Incidence Of Psychological Distress Research Articles

Evaluation of the Level of Psychological Distress in Construction Workers during the COVID-19 Pandemic in Southern Spain.

The COVID-19 pandemic posed a major challenge for construction companies, which were confronted with the need to prevent the enormous negative socio-psychological impact of the pandemic on their employees. The aim of this study was to evaluate the level of psychological distress among construction workers in an advanced phase of the COVID-19 pandemic in Andalusia, southern Spain. For this, a cross-sectional descriptive study was conducted using online questionnaires with data on sociodemographic variables and employment situation, COVID-19 pandemic-related data, and Goldberg's General Health Questionnaire (GHQ-12). A total of 860 questionnaires from all provinces of Andalusia, Spain, were collected between March and May 2022. Descriptive statistical analyses and non-parametric Mann-Whitney U and Chi-squared tests were performed, followed by logistic regression analysis. The incidence of psychological distress was higher among women, individuals under 43 years of age, those with a family income below EUR 1200, participants whose working conditions had been affected by the pandemic, those who had not received adequate means or specific training to protect themselves from infection, those who had experienced symptoms, those who had suffered side effects after vaccination, and those who had been hospitalised. The logistic regression analysis predicted the occurrence of psychological distress in this study by the effect of the pandemic on mental/emotional well-being, the working conditions affected during the pandemic, health-related variables, and the age of the worker. The correctly classified percentage was 75.1%. Assessing psychological distress in construction sectors may allow for the identification of vulnerable groups or even help to reduce the number of errors in daily practice and potential risks of occupational injury or illness.

Incidence and risk factors for psychological distress in adult female patients with breast cancer: a systematic review and meta-analysis.

Cancer-related distress can be described as a complex and unpleasant combination of psychological (such as cognitive, behavioral, and emotional), social, and spiritual challenges that may impact an individual's ability to effectively cope with the physical symptoms of cancer and its treatment. Existing literature has confirmed psychological distress (PD) as an important sequela of breast cancer diagnosis and treatment. However, the incidence and risk factors for PD in adult female patients with breast cancer remain unclear; therefore, focusing on the PD of female breast cancer patients is meaningful, as they are at highest risk of contracting breast cancer, and might differ in their coping styles from men. This review aimed to identify the incidence and risk factors for PD in adult woman patients with breast cancer, and to help guide targeted intervention to prevent distress. PubMed, Embase, Cochrane Library, CINAL, PsycINFO, China Knowledge Resource Integrated Database, Wanfang Database, the Chinese Biomedical Database, and Weipu Database were searched for data regarding the incidence and risk factors of PD in adult women with breast cancer. The prevalence of PD, assessed using the distress thermometer, ranged between 11.2%-86.7%, and a meta-analysis of 47 studies with 15,157 adult female breast cancer patients showed that the pooled prevalence was 52.0%. Further, this study identified 40 risk factors. However, owing to the inclusion of at least two studies for a certain risk factor, 10 risk factors were merged for the meta-analysis. Independent risk factors included higher education level, late-stage tumor, emotional concerns, no medical insurance, modified radical mastectomy, and history of depression; age and neuroticism were not associated with PD; and higher monthly income was revealed as a protective factor against it. The incidence of PD in female patients with breast cancer is high and it involves 10 risk factors, though some are controversial owing to insufficient evidence. Further research is needed to explore the underlying mechanisms of PD and develop risk factor-based holistic intervention programs to reduce its incidence. The protocol of this study has been registered in the database PROSPERO (registration ID: CRD42023433578).

Does declining social connection, and increased reported loneliness, explain the apparent increase in depressive and other mood disorders, particularly among younger people?

There is much conjecture about which social factors underpin an apparent increase in the incidence of psychological distress, depression and other mood disorders, self-harm and suicidal behaviour and presentations for mental health care (in economically-developed countries). These concerns are particularly focused on younger birth cohorts, where the epidemiological evidence appears strongest for a genuine increase in incidence of mood disorders and self-harming behaviours (Twenge et al., 2019).

