IES Scores Research Articles

The spectrum of psychological disorders in family members of patients suffering from delirium associated with critical illness: a prospective, observational study

During intensive care unit admission, relatives of critically ill patients can experience emotional distress. The authors hypothesized that families of patients who are diagnosed with intensive care unit (ICU) delirium experience more profound depression and anxiety disorders related to stress than do families of patients without delirium. We performed a prospective observational single-center study including families of adult patients (age above 18 years) hospitalized in a 17-bed ICU of a university hospital for at least 48 h who completed research questionnaires at day 2 after admission and day 30 after initial evaluation using dedicated questionnaires (HADS, CECS, IES, PTSD-C). A total of 98 family members of patients hospitalized in the ICU were included in the final analysis (50 family members whose relatives were CAM-ICU positive (DEL+), and 48 family members of patients without delirium (DEL−)). No statistically significant differences in demographics and psychosocial data were found between the groups. In the follow-up 30 days after the first conversation with a family member, the mean PTSD score for the relatives of patients with delirium was 11.02 (Me = 13.0; SD = 5.74), and the mean score for nondelirious patients' family members was 6.42 (Me = 5.5; SD = 5.50; p < 0.001). A statistically significant increase in IES scores for family members of patients with delirium was observed for total PTSD (p = 0.001), IES—intrusion (p < 0.001), and IES—hyperarousal (p = 0.002). The prevalence of anxiety symptoms, depression, and posttraumatic stress disorder (PTSD) was higher in families of patients diagnosed with ICU delirium within 48 h of admission to the ICU. No factors increasing the depth of these disorders in family members of patients with ICU delirium were identified. Taking appropriate actions and thus providing families with appropriate support will contribute to the understanding of unfavorable emotional states, including anxiety, stress, depression, anger, agitation, or avoidance.

Exposure to Traumatic Events at Work, Post-Traumatic Symptoms, and Professional Quality of Life among Italian Midwives: A Cross-Sectional Study.

The aim of this study is to investigate the potential occurrence of post-traumatic stress disorder (PTSD) symptoms, following exposure to traumatic events, in Italian midwives and their consequent influence on the quality of midwives' professional lives. In addition, data were collected on the major traumatic events described by midwives. A cross-sectional study related the socio-demographic characteristics of 286 midwives with the scores obtained on two assessment scales, one for post-traumatic stress disorder (IES-R) and the other for quality of life (ProQOL V). The percentage of midwives who obtained a score higher than the predetermined threshold value in both questionnaires was noted, and the correlations that emerged were highlighted. Through this qualitative method, their significant work-related traumatic events were investigated to finally detect the prevalence percentage of each category. The proportion of midwives scoring higher than 33 on the IES-R scale, indicating a higher likelihood of PTSD, was 48.6%. Freelancers or outpatient clinic midwives had lower mean IES scores (p = 0.049). A significant inverse correlation was observed between age and IES-R score and between the compassion satisfaction subscale and time since completing education (p = 0.028). A comparison between the IES-R and ProQOL scales showed a statistically significant correlation (p < 0.001), in particular, between the burnout (BO) (p < 0.001) and secondary traumatic stress (STS) (p < 0.001) subscales. The thematic categorization of traumatic events included mother/child death, mother/child medical complications, relational problems with patients or team members, and organizational problems/medical staff's inexperience. The emerging data may confirm the data in the literature, namely those showing that midwives are prone to developing work-related PTSD, particularly due to their exposure to traumatic events such as maternal and neonatal death.

Distress and its influencing factors among Chinese patients with incidental pulmonary nodules: a cross-sectional study

The study aims to investigate the distress level and its influencing factors in Chinese pulmonary nodules patients. A total of 163 outpatients in a tertiary hospital in Xi'an, China, were recruited and investigated by using the Impact of Event Scale, Decision Conflict Scale, Consultation Care Measure, Lung Cancer Worry Scale and a demographic questionnaire. The logistic regression model was used to identify the factors of distress. The mean IES score was 37.35 ± 16.65, which was a moderate level. Patients aged 50–60 years, with higher decision conflicts scores, lower physician–patient communication quality score, and who are anxious about the results of future tests or treatments had higher distress score. Distress levels were moderate in patients with pulmonary nodules. Communication between medical staff and patients is extremely important for the management of pulmonary nodules, which affects the quality of the patient's decision-making and his level of distress.

