solutions included reduced frequency of questionnaires and improved instructional aids. Conclusions: Identifying and treating symptoms and distress remains an important aspect of palliative oncology care. EHRs offer real-time engagement for patients through ePROs, although some challenges with uptake and utilization remain. Our providers viewed ePROs as favorable updates to their workflow and felt that challenges could be mitigated with further changes.

Within-person prospective associations between disordered eating, appearance dissatisfaction, and depressive symptoms from adolescence to midlife: A 28-year longitudinal population-based study.

Appearance dissatisfaction and depressive symptoms are considered key risk factors of disordered eating. However, their etiological status is equivocal; previous longitudinal studies have not accounted for time-invariant confounding effects and have not considered potential reverse temporal influences. In addition, whether associations differ between developmental periods and genders has remained untested. To address these issues, we employed a nationwide sample of Norwegian adolescents (N = 2,933; Mage = 15.4 years, 54.2% women) assessed at five time points until midlife. Random-intercept cross-lagged panel models were used to examine the prospective associations between appearance dissatisfaction, depressive symptoms, and disordered eating, net of all unmeasured time-invariant confounding effects. Results showed that high levels of appearance dissatisfaction and depressive symptoms significantly predicted increased disordered eating. Conversely, disordered eating was also a predictor of increased appearance dissatisfaction and depressive symptoms. These reciprocal effects were equal in magnitude across developmental periods and gender. These results suggest that successful interventions to reduce appearance dissatisfaction and depressive symptoms may alleviate disordered eating, while reduced disordered eating may have beneficial effects on appearance dissatisfaction and depressive symptoms, regardless of age or gender. (PsycInfo Database Record (c) 2023 APA, all rights reserved).