Impact of the COVID-19 Pandemic on the Psychological Well-Being of Health Care Professionals in India

Abstract Introduction and Objective Health care professionals (HPs) have been at the forefront facing the pressures and uncertainties of the COVID-19 pandemic, and thus have a higher psychological vulnerability. The incidence of psychological distress, which can negatively affect an HP's work efficiency and long-term well-being, has not been studied in depth in India. Materials and Methods A multicentric study was conducted using the digital means of communication across Max Healthcare between June and August 2020. HPs in the department of oncology, including doctors, nurses, and other support staff, were invited to voluntarily participate in the self-administered online survey. A total of 87 HPs in oncology (41 doctors, 28 nurses, and 18 in other fronts) were assessed using the 12-item General Health Questionnaire (GHQ-12). Outcome of interest was psychological distress (defined as a GHQ-12 score >15). Results The overall incidence of psychological distress among HPs in oncology during the COVID-19 pandemic was 17.20%. Significantly higher levels of psychological distress were observed among HPs with a history of psychiatric illness (p = 0.003), and among HPs with a work experience of less than 10 years (p = 0.017). Conclusion The COVID-19 pandemic had a significant impact on the psychological well-being of HPs in India. This study implicated the recognition of the psychological well-being of HPs in oncology as an unmet need during the COVID-19 pandemic, further recommending efforts toward increasing accessibility of mental health services for them.

Psychological Distress in Patients Treated for Renal Cell Carcinoma: A Systematic Literature Review.

(1) Background: The incidence of psychological distress and its impact on renal cell carcinoma (RCC) patients is unclear. Our aim was to analyze the literature regarding the prevalence of psychological distress and its impact on patients with non-metastatic or metastatic RCC; (2) Methods: A systematic search of five databases was performed. Studies were considered eligible if they included patients with RCC, had a prospective or retrospective design, and assessed anxiety, depression, or psychological distress at any time during treatment or follow-up. Exclusion criteria: no treatment for RCC, or not providing data for RCC patients; (3) Results: A total of 15 studies were included. Reported psychological distress was up to 77% and the prevalence of depressive and anxiety symptoms were up to 77.6% and 68.3% in patients with non-metastatic RCC. There was no association of depression with overall survival (OS) in patients with non-metastatic RCC treated by radical nephrectomy; on the contrary, in patients with metastatic disease, depression had an impact on OS. Limitations are related to the quality of the included studies; (4) Conclusions: Patients with RCC reported a high level of psychological distress like other cancer patients. It seems that for patients with localized disease, psychological distress does not impact OS, while it does in those with metastatic disease.

Physical multimorbidity and psychological distress among Chinese older adults: Findings from Chinese Longitudinal Healthy Longevity Survey.

Research has linked multimorbidity with psychological distress among people with multimorbidity but the available findings are inconsistent. This study was to investigate the prevalence of multimorbidity and incidence of psychological distress in a nationally representative sample of Chinese older adults and examine the association between multimorbidity and psychological distress in this population. This study was a cross-sectional, secondary analysis using data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS). Participants' socio-demographic characteristics and clinical information were obtained. Psychological distress including anxiety and depression were assessed by the Generalized Anxiety Disorder-7 (GAD-7) and the Center for Epidemiologic Studies Depression Scale (10-item CES-D). Binary logistic regression was used to ascertain the association between multimorbidity and psychological distress with covariates adjustment. Compared with those without physical chronic conditions, having five or more physical chronic conditions was associated with the likelihood of depression after covariates adjustment. Psychological distress is a common health issue among Chinese older adults with multimorbidity. Having multimorbidity might not be associated with psychological distress represented by anxiety and depression. Management of multimorbidity among this population would benefit from more attention on the mental health domain.

Association of Visual Impairment with Psychological Distress in Older Adults: A Survey of 105,092 Older People in Taiwan.

