Initial Psychological Distress Research Articles

Effects of sleep disturbance, cancer-related fatigue, and psychological distress on breast cancer patients’ quality of life: a prospective longitudinal observational study

More attention has gone to researching the cancer-related fatigue (CRF)–sleep disturbance (SD)–psychological distress (PD) symptom cluster in breast cancer patients during the chemotherapy period, but the change trend and heterogeneous development track in the whole treatment stage remain unclear, and it is also unclear whether the appearance of and changes in one symptom cause changes in other symptoms and quality of life (QoL). This study, using breast cancer patients’ data collected through a validated questionnaire, examined the relationships between SD, CRF, PD, and QoL using latent growth modeling analyses. CRF developmental trajectories showed an upward trend over five surveys (slope = 0.649, P < 0.001); PD showed a significant weakening trend (slope = − 0.583, P < 0.001); SD showed an increasing trend (slope = 0.345, P < 0.001), and QoL showed a statistically significant weakening trend (slope = − 0.373, P < 0.001). The initial CRF (coefficient = − 0.233, P < 0.01), PD (coefficient = − 0.296, P < 0.01), and SD (coefficient = − 0.388, P < 0.001) levels had a statistically significant negative effect on initial QoL level. The linear development rate of PD was statistically significant and negatively affected that of QoL (coefficient = − 0.305, P < 0.05), whereas the quadratic development rate of SD negatively affected that of QoL (coefficient = − 0.391, P < 0.05). Medical staff should identify the change characteristics of different variables based on SD, CRF, PD, and QoL change trajectories, and advance the intervention time, as changes in variables affect other variables’ subsequent changes.

Predictors of Symptoms Trajectories in Newly Diagnosed Ulcerative Colitis: A 3-Year Follow-up Cohort Study.

Psychological symptoms are associated with poorer ulcerative colitis [UC]-related outcomes. However, the majority of research is cross-sectional. We aimed to identify subgroups based on the longitudinal evolution of GI symptom levels and health-related quality of life [HRQoL], and to disentangle the directionality of effects between GI symptom levels and psychological distress. Self-reported gastrointestinal [GI] symptom severity, HRQoL, inflammatory biomarkers, and psychological distress were assessed in 98 newly diagnosed UC patients at disease onset and yearly for 3 consecutive years. Latent class growth analysis was used to determine subgroups based on longitudinal trajectories of symptom severity and HRQoL, and baseline predictors of trajectory group membership were determined. Cross-lagged structural equation models were used to disentangle temporal relationships between psychological functioning and symptom severity. Patients with higher initial psychological distress had increased probability of maintaining higher levels of diarrhoea and abdominal pain. Conversely, patients with lower initial levels of diarrhoea and abdominal pain had higher chances of maintaining lower levels of psychological distress. Higher levels of C-reactive protein at baseline predicted greater improvements in mental health after anti-inflammatory treatment. Reductions in diarrhoea and abdominal pain preceded reductions in psychological symptoms over time. Baseline psychological distress is predictive of increased GI symptom severity and reduced mental HRQoL over time, suggesting early assessment of psychological symptoms may identify patients who may have worse disease trajectories. Abdominal pain predicted increased psychological distress, but not the other way around. Intervening on abdominal pain may help prevent or reduce future psychological distress.

Transition from Higher Education in Nigeria to the United Kingdom

Moving across international borders to take up lecturing job in a higher institution is a significant life event with subjective experience and expectations that may impact the wellbeing of the individual and their new environment. The aim of this paper was to review the factors contributing to the transition experience of a lecturer from an African country in a UK university. Literature review, anecdotal narratives, and reflection were used. Differences in culture and technological advancement were identified as factors contributing to the transitional difficult experience of a lecturer from Nigeria working in a university in the UK. Language as a symbolic aspect of culture is an area the author did not expect to have difficulty; but because of the differences in the Received Language and the accent spoken by most natives in the UK, the author experienced initial psychological distress listening to different accents of English language. The culture of lower power distance in the UK contrasts with what obtains in Nigeria. So, the author was initially uncomfortable to see how senior and junior colleagues and students could relate officially without officious formalities. The individualist as against collectivistic culture in the UK was another thing to adapt to, so also the practice of Equality, Diversity and Inclusion which allows everyone freedom from discrimination due to protected characteristics such as gender that goes beyond binary. The identified technological difference related to Electronic Learning Environment (ELE) and the battery of integrated software for communication and organizing tasks were a bit of a challenge at the beginning. Transition from an African country to the UK as a lecturer in higher learning environment attracts challenges of cultural and technological differences. Forewarning and organized orientation on arrival of the differences may lessen the possibility of the distress occasioned by the life event.

