High Distress Risk Research Articles

Rural Adolescent Girls Are at High Risk for Abuse and Psychological Distress

Rural Adolescent Girls Are at High Risk for Abuse and Psychological Distress

Book‐to‐Market Equity, Distress Risk, and Stock Returns

ABSTRACTThis paper examines the relationship between book‐to‐market equity, distress risk, and stock returns. Among firms with the highest distress risk as proxied by Ohlson's (1980) O‐score, the difference in returns between high and low book‐to market securities is more than twice as large as that in other firms. This large return differential cannot be explained by the three‐factor model or by differences in economic fundamentals. Consistent with mispricing arguments, firms with high distress risk exhibit the largest return reversals around earnings announcements, and the book‐to‐market effect is largest in small firms with low analyst coverage.

Risk factors for internalizing and externalizing problems among gay, lesbian, and bisexual adolescents

This study investigated the risk factors associated with internalizing and externalizing problems among 169 gay, lesbian, and bisexual adolescents, ages 13 to 18, in northern New England, who were recruited through multiple methods. Data were gathered on individual, family, and community risk factors and youths' mental health and behavioral functioning. The youths did not differ on internalizing or externalizing problems by gender or by sexual orientation. Multivariate analyses demonstrated that risk factors unrelated to sexual orientation explained 18 percent and 19 percent of the variance in internalizing and externalizing problems, respectively. Risk factors related to sexual orientation explained an additional 4 percent of the variance in youths' internalizing problems and 1 percent in youths' externalizing problems. The results suggest that adolescent service providers should carefully assess gay, lesbian, and bisexual adolescents for concerns related and not directly related to their sexual orientation, as well as concerns specific to their identity. Even youths with positive feelings about their sexual orientation may be at risk. Key words: adolescents; bisexual youths; gay youths; lesbian youths, mental health; risk factors ********** Research with gay, lesbian, and bisexual adolescents suggests high risk of emotional distress, such as symptoms of depression and anxiety (D'Augelli & Hershberger, 1993; Rosario, Rotheram-Borus, & Reid, 1996), suicidality (Rotheram-Borus, Hunter, & Rosario, 1994), and problem behaviors (Rosario et al.). Adolescents' growing awareness of romantic or sexual feelings for individuals of the same sex often occurs in family and community environments marked by stigmatization, victimization, and a lack of support (D'Augelli, Hershberger, & Pilkington, 1998). Gay, lesbian, and bisexual adolescents are coming out at younger ages (Herdt & Boxer, 1993), raising critical questions about how best to ensure their health and well-being, particularly because evidence suggests that early self-identification is associated with greater morbidity (Remafedi, Farrow, & Deisher, 1991). Little is known, however, about potential risk factors, or whether the risk factors are unique to their experience as gay, lesbian, and bisexual adolescents or shared with other vulnerable adolescents. Research with gay, lesbian, and bisexual adolescents has tended to focus on risk factors specific to their sexual orientation (for example, age at self-labeling) rather than account for risk factors that have been implicated in child and adolescent psychopathology (for example, socioeconomic status or family mental health problems). Few studies have developed multivariate models to predict mental health and behavior problems that incorporate risks specifically related to sexual orientation and risks shared with other vulnerable youths. RISK FACTORS FOR MENTAL HEALTH AND BEHAVIOR PROBLEMS Risk factors for adolescent mental health and behavior problems that are frequently cited in the literature include low socioeconomic status, marital discord, and family mental health problems (for example, Rae-Grant, Thomas, Offord, & Boyle, 1989), with the risk increasing as the risk factors increase (Rutter, 1979). Other studies point to gender (Reinherz et al., 1993), poor family functioning (Fleming & Offord, 1990), and a lack of family support (Lewinsohn et al., 1994). Many studies have linked chronic life stressors (for example, Masten, Best, & Garmezy, 1990) and stressful life events with depression, suicidality, and delinquency in adolescents (for example, Compas, Orosan, & Grant, 1993; Garrison, Jackson, Marsteller, McKeown, & Addy, 1990; Reinherz et al.; Tiet et al., 1998). Few studies have examined an array of risk factors experienced by gay, lesbian, and bisexual adolescents, and even fewer have included young lesbians or bisexual females. …

Factors associated with distress in urban residential fire survivors.

