Increase In Emotional Distress Research Articles

Health and emotional regulation among persons with hemophilia

The psychosocial status of people with chronic ailments has garnered undivided attention in recent years, especially for diseases such as Aids, leukemia, and hemophilia. Numerous clinical and psychological issues associated with hemophilia have been found to attribute a significant increase in emotional distress. Due to the paucity of research on the psychosocial aspects of this inherited disorder. The aim of the research was to study emotional reappraisal, emotional suppression, and health among persons with hemophilia. A total of 50 patients participated in the study and were divided into 2 age groups (19-24) and (25-30). Standardized scales such as Emotion Regulation Questionnaire (Gross & John, 2003) and Patient Health Questionnaire (Spitzer et. al, 1999) were used. The obtained results were tabulated, and correlation and independent t-tests were used to compare the means of two age groups. The total sample mean was found to be 18.10 and the standard deviation was 8.30 respectively. The correlation of health was found to be positive and significantly related to emotional reappraisal (r= 0.10) and emotional suppression (r=0.08). The result portrays there is no difference between the two age groups on emotional regulation and health. Despite much research on the genetic causes of this condition in India, there is a dire need to study the psychological challenges, social problems, and opportunities available to persons with hemophilia (PWH). Psychological and genetic counseling shall be promoted for the holistic well-being of hemophiliacs.

Prospective Associations Between Preschool Exposure to Violent Televiewing and Psychosocial and Academic Risks in Early Adolescent Boys and Girls.

Risks of early exposure to media violence remain unclear. This study examines typical early childhood violent media exposure and subsequent psychosocial and academic risks. Our longitudinal birth cohort comprised 978 girls and 998 boys. Child-reported and teacher-reported measures of adjustment at age 12 years were linearly regressed on parent-reported televised violence exposure at ages 3.5 and 4.5 years while adjusting for individual/family confounders. For girls, preschool violent televiewing was associated with increases in emotional distress (b = 0.31; 95% confidence interval [CI], 0.13-0.49) and decreases in classroom engagement (b = -0.97; 95% CI, -1.55 to -0.40), academic achievement (b = -2.60; 95% CI, -3.48 to -1.72), and academic motivation (b = -0.58; 95% CI, -1.09 to -0.07) at age 12 years. For boys, preschool violent televiewing was associated with increases in emotionally distressed (b = 0.33; 95% CI, 0.13-0.53), inattentive (b = 0.25; 95% CI, 0.06-0.45), conduct disordered (b = 0.11; 95% CI, 0.00-0.21), and socially withdrawn behavior (b = 0.23; 95% CI, 0.05-0.40), as well as decreases in classroom engagement (b = -0.84; 95% CI, -1.57 to -0.12), academic achievement (b = -1.19; 95% CI, -2.15 to -0.23), and academic motivation (b = -0.58; 95% CI, -1.13 to -0.03) at age 12 years. Compared with no preschool exposure, violent televiewing is associated with distinct and enduring psychosocial risks by early adolescence. Acknowledging such risks remains a pertinent health literacy target for pediatric professionals, parents, and communities.

Age and Emotional Distress during COVID-19: Findings from Two Waves of the Norwegian Citizen Panel.

Older adults face the highest risk of COVID-19 morbidity and mortality. We investigated a one-year change in emotions and factors associated with emotional distress immediately after the onset of the pandemic, with emphasis on older age. Methods: The online Norwegian Citizen Panel includes participants drawn randomly from the Norwegian Population Registry. Emotional distress was defined as the sum score of negative (anxious, worried, sad or low, irritated, and lonely) minus positive emotions (engaged, calm and relaxed, happy). Results: Respondents to both surveys (n = 967) reported a one-year increase in emotional distress, mainly driven by elevated anxiety and worrying, but we found no difference in change by age. Multilevel mixed-effects linear regression comparing older age, economy-, and health-related factors showed that persons in their 60s (ß −1.87 (95%CI: −3.71, −0.04)) and 70s/80s (ß: −2.58 (−5.00, −0–17)) had decreased risk of emotional distress relative to persons under 60 years. Female gender (2.81 (1.34, 4.28)), expecting much lower income (5.09 (2.00, 8.17)), uncertainty whether infected with SARS-Cov2 (2.92 (1.21, 4.63)), and high self-rated risk of infection (1.77 (1.01, 2.53)) were associated with high levels of emotional distress. Conclusions: Knowledge of national determinants of distress is crucial to tailor accurate public health interventions in future outbreaks.