Impact of displacement context on psychological distress in refugees resettled in Australia: a longitudinal population-based study.

Refugees typically spend years in a state of protracted displacement prior to permanent resettlement. Little is known about how various prior displacement contexts influence long-term mental health in resettled refugees. In this study, we aimed to determine whether having lived in refugee camps v. community settings prior to resettlement impacted the course of refugees' psychological distress over the 4 years following arrival in Australia. Participants were 1887 refugees who had taken part in the Building a New Life in Australia study, which comprised of five annual face-to-face or telephone surveys from the year of first arrival in Australia. Latent growth curve modelling revealed that refugees who had lived in camps showed greater initial psychological distress (as indexed by the K6) and faster decreases in psychological distress in the 4 years after resettling in Australia, compared to those who had lived in community settings. Investigation of refugee camp characteristics revealed that poorer access to services in camps was associated with greater initial distress after resettlement, and greater ability to meet one's basic needs in camps was associated with faster decreases in psychological distress over time. These findings highlight the importance of the displacement context in influencing the course of post-resettlement mental health. Increasing available services and meeting basic needs in the displacement environment may promote better mental health outcomes in resettled refugees.

Genetic testing to restore the human right to identity in post-dictatorship Argentina: Ethical, legal, and social issues.

The last military dictatorship in Argentina (1976-1983), committed egregious violations of human rights, including torture assassinations and disappearance of 30,000 political dissidents as well as friends and relatives. This included hundreds of pregnant women who were kept in clandestine detention centers and killed after delivering their babies in abject conditions. The succeeding democratic governments applied forensic genetics at the Banco Nacional de Datos Genéticos to identify the estimated 500 children stolen at birth and being reared by military families with suppression of their identity. The first genetic identification was in 1984 of a 6 years old, while the latest was in 2019 of a 44 years old, completing so far 130 identifications along 35 years of post-dictatorship. The ethical, legal, and psycho-social complexities of restoration of genetic identity after years of appropriation and suppression of identity in the Argentine context, is discussed at length. Evidence indicates that after initial psychological distress, most individuals that had their true genetic identity restored experienced relief by learning the truth and reuniting with their biological families. Many "recovered grandchildren" are socially and politically involved in progressive causes and express pride for the social activism of their disappeared parents. The role played by genetics in support of the right to identity in Argentina has set an example of social responsibility of science in defense of human rights.

A Comparison of the Predictive Validity of Self-Esteem Level and Directly Measured Self-Esteem Stability in the Temporal Prediction of Psychological Distress.

In contrast to the widely used assessment approach in which self-esteem stability is measured as the standard deviation of repeated measurements, direct measurements of self-esteem stability have hardly ever been implemented in longitudinal studies. The primary goal of the present study was to examine the temporal stability and predictive validity of a direct assessment of self-esteem stability compared with the trait level of self-esteem with respect to the prediction of psychological distress (PD). We examined a sample of 136 employees who completed self-report measures of both self-esteem level [Rosenberg Self-Esteem Scale (RSES)] and self-esteem stability [Self-Esteem Stability Scale (SESS)] along with a measure of PD (SCL-90) at two time points across an interval of 1 year. The results underline the relevance of perceived self-esteem stability in the temporal prediction of PD: After controlling for initial PD, we found that self-esteem stability predicted PD better than self-esteem level did. Therefore, we recommend that the RSES be expanded by adding the three SESS items that directly measure the stability of self-esteem.

Transitional Employment and Psychological Distress: a Longitudinal Study.