To identify factors associated with recovery in a sample of urban residential fire survivors. 440 survivors, of residential fires were interviewed at approximately 3, 6, and 13 months after the fire to measure psychological distress. A set of factors was identified that correlated with survivors' ability to recover from the fire event. Potential predictors of increased distress were identified. Hypotheses were that participants who were lower in socioeconomic status, who were minority members, who had less social support, who engaged in attributional thinking, and had greater concurrent life stresses would have greater psychological distress in response to a residential fire and would be less able to recover from the fire event. Distress after fire was high at 3 months and decreased for the majority of participants, although one-third of survivors had higher distress at 13 months than at 3 months. Loss of control and attributional variables had the strongest influence on psychological distress over time. The findings are consistent with stress-response tendencies expected after a stressful event. A set of predictor variables was identified to help clinicians target survivors at high risk for psychological distress after a residential fire.

Influence of irradiation on therapy-associated psychological distress in breast carcinoma patients

Purpose: To confirm our assumptions regarding factors that apparently cause psychological distress related to adjuvant radiotherapy in breast cancer patients and to evaluate variables that can predict therapy-associated distress. Methods and Materials: Between January 1997 and April 1998, 111 women (33–84 years) with early-stage breast cancer were irradiated (56 Gy) after breast-conserving surgery. Patients were given self-assessment questionnaires on the first and last day of radiotherapy. Statistical analysis was performed using the structural equation model LISREL, variance analysis, and regression analysis. Results: The internal subject–related factors (coping, radiation-related anxiety, physical distress, psychological distress) reciprocally influenced each other, whereas external radiotherapy-specific factors (environmental influence, confidence in the medical staff) were causally related to coping, anxiety, and distress. Fifty-three percent of the women felt distressed because cancer affected the breast; 48% were initially afraid of radiotherapy. For 36%, anxiety was not reduced during treatment. Highly distressed women were identified by the following parameters: ≤58 years; initial anxiety; they were affected by having breast cancer, were negatively affected by environmental factors, and did not find distraction helpful. Conclusion: Despite considerable individual variability in breast cancer patients, it seems possible to identify women who run a high risk of therapy-associated distress. In these patients, psychosocial support is necessary to reduce treatment-related anxiety and to stabilize confidence in the medical staff.

Can skills training prevent relationship problems in at-risk couples? Four-year effects of a behavioral relationship education program.

Eighty-three couples were stratified into groups at high and low risk for relationship distress and randomized to either the Self-Regulatory Prevention and Relationship Enhancement Program (Self-PREP) or a control condition. As predicted, there were differential effects of Self-PREP on high-risk and low-risk couples. Because of low statistical power, results must be interpreted cautiously, but at 1-year follow-up high-risk couples in Self-PREP showed trends toward better communication than control couples. However, there was no difference in the communication of Self-PREP and control low-risk couples. High-risk couples receiving Self-PREP exhibited higher relationship satisfaction at 4 years than control couples, but in low-risk couples relationship satisfaction was higher in the control condition. High-risk couples seemed to benefit from skills-based relationship education, but low-risk couples did not.

The Relationship Between Agentic and Communal Personality Traits and Psychosocial Adjustment to Breast Cancer

Agency, communion, unmitigated agency (UA), and unmitigated communion (UC) are related to psychosocial health outcomes in nonclinical and medical populations. This study examined the relationship between these personality traits and emotional and interpersonal well-being, as up to 50% of women experience difficulties in psychosocial adjustment after being diagnosed with breast cancer. Seventy-four women newly diagnosed with breast cancer completed baseline assessment measures within 2 weeks prior to their first chemotherapy treatment or at the beginning of their hormonal therapy. Findings indicate that (1) agency and UA are important correlates of emotional and interpersonal adjustment and should be considered when attempting to identify women at high risk for psychosocial distress, and (2) UC deserves increased attention in behavioral medicine research, given its strong relationship with emotional distress in a breast cancer population. Thus, evidence continues to accumulate regarding the important relationship of these personality traits to psychosocial outcomes in medical populations.