This study aimed to evaluate the association between visual impairment (VI) and psychological distress (PD) among older adults in Taiwan. The present cohort study included participants aged >65 years who participated in a physical examination program. Participants were divided into two groups on the basis of whether they had PD at baseline. The association between PD and VI with other variables was compared using the two-sample t-test for continuous variables and chi-squared test for discrete variables. Cox regression analyses were used to calculate the hazard ratio (HR). Cumulative incidence of PD was analyzed using the Kaplan-Meier method, and differences among participants with different severities of VI were analyzed using the two-tailed log-rank test. Subgroup analyses were performed to calculate the HR for PD among participants with different severities of VI. The PD group showed a significantly high percentage of VI. In addition, participants with VI showed a significantly higher HR and seven-year cumulative incidence rate of PD than those without VI. VI was independently and significantly associated with a higher incidence of PD among older Asian people. Therefore, identifying and treating correctible VI is important to prevent PD and improve the overall quality of life.

Work ability and psychological distress in a working population: results from the Stockholm Public Health Cohort.

Psychological distress is a global public health concern with individual and societal implications causing work-related disability and loss of productivity. It is less known how much work ability contributes to the development of psychological distress. This study aimed to assess the association between self-perceived physical and mental work ability in relation to job demands, and the incidence of psychological distress in a Swedish working population. Data were obtained from three subsamples of the Stockholm Public Health Cohort with baseline in 2010 and follow-up in 2014, based on a working population in Stockholm County aged 18-60 years, with no or mild psychological distress at baseline (n=29,882). Self-perceived physical and mental work ability in relation to job demands were assessed at baseline with a subscale from the Work Ability Index. Study participants scoring 4 or more on the General Health Questionnaire 12 at follow-up were classified as having developed psychological distress during the study period. Poisson log linear regression was used to calculate crude and adjusted rate ratios with 95% confidence intervals. At follow-up, 2543 participants (12%) had developed psychological distress. Reporting poor physical and/or poor mental work ability in relation to job demands at baseline was associated with an almost doubled rate ratio of psychological distress at follow-up, compared to reporting good work ability (rate ratio 1.8; 95% confidence interval 1.6-2.0). Poor work ability is associated with a higher incidence of future psychological distress compared to good work ability.

The prevalence of psychological distress during pregnancy in Miyagi Prefecture for 3 years after the Great Eas t Japan Earthquake

BackgroundTo examine changes in psychological distress prevalence among pregnant women in Miyagi Prefecture, which was directly affected by the Great East Japan Earthquake and tsunami, and compare it with the other, less damaged areas of Japan.MethodsThis study was conducted in conjunction with the Japan Environment and Children`s Study. We examined 76,152 pregnant women including 8270 in Miyagi Regional Center and 67,882 in 13 other regional centers from the all-birth fixed data of the Japan Environment and Children’s Study. We then compared the prevalence and risk of distress in women in Miyagi Regional Center and women in the 13 regional centers for 3 years after the disaster.ResultsWomen in the Miyagi Regional Center suffered more psychological distress than those in the 13 regional centers: OR 1.38 (95% CI, 1.03–1.87) to 1.92 (95% CI, 1.42–2.60). Additionally, women in the inland area had a consistently higher prevalence of psychological distress compared to those from the 13 regional centers: OR 1.67 (95% CI, 1.18–2.38) to 2.19 (95% CI, 1.60–2.99).ConclusionsThe lack of pre-disaster data in the Japan Environment and Children’s Study made it impossible to compare the incidence of psychological distress before and after the March 2011 Great East Japan Earthquake. However, 3 years after the Great East Japan Earthquake, the prevalence of pregnant women with psychological distress did not improve in Miyagi Regional Center. Further, the prevalence of mental illness in inland areas was consistently higher than that in the 13 regional centers after the disaster.

Early posttraumatic stress symptoms and levels of distress in trauma patients treated in the resuscitation room: an exploratory study

BackgroundThe aim of the present study was to investigate the incidence of psychological distress and posttraumatic stress symptoms in trauma patients who have been recruited from the resuscitation room. Further, we wanted to explore risk factors for posttraumatic stress symptoms, taking different accident types into account.MethodsOur sample consisted of 45 patients who have been treated in the resuscitation room and were interviewed within the first ten days after treatment. Type of accident, third party fault, previous mental health problems and pretraumatic stress were examined. Patients were interviewed with respect to their currently felt distress regarding the accident. Posttraumatic stress symptoms were measured with the German version of the Impact of Event Scale. Injury severity was assessed by means of the Injury Severity Score.ResultsOur exploratory and cross-sectional project reveals that more severe injuries were associated with higher distress. However, posttraumatic stress symptoms were predicted by high distress and being involved in a car accident, but not by injury severity.ConclusionsWe identified two potential risk factors for the development of posttraumatic stress in trauma patients recruited from the resuscitation room: Being involved in a car accident and high distress.Trial registrationThe project has been registered at the Study Center of Mental Disorders (SPE) at the University Medical Center Mainz (No: 92072014).