Although it has been established that employed status is generally associated with better mental health than unemployed status, the psychological mechanisms that underlie the longitudinal association between employment status and psychological distress remain to be understood. Initial mental health, lower coping skills and social support, and more stressful events could potentially preselect certain vulnerable individuals to be at higher risk for unemployment or employment instability. The aim of this study was to examine the longitudinal association between employment status (including transitional employment status) and psychological distress, controlling for the effect of initial psychological distress, coping skills, social support, and stressful events. In 2009, residents from the epidemiological catchment area of south-west Montréal responded to a randomized household survey for adults. Follow-up surveys were conducted in 2011 and 2013 (n = 1168). Psychological distress was measured using the K-10 scale. Employment status was not significantly associated with psychological distress over time, however there were significant differences between the groups with the continually employed reporting the lowest average levels of psychological distress over time. Controlling for coping skills, social support, stressful events and initial psychological distress changed the strengths of the association between transitional employment status and psychological distress at follow-up. A significant longitudinal association between continual unemployment and psychological distress was observed. Initial psychological distress was significantly associated with becoming unemployed. Results suggest initial psychological distress as a risk factor for becoming unemployed and that the negative psychological implications of employment transitions can be significantly reduced when conditions for coping are optimized.

Guided self-help to reduce psychological distress in South Sudanese female refugees in Uganda: a cluster randomised trial

Innovative solutions are required to provide mental health support at scale in low-resource humanitarian contexts. We aimed to assess the effectiveness of a facilitator-guided, group-based, self-help intervention (Self-Help Plus) to reduce psychological distress in female refugees. We did a cluster randomised trial in rural refugee settlements in northern Uganda. Participants were female South Sudanese refugees with at least moderate levels of psychological distress (cutoff ≥5 on the Kessler 6). The intervention comprised access to usual care and five 2-h audio-recorded stress-management workshops (20-30 refugees) led by briefly trained lay facilitators, accompanied by an illustrated self-help book. Villages were randomly assigned to either intervention (Self-Help Plus or enhanced usual care) on a 1:1 basis. Within 14 villages, randomly selected households were approached. Screening of women in households continued until 20-30 eligible participants were identified per site. The primary outcome was individual psychological distress, assessed using the Kessler 6 symptom checklist 1 week before, 1 week after, and 3 months after intervention, in the intention-to-treat population. All outcomes were measured at the individual (rather than cluster) level. Secondary outcomes included personally identified problems, post-traumatic stress, depression symptoms, feelings of anger, social interactions with other ethnic groups, functional impairment, and subjective wellbeing. Assessors were masked to allocation. This trial was prospectively registered at ISRCTN, number 50148022. Of 694 eligible participants (331 Self-Help Plus, 363 enhanced usual care), 613 (88%) completed all assessments. Compared with controls, we found stronger improvements for Self-Help Plus on psychological distress 3 months post intervention (β -1·20, 95% CI -2·33 to -0·08; p=0·04; d -0·26). We also found larger improvements for Self-Help Plus 3 months post-intervention for five of eight secondary outcomes (effect size range -0·30 to -0·36). Refugees with different trauma exposure, length of time in settlements, and initial psychological distress benefited similarly. With regard to safety considerations, the independent data safety management board responded to six adverse events, and none were evaluated to be concerns in response to the intervention. Self-Help Plus is an innovative, facilitator-guided, group-based self-help intervention that can be rapidly deployed to large numbers of participants, and resulted in meaningful reductions in psychological distress at 3 months among South Sudanese female refugees. Research for Health in Humanitarian Crises (R2HC) Programme.

Guided Self-Help to Reduce Psychological Distress in South Sudanese Female Refugees in Uganda: A Cluster Randomized Trial