Authenticity as a Resilience Factor Against CV-19 Threat Among Those With Chronic Pain and Posttraumatic Stress Disorder.

ObjectiveThe novel coronavirus (2019; CV-19) is linked to increases in emotional distress and may be particularly problematic for those with pre-existing mental and physical conditions, such as chronic pain and posttraumatic stress disorder (PTSD). However, little empirical research has been published on resilience factors in these individuals. The present study aims to examine authenticity as a resilience factor among those with chronic pain and/or PTSD.MethodsPrior to the national response to the pandemic (January 10-24, 2020), participants were screened for pain-related disability (Oswestry Disability Index; ODI) and PTSD symptoms (Posttraumatic Checklist for DSM-5; PCL-5), and on the basis of those responses were categorized into one of four groups: healthy, chronic pain only, PTSD only, or comorbid chronic pain and PTSD. During the CV-19 pandemic (May 5-May 13, 2020), participants responded again to the ODI and PCL-5, in addition to the Wood Authenticity Scale, Brief Pain Inventory, and items related to the CV-19 pandemic.ResultsA total of 110 participants (54.55% women), aged 42.19 (SD = 13.16), completed the survey during the pandemic. The comorbid group endorsed higher levels of CV-19 Threat and Impact compared to all other groups. Authenticity moderated this relationship relevant to CV-19 Threat among those in the chronic pain only group, and not in any other group.ConclusionThe comorbid group endorsed higher levels of CV-19 Threat and Impact compared to all other groups. Importantly, greater authenticity was associated with less CV-19 Threat in the chronic pain only group, and not in any other group. The present study also highlights the importance of engaging authentically for those with chronic pain during the pandemic.

Integrated efforts to promote mental health care during the SARS-CoV-2 pandemic: Reflecting on the experience of a university helpline

IntroductionThe SARS-CoV-2 pandemic is affecting numerous dimensions of our society since the beginning of the outbreak. A significant increase in emotional distress was expected in the general population, particularly among the high-risk groups such as the oldest, chronic patients, healthcare professionals, and psychopathology vulnerable people. There was an urgent need to adapt and create solutions to promote mental health. Given the recommendations to minimize face-to-face interactions, several helplines were widely developed.ObjectivesIn this work, we aim to reflect on the experience of a university helpline, that integrated efforts with the regional mental health care services.Methods A University helpline was created to give support to the regional community outside academia. The team was created on an online teamwork platform, to communicate through the chat, carry videoconference meetings, and store useful files. A Manchester screening decision tree was adopted, to define a set of guidelines to provide support to the callers, based mainly on the guidelines defined by the Order of Portuguese Psychologists. Liaison with the mental health care services, including other specific helplines, was established.ResultsNotwithstanding all the efforts, the number of received calls was scarce, similarly to helplines created by other national universities and by other entities.ConclusionsA new approach to psychological intervention in crisis is needed, maintaining integrated efforts, and taking advantage of the opportunity to foster personalized mental health care in the digital era. It is important to continuously assess the value of integrated efforts in patient care and to the healthcare system.

Emotional Distress of the COVID-19 Cluster Infection on Health Care Workers Working at a National Hospital in Korea.