Health professionals who have worked in COVID-19 immunization centers suffer the effects of violence.

The phenomenon violence against health professionals has received increasing attention in recent years because of its frequency and significant impact on victims' mental health and disruption of health services. Despite this attention, little is known about the incidence of workplace violence in the highly politicized immunization services. Therefore, we decided to examine the prevalence of workplace violence in the COVID-19 immunization campaign, the risk and protective factors, and the impact on victims' mental health. Between March and April 2022, we conducted an anonymous online survey among health professionals working in COVID-19 vaccination centers in the Friuli-Venezia Giulia Region (Italy). We used the Questionnaire for Workplace Violence in Healthcare Settings and the Impact of Event Scale-Revised. Of the 200 participants, 93 (46.5%) reported being victims of an act of violence during the vaccination campaign, 60 of them verbally and 7 physically. In 35.5% of cases, the IES score indicated a possible post-traumatic stress reaction in the victim. Opinions on measures to prevent violence and support workers in the workplace differed according to the sex of the health professional, with women emphasizing the need for self-defense training and improvement of security arrangements (p < 0.001). One-third of health professionals involved in the COVID-19 immunization campaign reported that their mental health was affected by workplace violence. Public health professionals dealing with politicized and debated issues such as immunization should receive more attention, as should the implementation of a more structured and multidisciplinary approach to the problem within healthcare organizations.

A survey of pediatric intensive care unit clinician experience with restricted family presence during COVID-19

PurposeLimiting family presence runs counter to the family-centred values of Canadian pediatric intensive care units (PICUs). This study explores how implementing and enforcing COVID-19-related restricted family presence (RFP) policies impacted PICU clinicians nationally.MethodsWe conducted a cross-sectional, online, self-administered survey of Canadian PICU clinicians to assess experience and opinions of restrictions, moral distress (Moral Distress Thermometer, range 0–10), and mental health impacts (Impact of Event Scale [IES], range 0–75 and attributable stress [five-point Likert scale]). For analysis, we used descriptive statistics, multivariate regression modelling, and a general inductive approach for free text.ResultsRepresenting 17/19 Canadian PICUs, 368 of 388 respondents (94%) experienced RFP policies and were predominantly female (333/368, 91%), English speaking (338/368, 92%), and nurses (240/368, 65%). The mean (standard deviation [SD]) reported moral distress score was 4.5 (2.4) and was associated with perceived differential impact on families. The mean (SD) total IES score was 29.7 (10.5), suggesting moderate traumatic stress with 56% (176/317) reporting increased/significantly increased stress from restrictions related to separating families, denying access, and concern for family impacts. Incongruence between RFP policies/practices and PICU values was perceived by 66% of respondents (217/330). Most respondents (235/330, 71%) felt their opinions were not valued when implementing policies. Though respondents perceived that restrictions were implemented for the benefit of clinicians (252/332, 76%) and to protect families (236/315, 75%), 57% (188/332) disagreed that their RFP experience was mainly positive.ConclusionPediatric intensive care unit-based RFP rules, largely designed and implemented without bedside clinician input, caused increased psychological burden for clinicians, characterized as moderate moral distress and trauma triggered by perceived impacts on families.