Depression, Environmental Reward, Coping Motives and Alcohol Consumption During the COVID-19 Pandemic.

Background: Increases in the incidence of psychological distress and alcohol use during the COVID-19 pandemic have been predicted. Behavioral theories of depression and alcohol self-medication theories suggest that greater social/environmental constraints and increased psychological distress during COVID-19 could result in increases in depression and drinking to cope with negative affect. The current study had two goals: (1) to examine self-reported changes in alcohol use and related outcomes after the introduction of COVID-19 social distancing requirements, and; (2) to test hypothesized mediation models to explain individual differences in self-reported changes in depression and alcohol use during the early weeks of the COVID-19 pandemic.Methods: Participants (n = 833) were U.S. residents recruited for participation in a single online survey. The cross-sectional survey included questions assessing environmental reward, depression, COVID-19-related distress, drinking motives, and alcohol use outcomes. Outcomes were assessed via retrospective self-report for two timeframes in the single survey: the 30 days prior to state-mandated social distancing (“pre-social-distancing”), and the 30 days after the start of state-mandated social distancing (“post-social-distancing”).Results: Depression severity, coping motives, and some indices of alcohol consumption (e.g., frequency of binge drinking, and frequency of solitary drinking) were significantly greater post-social-distancing relative to pre-social-distancing. Conversely, environmental reward and other drinking motives (social, enhancement, and conformity) were significantly lower post-social distancing compared to pre-social-distancing. Behavioral economic indices (alcohol demand) were variable with regard to change. Mediation analyses suggested a significant indirect effect of reduced environmental reward with drinking quantity/frequency via increased depressive symptoms and coping motives, and a significant indirect effect of COVID-related distress with alcohol quantity/frequency via coping motives for drinking.Discussion: Results provide early cross-sectional evidence regarding the relation of environmental reward, depression, and COVID-19-related psychological distress with alcohol consumption and coping motives during the early weeks of the COVID-19 pandemic. Results are largely consistent with predictions from behavioral theories of depression and alcohol self-medication frameworks. Future research is needed to study prospective associations among these outcomes.

Effectiveness of Cognitive Behavioral Therapy on Health Outcomes in Patients with Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

"The incidence of psychological distress (such as anxiety and depression) is high in COPD patients. CBT has been proved to reduce depression and anxiety and enhance quality of life. This meta-analysis evaluated the effectiveness of cognitive behavioral therapy(CBT) on patients with chronic obstructive pulmonary disease(COPD). The following electronic databases were searched from inception to March 2020: PubMed, EMBase, Cochrane Library, Web of Science, Medline, OVID, CINAHL, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Wangfang Database (WF), PsycARTICLES, VIP database. The Scopus and Google scholar database that we did not use. Randomized controlled trials (RCTs) that compared CBT with routine methods of care in COPD were retrieved in electronic databases. The Cochrane Risk of Bias Tool and Review Manager version 5.3 were used for risk of bias assessment and meta-analysis, respectively. Both data synthesis and descriptive analysis were used for outcome assessment. A total of 10 RCTs involving 1173 patients were included. Data synthesis showed that CBT was statistically significant in improving short- and medium-term depression and treatment compliance. Mediumterm anxiety and quality of life were improved among COPD patients receiving CBT, although no significant effect was found for short-term quality of life and anxiety. Descriptive analysis showed that CBT could reduce dyspnea. No clear evidence supports the effectiveness on improving self-efficacy in COPD patients with the use of CBT (P > 0.05). CBT can be a useful strategy to improve the symptoms of depression, dyspnea and treatment compliance in patients with COPD. It can also improve patients’ quality of life and anxiety to some extent, but there is still lack of strong evidence in improving patients’ self-efficacy."