BackgroundFrontline healthcare workers responding to coronavirus disease 2019 (COVID-19) inevitably face tremendous psychological burden. Thus, the present study aimed to identify the psychological impact and the factors contributing to the likely increase in emotional distress of healthcare workers.MethodsThe participants include a total of 99 healthcare workers at Bugok National Hospital. Psychometric scales were used to assess emotional distress (12-item General Health Questionnaire; GHQ-12), depression symptoms (Patient Health Questionnaire-9; PHQ-9), and post-traumatic stress disorder-related symptoms (Impact of Events Scale-Revised; IES-R). A supplementary questionnaire was administered to investigate the experience of healthcare workers exposed to COVID-19-infected patients. Based on the results of GHQ-12 survey, participants were categorized into two groups: distress and non-distress. All the assessed scores were compared between the two groups. A logistic regression model was constructed to identify factors associated with emotional distress.ResultsEmotional distress was reported by 45.3% (n = 45) of all participants. The emotionally distressed group was more likely to be female, manage close contacts, have higher scores on PHQ-9 and IES-R, feel increased professional risk, and report that proper infection control training was not provided. Female gender, managing close contacts, higher scores on PHQ-9, and a feeling that proper infection control training was not provided were associated with emotional distress in logistic regression.ConclusionFrontline healthcare workers face tremendous psychological burden during the COVID-19 pandemic. Therefore, appropriate psychological interventions should be provided to the HCWs engaged in the management of COVID-19-infected patients.

Outdoor air pollution exposure and inter-relation of global cognitive performance and emotional distress in older women.

The interrelationships among long-term ambient air pollution exposure, emotional distress and cognitive decline in older adulthood remain unclear. Long-term exposure may impact cognitive performance and subsequently impact emotional health. Conversely, exposure may initially be associated with emotional distress followed by declines in cognitive performance. Here we tested the inter-relationship between global cognitive ability, emotional distress, and exposure to PM2.5 (particulate matter with aerodynamic diameter <2.5μm) and NO2 (nitrogen dioxide) in 6118 older women (aged 70.6±3.8 years) from the Women's Health Initiative Memory Study. Annual exposure to PM2.5 (interquartile range [IQR]=3.37μg/m3) and NO2 (IQR=9.00ppb) was estimated at the participant's residence using regionalized national universal kriging models and averaged over the 3-year period before the baseline assessment. Using structural equation mediation models, a latent factor capturing emotional distress was constructed using item-level data from the 6-item Center for Epidemiological Studies Depression Scale and the Short Form Health Survey Emotional Well-Being scale at baseline and one-year follow-up. Trajectories of global cognitive performance, assessed by the Modified-Mini Mental State Examination (3MS) annually up to 12 years, were estimated. All effects reported were adjusted for important confounders. Increases in PM2.5 (β=-0.144 per IQR; 95% CI=-0.261;-0.028) and NO2 (β=-0.157 per IQR; 95% CI=-0.291;-0.022) were associated with lower initial 3MS performance. Lower 3MS performance was associated with increased emotional distress (β=-0.008; 95% CI=-0.015;-0.002) over the subsequent year. Significant indirect effect of both exposures on increases in emotional distress mediated by exposure effects on worse global cognitive performance were present. No statistically significant indirect associations were found between exposures and 3MS trajectories putatively mediated by baseline emotional distress. Our study findings support cognitive aging processes as a mediator of the association between PM2.5 and NO2 exposure and emotional distress in later-life.

Emotional distress in young adults during the COVID-19 pandemic: evidence of risk and resilience from a longitudinal cohort study.

The coronavirus disease 2019 (COVID-19) pandemic and associated lockdown could be considered a 'perfect storm' for increases in emotional distress. Such increases can only be identified by studies that use data collected before and during the pandemic. Longitudinal data are also needed to examine (1) the roles of previous distress and stressors in emotional distress during the pandemic and (2) how COVID-19-related stressors and coping strategies are associated with emotional distress when pre-pandemic distress is accounted for. Data came from a cohort study (N = 768). Emotional distress (perceived stress, internalizing symptoms, and anger), COVID-19-related stressors, and coping strategies were measured during the pandemic/lockdown when participants were aged 22. Previous distress and stressors were measured before COVID-19 (at age 20). On average, participants showed increased levels of perceived stress and anger (but not internalizing symptoms) during the pandemic compared to before. Pre-COVID-19 emotional distress was the strongest predictor of during-pandemic emotional distress, followed by during-pandemic economic and psychosocial stressors (e.g. lifestyle and economic disruptions) and hopelessness, and pre-pandemic social stressors (e.g. bullying victimization and stressful life events). Most health risks to self or loved ones due to COVID-19 were not uniquely associated with emotional distress in final models. Coping strategies associated with reduced distress included keeping a daily routine, physical activity, and positive reappraisal/reframing. In our community sample, pre-pandemic distress, secondary consequences of the pandemic (e.g. lifestyle and economic disruptions), and pre-pandemic social stressors were more consistently associated with young adults' emotional distress than COVID-19-related health risk exposures.