PSYCHOLOGICAL IMPACT OF RIGHT HAND TRAUMA IN LABOR GROUP

OBJECTIVE: To determine the correlation between mean Disabilities of Arm, Shoulder, and Hand (DASH) scores and Impact of Event Scale-revised (IES-R) scores in laborer with right hand trauma. METHODS: This correlational study was carried out at the Department of Plastic Surgery, Civil Hospital Karachi, Pakistan from January 2022 to June 2022. The inclusion criteria were laborers of any gender, age ≥18 years, presenting with right hand trauma having dominant hand infection and were medically fit and well and had no systemic illness. The severity of symptoms was assessed via DASH questionnaire. While psychological impact was assessed via IES-R. RESULTS: Out of 60 patients, 56 (93.3%) were males and 4 (6.7%) were females. Mean age of the patients was 45.07±14.96 years. Majority (n=50; 83.3%) of the patients were married. Overall, a moderate positive correlation was observed in between DASH score and IES score (r: 0.503, p: &lt;0.001). Further stratification revealed moderate significant correlation of IES and DISH score for married workers (r: 0.578, p: &lt;0.001), &gt;5 years of experience (r: 0.663, p: &lt;0.001); whereas strong positive correlation was observed for crush injury (r: 0.943, p: &lt;0.001), puncture injury (r: 0.970, p: &lt;0.001) and cut injuries (r:0.754: p=0.012). CONCLUSION: This study revealed a considerable relationship of DASH scale and psychological impairment in patients with right hand trauma. Worker who have gone through right hand trauma due to crush, puncture or cut injuries, married and those having more than 5 years of experience should be considered as high-risk population for psychological impairment.

Patient-reported outcomes associated with reflex BRCA1/2 tumor and subsequent germline panel genetic testing for high-grade serous ovarian cancer.

Reflex genetic testing of tumor tissue is being completed to direct cancer treatment; however, the patient impact of this genetic testing model is unknown. This survey study evaluates psychological outcomes following tumor and germline genetic testing in individuals with a new diagnosis of high-grade serous ovarian cancer (HGSOC). Individuals were recruited from two hospitals in Toronto, Canada. Participants completed surveys 1 week after receiving tumor results and 1 week after receiving germline results (which included genetic counseling). Outcomes included cancer-related distress (Impact of Events Scale: IES), genetic testing-related distress (Multidimensional Impact of Cancer Risk Assessment: MICRA), and patient satisfaction. Paired t-tests were used to evaluate differences in outcomes following each genetic test result; Cohen's d was used to evaluate effect size. Subgroup analyses were undertaken according to age at diagnosis (<60 years vs. ≥60 years) and test results (any positive vs. both negative). McNemar's test assessed differences in satisfaction. Fifty-two individuals were included in the analyses. Mean IES scores were similar following disclosure of tumor and germline results (27.39 vs. 26.14; p=0.481; d=0.101). Compared to following tumor result disclosure, MICRA scores were significantly lower following receipt of germline results with genetic counseling (27.23 vs. 22.69; p=0.007; d=0.435). Decreases in MICRA scores from tumor to germline result disclosure were greater for those diagnosed <60 years or those who received only negative test results. Most individuals were satisfied/highly satisfied following tumor (85.7%) and germline (89.8%) results disclosure (p=0.774). Reflex tumor, and subsequent germline, genetic testing is a new model of care for cancer patients. In our cohort, genetic testing-related distress decreased significantly following receipt of germline results with genetic counseling, especially for individuals diagnosed under 60 years and those receiving only negative results. Most individuals were satisfied with this model of care.

A study of the Mental health assessment among COVID 19 patients

Background: People's mental health has been impacted by the novel corona virus COVID 19. According to studies, a significant percentage of people who have recovered from the infection have mental health problems. The research was carried out on people who had recovered from COVID 19 in the previous year. Participants were contacted a month after being discharged from the hospital and encouraged to complete a questionnaire that included the DASS and IES scales. Anxiety, depression, stress, and post-traumatic stress disorder were all examined in the results (PTSD). Those with scores that indicated severe levels were encouraged to see a psychiatrist for proper treatment and therapy. The results of the DASS revealed that 2.5 percent of the participants had scores indicative of severe stress, 25.3 percent had scores indicative of severe anxiety, and 7.3 percent had scores indicative of severe depression. According to the results of the IES, 15.1 percent of the participants said the event had a significant impact on their mental health, and 17.2 percent of the participants had scores that indicated the presence of post-traumatic stress disorder symptoms. There is a strong link between IES scores and the severity of lung involvement.