PRS56 PREDICTORS OF PSYCHOLOGICAL DISTRESS AND ITS INFLUENCE ON RELIEVER MEDICATION USE IN ASTHMA

Asthma affects more than 300 million people worldwide and over 26 million people in the US. Incidence of psychological distress (PD) in asthma, a consequence of coexisting psychological comorbidities like anxiety and/or depression, is on the rise. The study aims to identify sociodemographic and other factors that are associated with PD and assess its impact specifically on reliever medication use in Asthma. A retrospective, cross-sectional research data, obtained from the Medical Expenditure Panel Survey (MEPS, 2013-2015) and consisted of a sample of 5307 community dwelling asthmatics. PD was identified by using Kessler-6 scale (a score of ≥ 13), a self-administered written questionnaire embedded in MEPS. Use of three or more canisters of quick relief inhalers was defined as overuse of relievers. A Chi-square analyses was performed to test association between PD and reliever use. A set of logistic regression (LR) analyses was performed to determine the predictors of PD as well as reliever overuse in asthmatics with PD. Compared to those without distress, a higher proportion of psychologically distressed asthmatics reported reliever overuse (2=310956.703, 23.3% vs 12.2%, p<0.0001). Female asthmatics were 32.3% more likely to have PD than males (OR=1.323, C.I=1.320-1.326, p<0.0001). The LR results revealed that female asthmatics within the PD group were more likely to overuse relievers than males (OR= 2.263, C.I= 2.255-2.2343, p<0.0001), and those with 12 years or more of education were less likely to overuse relievers compared to those with less education (OR=0.555, C.I=0.553-0.556, p<0.0001). A Phi correlation coefficient (rφ=–0.103) revealed a significant negative correlation between PD scores and reliever overuse. Comorbidity of PD in asthma is associated with over-utilization of reliever medications. Inappropriate medication use can affect treatment plan, compromise patient’s quality of life, and increase the overall cost of care in asthma.

Study of psychological distress and quality of life in patients with oral cancer

To explore the relationship between the status quo and influencial factors of oral cancer patients and their quality of life. Using the Distress Themometer (DT) and the University of Washington Quality of Life Questionnaire (UW-QOL), 250 patients admitted to the First Affiliated Hospital of Zhengzhou University from October 2016 to September 2017 with oral cancer were investigated. Chi-square test, t test, logistic regression analysis and Spearman correlation analysis were used to analyze the data with SPSS20.0 software package. A total of 250 questionnaires were issued, 239 valid questionnaires were available for analysis. In 239 oral cancer patients, 139 (58.2%) had DT score ≥4. The average total score of UWQOL scale was 53.3±17.1, score <4 was noted in 100 patients (41.8%); the average UWQOL scale was 52.8±17.4. Univariate analysis showed that psychological distress was related to age, educational level, income level, pathological stage, jaw resection and recurrence (χ2 values were 5.12,21.31,34.2,10.69,31.3 and 7.84, respectively, P<0.05 ). Logistic regression analysis showed that age, jaw resection and relapse were the risk factors of psychological distress in patients with oral cancer (OR=4.06, 5.12 and 5.79, respectively; P<0.05). Spearman correlation analysis showed that the scores of pain, recreation, emotion and anxiety in UWQOL scale were negatively correlated with psychological distress scores (r=-0.58, -0.84, -0.66 and -0.69, respectively; P<0.05). Oral cancer patients have a higher incidence of psychological distress. Younger patients,and those with maxillectomy and recurrence have more serious symptoms of distress.

Ability to Predict New-Onset Psychological Distress Using Routinely Collected Health Data: A Population-Based Cohort Study of Women Diagnosed With Breast Cancer.