Impact of Emotional Distress on Prescription Opioid Abuse in a Rural Juvenile Drug Court Sample

Background: Ohio is at the epicenter of the opioid epidemic, and the current crisis disproportionately burdens rural areas. The Self-Medication Hypothesis and work examining adverse childhood experiences posit that drug use may be understood as a coping strategy to address emotional distress.Methods: Juvenile drug court participants in a Northwest Ohio county were administered a standardized biopsychosocial assessment. Intake interviews from January 2010 and November 2018 were used to evaluate the relationship between emotional distress reported using the Emotional Problem Scale (EPS) and lifetime nonmedical use of prescription opioids. Linear regression was used to examine temporal trends in EPS scores. Logistic regression was used to examine the relationship between EPS scores and prescription opioid misuse, controlling for temporal trends.Results: Linear regression showed a significant increase in emotional distress over the study period for both pre-scription opioid users and nonusers. Average scores increased 29.5 points (on a 100 point scale) over the duration of the study (P &lt;0.0001). A 10-point increase in EPS score was associated with a nearly 50% increase in the lifetime odds of pre-scription opioid misuse (OR = 1.46, 95% CI: 1.19-1.82, P = 0.0004). The odds of prescription opioid misuse declined each year (OR = 0.63, 95% CI: 0.48-0.81, P = 0.0006).Conclusion: Rates of prescription opioid misuse have decreased over time despite a significant association be-tween emotional distress and opioid misuse and trend toward increasing EPS scores. While efforts to reduce prescription opioid misuse appear to have been effective in this population, significant work is needed to reduce underlying risk fac-tors.

Multiple-victimisation due to armed conflict and emotional distress in the State of Magdalena, Colombia

BackgroundEmotional distress is common in Colombian armed conflict victims. Multiple-victimisation is associated with an increase in emotional distress than victimisation due a single event. However, the association between poly-victimisation and emotional distress among victims of the armed conflict in Colombia has not been documented. ObjectiveTo study the association between multiple-victimisation and emotional distress in victims of armed conflict in the State of Magdalena, Colombia. MethodsA cross-sectional study was designed, with a secondary analysis of registration of the Psychosocial Care Program and Victim Integral Health (PAPSIVI) in the State of Magdalena, from 2013 to 2014. The profile formula grouped demographic variables, victimising events, and a set of symptoms of emotional distress (perceived discrimination, depressive and anxiety-stress). Odds ratio (OR, 95%CI) were established as measures of association. ResultsA total of 943 people were included, with 67.4% women, and ages between 18 and 94 years (mean 47.9±14.2). A total of 109 (11.7%) suffered from multiple victimisation. Multiple victimisation events were associated with more emotional distress, depressive symptoms (OR=1.5; 95%CI, 1.3–1.8), perceived stigma (OR=1.3; 95%CI, 1.1–1.5), and anxiety-stress (OR=1.2; 95%CI 1.0–1.4) than a single event. ConclusionsThere are more emotional distress in multiple victimisations than in a single victimisation event during armed conflict in this region of Colombia. Further studies are required on this topic.

Polivictimización por el conflicto armado y sufrimiento emocional en el Departamento del Magdalena, Colombia

BackgroundEmotional distress is common in Colombian armed conflict victims. Multiple-victimisation is associated with an increase in emotional distress than victimisation due a single event. However, the association between poly-victimisation and emotional distress among victims of the armed conflict in Colombia has not been documented. ObjectiveTo study the association between multiple-victimisation and emotional distress in victims of armed conflict in the State of Magdalena, Colombia. MethodsA cross-sectional study was designed, with a secondary analysis of registration of the Psychosocial Care Program and Victim Integral Health (PAPSIVI) in the State of Magdalena, from 2013 to 2014. The profile formula grouped demographic variables, victimising events, and a set of symptoms of emotional distress (perceived discrimination, depressive and anxiety-stress). Odds ratio (OR, 95%CI) were established as measures of association. ResultsA total of 943 people were included, with 67.4% women, and ages between18 and 94 years (mean 47.9±14.2). A total of 109 (11.7%) suffered from multiple victimisation. Multiple victimisation events were associated with more emotional distress, depressive symptoms (OR=1.5; 95%CI, 1.3-1.8), perceived stigma (OR=1.3; 95%CI, 1.1-1.5), and anxiety-stress (OR=1.2; 95%CI 1.0-1.4) than a single event. ConclusionsThere is more emotional distress in multiple victimisations than in a single victimisation event during armed conflict in this region of Colombia. Further studies are required on this topic.