The Psychological Impact of COVID-19 on Residents of Saudi Arabia.

PurposeThis study aimed to determine the stress levels and identify various factors responsible for causing high-stress scores during the COVID-19 pandemic in the Saudi population.Patients and MethodsThis cross-sectional study was conducted at Imam Abdulrahman Bin Faisal University, Dammam, from June 2020 until December 2020 on 4052 respondents from the Eastern province of Saudi Arabia. An online survey was used to collect information about various stress factors. The psychological impact of COVID-19 was measured by using the COVID-19 impact event scale (COVID-19 IES), whereas general stress levels were assessed by K10 Kessler Psychological Distress Scale (K10).ResultsThe psychological impact of the COVID-19 outbreak revealed that 35.4% of participants suffered from moderate or severe psychological impact (score>33); 19.7% had a mild psychological impact (scores24–32), whereas 44.9% reported minimal psychological impact (score <23). The factors significantly associated with higher stress scores and COVID-19 IES included male gender, low monthly income, having a private business, living in apartments/residential complexes, poor general health status, visit hospital/doctor in the past three months, presence of chronic disease, direct/indirect contact with someone diagnosed with/suspected to have COVID-19, contact with surfaces/tools infected with COVID-19, getting screened or quarantined for COVID-19, follow-up of the latest news about COVID-19 and knowledge of a greater number of people infected and died with COVID-19 (p < 0.05). In contrast, being an elementary school student, having 4–10 children, observing various protective measures, and staying home for 4–12 hours were associated with lower COVID-19 IES (p < 0.05).ConclusionDuring the initial six months of the COVID-19 outbreak in Saudi Arabia, 35.4% participants suffered from moderate to the severe psychological impact. This study identified various factors responsible for high COVID-19 IES and K10 stress scores. These findings can help formulate psychological interventions for improving the stress scales in vulnerable groups during the COVID-19 pandemic.

Impact initial de la pandémie COVID-19 sur les parents et les enfants tunisiens

IntroductionThe infection with SARS-CoV-2 Coronavirus started in the city of Wuhan in China in 2019 and has not stopped spreading around the world since then. From March 11, 2020 The World Health Organization (WHO) has declared this COVID-19 infection a global pandemic. As a result, the Tunisian government has taken several measures in order to prevent the progression of the pandemic. These different changes can have different psychological consequences for both adults and children. ObjectivesWe proposed to study the initial impact of the spread of the COVID-19 pandemic on Tunisian parents and children. Material and methodsWe conducted a prospective descriptive study two weeks after the proclamation of the curfew and one week after the proclamation of sanitary lockdown in Tunisia. Parents of Tunisian children were invited to voluntarily answer an anonymous questionnaire posted on social media. The questionnaire included questions on socio-demographic characteristics and the degree of impact of the spread of the COVID-19 pandemic on family habits and activities. The stress level of the parent responding to the questionnaire was measured by the Impact Event Scale Revised (IES-R). ResultsOne hundred and thirty-eight parents answered this questionnaire of which 88% were mothers. Fathers had to operate changes in their working arrangements in 87.2% of the cases and mothers had to do so in 79.8%. One of the parents chose to live far from the family in 13% of the cases. Only 1% of parents did not teach or talk to their children about hygiene rules. The parents of our study reported that they had a child aged 12 or less in 91% of cases with an average age of six years and a sex ratio of 1.13. Parents sought to keep them occupied in 58.6% of the cases. Children did different activities during this period: watching television in 41%, playing games in 27% and studying in 38% of the cases. In 41.4% of the cases, parents had a child aged over 12 years with an average age around 15 years and a sex ratio of 0.9. Teenagers often spent their time on tablets/computers in 80%, 52% watched movies or series, 31.25% participated in house cleaning activities, 27% spent time cooking for their family, 14.5% read books and 4.16% did social work. Parents reported that their children's behaviour changed in 60% of the cases when the children were 12 or younger and in 20% of the cases when the children were older than 12. The IES-R scores for the parents interviewed ranged from 2 to 79 with an average of 28.9±18. In 48 cases, the score was greater than 32. The severity of the impact was associated with the female sex of the parent responding to the questionnaire (P=0.04). We found a positive correlation between the IES score and the symptomatology of children with P<0.001 and r=0.52 when the age was 12 years or less and P=0.001 and r=0.518 when the age was strictly superior to 12. ConclusionsBoth parents and children were affected when the COVID-19 pandemic began to spread in Tunisia. Psychological intervention is essential in order to help them get through this crisis with as few consequences as possible.