Psychological impact of receiving aBRCA1/BRCA2 test result

Mutation analysis for autosomal dominant hereditary breast/ovarian cancer genes (BRCA1/BRCA2) became an important technique for women at risk of carrying these mutations. Healthy female mutation carriers have a high lifetime risk for breast and/or ovarian cancer and may opt for frequent breast and ovary surveillance or prophylactic surgery (mastectomy and/or oophorectomy). Psychological distress was assessed in 78 healthy women at risk of having inherited a BRCA1/BRCA2 mutation opting for genetic testing and 56 partners several weeks prior to ("pre-test") and after ("post-test") learning about their DNA test result. Twenty-five women were found to be mutation carriers, and 53 were non-mutation carriers. One goal of the study was to identify individuals at risk for high distress in the weeks following disclosure of the test result. Interview transcripts were used to give a fuller picture of pre- and post-test distress. High post-test anxiety was reported by 20% of the mutation carrier women and by 35% of their partners. Eleven percent of women without the mutation and 13% of their partners reported high post-test anxiety levels. High post-test anxiety in women was significantly related to 1) a high level of pre-test anxiety and 2) being a mutation carrier. Women without a mutation who had a sister identified as a mutation carrier recently had higher post-test levels of depression than the other non-mutation carriers. It is suggested to consider seriously the need for psychological support in mutation carriers who had been anxious at pre-test already. For most non-mutation carriers, psychological follow-up might be of lesser importance, but those having a sister receiving an unfavorable test result should be informed about the possibility that they might not feel relief.

Age-related differences in the quality of life of breast carcinoma patients after treatment

The objective of this study was to compare the quality of life (QOL) of younger (< or =50 years) versus older (>50 years) women on recent completion of treatment of breast carcinoma. Data reported herein were obtained from a baseline assessment of 304 breast carcinoma patients. These patients were enrolled in a multiinstitutional, randomized trial testing a psychosocial telephone counseling intervention for breast carcinoma patients immediately after treatment. The assessment was made using a self-administered (mail) questionnaire, with an overall response rate of 86%. Included in this questionnaire were standardized measures of QOL using the Functional Assessment of Cancer Therapy-Breast instrument, the Center for Epidemiologic Studies Depression Scale, and the Impact of Event Scale. Comparisons of baseline data analyzed according to age approximating menopausal status (< or =50 years and >50 years) indicated that younger women reported significantly greater QOL disturbance. QOL was significantly worse for younger women globally (P = 0.021), and with regard to domains of emotional well-being (P = 0.0002) and breast carcinoma specific concerns (P = 0.022). Furthermore, symptoms of depression (P = 0.041) and disease specific intrusive thoughts (P = 0.013) were significantly worse for younger women. No significant sexual dysfunction or body image differences were noted. Results from this analysis suggest that younger women with breast carcinoma should be considered to be at high risk for QOL disruption and significant clinical distress. Targeted interventions for this cohort are recommended.

Impact of Re-employment on Psychological Distress among Long-term Unemployed

This article reports results from a two-wave panel study representative of long-term unemployed in Norway in 1991-92. We looked especially at the impact of re-employment on psychological distress. Is any job better than unemployment, and does re-employment improve mental health dramatically? Our findings showed that re-employed people did not have less distress than those still unemployed and outside the labour force when other factors were controlled for. What mattered was that re-employment represented a secure job. High risk of distress was especially persistent among those who experienced financial hardship and marital break-up and who had not had previous psychological distress. Women exhibited higher distress than men, and older persons higher distress than younger. To a certain extent, psychological distress was unrelated to the unemployment situation itself, but seemed instead to be due to a selective process ending in long-term unemployment experienced by persons with psychological distress at the outset of joblessness. These persons experienced cumulative problems related to poor economic situations and marginal positions in the labour-market. Earlier research has tended to overestimate the emotional damage created by job loss per se and the beneficial effects of re-employment.

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

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

A Prospective Longitudinal Investigation of Spousal Bereavement Examining Parkes and Weiss’ Bereavement Risk Index

The purpose of this study was (a) to describe spousal bereavement both prospectively and longitudinally and (b) to examine the validity of the Bereavement Risk Index (BRI) published by Parkes and Weiss (1). Psychological distress was measured in 46 subjects across five time intervals beginning prior to a spousal death from lung cancer and ending 25 months after the death using the Brief Symptom Inventory (BSI) (2). The hypothesis that the BRI discriminates between bereaved spouses at high and low risk for psychological distress was supported by measurements taken within two months of the patient's diagnosis (prior to death), at 6 weeks following the death, and at 6 and 13 months thereafter. These findings support the need for early identification of individuals at high risk for negative bereavement outcomes even prior to the spousal death.