The impact of multiple concussions on emotional distress, post-concussive symptoms, and neurocognitive functioning in active duty United States marines independent of combat exposure or emotional distress.

Controversy exists as to whether the lingering effects of concussion on emotional, physical, and cognitive symptoms is because of the effects of brain trauma or purely to emotional factors such as post-traumatic stress disorder or depression. This study examines the independent effects of concussion on persistent symptoms. The Defense Automated Neurobehavioral Assessment, a clinical decision support tool, was used to assess neurobehavioral functioning in 646 United States Marines, all of whom were fit for duty. Marines were assessed for concussion history, post-concussive symptoms, emotional distress, neurocognitive functioning, and deployment history. Results showed that a recent concussion or ever having experienced a concussion was associated with an increase in emotional distress, but not with persistent post-concussive symptoms (PPCS) or neurocognitive functioning. Having had multiple lifetime concussions, however, was associated with greater emotional distress, PPCS, and reduced neurocognitive functioning that needs attention and rapid discrimination, but not for memory-based tasks. These results are independent of deployment history, combat exposure, and symptoms of post-traumatic stress disorder and depression. Results supported earlier findings that a previous concussion is not generally associated with post-concussive symptoms independent of covariates. In contrast with other studies that failed to find a unique contribution for concussion to PPCS, however, evidence of recent and multiple concussion was seen across a range of emotional distress, post-concussive symptoms, and neurocognitive functioning in this study population. Results are discussed in terms of implications for assessing concussion on return from combat.

Antenatal maternal emotional distress and duration of pregnancy.

Objective(s)We sought to prospectively study the association between antenatal emotional distress and gestational length at birth as well as preterm birth.Study DesignWe followed up 40,077 primiparous women in the Norwegian Mother and Child Cohort Study. Emotional distress was reported in a short form of the Hopkins Symptom Checklist-25 (SCL-5) at 17 and 30 weeks of gestation. Gestational length at birth, obtained from the Medical Birth Registry of Norway, was used as continuous (gestational length in days) and categorized (early preterm (22–31 weeks) and late preterm (32–36 weeks) versus term birth (≥37 weeks)) outcome, using linear and logistic regression analysis, respectively. Births were divided into spontaneous and provider-initiated.ResultsOf all women, 7.4% reported emotional distress at 17 weeks, 6.0% at 30 weeks and 5.1% had a preterm birth. All measurements of emotional distress at 30 weeks were significantly associated with a reduction of gestational length, in days, for provider-initiated births at term. Emotional distress at 30 weeks showed a reduced duration of pregnancy at birth of 2.40 days for provider-initiated births at term. An increase in emotional distress from 17 to 30 weeks was associated with a reduction of gestational length at birth of 2.13 days for provider-initiated births at term. Sustained high emotional distress was associated with a reduction of gestational length at birth of 2.82 days for provider-initiated births. Emotional distress did not increase the risk of either early or late preterm birth.ConclusionEmotional distress at 30 weeks, an increase in emotional distress from 17 to 30 weeks and sustained high levels of emotional distress were associated with a reduction in gestational length in days for provider-initiated term birth. We found no significant association between emotional distress and the risk of preterm birth.