The Psychological Impact of the COVID-19 Pandemic on Oral Health Care Workers and its Impact on Their Willingness to Work During this Pandemic

This study was aimed to investigate the relationship between the psychological status of oral health care workers (OHCWs) and the willingness to treat a patient during the COVID-19 pandemic. This cross-sectional study was carried out on oral health care workers at ten different dental hospitals in Pakistan from March to July 2020. Information on the socio-demographic status, and willingness to report for duty and treat patients during the COVID-19 pandemic were assessed using a self-administered questionnaire. The psychological impact of the COVID-19 pandemic was assessed using the Urdu version of the Generalized Anxiety Disorder Scale and Impact of Events Scale. Simple and multiple linear regression tests were used for analysis. A total of 392 OHCWs participated in this study and 25% of them had moderate to severe anxiety levels and only 14% had post-traumatic stress disorder. About 26% of the OHCWs were willing to work and treat patients during the COVID-19 pandemic and they had lower anxiety and stress scores. Greater anxiety and stress were associated with participants who were older, female, single, married, living with family and friends. The adjusted coefficients of GAD and IES scores were greater in participants who were not willing and unsure to work compared to their colleagues who were willing. The OHCWs are anxious and stressed because of the COVID-19 outbreak and that affects the perception of whether they should work and treat patients during the pandemic.

Mental Health and Endocrine Telemedicine Consultations in Transgender Subjects During the COVID-19 Outbreak in Italy: A Cross-Sectional Web-Based Survey

Transgender people are a vulnerable group with a higher incidence of mental health issues and, during the COVID-19 outbreak, they may have faced psychological, physical and social obstacles. To evaluate the impact of the pandemic and the access to health care services during the COVID-19 pandemic on the mental health of the transgender people living in Italy. An anonymous web-based survey was conducted among transgender people living in Italy. The survey consisted of 41 questions (to address socio-demographic and COVID-19 related variables, general health problems and trans-related health issues) and three validated questionnaires (the Impact of Event Scale [IES], the Beck Depression Inventory [BDI-II] and the SF-12. In total 108 respondents were included in the analysis, of these 73.1% were transmen and 26.9% transwomen. The mean age was 34.3 ± 11.7 years with 88.9% undergoing gender affirming hormonal treatment (GAHT). Of these respondents 55.6% were not working during the COVID-19 pandemic, mainly because they lost their jobs due to the lockdown (30.5%) or because they were otherwise unemployed (25.0%). Only four subjects were quarantined at home because of a positive COVID-19 swab. The mean total IES score was 21.1 ± 14.9 with 24.1% of subjects scoring over the cut-off score of 26 thereby suggesting a moderate-to-severe impact of the pandemic event. Mean BDI score was 8.6 ± 8.4. SF-12 total mean score was 96.1 ± 11.9 with a Mental Component Summary (MCS) score of 42.8 ± 9.1. Access to endocrinological consultations for hormonal prescription via telemedicine services was associated with better IES total scores (P=.01). Our results highlight the impact of the pandemic on the mental health of this particular population and how telemedicine services may serve to mitigate negative psychological effects. Internet-based surveys may select a group of people not necessary representative of the whole population. The self-reporting bias should also be considered. Those who responded to our survey were mainly from northern Italy were COVID-19 has had a greater impact. Vulnerable groups such as the transgender population should receive more consideration also during pandemic events and their access to health services especially for endocrine and mental health care should be improved. A nationwide plan for the extended use of telemedicine should be established with targeted intervention to reduce psychological distress. Gava G, Fisher AD, Alvisi S, etal. Mental Health and Endocrine Telemedicine Consultations in Transgender Subjects During the COVID-19 Outbreak in Italy: A Cross-Sectional Web-Based Survey. J Sex Med 2021;18:900-907.