Objectives: The primary objective of this study was to identify the predictors of new-onset psychological distress available in routinely collected administrative health databases for women diagnosed with breast cancer. The secondary objective was to explore whether the predictors vary based on the period of cancer care. Methods: A population-based cohort study followed 16,495 female patients with newly diagnosed breast cancer who did not experience psychological distress during the 14 months before breast cancer surgery. The incidence of psychological distress was reported overall and by type of mental health problem. Time-varying Cox proportional hazards models were developed to identify predictors of new-onset psychological distress during 2 key periods of cancer care: (1) hospital-based treatment during which women undergo treatment with breast surgery, chemotherapy, and/or radiation, and (2) 1-year transitional survivorship when women begin follow-up care. Results: The incidence of psychological distress was 16% within each period. Anxiety was present in 85.1% and 65.5% of new cases during hospital-based treatment and transitional survivorship, respectively. Predictors during both periods were younger age, receipt of axillary lymph node dissection, rheumatologic disease, and baseline menopausal symptoms, as well as new opioid dispensations, emergency department visits, and hospital contacts that occurred during follow-up. Other predictors varied based on the period of cancer care. More advanced breast cancer and type of treatment were associated with onset of psychological distress during hospital-based treatment. Psychological distress during transitional survivorship was predicted by diagnosis of localized breast disease, shorter duration of hospital-based treatment, receipt of additional hospital-based treatment in survivorship, and newly diagnosed comorbidities or symptoms. Conclusions: This study identified the predictors of new-onset psychological distress available in routinely collected administrative health databases, and showed how predictors change between hospital-based treatment and transitional survivorship periods. The results highlight the importance of developing predictive models tailored to the period of cancer care.

Screening for psychological distress before radiotherapy for painful bone metastases may be useful to identify patients with high levels of distress

Background: Psychological distress (PD) has a major impact on quality of life. We studied the incidence of PD before and after radiotherapy for painful bone metastases. Furthermore, we aimed to identify factors predictive for PD.Methods: Between 1996 and 1998, the Dutch Bone Metastasis Study included 1157 patients with painful bone metastases. Patients were randomized between two fractionation schedules. The study showed a pain response of 74% in both groups. Patients filled out weekly questionnaires for 13 weeks, then monthly for two years. The questionnaires included a subscale for PD on the Rotterdam Symptom Checklist. We used generalized estimating equations and multivariable logistic regression analyses.Results: At baseline, 290 patients (27%) had a high level of PD. For the entire group, the level of PD remained constant over time. The majority of patients with a low level of PD at baseline remained at a low level during follow-up. In patients with a high level of PD at baseline, the mean level of PD decreased after treatment and stabilized around the cutoff level. Female patients, higher age, worse performance, lower pain score and worse self-reported QoL were associated with an increased chance of PD, although the model showed moderate discriminative power.Conclusions: A substantial proportion of patients had a high level of PD before and after radiotherapy for painful bone metastases. Most patients who reported high levels of PD when referred for palliative radiotherapy remained at high levels thereafter. Therefore, screening of PD prior to treatment seems appropriate, in order to select patients requiring intervention.

Fruit and vegetable consumption and psychological distress: cross-sectional and longitudinal analyses based on a large Australian sample

ObjectivesGrowing evidence suggests a link between diet and mental health. This study aimed to investigate the association between fruit and vegetable consumption and the prevalence and incidence of psychological distress...

Association of serum n-3 polyunsaturated fatty acids with psychological distress in the second and third trimesters of pregnancy: Adjunct Study of Japan Environment and Children's Study

The results of several epidemiological studies and clinical trials investigating the effects of n-3 polyunsaturated fatty acids (PUFAs) on antenatal and postnatal depression remain controversial. In a previous case-control study of early pregnancy in Japan, we found an inverse association between eicosapentaenoic acid and risk of psychological distress after adjusting for possible confounders. Here, in a 1:2 matched case-control study, we further investigated the possible relationship between serum n-3 PUFAs and risk of psychological distress in the second and third trimesters of pregnancy. The psychological distress group (n=71) consisted of subjects with a score of ≥13 on the Kessler Psychological Distress Scale. The control group (n=142) was matched for age, educational level, and family income. Fatty acid composition of total lipid was determined from serum samples by gas chromatography. Associations between fatty acid levels and incidence of psychological distress were evaluated by logistic regression. Sixty-six percent of blood samples were collected in the second trimester and the remainder in the third. There were no significant differences in any of the n-3 PUFAs between the two groups. After adjustment for possible confounders, none of the n-3 PUFAs showed an association with risk of psychological distress. Peripheral n-3 PUFA levels might not influence the risk of psychological distress in later pregnancy. Further research is warranted to clarify this finding.