Efectos de la primera visita de consejo genético sobre la percepción de riesgo y el malestar emocional

Objetivo: Analizar los efectos que provoca la primera visita de consejo genético para cáncer hereditario sobre la percepción de riesgo, y el malestar emocional en pacientes que acuden por primera vez a la Unidad de Consejo Genético (UCG) por historia familiar de cáncer de mama, ovario o colon hereditario. Método: Se evaluó la percepción de riesgo de padecer cáncer (al año, a 10 años, y a lo largo de toda la vida), y la intensidad del malestar emocional (evaluada como la ansiedad, tristeza y preocupación por la salud experimentadas durante la última semana) en tres ocasiones: inmediatamente antes de la primera visita de consejo genético (CG), inmediatamente después de la misma, y al cabo de 2-3 semanas. Resultados: El malestar emocional previo a la visita se producía en aproximadamente un 30% de los pacientes, siendo mayor en las personas que no realizaban actividad laboral. Si bien la visita de CG reducía el malestar emocional en muchos casos, ocurría lo contrario en algunos pacientes inmediatamente después de la misma (un 34% se sentía más ansioso, un 32% se sentía más triste, y un 23% se sentía más preocupado), y ello guardaba relación con la preocupación por los hijos (tanto si se tenían como si se pretendía tenerlos en el futuro). No obstante, este malestar se reducía en las 2-3 semanas posteriores. La visita de CG reducía la percepción de riesgo de padecer cáncer a lo largo de toda la vida (p&lt; .01), no existiendo diferencias en función del tipo de cáncer. Conclusiones: Esta primera visita reduce la sobreestimación del riesgo de padecer cáncer que los pacientes tienen antes de la misma, pero, en aproximadamente un tercio de los mismos, no reduce los niveles de malestar emocional, observándose, incluso, un incremento de éste que va disminuyendo durante las semanas posteriores a la visita. Son necesarios más estudios que permitan determinar si este incremento es una consecuencia inevitable del inicio del proceso de CG, o si puede reducirse modificando algún aspecto del protocolo que se aplica en la primera visita.

The Role of Anxiety Sensitivity, Fear of Pain and Experiential Avoidance in Experimental Pain

The aim of this study was to investigate whether distraction is less effective when pain is perceived as threatening. Forty-one female undergraduate participants were assigned to distraction and not distraction conditions that consisted in performing a distraction task and the threat value of the pain stimuli was manipulated using instructions. AS, EA an FP were considered as covariates. Results indicated that distraction manipulation had a main effect on less pain intensity, more tolerance and less catastrophic thoughts. Interestingly, the covariate AS had a significant effect over tolerance and EA had an effect on distress and anxiety related to pain. These results suggest that AS and EA are distinct processes and that each could play a different role in the response to pain. Anxiety sensitivity involves behavioural avoidance, whereas EA is a rejection of the internal experience that contributes to an increase in emotional distress.

Moving Mental Health into the Disaster-Preparedness Spotlight

As the Deepwater Horizon oil disaster enters its next phase, consensus is emerging that among its most profound immediate health effects are those on the emotional and psychosocial health of Gulf Coast communities. State mental health and substance-abuse agencies report an increase in emotional distress and demand for assistance. Calls to domestic-violence hotlines are increasing. Fishermen fear for their families' economic future, and communities wonder how the influx of clean-up workers and volunteers will affect their way of life. Most major disasters, including the Exxon Valdez spill, Hurricane Katrina, and the 9/11 attacks, have been followed by increases in the . . .

Tomando Control

The purpose of this study was to pilot test the feasibility, acceptability, and efficacy of a culturally appropriate and culturally relevant Spanish-language cognitive-behavioral diabetes self-care educational intervention for Hispanic Americans with type 2 diabetes mellitus. The study site was an urban community health center in the Northeast, at which 16 Latino patients with type 2 diabetes mellitus were recruited. This was a 1-group pretest-posttest pilot study, during which qualitative and quantitative data were collected on demographic, physiologic (HbA1c, body mass index, lipids), psychosocial (diabetes-related distress and health beliefs), knowledge, and language-based acculturation variables at baseline, 3 months, and 6 months. Data were collected using questionnaires, laboratory data, and chart review. The intervention was culturally appropriate in terms of language, social emphasis, nutritional guidance, and acknowledgment of cultural health beliefs. Descriptive and inferential statistical analysis was used to evaluate response variables of glycemic control, lipid levels, and psychosocial and knowledge outcomes. The intervention acceptability process was evaluated by attendance and attrition. This pilot study demonstrated excellent acceptance for and feasibility of this intervention. Most study participants (9 women, 7 men) were middle-aged married individuals who had had diabetes mellitus for an average of 8 years; English was a second language for all of them. Most were overweight and had suboptimal glycemic control and lipid profiles and moderate levels of knowledge at the outset of the study. Most had received a one-on-one diabetes educational session prior to the intervention. Over the 6 months of the study, most of both men and women showed an increase in knowledge scores, improvement in lipid profiles, and reduction in HbA1c levels. Men demonstrated a temporary increase in emotional distress much greater than that reported by women during the first 3 months of the study. The findings suggest that a culturally relevant type 2 diabetes mellitus educational program, particularly one that addresses different learning needs and styles of men and women, can have a positive impact on Hispanic Americans with diabetes. Implications for practice include awareness of gender-based differences in response to self-management education, the importance of providing realistic samples of meals prepared in a manner consistent with American Diabetes Association principles, and the rationale for offering a brief and focused refresher course 6 to 9 months following this type of intervention.