Background: Innovative solutions are required to provide mental health support at scale in low-resource humanitarian contexts. We aimed to assess the effectiveness of a guided self-help intervention (Self-Help Plus; SH+) to reduce psychological distress in female refugees. Methods: We conducted a cluster randomized trial in rural refugee settlements in northern Uganda. Participants were female South Sudanese refugees with at least moderate levels of psychological distress (cut-off ≥5 on the Kessler 6). Intervention comprised access to usual care and five 2-hour audio-recorded stress management workshops (20-30 refugees) led by briefly trained lay facilitators, accompanied by an illustrated self-help book. Villages were randomized on a 1:1 basis. Within 14 villages, randomly selected households were approached. Screening of women in households continued until 20-30 eligible participants were identified. The primary outcome was individual psychological distress, assessed using the Kessler 6 one-week before, one-week after, and three-months after intervention. Secondary outcomes included: personally-identified problems; posttraumatic stress; depression symptoms; feelings of anger; social interactions with other ethnic groups; functional impairment; and subjective well-being. Assessors were masked to allocation. Findings: Of 694 eligible participants (331 SH+, 363 EUC), 613 (88.3%) completed all assessments. We found stronger improvements for SH+ on psychological distress three months post-intervention (β = -1.20; p =0.04; 95% CI= -2.33, -.08, d= -0.26). We also found larger improvements for SH+ three months post-intervention for five of eight secondary outcomes (effect size range d=-0.30 to d=-0.36). Refugees with different trauma exposure, length of time in settlements, and initial psychological distress benefited similarly. Interpretation: An innovative guided self-help intervention that can be rapidly deployed to large numbers of participants resulted in meaningful reductions in psychological distress at three months among South Sudanese female refugees. Trial Registration: Prospectively registered at ISRCTN50148022 Funding Statement: This study was funded by the Research for Health in Humanitarian Crises (R2HC) Program, managed by Elhra (grant#12934). Declaration of Interests: None of the authors have conflicts of interests to disclose. Ethics Approval Statement: The project was approved by the MildMay Uganda Research Ethics Committee, the Uganda National Council for Science and Technology, and the WHO Ethical Review Committee and all participants provided informed consent.

Attachment style among outpatients with substance use disorders in psychological treatment.

To explore the associations between self-rated attachment style, psychological distress and substance use among substance use disorder (SUD) outpatients in psychological treatment. In this practice-based study, 108 outpatients were asked to fill in the Experiences in Close Relationships - Short form, the Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM), the Alcohol Use Disorders Identification Test (AUDIT), and the Drug Use Disorders Identification Test (DUDIT) at treatment start and end. Patients were given psychological treatments with a directive, reflective or supportive orientation. An insecure attachment style was more common among the SUD outpatients, compared to non-clinical groups. Patients with a fearful attachment style scored higher on psychological distress than patients with a secure attachment style. The associations between the attachment dimensions and psychological distress were stronger than those between attachment and SUD. Significantly more patients had a secure attachment style at treatment end. This study shows significant relations between patients' attachment style and their initial psychological distress. The causal relationship between attachment style and psychological distress is, however, not clear and can likely go in both directions. The psychological treatment of patients with SUD contributed significantly to changes from insecure to secure attachment style. We found among patients with SUD a strong relation between patients' attachment style and their psychological distress. Knowledge of the patient's attachment style may help the therapist to tailor the treatment to the patient's needs. A change from insecure to secure attachment style can be an important goal for a SUD treatment, as it may prevent the patient from using defence strategies involving substance use for regulating emotions and interpersonal relationships.

Early symptom change in adult outpatients: Relationship with patient characteristics and therapeutic alliance.

This study has three aims: (1) to identify early change trajectories, (2) to examine patient characteristics predicting trajectory classes, and (3) to investigate the moderating effect of trajectory class membership on the working alliance. In a sample of 402 outpatients (M age=38.27, 64.9% women), outcome scores (OQ-45) on three time points (sessions 1, 3, and 5) were analysed by means of Latent Class Growth Curve Analysis. A multinomial logistic regression was used to investigate whether patient's age, gender, initial distress (OQ-45), and personality traits (Dimensional Assessment of Personality Pathology-Short Form) predicted trajectory class membership. A repeated-measures ANOVA examined whether differences in trajectory classes moderated the alliance quality (Working Alliance Inventory-Short version) over time. Four trajectory classes were identified: High distress-no change; moderate/high distress-small improvement, low distress-moderate improvement, and moderate/low distress-strong improvement. Gender, initial distress, and emotion dysregulation significantly predicted patients' trajectory class membership. The Task/Goal alliance component increased linearly over time, whereas the Bond component followed a reversed U-shaped pattern. The alliance was not moderated by trajectory class membership. Four clinically relevant subgroups could be identified on the basis of the early symptom change trajectories. Gender, initial psychological distress, and emotion dysregulation predicted patient's trajectory class membership. Trajectory class membership did not influence the development of the early working alliance. As early change in highly distressed patients (Axis I and II) is not characterized by significant symptom change, clinicians should support and facilitate emotion regulation and social skills. Investing in a strong alliance is recommended, although it does not differentiate early responders from non-responders.