Psychosocial Effects of Isolation on Nipah Virus Infection Suspects During an Outbreak

Background and Methodology: Nipah Virus (NiV) belonging to the genus Henipavirus is a biosafety level 4 pathogen with high human to human transmission. Nipah Virus outbreak of 2018 in Kozhikode, Kerala has evoked immense panic and fear in the system. Other viral infections with similar transmission pattern (Ebola, SARS, MERS or COVID 19) also identified with the negative impacts of isolation. This retrospective observational study was planned during November –December 2018 to understand the psychosocial effects among the subjects in Nipah isolation facility. The symptoms of Post-traumatic stress disorder (PTSD) were assessed using the Impact of Events Scale-Revised version (IES-R). Results and Conclusions: Of the 81 subjects, 73 could be contacted with a response rate of 90.12%. The mean age was 38 years (SD = 15.43) and 13.7% were health care workers. 63% of the subjects experienced fear of death during isolation stay and 12.3% of the subjects had lost their relatives or friends to Nipah infection. The mean IES score obtained was 10.78 (SD: 9.679, range 0-49) and 5 subjects had above the cut off 22. Nipah outbreak had evoked significant psychological disturbances in subjects who remained in isolation with its negative impacts.Funding Statement: No financial support received for this study.Declaration of Interests: Authors state that they do not have any commercial or other association that might pose a conflict of interest.Ethics Approval Statement: Approved by the Institutional Ethics Committee.

Prevalence and predictors of post-traumatic stress symptoms and depressive symptoms among Bangladeshi students during COVID-19 mandatory home confinement: A nationwide cross-sectional survey

The COVID-19 pandemic has brought not only the risk of infection but also unbearable mental health difficulties with the concern of educational loss among students. This study explored the adverse impact of the COVID-19 outbreak on Bangladeshi students’ mental health and detected potential influencing factors related to post-traumatic stress symptoms (PTSS) and depressive symptoms. Convenience sampling was applied to collect data via online survey from 3997 college and university students between 29th May and 22nd July 2020. PHQ-9 and IES scales were used to assess depressive symptoms and PTSS, respectively. Of all participants, 52.87% had depressive symptoms and 40.91% had PTSS. Severe educational disruption was a risk factor for depressive symptoms (AOR = 1.68; 95% CI: 1.37–2.06) and PTSS (AOR = 1.86; 95% CI: 1.51–2.29). COVID-19 like symptoms including fever, cough, breathing difficulty and fatigue showed a stronger association with higher IES and PHQ-9 scores than other symptoms (e.g., diarrhea, sore throat) (p ≤ 0.01). Fear of infection and death by COVID-19 were risk factors for PTSS and depressive symptoms (p ≤ 0.01). Recreational activity and regular physical exercise emerged as the most protective factors for depressive symptoms and PTSS. The mental health of students is significantly affected in this pandemic suggesting the need for adequate psychological support.

Psychological stress: Repercussions of COVID‐19 on gender

The purpose of our study is to examine the effect of Coronavirus disease (COVID‐19) on psychological health of people specific to IES, mental health, family social support, lifestyle changes and also, to analyze the gender differences of perceiving and handling the psychological stress due to the COVID‐19. An online questionnaire was filled by 325 respondents. All the respondents of the study have an IES score ≥ 26, reflecting a powerful impact of the pandemic. However, females (IES = 39.99) were gravely effected due to the pandemic. 60% of the respondents felt horrified due to the pandemic. Majority of the respondents received support from friends and family members. In conclusion, females and the age group 31+ were severely impacted due to sudden health and lifestyle changes.