Pathways of economic influence on adolescent adjustment.

An important part of a science aimed at the prevention of human dysfunction involves the development of empirically based models that identify processes of risk for or protection from emotional distress or behavioral problems over time. The present study developed and evaluated such a model that proposed two pathways through which family economic pressure was expected to influence change in adolescent internalizing symptoms (depression and anxiety) during the period from the eighth to the tenth grades. A total of 377 rural families in a midwestern state provided data for the analyses. The results were generally consistent with the conceptual model in that family economic pressure increased adolescent perceptions of family economic hardship, which, in turn, reduced the adolescent's sense of control or mastery over time. Lowered mastery was associated with increases in emotional distress. Also consistent with the model, prior levels of mastery appeared to reduce the magnitude of economic stress experienced by the adolescent, whereas prior emotional distress intensified the economic stress process. Although gender differences were found in these processes, the overall pattern of results suggests that girls and boys are both at risk for internalizing problems when families experience economic pressure. Implications of the findings for the development of effective preventive interventions with financially stressed families in rural areas are discussed.

EMOTIONAL DISTRESS IN CHILDREN OF HIGH‐CONFLICT DIVORCE

This study examines factors that contribute to the emotional distress of children whose parents experience an acrimonious divorce with conflict over custody and visitation issues. Information was gathered systematically from guardian ad litem reports on 105 children in order to explore the child's emotional distress in response to individual‐, parental‐, marital‐, and custody–related factors. Findings emphasize the impact of the level of marital conflict in predicting increases in the child's emotional distress. The child who witnesses domestic violence and experiences child malmatment suffers a powerful cumulative impact from these factors. which results in a steep increase in emotional distress symptoms. A cluster of relevantfactors taken jointly, including the level of marital conflict, violence against a partner or against the child, the parent's mental health, the child's medical condition, and the nature of visitation changes, all contribute signifcantly to the child's emotional distress.

The impact of re-engineering and other cost reduction strategies on the staff of a large teaching hospital: a longitudinal study.

To examine changes over time in the hospital staff's perceptions of how rapid organizational change, caused by fiscal constraints imposed by governments, affects them, their work environment, and the quality of care and services that they provide. A random sample of hospital employees (n = 900) of a large Ontario teaching hospital participated in a longitudinal study which involved surveys at 3 measurement periods over a 2-year period. The questionnaire used in this study included scales reflecting work environment, emotional distress, personal resources, spillover from work to home and vice versa, and perceptions regarding patient care and the hospital as an employer. Significant increases in depression, anxiety, emotional exhaustion, and job insecurity were seen among employees, particularly during the first year of the change process. By the end of the second year, employees reported deterioration in team work, increased unclarity of role, and increased use of distraction to cope. Job demands increased throughout the period whereas little change occurred in the employee's job influence or decision latitude. Overall, the work environment was negatively affected. Although patient care was unaffected in the first year, a significant decline in perceptions of patient care, attention to quality improvement, and overall quality of care were later seen. This study raises questions about whether hospital re-engineering and mergers will be able to achieve the cost reductions sought without sacrificing quality of work life. Along with the rapid change, there was increase in emotional distress among staff and a deterioration in their relationship with their employer.