The Role of Psychological Distress in Relapse Prevention of Alcohol Addiction. Can High Scores on the SCL-90-R Predict Alcohol Relapse?

The aim of this study was to identify if psychological distress may contribute to treatment outcome in alcohol-addicted patients during a follow-up period of 5 months after detoxification. As part of a prospective, multicenter, randomized study in relapse prevention, patients' levels of psychological distress were assessed using the Symptome Checklist (SCL-90-R). At study inclusion, all patients were detoxified and showed no more withdrawal symptoms. The patients who relapsed during the 5-month follow-up period were compared with those who remained abstinent. Predictors for relapse were investigated in a logistic regression. First, a significant difference in initial psychological distress between patients who stayed abstinent and patients who relapsed was found: following detoxification, patients who relapsed scored significantly higher on the SCL-90-R at study inclusion. In addition, psychological distress differed over time in both groups. Second, patients without relapse showed a larger decrease in some SCL-90-R scales between the beginning and the end of the observation period than patients who relapsed. Third, the logistic regression analyses showed that high scores on the overall score GSI (Global Severity Index) of the SCL-90-R can be seen as a predictor for future relapse. The SCL-90-R may be a useful instrument to predict relapse. As our study indicates that high levels of psychological distress increases the risk of relapse, specific interventions may be targeted at this risk factor.

Clinically assessed consequences of workplace physical violence.

ObjectivesTo assess consequences of physical violence at work and identify their predictors.MethodsAmong the patients in a medicolegal consultation from 2007 to 2010, the subsample of workplace violence victims (n = 185) was identified and contacted again in average 30 months after the assault. Eighty-six victims (47 %) participated. Ordinal logistic regression analyses assessed the effect of 9 potential risk factors on physical, psychological and work consequences summarized in a severity score (0–9).ResultsSeverity score distribution was as follows: 4+: 14 %; 1–3: 42 %; and 0: 44 %. Initial psychological distress resulting from the violence was a strong predictor (p < 0.001) of the severity score both on work and long-term psychological consequences. Gender and age did not reach significant levels in multivariable analyses even though female victims had overall more severe consequences. Unexpectedly, only among workers whose jobs implied high awareness of the risk of violence, first-time violence was associated with long-term psychological and physical consequences (p = 0.004). Among the factors assessed at follow-up, perceived lack of employers’ support or absence of employer was associated with higher values on the severity score. The seven other assessed factors (initial physical injuries; previous experience of violence; preexisting health problems; working alone; internal violence; lack of support from colleagues; and lack of support from family or friends) were not significantly associated with the severity score.ConclusionsBeing a victim of workplace violence can result in long-term consequences on health and employment, their severity increases with the seriousness of initial psychological distress. Support from the employer can help prevent negative outcomes.

Social support and psychological distress in rheumatoid arthritis: a 4-year prospective study

Introduction: The objective of the study was to investigate the course of psychological distress in early rheumatoid arthritis patients and to explore the strength of its associations with disease-related variables over time. A further aim focused specifically on the associations between social support and psychological distress. Methods: The study had a longitudinal design, with four annual measurements over consecutive years. The course and stability of psychological distress on the individual level were investigated via test–retest correlation coefficients and changes over time were studied using the Friedman test for repeated measurements. Hierarchical regression analysis was performed to analyze the multilinear associations of disease activity, functional disability, joint tenderness, pain and social support with psychological distress. Results: Significant cross-sectional associations were found among functional disability, joint tenderness, pain, emotional support, instrumental support and psychological distress. However, after controlling for the erratic pattern of the disease and the relevant variables, only initial psychological distress and emotional support retained a significant relationship with psychological distress. The final regression model, in which functional disability, pain, emotional support and initial psychological distress were significant variables, explained 36% of the variance in psychological distress. Conclusion: The study stresses the importance of initial psychological distress, which was found to have the highest correlation with psychological distress experienced 4 years later. In addition, higher emotional support and lower pain were found to be the only variables independently associated with lower levels of psychological distress after controlling for the relevant variables.Implications for RehabilitationPsychological distress is a relevant problem in rheumatoid arthritis patients and should be recognized early in the disease as it might reflect a lack of social resources which can be crucial in the further course of the disease.Special attention should be paid to different types of social support in relation to psychological distress, which might improve targeting psychosocial interventions.