Expressive writing - Who is it good for? Individual differences in the improvement of mental health resulting from expressive writing

Objectivewe examined individual differences in the effects of expressive writing. We hypothesized that moderate levels of neuroticism, low levels of experiential avoidance, and highly rated subjective severity would be linked to greater change in well-being post-writing. Designparticipants were randomly assigned to the expressive group (N = 104) who wrote about emotion-laden experiences, or the control group (N = 51) who wrote about everyday events. All completed the IES and BSI pre and 1, 3, and 6 weeks post-writing. Resultsoverall, we replicated the seminal result, with greater reductions in IES scores in the expressive writing group. In addition, in the expressive group, as expected, participants with higher severity scores had greater reductions in BSI scores. Surprisingly, individuals with high rather than moderate neuroticism and high rather than low experiential avoidance scores also experienced more benefit. Conclusionsparticipants who are more aware of, in touch with, and suffer more from negative feelings are those who gain the most from expressive writing. Based on this conclusion, clinical implications relevant to both psychotherapy patients and non-patients are suggested.

Predictors of psychological distress following major trauma

AimThe aim of this study was to identify variables that may predict later psychological distress in patients following admission to a Major Trauma Centre (MTC) and to determine whether a psychological screening tool, the Posttraumatic Adjustment Screen (PAS), administered on admission was able to contribute to this. MethodsPatients referred to the MTC clinical psychology service completed the PAS during their inpatient stay over an eight-month period. Following discharge from hospital, patients were telephoned (1 month, 3 months and 6 months post injury) by a member of the clinical psychology team and asked two validated questionnaires; the Impact of Events Scale revised (IES-R) (measure of posttraumatic stress symptoms) and the CORE-10 (measure of global psychological distress). In addition, patients’ data from the local Trauma Audit & Research Network (TARN) database was reviewed to identify information related to injury and other demographic data. Patients were divided into groups for comparison based upon their PAS scores using previously described severity cut offs for posttraumatic stress symptoms and depression. Receiver Operator Characteristic and Multiple Linear Regression analysis was used to examine for significant baseline predictors of psychological distress during follow up according to the IES and CORE-10 scores. ResultsOne hundred and fourteen patients completed the PAS over the study period. Follow-up psychological data was available for 63 (56%) of patients. Except for the patient’s home address, no baseline parameter examined in this study regarding patient demographics, injury or treatment was associated with reported psychological symptoms in the first six months post injury as measured by the IES-R or CORE-10 scores. Multiple linear regression analysis revealed that both PAS-P and PAS-D were significant predictor variables for patients reporting significant symptoms of posttraumatic stress and global psychological distress (according to IES-R and CORE-10 scores) in the first six months post injury. ConclusionsPsychological screening on admission may be helpful in identifying patients admitted to MTCs who are at risk at developing posttraumatic stress symptoms and psychological distress following major trauma.

Postpartum psychological distress after emergency team response during childbirth

Purpose: To evaluate the feasibility and acceptability of a protocol determining the relationship between emergency team response (ETR) during childbirth and acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) symptoms.Methods: In a prospective, observational, cohort design, women experiencing ETR during childbirth were approached and recruited on postpartum day-1 and followed for six weeks. Demographics, obstetric and birth characteristics, ASD scores and PTSD scores (by Impact of Events Scale, IES and PCL-civilian) were recorded. Recruitment and retention rates were recorded, and scores were compared to women who did not experience ETR.Results: Three hundred sixty-nine were approached and 249 were enrolled (67.5% recruitment rate). One hundred twenty-five completed all procedures (50.2% retention). Twenty experienced ETR (3.5% event rate), 12 enrolled (60.0% recruitment rate) and 8 completed the study (66.7% retention). The ETR group had higher PCL and IES scores (PCL: ETR median 12, non-ETR median 2, p = .08; IES: ETR median 22.5, non-ETR median 20, p = .08). ASD scores were similar between groups.Conclusions: Methodology investigating the link between ETR and postpartum psychological distress is feasible and acceptable. A relationship between ETR and PTSD symptoms appears to exist, with ETR being associated with higher PTSD scores compared to non-ETR childbirths. Methods that incorporate awareness of the unique concerns of vulnerable populations are needed.