Strategies to Prevent the Emergence of Radiation-Induced Malignancies.

DEAR EDITOR, Radiations are categorized as ionizing radiation (viz., alpha particle, beta particles, neutrons, etc.,) and nonionizing radiation (viz., infrared, microwaves, radio waves, etc.,) based on their ability/inability to liberate electrons from atoms or molecules.[1,2] Humans are generally exposed to both natural and man-made sources of radiation during the course of their lives.[1,2] Although radiation has definitive applications in fields such as medicine, industry, and research, it remains a major cause of health concern if not properly used.[1,3] Multiple adverse consequences, such as acute events (such as skin burns and local radiation injuries); malignancy; congenital anomalies; and even death, have been reported in cases of exposure to radiations beyond the permissible limits.[1,2,3] Furthermore, subsequent to a nuclear accident, a remarkable rise in the incidence of psychological distress and psychiatric conditions (such as posttraumatic stress disorder, anxiety disorders, depression, and alcohol abuse) have been observed among the survivors.[4,5] However, attributes such as age at the time of exposure, type of radiation, radiation dose, exposure duration, and sensitivity of tissues/organs, eventually determine the extent of radiation-induced damage.[1,6,7] It has been observed that incidence of radiation-induced malignancy/complications is still on the rise in heterogeneous settings, because of the presentation of clinical symptoms after a long interval; poor awareness among general population about the sources or side effects of radiation; limited orientation of medical students about assessment of radiation exposure; the absence or poor quality of protective devices in industries; nonutilization of the protective equipments despite their availability; no uniformity in the preplacement examination or regular health check-up; lack of infrastructure to enable early diagnosis; and limited access to information about supportive care services.[1,3,5] To address the above-mentioned challenges and thus bring about a significant reduction in the incidence of radiation associated malignancy, there is a crucial need that policy makers should explore all possible sources of radiation exposure, and then develop interventions in coordination with different stakeholders.[1,5] These strategies include promoting thorough risk assessment among the exposed persons;[4] developing a model to establish a relationship between time since exposure/age at exposure to radiation-induced malignancy;[7] advocating implementation of appropriate preventive strategies in the industries;[3] sensitizing physicians, population, and health professionals about radiation-induced malignancies;[3] developing guidelines to ensure standardized case management based on the exposed dose of radiation and patient-related variables;[8] establishing a mechanism to ensure follow-up of at-risk populations to encourage early detection and prompt initiation of specific treatment;[4,8] building a strategic plan to enable preparedness, evacuation and relocation of people at times of any nuclear accident;[4,5] and fostering linkages with international organizations to strengthen the overall system.[1] In conclusion, both ionizing and nonionizing radiations have been attributed to the causation of multiple cancers. Thus, it is the responsibility of the policy makers and other stakeholders to work in collaboration to eventually reduce the contribution of radiation on the development of malignancies. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Psychological Distress in the Active Duty Military Spine Patient

Disorders of the spine are a substantial burden to the military health care system that degrades readiness in the overall force. Because treatment outcomes are affected by psychosocial factors, assessment of psychological distress is important for patients with spine complaints. The incidence of psychological distress in the unique military population is not well described. The purpose of this retrospective case-control study was to determine the rate of psychological distress and identify associated patient characteristics among many variables collected in the military health system. A consecutive cohort of active duty service members presenting to a spine specialty clinic was assessed as Normal, At Risk, or Distressed using the Distress and Risk Assessment Method. Of 74 active duty patients (63 male, 11 female), 43 (58%) had some level of psychological distress: 29 (39%) At Risk, 12 (16%) Distressed-Depressive, and 2 (3%) Distressed-Somatic. Multivariate regression analysis identified female gender (odds ratio [OR] 7.90), higher disability as measured by Oswestry Disability Index/Neck Disability Index (OR 8.0 per 13.8 point increase), and assignment to a Warrior Transition Unit or Medical Evaluation Board (OR 7.35) as statistically significant variables. The results indicate that active duty patients are subject to similarly high levels of psychological distress as their civilian counterparts.