An educational intervention for newly‐diagnosed cancer patients undergoing radiotherapy

AbstractThis is a prospective, randomized pilot trial of an educational intervention for newly‐diagnosed cancer patients under going radiotherapy. The trial was conducted in a relatively rural area in northwest Texas. Our hypothesis was that the intervention would reduce psychological distress. A group of 31 patients who were predicted by the Omega Screening Instrument to be at high risk for psychological distress were selected to be the subjects for this study. The patients were randomly assigned either to the intervention (n = 15) or to a control group (n = 16). The intervention was a series of three one‐hour individual sessions which gave information about radiotherapy and cancer, coping strategies, and communication skills. The sessions occurred during the second, third, and fourth weeks of each patient's radiotherapy. Psychological distress was measured with the Brief Symptom Inventory (BSI) at study entry, and one and three months later. We also used the Inventory of Current Concerns (ICC) to determine the specific areas of concern which were correlated with psychological distress. Knowledge gained was measured with a 15‐item multiple choice test which we developed from the factual material in the intervention and which we administered to both groups at entry, one month and three months. The intervention group's mean scores on the BSI Depression subscale fell over the three months on study, while those of the control group rose. The difference was statistically significant. However, the BSI scores overall were not different between the groups. Psychological distress in both groups was correlated most closely with Health, Existential, and Self‐Appraisal concerns on the ICC. Knowledge, as measured by the multiple choice test, did not increase in the intervention group, and there was no statistically significant difference between the scores of the intervention and control groups at any time. Since the BSI Depression scale has independent convergent validity with other measures of depression, we believe that the change in the intervention group's Depression scores could represent a meaningful effect. However, the lack of any measurable increase in knowledge suggests that any benefit of the educational intervention was probably non‐specific, resulting more from individual attention than from information gained.

Self-Rated Defense Style, Life Stress, and Health Status: An Empirical Assessment

The authors compared the 14-defense and 20-defense versions of the self-report Bond Defense Style Questionnaire in a nonclinical sample of adults. Factor analyses of both versions yielded a stable factor representing immature defenses, while factors representing image-distorting, neurotic, and mature defenses were less stable. In correlational analyses, immature defenses were highly associated with higher reported levels of life stress, physical illness, and affective symptoms. Methodological issues and the possible implications of these findings are presented. The Bond questionnaire appears to be an additional helpful tool in consultation-liaison psychiatry for identifying poor copers at high risk for distress.

Stress, Social Support, and Psychological Distress of Family Caregivers of the Elderly

The effects of stress and social support and their interaction with the psychological well-being of 87 family caregivers of impaired elderly were examined. Perceived stress and satisfaction with support accounted for 32% to 36% of the variance in psychological distress or depression, p less than .001; however, when characteristics of the caregiver situation were included in the models, the effects of perceived stress were found to be spurious. The revised models accounted for 44% to 48% of the variance in psychological distress or depression, p less than .000, and included years of caregiving and mental impairment of the elder instead of perceived stress. Although there were no buffering effects for social support, main effects accounted for 19% to 22% of the variance in psychological distress or depression. The findings indicate that caregivers who are caring for a mentally impaired elder, who have been providing care for an extended time, and who have low social support are at high risk for psychological distress or depression.

Steatorrhea in patients with intrahepatic cholestasis of pregnancy

A prospective study was undertaken to evaluate fat malabsorption during intrahepatic cholestasis of pregnancy (ICP), a disease characterized by a mild cholestasis of short duration appearing in otherwise healthy young women. An abnormal fecal fat excretion (mean 15.8 g/24 h, range 6–31 g/24 h) was demonstrated in 10 of 12 patients with the icteric form of ICP and in 2 of 11 patients with pruritus gravidarum. The increased fecal fat excretion was generally asymptomatic, could be detected as early as 3 wk after the clinical onset of ICP, remained stable during the affected pregnancies, and returned to normal from 3 to 9 wk after delivery. Steatorrhea correlated with the severity of ICP, estimated by serum levels of bilirubin, total bile salts, and glutamic pyruvic transaminase. A significant fall in the maternal weight/height index was detected after the onset of ICP, being more intense in patients with steatorrhea than in those without it (to 92.6% ± 3.0% of initial values versus 96.7% ± 2.8%, respectively; p < 0.05). A high risk of premature deliveries and fetal distress was demonstrated in these patients, also correlating with the severity of ICP. No direct relationship could be established between steatorrhea or maternal nutritional impairment and fetal prognosis.