Association between health literacy, communication and psychological distress among myelodysplastic syndromes patients

MDS is a complex and potentially severe disease which can trigger psychological distress. A lack of information received and understood about MDS may also arouse feelings of distress. Low health literacy (HL) might play a role particularly among older patients. Our aim was to assess MDS-related distress and to study the factors associated with it, including medical and non-medical factors such as HL.A self-administered questionnaire was mailed to all members of French and Australian patients’ national MDS associations. Data of 280 patients were analysed.A majority of patient (59.5%) reported low functional HL and 50% reported regular difficulties in asking physicians questions. Distress was not modified by gender, awareness of increased risk of developing leukaemia or MDS characteristics. French patients had a higher mean IES score (adjusted β = 5.9, p = 0.004) compared to Australian patients. Poor satisfaction with information provided about MDS, lower functional HL and difficulties in asking physician’s questions were also independently associated with distress.MDS-related distress seems more related to HL and communication with physicians than to MDS characteristics. More efforts are needed to improve health literacy, tailor information for MDS patients and support them psychologically in order to improve their emotional well-being.

A Randomized Trial of a Family-Support Intervention in Intensive Care Units

BackgroundSurrogate decision makers for incapacitated, critically ill patients often struggle with decisions related to goals of care. Such decisions cause psychological distress in surrogates and may lead to treatment that does not align with patients’ preferences.MethodsWe conducted a stepped-wedge, cluster-randomized trial involving patients with a high risk of death and their surrogates in five intensive care units (ICUs) to compare a multicomponent family-support intervention delivered by the interprofessional ICU team with usual care. The primary outcome was the surrogates’ mean score on the Hospital Anxiety and Depression Scale (HADS) at 6 months (scores range from 0 to 42, with higher scores indicating worse symptoms). Prespecified secondary outcomes were the surrogates’ mean scores on the Impact of Event Scale (IES; scores range from 0 to 88, with higher scores indicating worse symptoms), the Quality of Communication (QOC) scale (scores range from 0 to 100, with higher scores indicating better clinician–family communication), and a modified Patient Perception of Patient Centeredness (PPPC) scale (scores range from 1 to 4, with lower scores indicating more patient- and family-centered care), as well as the mean length of ICU stay.ResultsA total of 1420 patients were enrolled in the trial. There was no significant difference between the intervention group and the control group in the surrogates’ mean HADS score at 6 months (11.7 and 12.0, respectively; beta coefficient, −0.34; 95% confidence interval [CI], −1.67 to 0.99; P=0.61) or mean IES score (21.2 and 20.3; beta coefficient, 0.90; 95% CI, −1.66 to 3.47; P=0.49). The surrogates’ mean QOC score was better in the intervention group than in the control group (69.1 vs. 62.7; beta coefficient, 6.39; 95% CI, 2.57 to 10.20; P=0.001), as was the mean modified PPPC score (1.7 vs. 1.8; beta coefficient, −0.15; 95% CI, −0.26 to −0.04; P=0.006). The mean length of stay in the ICU was shorter in the intervention group than in the control group (6.7 days vs. 7.4 days; incidence rate ratio, 0.90; 95% CI, 0.81 to 1.00; P=0.045), a finding mediated by the shortened mean length of stay in the ICU among patients who died (4.4 days vs. 6.8 days; incidence rate ratio, 0.64; 95% CI, 0.52 to 0.78; P<0.001).ConclusionsAmong critically ill patients and their surrogates, a family-support intervention delivered by the interprofessional ICU team did not significantly affect the surrogates’ burden of psychological symptoms, but the surrogates’ ratings of the quality of communication and the patient- and family-centeredness of care were better and the length of stay in the ICU was shorter with the intervention than with usual care. (Funded by the UPMC Health System and the Greenwall Foundation; PARTNER ClinicalTrials.gov number, NCT01844492.)