Relation of Perseverative Tendency and Life Events to Depressive Symptoms: Findings from a Prospective Study in Non-referred Adolescents in Taiwan

This study aimed to explore the role of perseveration in the relations between life events and depression in a 2-year prospective study of non-referred adolescents. Participants were 400 middle school students randomly selected in Taipei. Baseline perseveration was measured using Perseverative Errors on the Wisconsin Card Sorting Test and psychological distress was measured using Anxious/Depressed syndrome on the Child Behavior Checklist. These individuals also completed the Life Event Checklist and the Center for Epidemiologic Studies Depression Scales at follow-up. With adjustment for initial psychological distress and demographic features, the results of multiple regression analyses showed that more perseveration at baseline was associated with greater influence of negative life events on the subsequent depressive symptoms. Perseveration might act as a moderator on the relations of life events to depressive symptoms and lowering perseveration may be a plausible way to decrease the impact of negative life events on adolescent depressive symptoms.

Dauer und Umfang ambulanter Psychotherapie und Implikationen für die Versorgungspraxis

Time structure of outpatient psychotherapy is important for clinical practice, as well as for theoretical and cost-effectiveness reasons. In this paper, important time variables (session number and frequency, therapy duration, utilization of the allocated session contingent, extension of therapy) are studied in a sample of n=714 German insurees in outpatient psychotherapy over a four-year period. Session number and duration of therapy were modelled with survival analysis, Cox regression was used to study the influence of covariates assessed at the beginning of therapy. Results are reported separately for the three therapy approaches financed by the German health insurance system: psychoanalytic psychotherapy (AP), psychodynamically-oriented therapy (TP) and cognitive-behavioral therapy (VT). Results show median session numbers of 25 (VT), 42 (TP) and 101 (AP) and a therapy duration of 12.8 (VT), 16.7 (TP) and 23.5 (AP) months. Initial therapeutic alliance was negatively associated with therapy duration and session number in AP. In TP and VT, a negative association between age and treatment duration was observed. 72.5% of the total session contingent was utilized and 38.4% of the participants applied for additional therapy sessions. An extension of psychotherapy happened more frequently 1) in psychoanalytic treatments and 2) in participants with higher initial psychological distress. Results show that the utilization of therapeutic resources differs from both theoretical concepts and fixed contingents allocated by health insurances. Potential implications for the allocation of psychotherapeutic resources are discussed.

Psychological distress in mothers and fathers of preschool children: a 5‐year follow‐up study after birth

Maternal and paternal psychological distress influence children's development and health beyond the perinatal period. The aim of our study was to describe psychological health during a 5-year period in parents of preschool children. Secondarily, we wanted to explore differences between mothers and fathers and identify predictors for increased psychological distress in parents. Prospective cohort study. A county in Southern Norway 1998-2004. One hundred and twenty-three mothers and 112 fathers were candidates for the follow-up study. Parental psychological responses were assessed using the General Health Questionnaire (GHQ-28), State Anxiety Inventory-X1 and Impact of Event Scale at 0-4 days, 6 weeks, 6 months and 5 years after delivery of a healthy child. Parental psychological distress defined by GHQ-28 Likert sum score at 5-year follow-up. Clinically important psychological distress (GHQ case score > or = 6) was reported by more mothers (29%) than by fathers (11%) (P = 0.004). In multivariate analysis, psychological distress (GHQ-28 Likert sum score) after 5 years was predicted by initial psychological distress, being single and low educational level in mothers, and unemployment and low quality of relationship with partner in fathers. Fathers reported significantly lower frequency of clinically important psychological distress and more stable scores than mothers throughout the period. The results indicate that selected psychometric screening may be warranted for parents with known psychosocial risk factors.