Expiratory flow limitation in infants with bronchopulmonary dysplasia

We evaluated lung function in 20 infants with bronchopulmonary dysplasia (BPD) during the first year of life. Compared with a group of age- and size-matched controls, the infants with BPD had a significantly (P less than 0.005) lower functional residual capacity (FRC; 25 +/- 4 vs 18 +/- 6 ml/kg) at less than 10 1/2 months after conception, but no significant difference during the remainder of the first year. The partial expiratory flow volume curves in the infants with BPD were markedly concave, with tidal breathing approaching expiratory flow limitation. The infants with BPD had significantly (P less than 0.01) lower absolute and size-corrected flows than did control infants, and 50% of the infants with BPD required rehospitalization because of acute respiratory distress associated with a lower respiratory tract illness. In addition, the slope of the linear regression of maximal expiratory flow at FRC (in milliliters per second) vs length (in centimeters) was significantly lower (P less than 0.001) for the infants with BPD than for normal control infants (2.25 vs 4.52), indicating poor growth of the airways. Oxygen saturation (SaO2 was negatively correlated with maximal expiratory flow at FRC, indicating that measurement of SaO2 alone may not be sufficient in the evaluation of lung function in infants with BPD. We conclude that, although infants with BPD improve clinically during the first year of life, they have abnormal functional airway growth; the decreased expiratory flow reserve helps to explain their high risk for acute respiratory distress during lower respiratory tract illness.

Hypertension in the neonate.

Blood pressure (BP) is low at birth. It increases with age, by about 1 mm Hg per day within the period of 3 to 8 days. It rises by about 1 mm Hg per week between ages 5 to 6 weeks. At a latter age, systolic BP is close to 95 +/- 10 mm Hg. Hypertension is a rare condition in the neonate, where it carries a high risk of cardiorespiratory failure and cerebral distress. Causes of neonatal hypertension are either secondary to congenital malformations or to acquired disease states: Congenital malformations: renal artery stenosis, renal artery hypoplasia, abdominal aortic atresia, coarctation of the aorta, kidney cystic disease, reflux nephropathies. Acquired diseases: thrombo-embolic renal artery complications secondary to umbilical artery catheterization or to thrombosis of ductus arteriosus, closure of abdominal wall defects, adrenal hematoma with renal artery compression, seizures in preterm infants, central nervous system disorders, drug-induced hypertension, infants of drug-dependent mothers. The morbidity and the mortality of neonatal hypertension are elevated. Death may be caused by severe uncontrollable hypertension or by concomitant problems. Morbidity may be related to drug-resistant hypertension, or to the side-effects of hypotensive drugs. Surgery in these severely ill infants also carries a significant risk.

Hypertension in the Neonate

Blood pressure (BP) is low at birth. It increases with age, by about 1 mm Hg per day within the period of 3 to 8 days. It rises by about 1 mm Hg per week between ages 5 to 6 weeks. At a latter age, systolic BP is close to 95 +/- 10 mm Hg. Hypertension is a rare condition in the neonate, where it carries a high risk of cardiorespiratory failure and cerebral distress. Causes of neonatal hypertension are either secondary to congenital malformations or to acquired disease states: Congenital malformations: renal artery stenosis, renal artery hypoplasia, abdominal aortic atresia, coarctation of the aorta, kidney cystic disease, reflux nephropathies. Acquired diseases: thrombo-embolic renal artery complications secondary to umbilical artery catheterization or to thrombosis of ductus arteriosus, closure of abdominal wall defects, adrenal hematoma with renal artery compression, seizures in preterm infants, central nervous system disorders, drug-induced hypertension, infants of drug-dependent mothers. The morbidity and the mortality of neonatal hypertension are elevated. Death may be caused by severe uncontrollable hypertension or by concomitant problems. Morbidity may be related to drug-resistant hypertension, or to the side-effects of hypotensive drugs. Surgery in these severely ill infants also carries a significant risk.