Course of psychological distress and its predictors in advanced non‐small cell lung cancer patients

This study investigated longitudinal changes and predictive factors for psychological distress among 85 newly diagnosed advanced non-small cell lung cancer (NSCLC) patients. Whereas tension-anxiety after diagnosis (T1) was significantly reduced at two months (T2) and six months (T3) after diagnosis and depression-dejection at T1 was significantly reduced at T2, other forms of psychological distress, including anger-hostility, vigor, fatigue, and confusion, did not show significant changes. Total mood disturbance did not show significant change. Only a higher total mood disturbance at T1 was a significant predictor of total mood disturbance at T3. These findings demonstrate that most types of psychological distress experienced by advanced NSCLC patients is likely to persist during the subsequent clinical course. The findings also suggest that initial psychological distress itself after cancer diagnosis is the most important predictor for subsequent psychological distress and that early intervention beginning immediately after the disclosure of a diagnosis of cancer is one way to prevent and/or reduce subsequent psychological distress in advanced NSCLC patients.

The development of psychological changes following whiplash injury

Psychological distress is a feature of chronic whiplash-associated disorders, but little is known of psychological changes from soon after injury to either recovery or symptom persistence. This study prospectively measured psychological distress (General Health Questionnaire 28, GHQ-28), fear of movement/re-injury (TAMPA Scale of Kinesphobia, TSK), acute post-traumatic stress (Impact of Events Scale, IES) and general health and well being (Short Form 36, SF-36) in 76 whiplash subjects within 1 month of injury and then 2, 3 and 6 months post-injury. Subjects were classified at 6 months post-injury using scores on the Neck Disability Index: recovered (<8), mild pain and disability (10–28) or moderate/severe pain and disability (>30). All whiplash groups demonstrated psychological distress (GHQ-28, SF-36) to some extent at 1 month post-injury. Scores of the recovered group and those with persistent mild symptoms returned to levels regarded as normal by 2 months post-injury, parallelling a decrease in reported pain and disability. Scores on both these tests remained above threshold levels in those with ongoing moderate/severe symptoms. The moderate/severe and mild groups showed elevated TSK scores at 1 month post-injury. TSK scores decreased by 2 months in the group with residual mild symptoms and by 6 months in those with persistent moderate/severe symptoms. Elevated IES scores, indicative of a moderate post-traumatic stress reaction, were unique to the group with moderate/severe symptoms. The results of this study demonstrated that all those experiencing whiplash injury display initial psychological distress that decreased in those whose symptoms subside. Whiplash participants who reported persistent moderate/severe symptoms at 6 months continue to be psychologically distressed and are also characterised by a moderate post-traumatic stress reaction.

Psychological characteristics of mothers of children with disabilities.

The purpose of this study was to investigate the psychological characteristics of mothers of children with disabilities. This study was performed under the hypotheses that, at the initial diagnosis of the children's disabilities, (1) the mothers suffered from serious psychological distress; (2) the more severe the child's disability was, the more serious the mother's psychological distress was; and that (3) the mother's psychological distress might be resolved within 8 weeks of rehabilitational interventions. The results were as follows: 1) mothers of children with disabilities showed significant (p < 0.05) somatization, depression, anxiety, hostility, and phobic anxiety more so than the control group; 2) there was no significant difference in T scores of 9 dimensions of the Symptom Checklist-90-Revision (SCL-90-R) of the mothers at the initial diagnosis of children's disabilities according to severity of child's disability; 3) there was no significant difference in T scores of 9 dimensions of SCL-90-R in mothers of children with disabilities between at initial evaluation and after 8 weeks of rehabilitational interventions. In conclusion, : 1) mothers of children with disabilities suffered from serious psychological distress at the initial diagnosis of their child's disability; 2) the severity of the child's disability had little influence on the degree of the mother's initial psychological distress; 3) this distress did not resolve with only 8 weeks of rehabilitational interventions. Therefore, effective rehabilitational programs should provide sufficient opportunities for repeated follow-up interviews which offer not only adequate information on the children's disabilities but also psychological support for the mothers.